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Stafford & Surrounds Clinical Commissioning Group Governing Body Meeting in Public Beacon International Centre, Unit 26 Anson Court, Staffs Technology Park, Stafford, ST18 0GB

To be held on Tuesday 30th June 2015 14:00 – 16:30

AGENDA

12:30 – 14:00 Confidential Governing Body Meeting

FOLLOWED BY:

14:00 – 16:30 Governing Body Meeting in Public

A=Approval R=Ratification D=Discussion I=Information A/R/ Enc Lead D/I 1. Welcome by the Chair Verbal PH I 2. Apologies for Absence Verbal PH I Conflicts of Interests 3. Declarations of Interest Register for Stafford & Surrounds Enc 01 PH I Governing Body Mark 4. WMAS Presentation Verbal I Docherty Minutes of the last meeting: 5. • Minutes of Meeting 21/04/15 Enc 02 PH A

• Matters Arising/Action List Enc 03 PH A 6. Chairs Report Verbal PH I 7. Chief Officers Report Enc 04 AD I 8. Quality and Safety Report Enc 05 VJ I 9. Performance Report Enc 06 AT I 10. Board Assurance Framework (BAF) Enc 07 SY D 11. Finance Report Enc 08 PS D/I Jon 12. Section 19 – External Auditors - Grant Thornton Enc 09 I Roberts 13. CCG 360o Stakeholder Survey 2015 - Summary Enc 10 AD D/I 14. Q3 SAS CCG Assurance Letter Enc 11 PH I 15. COPD Emergency Admissions – Business Case Enc 12 PH I 16. CCG Workforce Report 2014/15 Enc 13 SY I Enc 00 17. Shared Parental Leave Policy Enc 14 SY R Items for Information • Finance, Performance & Contracting Minutes

19/02/15; 19/03/15; 23/04/15 18. Enc 15 PH I • Audit Committee Minutes 27/04/15

• Comms & Engagement Committee Minutes 24/02/15; 28/04/15 19. Any Other Business Verbal PH I 20. Questions from the public: 16:00 – 16:30 Verbal 21. Glossary of Terms Enc 16 I Next Meeting in Public

Date: Tuesday 28th July 2015 22. Time: 14:00 – 16:30 Venue: Beacon International Centre, Unit 26 Anson Court, Staffordshire Technology Park, Stafford, ST18 0GB

Declarations of Interest Register for Stafford & Surrounds Governing Body

Name Position/Role Date of Designation Potential or actual area where interest Declaration could occur Dr Manu GP 12.05.2015 Rising Brook Practice member of GP First Agrawal Surgery Director of GPF Rising Brook Limited Membership Board Member Andrew Donald Chief Officer 06.05.2015 CC & SaS Spouse - Chief Operating Officer North CCG division Staffordshire & Stoke on Trent Partnership Trust. Working across both CCGs. Ruth Goodison Lay Member 06.05.2015 Stafford & Nil to declare for PPI Surrounds CCG Dr Paddy Chair 13.05.2015 Holmcroft Partner at Holmcroft Surgery Hannigan GP Surgery Practice is Shareholder in GP First Spouse - Consultant Neonatologist at UHNM Jean Harrison Lay Member 08.05.2015 Stafford & Sibling is Director of Stafford Railway Circle (Non Surrounds Ltd Statutory) CCG Trustee and Chair of The Proteus Family Network UK Charity Bank Staff in Finance Department at Katharine House Hospice 'Member of the Proteus Family Network UK Medical Advisory Board at Gt Ormond St Hospital, London Dr Marianne GP 05.06.2015 Hazeldene Partner at Great Haywood Healthcare Holmes House Surgery Private Company Practice Member GP First Val Jones Director 18.05.2015 CC & SaS Working across both CCGs. Quality & CCG Safety/ Chief Nurse Dr Kate GP 06.05.2015 Mansion Partner Mansion House Surgery Millward House Practice Member GP First Practice representative on CCG Membership Board & Governing Body Clinical Advisor in Quality & Safety for CCG Doug Secondary 01.05.2015 CC & SaS No direct connection Liaison with various Robertson Care CCG organisations in NHS role. Consultant Honorary lecturer at Warwick University Medical School. Employed by Sandwell and West Birmingham Hospital as Consultant Physician. Small research interest – Grants go through Sandwell research fund. Secondary Care consultant for North Staffs CCG and Stafford and Surrounds CCG Paul Simpson Director of 06.05.2015 CC & SaS Working across both CCGs Finance CCG

Page | 1 June 2015

Declarations of Interest Register for Stafford & Surrounds Governing Body

Name Position/Role Date of Designation Potential or actual area where interest Declaration could occur Diana Smith Lay Member 21.05.2015 Stafford & Active member of the Labour Party (Non Statutory) Surrounds CCG Non- voting – In attendance Adele Communications 06.05.2015 CSU Works for the CSU Edmondson & Engagement Working across both CCGs Manager

Lynn Millar Director of 18.05.2015 CC & SaS Working across both CCGs Primary Care CCG

Sally Young Assistant to 06.05.2015 CC & SaS Working across both CCGs Chief Executive CCG

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Stafford & Surrounds Clinical Commissioning Group Governing Body Meeting In PUBLIC

Tuesday 21st April 2015 2.00 pm – 4.30 pm Upper Tower Room, Beacon International Centre Unit 26 Anson Court, Stafford, ST18 0BG

Members: 21/04/15 Quoracy

Dr Anne-Marie Houlder (AMH)  Chair Andy Donald (AD)  Chief Officer Paul Simpson (PS) Director of Finance and Deputy Chief  Executive Val Jones (VJ) Director of Quality &  Safety & Board Nurse Dr Doug Robertson (DR)  Secondary Care Consultant Dr Paddy Hannigan (PH)  Clinical Leader Dr Marianne Holmes (MH)  Clinical Leader Dr Kate Millward (KM)  Clinical Leader

Dr Manu Agrawal (MA) member and at least 2 Clinical Leaders 

Clinical Leader officer/Chief Finance Officer, at least one lay Voting Members including Chair/Vice Chair, Chief Ruth Goodison (RG) 6  Lay Member for PPI

In attendance: Jean Harrison (JH)  Lay Member Diana Smith (DS)  Lay Member Sally Young (SY) Assistant to the  Chief Executive Lynn Millar (LM)  Director of Primary Care

Dr Janet Eames (JE), LMC  Representative Gill Hackett – Minutes (GH)  Executive Assistant Liann Brookes-Smith (LB-S) Public  Health Andrew Tanner (AT)  Deputy Director of Operations Adele Edmondson (AE), Comms &  Engagement Dawn Rayson (DR), Comms &  Engagement

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Action

1. Welcome by the Chair AMH welcomed all present to the meeting. AMH advised the public that there would be time at the end of the meeting for any questions.

AMH welcomed Dr Doug Robertson as the newly appointed Secondary Care Consultant for the CCG, and asked that all members introduce themselves around the table. DR then introduced himself and gave a brief background to his career.

2. Apologies for Absence There were no apologies for absence.

3. Conflicts of Interest It was noted that any matters relating to GP First are a conflict of interest for the GP Clinical Leads.

4. Minutes of Previous Meeting Members confirmed the minutes of 17th February 2015 were a true and accurate record of the meeting.

Actions were noted on the Action List

5. Chair’s Report SY then explained to the public the meaning of Purdah and that no significant appointments could be announced at this time.

AMH reported to the Governing Body on the following subjects:-

OD session March for Governing Body AMH advised on the Organisational Development session on Patients in Control that was held in March. AMH stated that patients should be encouraged to take part in the commissioning process at every stage through co-design. AMH explained that Patients in Control was launched in November by NHS England and was getting patients to manage their own health. ACTION: VJ to present Patients in Control papers to EMT VJ

Assurance Meeting Q3 AMH explained that this was a review of the outstanding actions from Q2 and progress made on the financial agenda.

Cancer Task Force AMH explained that the Cancer Task Force was announced in January with the remit to design cancer services for the next 5 years from early detection, screening, prevention and all treatment including End of Life. AMH advised that she had attended a Cancer Strategy Workshop for patient services during the morning and that it was apparent that patients still bad experiences. AMH

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Action confirmed that there would be a report produced by the Cancer Work Force at the end of June.

Clinical Leaders Group This was a Monthly group-membership-CCGs, NHSE and secondary and community providers clinical leaders.

Initially this had been set up to provide clinical sign off for the recommendations from the Ian Sturgess report but it will also act as part of the clinical opinion for new pathways and service redesign and output from the KPMG report and will be opened up to include a Staffordshire wide membership. AMH advised that she had found this meeting to be very useful which involved CCGs leads, acute hospital leads and nurses across the Staffordshire area.

The Governing Body RECEIVED AND NOTED the Chair’s Report

6. Chief Officer’s Report

Strategic Resilience AD advised that during March the system had achieved the 4 hour 95% standard for the first time which suggests the system is becoming more stable and resilient. AD explained that there were still challenges and after the Easter break, performance again dipped below acceptable levels. However, the CCG team continue to work with all Providers to maintain a long term sustainable position with regard to urgent care.

Challenges still persist at the Royal Stoke site. The CCG management team is

playing its part supporting the system and all Providers to achieve the standard.

The unprecedented activity over the winter means that a number of routine operations were cancelled. The Trust is now working on clearing the backlog this will therefore see a dip in the 18 week admitted performance target. The plan is to ensure the standard is achieved by the end of May 2015.

AD advised that work was continuing with partners to focus on further service transformation to ensure more services are provided locally in Stafford. He explained that the production of the Forward View by NHS England sets out a number of opportunities to work differently with Providers linking Primary, Community and Acute based care together.

Service Transition The transfer of Paediatrics had been approved by the University Hospitals of North Midlands in March 2015. This will take place on 18th May 2015; this followed a detailed piece of work between Providers and Commissioners which had been the subject to the double-lock assurance process.

Better Care Fund – AD gave a brief outline on the Better Care Fund:- The CCGs and County Council Better Care Fund (BCF) submission was finally approved on the 26th March 2015.

The Section 75 and Section 256’s (the legal basis for allowing a pooling of resources) are complete and will be signed off by all organisations by the 30th

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Action April 2015.

A work programme to deliver the BCF had been developed and a programme

structure for delivery was in place.

AD advised that the important point to note was that there was a significant efficiency programme that needed to be delivered over and above CCGs financial recovery plans and County Councils medium term financial strategy. This would require joint working at a scale not previously seen if we are to deliver the aspirations of the BCF which include:-

An integrated front door A scheme to ensure that patients in receipt of healthcare are re-abled as quickly as possible A scheme to ensure that patients are able, after an intervention, to return home .

End of Year AD explained that the CCG teams were working to finalise the end of year position both in terms of finance and performance.

All the indications are that the CCG will meet its control total set at the start of the year which means it not only delivered most of its efficiency programme but delivered further efficiencies which allowed the CCG to support the Mid Staffordshire Hospitals NHS Trust during its most fragile period in the summer of 2014.

Performance standards during the year have continued to be maintained despite the significant workload for the team due to the dissolution of Mid Staffordshire Hospitals Trust.

Activity and Finance Plans 2015/16 AD advised that each year the CCG was required to agree contracts with our Providers and produce activity and finance plans for the coming twelve months which underpin these contracts. He explained that the activity plan had recently been signed off and were awaiting confirmation of the financial control total for 2015/16. This control total would be further reduced (i.e. smaller deficit) which would enable the CCG to continue to focus on its financial recovery.

The national challenges related to the tariff means that contracts for 2015/16 were yet to be signed off. AD advised the Board that the target was to ensure that these contracts were signed off by the end of April 2015.

Primary Care Co-commissioning The CCG application for Primary Care Co-commissioning at level 2 was approved during March 2015. This means that the CCG would work jointly with NHS England and other Staffordshire CCGs to take more responsibility for commissioning GP services. AD explained that this would increase opportunities to ensure a more integrated approach to care with other Providers in the future.

RG asked about the integrated front door. AD advised that the Council and the Police were working on a project in that there was one front door for both Council and Police. An integrated front door across health services, police, fire service etc. with the Health Services would provide benefits to patients.

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Action

AMH advised that the Fire Service also had the same high risk patients as the Health Service. Therefore, working together with an integrate front door would be beneficial to all. It was suggested that the CCG invite Peter Dartford from the Staffordshire Fire Service to a future GB meeting. ACTION: SY to invite Peter Dartford, Staffordshire Fire Service to a future SY GB.

The Governing Body RECEIVED AND NOTED the Chief Officer’s Report

7. Quality & Safety Report VJ gave highlights from the quality report as below and reminded members that the data contained within the report related to February 2015.

1. The level of concern for RSUH had escalated to RED due to a number of indicators which signify the Trust continues to be under severe pressure. The most visible is the excessive number of trolley breaches, the highest ever recorded, which were reported by the Trust in January despite a brief period of respite when there were none Other safety metrics are showing some signs of pressure such as the number of retained venflons, the number of falls and general pressures exacerbated by ward closures due to infection control outbreaks. This is does not seen to be impacting heavily on patient experience yet with only one or two point reductions; however in the context of the other safety indictors this will be closely monitored. The urgent care situation is being managed through an enhanced surveillance system on a weekly basis involving the Stoke CCG, TDA & NHSE.

2. The level of concern for County had reduced to AMBER to reflect that the situation is more stable with improving A&E performance and infection control within target and no wards closed due to outbreaks. The staffing situation in January remained unchanged in respect of the use of agency staff although there have been no staffing incidents or escalation reported by the Trust. VJ advised that the March report would in fact be reduced to Green. VJ that the staffing had significantly changed and that

3. The level of concern for SSSFT was rated at GREEN as there were no major quality or safety concerns at this time however it is noted that the main cause for the 4 hour breaches were due to staff breaches and this trend will need to be monitored.

4. The level of concern for SSOTPT had changed within the reporting cycle from GREEN to AMBER this was to reflect the issues noted in the publication of the CQC report and recently further whistleblowing incidents. There was a growing trend in pressure ulcers over the last quarter with a recent significant increase which has not yet been validated and may be due to loss of senior leadership and specialist vacant posts. It has been noted that the social care staff are struggling to meet assessment targets which could have an indirect impact on NHS capacity. The inability of the Trust to provide workforce assurance around

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Action vacancies and agency usage has increased the level of general concern around organisational capacity. The CCGs North and South are working with NHSE to follow through on concerns. From July 2015 there would be on integrated CQRM across South and North chaired by SAS CCG Director for Quality and Safety/ Chief Nurse which should provide more opportunity for scrutiny and challenge from commissioners. ACTION: VJ advised the at the CQC action plan would be brought to the next VJ meeting.

5. The level of concern for BHT remains at AMBER whilst the Trust is in special measures. The number of serious incidents has reduced this month along with a significant reduction in the number of complaints. Whilst the C Diff is over trajectory all but one case has been classified as unavoidable. Action taken by the Trust to reduce the number of falls has resulted in a significant reduction from quarter one to quarter two.

6. The level of concern for RWT remains at AMBER to reflect the referral to treatment and the cancer waiting times reported previously which are now subject to contract action. The number of patients for this CCG affected is small and the CCG has asked for assurance that there has not been any adverse clinical impact on those patients.

7. The level of concern for WHT remains at AMBER as a result of severe problems in meeting referral to treatment and cancer waiting times which are already the subject of contractual action with remedial action plans in place. Pressure in A&E is now impacting on patient experience satisfaction and response rates. Serious incidents have increased for December and despite the increase in number of falls none resulted in serious harm and the overall falls rate is below national average.

VJ also noted that the Assurance Panel Meeting for paediatric transfer of services stated in the report that it took place on 12th May 2015 which was incorrect and the date should be 12th March 2015.

RG asked about the County Hospital and the meetings that didn’t take place and whether they had provided a report to cover any gaps. VJ advised that an interim meeting had taken place with the provider.

AD confirmed that VJ and her team had made an unannounced visit to the County Hospital on 13th March 2015 and VJ would report back at the next board meeting. ACTION: VJ to report on the unannounced visits to County Hospital at the VJ next Public Governing Body meeting in June.

DS gave concerns about the staffing and the way in which indicators were being monitored and whether there were ways in which the organisations encouraged staff to have a role in their organisations. VJ responded that UHNM had a large staff engagement programme which had been shared with the staff at County. VJ confirmed that the Quality Team could be able to report back to the Board on the staffing at the hospitals. AD also advised that he had spoken to Mark Hackett from UHNM who had confirmed that the morale of staff was very different now at both hospitals.

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Action

AMH asked about the workforce metrics in SSOTP. VJ advised that she would report back to the Board at the next meeting. ACTION: VJ to report at the next VJ meeting with regard to the workforce metrics in SSOTP

KM gave her concerns regarding the sections on Statutory and Mandatory Training Compliance and Appraisal Completion which had not reached the internal targets. VJ confirmed that they had asked for an action plan on how the SSOTP were going to resolve this issue. ACTION: VJ to obtain an action plan from SSOTP on Staff Training and VJ Appraisals

The Governing Body therefore NOTED the Report for information. 8. Performance Report AT gave good news that we had reached cancer waits targets for January 2015.

The performance measures not achieved for this period were: • Admitted patients to start treatment within a maximum of 18 weeks from referral • Patients waiting for a diagnostic test should have been waiting no more than 6 weeks from referral • Maximum 62 day wait from referral from an NHS screening service to first definitive treatment for cancer • Category A calls resulting in an emergency response arriving within 8minutes – Red 1 • Category A calls resulting in an emergency response arriving within 8minutes – Red 2 • Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department

AT confirmed that contractual levers were being applied to improve performance.

62 Day Cancer Waits – RAP (Remedial Action Plan) now closed but recent performance has raised concerns by both commissioners and TDA with recovery date agreed for May 2015. Financial penalties being applied.

Diagnostics – Commissioner notice sent but RAP not trajectory not agreed yet. Financial penalties being applied.

RTT – failed in January and February which meant that for 14/15 we would be under 90%, mainly due to the cancelled treatments.

Ambulance Response - RAP being developed for 15/16 to address local and regional performance. Focus locally to be on 111 diversions, handover times in MIUs and WICs and anti-biotic prescribing by paramedics. Withholding monies being applied if May trajectory not met to recover Red 2 performance. An action plan is being produced with WMAS looking at quality delays and also to widen the role of paramedics to prescribe locally.

A&E waits- RAP sent to commissioners. Financial penalties being applied.

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Action AD advised that the trend is getting worse and what could be done to remedy this situation. AT advised that we are putting remedial action plans in place in order to resolve this issue.

MA asked is the ambulance callouts were more frequent out of hours? AT confirmed that they had been fairly constant and would look into this and report back to the Board. ACTION: AT to report to the GB on the timings of AT ambulance callouts.

JE asked if there was a way of communicating with care agencies. DR explained that there was no oversight on the operating procedures of these agencies and perhaps more anomalies would come out. LM advised that Sam Buckingham was developing a procedure for this. AD explained that the urgent care system was fragmented.

AT advised that the CCG had invested more resources in Telemed at NHS111 call centre. AT confirmed that there was an analysis being done on the inappropriate call outs and these notes could be taken forward with WMAS for a public discussion in June.

The Governing Body therefore NOTED the Report for information. 9. Board Assurance Framework (BAF) SY updated the Governing Body on the high level risks contained within the BAF.

SY advised the Board that of the ten risks that were reported on in January, nine have now been reduced.

ACTION: It was agreed that PS would update the wording of the control PS total risk.

The Governing Body NOTED the Report for information. 10. Finance Report PS advised on the current financial status and the positive news that the deficit was being reduced.

1. This report sets out the in-year financial position at Month 11. This shows a deficit of £0.918m against plan. 2. At this stage in the year, we are reporting that we will not spend more than the planned deficit for 2014/15. 3. The QIPP programme is forecast to underachieve against target beyond the risk reserve that is held but additional mitigations have been identified to counteract this shortfall.

PS advised that he would bring the Governing Body up to date with the 14/15 year end and that the good news was that we had delivered the control total for the year.

AMH gave her congratulations to PS and the rest of the CCG team for their work on achieving the control total.

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Action PS advised that we had submitted the latest version of the FRP and that we would continue to be under scrutiny as we were still in deficit. PS advised that we would still be in deficit by £25m by the end of next year and that 2015/16 would also be very challenging.

AD reiterated that 2013/14 was chaotic; 2014/15 was stable and was going in the right direction. However, 2015/16 was about transformation and focus on the patients to give a level of services that was needed. AD also advised that capability and capacity of the staff across the CCG had improved significantly and he praised the team for their hard work.

PS advised that a lot of QIPP plans were now contractualised and would be in place from the start of the year.

AD added that although NHS England had given us credibility, we now have to work on credibility with the public and we need to communicate and engage better with the public.

The Governing Body NOTED the Report for information.

11. Annual IG Report SY advised that every year the CCG must demonstrate compliance with Information Governance requirements by completing the Health & Social Care Information Centre IG Toolkit. There was a requirement for all NHS organisations to meet the minimum of level 2 across ALL requirements within the toolkit. However, the CCG should also seek to improve this score and show that the IG work programme was embedded within the organisation and continually reviewed to ensure IG requirements meet the needs of the organisation.

SY explained that by 31st March, the CCG had to submit Information Governance Toolkit return. The senior management within the organisation must sign off each sub requirement of the toolkit as well as the overall score. The 2014-15 submission for Stafford & Surrounds CCG was 83%.

The Governing Body NOTED the Report for information.

12. IVF/ICIS Policy 2015 MH advised what was being proposed as follows:-

• Single IVF cycle only for eligible couples. NICE 3 cycle recommendation is evidence based, but would increase costs considerably. Most CCGs currently offer 1 cycle only. A full cycle of fresh IVF can cost the NHS around £3,000. A cycle of intracytoplasmic sperm injection (ICSI) costs the NHS an extra £500. • Maintain current female age range 23-39 years. Additional costs estimated as £61k per annum for population of 600,000. This allows for approximately 20 additional cycles, which may be an underestimate. • Decline with age in rates of conception is seen mostly after age 30 years and is more marked after age 35. Testing for ovarian reserve is recommended

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Action for women 35-39 years, using AMH as the test of choice, since it has been found to be reliable and can be performed at any stage of the cycle. It is proposed that a threshold of AMH >3 should be applied to all women 35 years or over for access to IVF treatment. Younger women have been shown to conceive using IVF, even if their ovarian reserve proves low on testing. Cost is around £29, and should be included in the provider fees. • Surgical sperm retrieval will be funded in appropriately selected patients, providing that azoospermia is not the result of a sterilisation process, and will only be funded where the couple meet the eligibility criteria set out within this document. Surgical correction should be considered as an alternative to surgical sperm recovery and IVF. • Sperm donation will not normally be available. • Oocyte donation may be commissioned as part of IVF/ICSI policy when clinically appropriate:  Premature ovarian failure  Gonadal dysgenesis including Turner syndrome  Bilateral oophorectomy  Ovarian failure following chemotherapy or radiotherapy • Proposal to offer cryopreservation of gametes to all patients undergoing treatment that may render the patient infertile, rather than just those undergoing chemotherapy. This is a more equitable approach than NICE CG. Will only continue to be stored as long as the couple are entitled to treatment through the policy. • On the basis of equality, CCGs will fund IVF treatment for same sex couples and people with a physical disability, provided there is evidence of subfertility and where it is possible to do so within the eligibility criteria. This clearly excludes same sex male couples.

MH advised that although the policy had been approved at Membership Board, she would need to clarify the definition of the cycles that had been stated within the policy.

It was agreed that the Policy could not be approved at this meeting due to clarification/definition of the cycles stated in the policy, and that it would need to be returned to the Membership Board and then return to Governing Body in due course.

The Governing Body therefore did NOT APPROVE the proposed modified IVF/ICSI policy.

13. Items for Information The Governing Body NOTED the following items for information • Finance, Performance & Contracting Minutes 14. AOB Not further business the Chair closed the meeting.

16. Questions from the Public Questions from the public were recorded by Communications and Engagement.

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Action

17. Next Meeting – In public

Date: Tuesday 30th June 2015 Time: 2.00 pm – 4.30 pm

Venue: Beacon International Centre, Unit 26 Anson Court, Staffordshire Technology Park, Stafford ST18 0GB

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STAFFORD & SURROUNDS CCG GOVERNING BODY IN PUBLIC Action List 21st April 2015

Update Meeting Officer Agenda Item Reference Action (Completed items will remain on Date Responsible the Action List until the following meeting) Actions from Meeting Held 21st April 2015g This has been rescheduled to July due to capacity issues and the need to involve other VJ to present findings from Patient in Control 21.04.15 Chair’s Report 5.0 Val Jones directorates in agreeing the workshop to EMT action plan. Update will be given at the AUGUST meeting SY to invite Peter Dartford, Staffordshire Fire 21.04.15 Chief Officer’s Report 6.0 Service to a future GB. Sally Young COMPLETED

COMPLETED SSOTPT have presented their CQC action VJ advised that the CQC action plan would plan at CQRM where the 21.04.15 Quality & Safety Report 7.0 Val Jones be brought to the next meeting. actions and their response are being monitored.

COMPLETED 26th March Unannounced visit to A & E ward 12 was conducted as part of the post transfer surveillance. To date CCG has VJ to report on the unannounced visits to conducted monthly visits. The 21.04.15 Quality & Safety Report 7.0 County Hospital at the next Public Governing Val Jones highlights for the March visit Body meeting in June. are that:

• The visit was a follow up from the January 2015 visit.

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Update Meeting Officer Agenda Item Reference Action (Completed items will remain on Date Responsible the Action List until the following meeting) • The visiting team were given an overview of staffing, training, ward moves. • Overall the visit was very positive

COMPLETED - SSOTP have an SDIP in the contract which covers workforce. The agreement within the 2015/2016 contract is that in Q1 we will have a themed review of the workforce and a report against the SDIP. The VJ to report at the next meeting with regard 21.04.15 Quality & Safety Report 7.0 Val Jones SDIP has a plan with to the workforce metrics in SSOTP timescales: Monthly Bank and agency report to be presented at the Sept 2015 CQRM. This will include a breakdown of bank and agency use by head count versus vacancies / sickness.

COMPLETED - SSOTPT have presented CCGs at CQRMs with reasons for poor performance and with actions VJ to obtain an action plan from SSOTP on they have taken. However, this 21.04.15 Quality & Safety Report 7.0 Val Jones Staff Training and Appraisals was not perceived as sufficiently robust by CCGs who have requested further information to be presented at the new integrated North and

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Update Meeting Officer Agenda Item Reference Action (Completed items will remain on Date Responsible the Action List until the following meeting) South CQRM to be held in July.

AT to report to the GB on the timings of 21.04.15 Performance Report 8.0 Andrew Tanner ambulance callouts Board Assurance It was agreed that PS would update the 21.04.15 9.0 Paul Simpson COMPLETED Framework wording of the control total risk. Actions from Meeting Held 20 January 2015 JUNE – LM to provide Update on Waste LM to provide update in April with Feedback feedback at the next meeting 20.01.15 12.0 Lynn Millar Medicines Campaign from the campaign. in June – on forward plan – MOVED TO JULY Actions from Meeting Held 21 October 2014 17.02.15 AT to update at the next meeting in April – 21.04.15 AT advised that he could provide this information Performance Report – JB to provide developed metric to show 21.10.14 11.0 Andrew Tanner – perhaps look at comparative July 2014 performance improvement performance at the next meeting in June 2015 - on forward plan – MOVED TO JULY Actions from Meeting Held 19 August 2014 CCG Prioritisation of Health Care Resources To be carried forward to the MH to bring the paper to the next GB 19.08.14 – Recommendations 9.0 Marianne Holmes next OD session in AUGUST. meeting. from Clinical Priorities on forward plan Policy Group (CPPG)

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Item: 07 Enc: 04

REPORT TO THE Clinical Commissioning Group Governing Body Meeting in Public TO BE HELD ON: Tuesday 30th June 2015

Subject: Chief Officers Report Board Lead: Andrew Donald Officer Lead: Andrew Donald For For For For Recommendation:  Approval Ratification Discussion Information PURPOSE OF THE REPORT: To update Governing Body Members on:- • Service Transition (County Hospital) • System Resilience • Staffordshire Transformation • Transforming Cancer and End of Life Care

KEY POINTS: Service Transition (County Hospital) The Trust Special Administrator outlined a series of recommendations with regards to services transfers following the dissolution of Mid Staffordshire Hospitals NHS Trust. It has previously been reported that successful service transfers of Consultant led Obstetric, Acute Surgery and Critical Care have taken place.

On the 18th May 2015 Paediatric Inpatient Services transferred to Royal Stoke and Royal Wolverhampton Hospitals and a new Paediatric Assessment Unit opened at the County Hospital.

Further work is ongoing at the County Hospital to improve and enhance the facilities and this work will continue over the coming months.

The Local Transition Board which oversees the work to transition service has now been stood down and the work transferred to Stafford and Surrounds and Cannock Chase CCGs this includes the work on benefits realisation. This work now sits in the portfolio of the Director of Quality and Safety and Chief Nurse. The Joint Quality Committee will be the CCG body that monitors the achievement of the envisaged benefits of the changes.

System Resilience The system in the Mid Staffordshire area has become much more stable over the last few months, performance has improved significantly. Challenges have existed for the two providers who provide the majority of Cannock Chase CCG acute services over winter; this is similar to many other acute providers. However that position is now starting to improve. Preparation for winter 2015/16 is well underway across Staffordshire. This work is overseen by System Resilience Groups.

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Item: 07 Enc: 04 There continues to be challenges at Royal Stoke and the Strategic Resilience Group continues to work together across the system on delivery of a plan to reduce the present pressures and achieve the key standards that measure system performance.

There has been significant press coverage of the problems at Royal Stoke and this has been directly related to the closure of the Accident and Emergency Department overnight at the County Hospital (formally Stafford Hospital). Having reviewed the data the number of overnight transfers to Royal Stoke continues to be on average 4 ambulances per night. The Accident and Emergency Department is open during the day and continues to take both patients with major and minor needs. From the 18th May 2015 there will be some further emergency transfer for Paediatrics but these should be small in number as the new Paediatric Assessment Unit based at the County Hospital will manage the majority of children requiring treatment. There is therefore no direct correlation between the closure of A&E overnight at the County Hospital and the pressures at Royal Stoke, to make this connection would be over simplistic and ignores a number of other factors which are creating pressures at Royal Stoke. The two CCGs in South West Staffordshire will continue to monitor the situation and play a full part in the systems Strategic Resilience Group.

Staffordshire Transformation To deliver a clinically and financially sustainable healthcare system Staffordshire CCGs need to work together to define the future range, scale and scope of services which meet the needs of Staffordshire residents but also address the significant financial challenge that exists across Clinical Commissioning Groups.

The six Clinical Commissioning Groups have been developing through the Commissioning Congress a programme plan which sets out the key steps that CCGs will need to undertake to detail their proposals for transformation. This will include work in local areas with the public to define the choices available and the services required through to a full consultation with the public on any changes which significantly move away from current service provision.

This work is in its infancy but it is important that Governing Body members are made aware of this work which sees for the first time a coordinated approach to commissioning across Staffordshire through the six CCGs.

Transforming Cancer and End of Life Care Governing Body members will be aware of this programme as various reports have been received on a regular basis.

The Cancer programme has now reached an important point. Dialogue commenced in April and during dialogue three of the organisations put forward a proposal to work together. The three organisations have requested that they hold dialogue sessions with the Commissioners as a consortium. This development is significant as it brings together expertise from the NHS and the private sector. Two other Providers have withdrawn from the dialogue. This therefore means that the Consortium is the single group that Commissioners are continuing in dialogue with. It is hoped that this dialogue will lead to a formal proposal from the consortia to be the Service Integrator for the Cancer Programme through the presentation of a full business case which as part of the procurement process will be fully evaluated. If the above is achieved a contract will be awarded by December 2015.

The objectives of the programme remain the same to significantly improve outcomes and experience for patients and carers.

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Item: 07 Enc: 04

RELEVANCE TO KEY GOALS A 10% reduction the levels of obesity against the expected prevalence A reduction in the proportion of people with undiagnosed disease from 30 – 10 %. A “levelling up” of health outcomes so that all residents N/A experience the same health care outcomes A reduction in excess winter deaths of 50% A reduction in unplanned admissions to hospital for people with Long Term Conditions of 50%

IMPLICATIONS Legal and/or Risk N/A CQC N/A Patient Safety N/A Patient Engagement N/A Financial N/A Sustainability N/A Workforce/Training N/A

RECOMMENDATIONS/ACTION REQUIRED:

The Governing Body is asked to: That the CCG Governing Body notes the report.

Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken?  Has an equality impact assessment been undertaken?  Has a privacy impact assessment been completed?  Have partners / public been involved in design?  Are partners / public involved in implementation?  Are partners / public involved in evaluation? 

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Item: 08 Enc: 05

REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Tuesday 30th June 2015

Subject: Quality Report Board Lead: Val Jones Officer Lead: Lynn Tolley For For For For Recommendation:  Approval Ratification Discussion Information PURPOSE OF THE REPORT:

To update the CCG Joint Quality Committee of the quality issues and matters relating to health care services commissioned by the CCG. The information and reports relate mainly to the month of April with some yet to be validated data for May.

KEY POINTS:

1. The RAG rating for UHNM County Site remains at GREEN to reflect the continued low level of patient safety incidents and high levels of patient experience. However there has been a significant increase in complaints following an upward trend since February, the analysis of which will be reported at the next CQRM. The recent infection control performance is poor in comparison to their end of year out turn for 2014/15 and the CCG Head of Infection Prevention & Control is investigating the reasons for this within the general concern around increased C Diff rates across the local economy. 2. The RAG rating for UHNM Royal Stoke Site remains at RED although patient safety incidents and complaints have markedly decreased this month again. Along with the sustained reduction of Trolley breaches to single figures the Trust is reflecting improved management of patient flow. However the Trust has significantly breached its C. Diff objective and had an attributable MRSA and continues to have large waiting list backlogs. 3. The RAG rating for SSOTPT remains at AMBER/RED whilst the CCGs are confident that workforce assurance and other indicators of organisational pressure reported previously are resolved. There was a significant decrease in the number of reported serious incidents however the all the incidents reported were pressure ulcers; this is in the context of an increasing upward trend in pressure ulcers classified as avoidable. A risk review meeting led by NHSE is to be held with the Trust, CCGs and other stakeholders to clarify the quality and safety issues and to agree actions and support. 4. The RAG rating for RWT remains at AMBER although the Trust is making good progress against the Cancer Recovery Plan it has reported breaches for the 62 day target; this is due to late Page | 1

Item: 08 Enc: 05 referrals from other hospitals which us being addressed by Monitor and the TDA. Both complaints and serious incidents have decreased significantly this month however the Trust has exceeded its C Diff trajectory and patient experience score for New Cross is the lowest across the providers with Cannock scoring 100. 5. The RAG rating for WHT remains at AMBER as the issues reported last month are not fully resolved and Trust has reported EMSA and Trolley breaches. 6. The RAG rating for BHT remains at GREEN with the Trust sustaining improvement with a reduction in the number of complaints and serious incidents. The Trust have again reported EMSA breaches in their critical care unit due to capacity and are considering pathway changes to reduce the likelihood of this continuing to reoccur. 7. The RAG rating for WMAS remains at AMBER due to performance issues in regard to local targets which the Trust advises require additional investment from the CCG. The Trust is undertaking quality improvement work with CCGs through CQUINs to reduce the number of patients having to be transported to A&E. 8. The RAG rating for SSSFHT is GREEN as there are no major quality and safety concerns at this time with this provider. 9. The RAG rating for Rowley Hospital is GREEN as there are no major quality and safety concerns at this time with this provider. 10. The RAG rating for the NHS 111 Service is GREEN although the service has underperformed in achieving call back targets. This is due to the number of calls being referred to the clinical advisor which provides clinical oversight.

RELEVANCE TO KEY GOALS To reduce health inequalities across Cannock Chase through targeted interventions. To identify and support patients with Long Commissioning for quality will enable the CCG to put in Term Conditions to ensure care delivery place exemplary systems for commissioning intentions and closer to home. provider performance management that will deliver its Key To improve and increase overall life Goals expectancy. To develop integrated services with simple, easy access. IMPLICATIONS Legal and/or Risk Enable the CCG to meet its statutory responsibilities for commissioning quality; reduce and mitigate risks to the organisation and to patients. CQC Enable the CCG to meet commissioner responsibilities for CQC Essential Standards for Health including that providers have up to date registration with the CQC. Patient Safety Integral element of the Quality Strategy which describes the systems that will be deployed to “keep patients safe.” Patient Engagement Integral element of the Quality Strategy which describes how the CCG will use patient engagement and experience to form the intelligence essential for effective and safe commissioning Financial Following the baseline assessment of the CCG structure, systems and processes there maybe implications for additional funding. Sustainability A three year plan which will be refreshed on an annual basis through the annual Quality Improvement Plan Workforce / Training Organisational Development Plan for the CCG is in place to develop members, staff and leadership. Page | 2

Item: 08 Enc: 05

RECOMMENDATIONS / ACTION REQUIRED: The Quality Committee is asked to: Note the key quality and safety issues in the report and actions taken to improve quality and reduce risk

Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken?  Has an equality impact assessment been undertaken?  Has a privacy impact assessment been completed?  Have partners / public been involved in design?  Are partners / public involved in implementation?  Are partners / public involved in evaluation? 

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SAS & CC CCG Joint Quality Committee Quality and Safety Report July 2015 Main Issues/Top Themes For Providers

1. University Hospital of North Midlands (UHNM) – County Hospital a. Infection Control MRSA/C.diff Breaches 2. University Hospital of North Midlands (UHNM) – Royal Stoke a. Patient Safety Metrics b. Infection Control 3. Staffordshire Stoke On Trent Partnership Trust (SSOTPT) a. Workforce Assurance a. NHS Safety Thermometer 4. South Staffordshire Shropshire Healthcare Foundation Trust (SSSHFT) a. No main issues 5. Burton Hospital Foundation Trust (BHFT) a. EMSA 6. Royal Wolverhampton Hospital Trust (RWHT) a. Cancer Standards b. Falls c. Infection Control 7. Walsall Hospital Trust (WHT) a. CQC update b. EMSA c. 12 Hour Trolley Breaches 8. Rowley a. CQUIN update 9. BPAS a. Not due until June 2015 10. Staffordshire 111 a. Warm Transfers b. 60 min call back 11. West Midlands Ambulance Service (WMAS) a. Regional Red Performance – April 2015

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University Hospital of North Midlands – County Hospital REGULATORS INVOLVEMENT AND ISSUES

County was registered with CQC on 1 November 2014. However, CQC have made an announced visit in April 2015, report has not yet been published.

MAIN ISSUES FOR PROVIDERS

Infection Control County Hospital has breached on both MRSA and C.Diff. CCG Head of Infection Prevention and Control is monitoring this closely.

INFECTION CONTROL

2015/2016 County Target Trend Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD MRSA 0 = 1 1 Bacteraemia C Difficile 24  4 4 • Note the above data requires validation against Public Health England data

MRSA There was 1 case of MRSA Bacteraemia reported during April 2015, which upon investigation was deemed Trust attributable and avoidable.

Clostridium difficile There was 4 report of Clostridium difficile infection during April 2015. The objective for April was 2, thus causing the trust to breach its objective.

Outbreaks and Serious Incidents

D&V Two wards closed to D&V/Norovirus in April 2015, this was ongoing from March 2015. The wards have since been reopened.

Scabies Trust reported that on Ward 10 five patients were displaying rashes, possibly due to scabies. 3 out of the 5 patients were admitted with the rash. Scabies has been confirmed, Public Health England has been consulted and treatment commenced accordingly. PATIENT EXPERIENCE

Family and Friends Test (FFT)

UHNM Jan Feb Mar UHNM County RWHT BHFT WHT

APRIL F & F Inpatient Percentage Rec 93 96 97 96 98 91 98 95 F & F Inpatient Response Rate (%) 45.71 45.08 35.90 31.3 43.2 33 26.6 50.4 F & F A & E % Rec 92 84 86 78 80 84 98 93 F & F A & E Response Rate (%) 26.7 14.8 34.6 24 25 22.5 10.8 2 F & F Maternity (Antenatal Care) % Rec - N/A N/A N/A 83 93 84

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F & F Maternity (Antenatal Care) Total Res 0 N/A N/A 0 6 15 38

F & F Maternity (Birth) % Rec - 98 0 100 100 100 98 F & F Maternity (Birth) Res Rate - 11.6 0 13.1 17.9 42.1 237.8 (%) F & F Maternity (Postnatal Ward) - 100 90 97 84 99 98 % Rec F & F Maternity (Postnatal Ward) - 50 70 36 159 98 286 Total Res F & F Maternity Community % N/A 95 100 100 Rec F & F Maternity Community Total 0 21 7 11 Res F & F – Staff – Q2 - % Rec Next Report will be Q3 data not yet available on national system F & F – Staff – Q2 - % Res. Rate *Data has been revalidated using new percentage recommended methodology in place of the old Score rating. F & F Antenatal Care/Postnatal Ward does not have Percentage Recommended data. Data is collected on Total Responses, Percentage Recommended and Percentage not recommended only.

Eliminating Mixed Sex No breaches were reported for April 2015.

Complaints UHNM received a total of 66 complaints in May, of which 24 were related to County. This is an increase from the 16 received in April 2015. The County site have been showing an increased trend since February 2015 when they received 11. Further information will be available for the next quarterly report on the main focus of the trends following challenge at June CQRM.

PATIENT SAFETY

Out of a total of 12 Serious Incidents reported in May 2015 at UHNM, 2 Serious Incidents appertained to County Hospital.

April 2015 May 2015 Slips/Trips/Falls x 1 C.Diff & Health Care Acquired Infections x 1 Pressure Ulcer Grade 3 x 1 Ward Closure x 1 MRSA Bacteraemia x 1 County Total = 3 County Total = 2

University Hospital of North Midlands (UHNM) – Royal Stoke site REGULATORS INVOLVEMENT AND ISSUES CQC ‘s last published a report in March 2014, whereby the trust was compliant with all standards of inspection criteria. However, CQC have made an announced visit in April 2015, report has not yet been published.

MAIN ISSUES FOR PROVIDERS

12 hour Trolley Breaches The number of Trolley breaches that have been reported by the Trust continue to decrease from the exceptionally high numbers at the end of last year to the current figure of 4. The Trust is using a RCA process which has been commended by NHSE to review every Trolley breach and is also conducting a 10% audit of those nearing the breach threshold to identify potentially avoidable factors.

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Patient Safety Metrics The CCG and the NTDA have attended groups to undertake reviews and receive further assurance about process and content of meetings in relation to the impact of sustained hospital through put pressures and the impact on patient safety metrics such 12 Hour A&E Breaches, Pressure Ulcers and Mortality. The meetings have been productive and provided assurance on the robustness of the internal review and reporting onwards in the organisation and to stakeholders.

Infection Control The trust has had one MRSA case against a zero objective. They have significantly breached the number of C.diff cases. CCG Head of Infection Prevention is working closely with the UHNM’s Infection Control lead to ensure processes are in place to address this.

INFECTION CONTROL

2015/2016 UHNM Target Trend Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD MRSA Bacteraemia 0  1 1 C Difficile 50  9 9

MRSA The trust reported 1 MRSA during April 2015, which was deemed trust attributable and avoidable.

Clostridium difficile The trust reported 9 Trust apportioned cases of C difficile toxin infections (CDI) in April 2015, which has breached the trusts accumulative objective of 4.

Outbreaks and Serious Incidents D&V The trust reported 5 ward closures in April 2015 due to D & V/Norovirus. This will be monitored by the Head of Infection Control and Prevention who is in the process of forming a new short life working group to address the high incidence of C.diff across the County.

PATIENT EXPERIENCE Family and Friends Test (FFT)

UHNM Jan Feb Mar UHNM Royal RWHT BHFT WHT Stoke April F & F Inpatient Percentage Rec 97 96 97 96 96 91 98 95 F & F Inpatient Response Rate (%) 29.3 45.08 35.90 31.3 29.8 33 26.6 50.4 F & F A & E Percentage Rec 78 84 86 78 77 84 98 93 F & F A & E Response Rate (%) 15.0 14.8 34.6 24 23.7 22.5 10.8 2 F & F Mat (Antenatal Care) % Rec - N/A N/A N/A 83 93 84

F & F Mat (Antenatal Care) Total 1 N/A N/A N/A 6 15 38 Res F & F Mat (Birth) % Rec 97 98 0 0 100 100 98 F & F Mat (Birth) Res Rate (%) 6.8 11.6 0 0 17.9 42.1 237.8 F & F Mat (Postnatal Ward) % Rec 100 100 90 90 84 99 98 F & F Mat (Postnatal Ward) Total 20 50 70 70 159 98 286 Res F & F Maternity Community % Rec N/A 95 100 100 F & F Maternity Community Total 0 21 7 11 Res F & F – Staff – Q2 - % Rec Next Report will be Q3 data not yet available on national system

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F & F – Staff – Q2 - % Res. Rate There is a significant increase in the Family and Friends rates. This is a result of a change to the methodology for reporting in response to National Guidance. The impact of this is that there will be an increase in all scores.

Complaints UHNM received a total of 66 complaints in May, of which 42 were related to RSUH. This is a reduction from the 57 received in April. RSUH site have been showing a downward trend since January 2015 when they received 81. Further information will be available for the next quarterly report on the main focus of the trends following challenge at June CQRM.

Eliminating Mixed Sex Accommodation No breaches were reported for April 2015.

PATIENT SAFETY

Serious Incidents (SIs) UHNM’s SI’s have been split by site, Royal Stoke reported 10 and County Hospital reported 2, which equals 12 across both sites for the month of May 2015.

April 2015 May 2015 C.Diff & Health Care Acquired Infections x 1 Pressure Ulcer Grade 3 x 5

Maternity Services - Unexpected admission to NICU (neonatal C.Diff & Health Care Acquired Infections x 1 intensive care unit) x 1 MRSA Bacteraemia x 1 Other Retained Cannula x 2 Other x 2 ( 1 retained cannula/Paed mental health bed availability) Screening Issues x 1 Pressure Ulcer Grade 3 x 10 Adverse media coverage or public concern about the organisation or the wider NHS x 1 Slips/Trips/Falls 4 Stoke Total = 19 Stoke Total = 10

Staffordshire Stoke On Trent Partnership Trust (SSOTP) REGULATORS INVOLVEMENT AND ISSUES

CQC Visit CQC conducted two unannounced visits to Community Health Inpatient Services and Community Health Services for Adults; on the 5 November 2014, as a result of a number whistle-blowing letters received from staff. CQC concentrated on two areas; Safety and Leadership. Both reports were published on the 19 March 2015. The action plan is being monitored through CQRM. From July 2015 the North and South CQRMs will be integrated into a single monthly CQRM. This will enable more consistent and focused scrutiny.

MAIN ISSUES FOR PROVIDER

Workforce Assurance The North and South CCGs continue to work with the Trust to improve the level of reporting for workforce assurance to ensure that there is early warning of any deterioration in patient safety. The first Joint CQRM in July 2015 will have a themed discussion on workforce which will be presented by the Providers Head of HR to show progress against the Service Delivery plan agreed in the 2015/16 contract.

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Pressure Ulcers (PUs) Grade 3 or 4 The increase in avoidable PUs has previously been reported to members and a themed review is being presented at the new North and South integrated CQRM in August.

NHS Safety Thermometer The Trust has reported an increase in patient safety incidents which is to be explored at CQRM however the recent NHS Safety Thermometer data which collects national data on the level of harm reported by providers demonstrates that patients are suffering less harm.

INFECTION CONTROL

MRSA The trust reported zero cases of MRSA Bacteraemia April 2015.

Clostridium difficile There were 2 reports of Clostridium difficile during April 2015.

2015/2016 SSOTP Target Trend Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD MRSA 0 = 0 0 Bacteraemia C Difficile 10 = 2 2 *validation of figures

PATIENT EXPERIENCE

Trust Overall Feb Mar Apr May June July Aug Sept Dec Jan Feb Mar F & F Score 72.12 70.61 70.32 69.79 73.57 68.31 68.66 71.31 74.46 71.84 97 97 Number of surveys received 2915 2419 2092 2189 2417 2977 1768 1969 1826 1607 1754 ∗There is a significant increase in the Family and Friends rates. This is a result of a change to the methodology for reporting in response to National Guidance. The impact of this is that there will be an increase in all scores.

In April 2015, the Trust received 1842 User Experience surveys, which is an increase compared to 1754 in March., and SSOTPT reported that 98% of users would recommend services to Friends and Family in April, which is a slight increase compared to 97% in March. F&F South East Staffs Tamworth / Stafford Cannock Seisdon Community Lichfield teams

Responses Received 246 67 20 60 27 45

Score 99% 98% 100% 97 100% 100%

Complaints The Trust received 24 complaints in April 2015, which was a slight decrease from 32 in March 2015. Out of the 24 complaints; 13 related to Health and 11 Adult Social Care. This shows health complaints have reduced from 18 in March to 13 in April 2015. The end of year total was 357 of which 208 were health related

Eliminating Mixed Sex Accommodation No breaches were reported for April 2015.

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PATIENT SAFETY

Serious Incidents (SIs) North & South Divisions There were 10 serious incidents reported during May 2015; a significant decrease from the 28 reported in April 2015. All 10 incidents related to Grade 3 and 4 Pressure Ulcers.

April 2015 May 2015 Pressure Ulcer Grade 3 12 x unknown Pressure Ulcer Grade 3 2 x North Community hospitals 5 x North 6 x North 2 x East 1 x East 2 x south

Pressure Ulcer Grade 4 1 x South Pressure Ulcer Grade 4 1 x South Slips/Trips/Falls 2 x North Ward Closure 4 x North SSOTPT combined North and South Total = 28 SSOTPT combined North and South Total = 10

South Staffordshire Shropshire Healthcare Foundation Trust (SSSHFT)

REGULATORS INVOLVEMENT AND ISSUES No issues reported to the CCG this month.

MAIN ISSUES FOR PROVIDER

Workforce Indicators There are a number of areas where the trust are not compliant with the Trust internal standards. The Trust has provided exception reports to CQRM.

CQRM The host CCG has formally approved via the Governing body the change in frequency of the CQRM to bi-monthly as of July 2015.

CQUINs 2015/2016 All local CQUINs have now been agreed and the Trust is working towards Q1 Milestones at the time of writing this report.

NMC Revalidation Process The trust will be formally asked what their plans are in terms of readiness for the launch of NMC Nurses and Midwives revalidation process ; and how staff will be supported.

INFECTION CONTROL

The trust reported zero case of both MRSA and C.difficile in April 2015.

2015/2016 SSSFT Target Trend Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD MRSA 0 = 0 0 Bacteraemia C Difficile 0 = 0 0 *validation of figures

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Outbreaks and Serious Incidents No outbreaks or serious incidents reported for April 2015.

PATIENT EXPERIENCE

Friends and Family Inpatients test Results Scores 44% MH Community Recommendations for the service.

Complaints No data has been made available for April 2015.

Eliminating Mixed Sex Accommodation No breaches were reported for April 2015. PATIENT SAFETY

Serious Incidents (SIs) The number of SIs reported to commissioners for May 2015 is 4; this is a significant decrease from the 12 reported in April 2015.

April 2015 May 2015 Admission of under 18s to adult mental health ward x 3 Slips/Trips/Falls x 2 Homicide by Outpatient (not in receipt) x 1 Fire (accidental) x 1 Suspected suicide x 5 Unexpected Death x 1

Unexpected Death of Community Patient (in receipt) x 3 Total = 12 Total = 4

*Captured by reported date so we can capture any serious incidents which are reported late

Burton Hospital Foundation Trust (BHFT) REGULATORS INVOLVEMENT AND ISSUES

There have been no reported CQC visits. The CQC will be conducting a planned and scheduled visit to the Trust in July 2015.

MAIN ISSUES FOR PROVIDER

EMSA 11 breaches were reported for April 2015 which were all due to capacity issues in Critical Care. These figures are the trust reported figures and not national figures.

INFECTION CONTROL

2015/2016 Burton Target Trend Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD MRSA Bacteraemia 0 = 1 1 C Difficile 20 = 2 2

MRSA The trust reported 1 MRSA Bacteraemia in April 2015 which was due to a contaminant

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Clostridium difficile The trust reported 2 cases of C.difficile during April 2015.

Outbreaks and Serious Incidents The Trust reported 1 Ward Bay closure during April 2015.

PATIENT EXPERIENCE

Family and Friend Test (FFT)

BHFT Jan Feb Mar BHFT UHNM RWHT WHT

April F & F Inpatient Score 97 97 97 98 96 91 95 F & F Inpatient Response Rate (%) 33.29 38.73 78.31 26.6 31.3 33 50.4 F & F Score - A & E 97 97 94 98 78 84 93 F & F - A & E Response Rate (%) 19.8 26.1 18.7 10.8 24 22.5 2 F & F Maternity (Antenatal Care) N/A 88 88 94 93 83 84 Percentage Rec F & F Maternity (Antenatal Care) Total 16 26 35 15 N/A 6 38 Responses F & F Maternity (Birth) Percentage Rec 98 96 99 100 0 100 98 F & F Maternity (Birth)Response Rate (%) 47.6 36.5 49 42.1 0 17.9 237.8 F & F Maternity (Postnatal Ward) 98 99 98 99 90 84 98 Percentage Rec F & F Maternity (Postnatal Ward) Total 129 84 92 98 70 159 286 Responses F & F Maternity Community % Rec 100 N/A 95 100 F & F Maternity Community Total Res 7 0 21 11 F & F – Staff – Q2 - % Rec Next Report will be Q3 data not yet available on national system F & F – Staff – Q2 - % Res. Rate There is a significant increase in the Family and Friends rates. This is a result of a change to the methodology for reporting in response to National Guidance. The impact of this is that there will be an increase in all scores.

Complaints Since December 2014 the trend has been downwards however there was a slight upwards trend in February (19) and March (19); however this has again decreased in April to 10.

Patient Experience The Trust overall local patient experience score on “patient involvement in decisions on treatment” and “care and being able to get attention from staff” has improved with the overall RAG rating for April 2015 being Green. There are, however 3 areas which remain Amber which are being monitored.

Eliminating Mixed Sex Accommodation

There were 11 breaches in April 2015 which was an increase from 4 in March 2015. The Trust has consistently reported breaches since December 2014. All the breaches have occurred in the Critical Care due to capacity issues. In April 2015 3 CC CCG patients were affected

PATIENT SAFETY

Serious Incidents (SIs) The number of SIs reported for May 2015 is 2, which is a decrease of 7 from April 2015. Both incidents were Grade 4 Pressure Ulcers. 9

April 2015 May 2015 C.Diff & Health Care Acquired Infections x 1 Pressure ulcer Grade 4 x 2 Maternity Services - Unexpected admission to NICU (neonatal intensive care unit) x 1 Maternity Services - Unexpected neonatal death x 1 Pressure ulcer Grade 3 x 1 Pressure ulcer Grade 4 x 2 Slips/Trips/Falls x 1

Total = 7 Total = 2 *Captured by reported date so we can capture any serious incidents which are reported late

Royal Wolverhampton Hospital Trust (RWT) REGULATORS INVOLVMENT AND ISSUES

CQC Planned Inspection – A CQC full impaction has taken place between the 2nd and 5th June 2015. The Provider will share the draft report when available

MAIN ISSUES FOR PROVIDER

Cancer Standards The Trust has struggled to meet the 62 day target for April 2015, due to late tertiary referrals. RWT have raised these issues with the TDA who have approached Monitor and they have agreed to liaise with the relevant Trust. The Cancer recovery plan has started to indicate positive impact on performance and provides assurance that the new equipment and recruitment is helping to reduce pressures. The Trust is predicting that May will show an improved and sustained performance.

For 62 Day to First Treatment - there were 22 patient breaches during the month of April • 8 x Tertiary referrals received between day 34 - 80 of the patients pathway (operating guidelines state referrals should be made within 42 days), • 6 x Capacity Issues, 6 Complex Pathways and 2 x Patient Initiated. Of the tertiary referrals received in month • 75% were received after day 42 of the pathway and 25% of the total tertiary referrals were received after day 62 of the Pathway.

Cancer Recovery Plan As previously reported, RWT have made good progress following implementation of the Cancer Recovery Plan and have completed many of the actions required. Ongoing actions which have not yet been completed within the Cancer Recovery Plan are being monitored by CCGs and the Clinical Quality Review Meetings.

Falls Falls per 1000 bed days in April was 6% which is above the Trust target of 5.6%. Care of the Elderly speciality has had a high number of repeat fallers due to a particular group of delirious/confused patients that required supervision to reduce risk. A new Falls Policy has been rolled out. A new audit tool is currently being developed to reflect the policy changes and facilitate monitoring performance against the new policy in all areas. This will give clear robust data that can be used to investigate specific incidents.

Request for Additional Hospital Ambulance Liaison Officers (HALO’s) The standard NHS contract details the fines that are applicable to Acute Trusts for breaches to the 30 min and 60 min hand over of ambulance conveyed patients. As part of the WMAS contract, RWT has a full time HALO on site. From experience, RWT manages the handover of ambulance patients very well, and have some of the lowest fines applied to the contract for delays in handover across the Black Country. However, there are a number of times each year when the Trust requests additional support to manage ambulance handover within the ED. 10

INFECTION CONTROL

Clostridium difficile 13 cases were positive by toxin test; 5 of these were attributable to RWT, (using the external definition of attribution) against a target of 3 for the month. This means RWT are 2 cases over target at the end of month one. 2015/2016 RWT Target Trend A M J J A S O N D J F M YTD MRSA Bacteraemia 0  0 0 C Difficile  5 5

PATIENT EXPERIENCE Family and Friend Test (FFT) Royal Wolverhampton Trust Jan Feb Mar Apr New Cannock UHNM BHFT WHT Comb Cross Comb April F & F Inpatient % Rec 94 90 86 91 90 100 96 98 95 F & F Inpatient Res Rate (%) 23.68 31.69 42.10 33 32.9 43.2 31.3 26.6 50.4 F & F A & E % Rec 85 85 83 84 84 78 98 93 F & F - A & E Res Rate (%) 30.3 27.6 26.3 22.5 22.5 24 10.8 2 F & F Maternity (Antenatal Care) N/A % Rec - 80 * 83 93 84

F & F Maternity (Antenatal Care) N/A 3 5 * 6 15 38 Total Res F & F Maternity (Birth) % Res 0 100 100 99 100 100 98 F & F Maternity (Birth) Res Rate 0 11.5 21.3 19.7 17.9 42.1 237.8 (%) F & F Maternity (Postnatal 90 88 88 81 84 99 98 Ward) % Rec F & F Maternity (Postnatal 70 17 60 111 159 98 286 Ward) Total Res F & F Maternity Community % N/A 95 100 100 Rec F & F Maternity Community 0 21 7 11 Total Res F & F – Staff – Q2 - % Rec Next Report will be Q3 data not yet available on national system F & F – Staff – Q2 - % Res. Rate ∗ There is a significant increase in the Family and Friends rates. This is a result of a change to the methodology for reporting in response to National Guidance. The impact of this is that there will be an increase in all scores.

Complaints The Trust received 27 complaints during April 2015 in comparison to 51 complaints during March 2015.

Eliminating Mixed Sex Accommodation No breaches were reported for April 2015. PATIENT SAFETY

Serious Incidents The serious incidents have significantly decreased for the third consecutive month to 29 for April 2015.

March 2015 April 2015 Confidential Leak x 8 1 x Confidential Leak Grade 3 Hospital Acquired Pressure Ulcers x 11 7 x Grade 3 Hospital Acquired Pressure Ulcers Grade 3 Community Acquired Pressure Ulcers x 6 7 x Grade 3 Community Acquired Pressure Ulcers 11

Grade 4 Community Acquired Pressure Ulcers x 2 2 x Grade 4 Community Acquired Pressure Ulcers Infection – (1 x Norovirus; 2 x Cdiff; 1 x CPO) x 4 1 x CDIFF Slip/ trips / falls x 2 4 x Slips/Trips /falls Drug error x 1 1 x Drug Incident delayed diagnosis x 3 1 x Delayed Diagnosis Unexpected Neonatal Death x 1 1 x Unexpected Death Failure to Act on Test Results x 1 1 x Failure to Act on Test Results Maternal Death x 1 1 Child Death Surgical error x 1 1 x Hospital Associated VTE 1 x VRE Infection RWT combined Acute and Community Total = 41 RWT combined Acute and Community Total = 29 CCH =0 CCH =0

Walsall Hospital Trust (WHT) REGULATORS INVOLVEMENT AND ISSUES

CQC - As previously reported, the Care Quality Commission (CQC) is planning to complete a full inspection in the first week of September 2015. WHT is currently preparing for the inspection: • A mock inspection programme was completed during 2014-15 and report outcomes shared with staff and action plans developed. • There is on-going monitoring of progress through a strong governance structure • The Trust has an established Programme Management Structure which will ensure that a robust project management approach is followed. • A comprehensive Communications Plan has been developed for all staff and our stakeholders. • There has been liaison with neighbouring Trusts to learn lessons of their CQC experience

The Trust Development Authority (TDA) continues to provide support to WHT and the schedule of announced visits is ongoing.

Mixed Sex Accommodation Breach There were 9 mixed sex accommodation breaches (relating to 12 days) recorded in High Dependency Unit in April 2015.

12 Hour Trolley Breach The ten 12 hour trolley breaches were between Easter bank holiday Monday and the following Tuesday morning. A root cause analysis has been completed and a report has been submitted to the System Review Group in relation to the escalation of learning points relating to discharge planning and access to assessment beds.

Infection Control

MRSA There were no cases of MRSA bacteraemia attributed to Walsall Healthcare during April 2015. Year to date has achieved with no cases of MRSA reported this financial year.

Clostridium difficile During April 2015 there was one reported case of hospital attributable toxin positive C.Difficile on Swift Discharge Suite. The contract for 2015/16 invokes financial penalties if the number of avoidable cases during the year exceeds 18

2015/2016 WHT Target Trend Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr YTD MRSA 0 = 0 0 Bacteraemia C Difficile 18  1 1

12

PATIENT EXPERIENCE

Family and Friends Test (FFT)

Walsall Hospital Trust Jan Feb Mar WHT BHFT UHNM RWHT

April F & F Inpatient Score 94 90 86 95 98 96 91 F & F Inpatient Response Rate (%) 23.68 31.69 42.10 50.4 26.6 31.3 33 F & F Score - A & E 85 85 83 93 98 78 84 F & F - A & E Response Rate (%) 30.3 27.6 26.3 2 10.8 24 22.5 F & F Maternity (Antenatal Care) %e Rec N/A - 80 * 84 93 83

F & F Maternity (Antenatal Care) Total Res 3 5 * 38 15 N/A 6 F & F Maternity (Birth) % Rec 100 100 99 98 100 0 100 F & F Maternity (Birth)Response Rate (%) 11.5 21.3 19.7 237.8 42.1 0 17.9 F & F Maternity (Postnatal Ward) % Rec 88 88 81 98 99 90 84 F & F Maternity (Postnatal Ward) Total Res 17 60 111 286 98 70 159 F & F Maternity Community % Rec 100 100 N/A 95 F & F Maternity Community Total Res 11 7 0 21 F & F – Staff – Q2 - % Rec Next Report will be Q3 data not yet available on national system F & F – Staff – Q2 - % Res. Rate * There is a significant increase in the Family and Friends rates. This is a result of a change to the methodology for reporting in response to National Guidance. The impact of this is that there will be an increase in all scores.

Complaints No report received from provider for the month of April 2015.

Eliminating Mixed Sex Accommodation The Trust reported 9 patient breaches on High Dependency Unit (HDU) for the month of April. This is an improvement compared to 17 patient breaches reported in March. For the 9 patient breaches reported in April

Patient Safety

Serious Incidents There were 19 Sis reported to Walsall CCG in April 2015.

March 2015 April 2015 HCAI’s – 2 ward closures attributed to Norovirus and 1 12 hour Trolley Breaches x 10 MRSA Bacteraemia x 3 Patient falls x 3 inter - uterine death x 1

intra-uterine death x 1 patient fall x 1

delayed diagnosis x 2 suboptimal care of deteriorating patient x 1

sub-optimal care of deteriorating patient (stroke) x 1 HCAI – all ward closures due to Norovirus x 5 Outpatient department appointment delay X 1 category 3 pressure ulcers – community acquired x 2

WHT Acute and Community combined Total = 13 WHT Acute and Community combined Total = 18

13

Staffordshire NHS 111 Service REGULATORS INVOLVEMENT AND ISSUES Nil to report

MAIN ISSUES FOR PROVIDER

Warm Transfers This target is currently being negatively impacted upon by the increased number of calls transferred to a clinical advisor as a result of the work to reduce inappropriate ambulance dispatches, and Emergency Department referrals. As call volumes have climbed the pass through rate to a clinical advisor has also increased.

Presently the target averages are 85.7%, therefore, this has been escalated to commissioners, who have agreed not to enforce performance against this LQR.

Call Back within 10 and 60 minutes As previously reported the performance against this ‘Call Back’ targets have been negatively impacted by the introduction of procedures to reduce inappropriate ambulance and ED referrals. Therefore, Commissioners have agreed not to enforce performance against this target.

West Midlands Ambulance Service REGULATORS INVOLVEMENT AND ISSUES

No issues reported this month

MAIN ISSUES FOR PROVIDER

Red Targets As previously reported WMAS have confirmed that all rural CCGs have underperformed on RED 1,2 & 19 standards. There is a rural factor in respect of geography which impacts on the Trust’s ability to achieve this target. The Trust has advised that in order to meet the target there would need to be additional investment..

The operational performance thresholds (Red 1s, 2s and 19s) referred to in this report are not currently contracted to a level that requires performance individually at each CCG, performance is contracted on a regional basis only for the Ambulance Trust, as required by the NHS Standard Contract issued for use by NHS England.

Serious Incidents Zero Serious incidents or Never Events were reported for Stafford and Surrounds and Cannock Chase CCG in April 2015.

Paramedic Pathfinder Event – 11th June 2015 The Paramedic Pathfinder Event was held on 11th June which was open to all local health economies who commission collaboratively for a regional EU Ambulance service (6 LHEs in total representing 22 CCGs, albeit 21 CCG currently because one CCG is outside of contact to date). Stafford and Surrounds and Cannock Chase CCG sent a representative who can make clinical/quality decisions to decide the milestones in the paramedic pathfinder CQUIN indicator for their area. The CQUIN indicators in the scheme this year are related and support achievement of the five year forward vision.

The objective of the event is for each Local health Economy (LHE) to develop their pathways and decide on the local health economy reduction trajectories for measurement in the CQUIN Schedule, and to develop a suitable trajectory to input into indicator 1.1. As a result of paramedic pathfinder going active within the LHEs, the emphasis is focussed

14

upon reduced conveyance to A&E for “Green” activity,(i.e. urgent activity as opposed to real emergency “Red” activity). As the Green activity accounts for about 60% of activity in the WMAS contract and is the growing element.

Patient Experience

Family and Friends Test (FFT) No data currently available for WMAS for April 2015.

Complaints No information received for April 2015

Rowley REGULATORS INVOLVEMENT AND ISSUES Nil to report

CQUINS – Quarter 3 & 4 Milestones It was confirmed at CQRM on 4th June, that all quarter 3 & quarter 4 milestones for all CQUINs have been achieved.

Information relating to workforce with practicing privileges (For information only) 1 Consultant has had their practicing privileges withdrawn pending the outcome of a review by the Medical Advisory Committee for Rowley Hall hospital. The responsible officer for the Consultant in question has been informed, and the Medical Director has also been informed at the Consultants Trust

Infection Control Rowley Hall Hospital has a longstanding history of zero incidents of MRSA, C Difficile and MSSA bacteraemia infections. All patients are screened for MRSA prior to admission if required. The screening test is viable for 6 weeks. If admission has not taken place during this time the patient is rescreened before admission. Patients with colonised MRSA are sent to their GP for treatment and retested before admission. Patients with colonised MRSA in the groin or nose are not accepted for treatment unless they are treated and clear. There have been a total of 4 surgical site infections reported within Q4. No themes or trends have been identified.

PATIENT EXPERIENCE Rowley Hall Hospital has an excellent track record for positive patient experience and this continues. Within Q4 there has been 1 complaint regarding clinical care which relates to a medication incident, and this investigation is ongoing. There have been 2 formal complaints relating to Administration processes and 1 complaint relating to the payment for an outpatient appointment (Private patient) Wherever possible concerns are acted upon immediately and this may be the reason why few concerns result in formal complaints. Ongoing customer care training continues to be a priority and is therefore part of our mandatory training for all staff.

Complaints Three complaints were reported of which one identified an internal serious incident which would not be reportable to our reporting systems

Eliminating Mixed Sex Accommodation There were 0 mixed sex accommodation breaches

15

Patient Safety There was a total of 4 medication incidents reported in March 2015, None of the incidents during this quarter show any evidence of themes or trends. There were no serious incidents reported in March, but have been informed there is an incident which has arisen form a complaint. This is being fully investigated and the CCG will receive feedback once completed

Acronym Explanation BADGER Birmingham And District General Emergency Rooms BHFT Burton Hospitals Foundation Trust CCG Clinical Commissioning Group CHKS Leading provider of healthcare intelligence and quality improvement services CHRT Crisis Home Resolution Team CDIFF Clostridium Difficile CQRM Clinical Quality Review Meeting CSU Clinical Support Unit D & V Diarrhoea and Vomiting EMSA Eliminating Mixed Single Sex Accommodation EPR Electronic Patient Record FFT Friends and Family Test GC 28 Provider cannot be fined for services which are below trajectory due to industrial action or other reasons beyond their control HCAI Health Care Associate Infections HEFT Heart of England Foundation Trust IAPT Improving Access to psychological therapies IPC Infection Prevention and Control M&L CSU Midlands & Lancashire Commissioning Support Unit MRSA Methicillin Resistant Staphylococcus Aureus NHQA Nursing Home Quality Assurance NICU Neonatal intensive care unit NSL Non Urgent Patient transport provider OFSTED Office for Standards in Education, Children’s Services and Skills PALS Patient Advisory Liaison Service Red 1 Life Threatening emergency - primarily cardiac arrest patients - target response time 8 mins - Airway obstruction (e.g. choking); Ineffective breathing; Unconscious with abnormal breathing; Hanging; In labour with an imminent delivery, baby’s head is out Red 2 Life Threatening emergency - target response time 8 mins. Red 19 Red 1 and Red 2 incidents, measuring the time to get a conveying vehicle to scene - target response time 19 mins. Green 2 Non immediate life threatening emergency - target response time 30 mins. Green 4 Non life threatening emergency - target response time - response in 60 mins or telephone triage in 30 mins. RCA Root Cause Analysis RTT Referral to Treatment Times RIO Electronic care system RWT Royal Wolverhampton Trust SDIP Service Delivery Improvement Plan SSOTPT Staffordshire and Stoke on Trent Partnership Trust SSSFT South Staffordshire and Shropshire NHS Mental Health Foundation Trust

16

Item: 08 Enc: 06

REPORT TO THE Clinical Commissioning Group Governing Body Meeting in Public TO BE HELD ON: Tuesday 30th June 2015

Subject: Performance Report – April 2015 Board Lead: Alex Bennett – Director of Performance Officer Lead: Alex Bennett For For For For Recommendation:  Approval Ratification Discussion Information PURPOSE OF THE REPORT: • To provide a high level summary of the key performance issues for the CCG for April/ May 2015. Performance is shown for the NHS Constitution measures. • To provide assurance and details of remedial action being taken to improve performance and mitigate risk and, where applicable, contract queries that have been issued and financial consequences applied

KEY POINTS: Performance measures not achieved in April 2015:

• RTT 18 weeks admitted adjusted 84.8%, Target (90%) • Diagnostics 98.9%, Target (99%) • A&E 4 hour wait 83.2%, Target (95%)

Cancer • 2 week breast symptom referrals 89.5%, Target (93%) • 31 days first definitive treatment 91.5%, Target (96%) • 31 days subsequent surgery 84.6%, Target (94%) • 62 days Urgent GP referral 81.8%, Target (85%)

Ambulance (May 15) • Red 2 68.6%, YTD 70.2%, Target (75%) • Red 19 94.3%, YTD 95.7%, Target (95%)

RTT

• UHMN have plans and trajectories in place to deliver deadline performance by early autumn at speciality level at Qtr 4 of this year.

Page | 1

Item: 08 Enc: 06 Cancer

• 62 day waits is the most problematic in terms of delivery, main speciality being Urology. Acute Trusts have plans in place to deliver going forward. UHNM have got the IST (Intensive Support Team) to support them in the delivery of these specialties. Planned care group have also agreed to review breast, lung and urology pathways via the cancer local implementation team.

Ambulance

• Cat Red 1 achieved the target for the first time in 8 months. However Red 2 and Red 19 targets were not achieved. This is being addressed at both local and regional level and it has agreed to implement 4 to 5 pathways as part of the pathfinder work across Staffordshire.

RELEVANCE TO KEY GOALS: A 10% reduction the levels of obesity against Performance metric to be developed to show the expected prevalence improvement. A reduction in the proportion of people with Performance metric to be developed to show undiagnosed disease from 30 – 10 %. improvement. A “levelling up” of health outcomes so that all Performance metric to be developed to show residents experience the same health care improvement. outcomes Performance metric to be developed to show A reduction in excess winter deaths of 50% improvement. A reduction in unplanned admissions to Performance metric to be developed to show hospital for people with Long Term Conditions improvement. of 50% IMPLICATIONS: Legal and/or Risk Note the risks identified relating to delivery of Quality, Improvement, Productivity and Prevention (QIPP), Acute Trust Activity and Continuing Care. Reputation risks if any of the elements of the national operating framework are not delivered. CQC None Patient Safety Patients and their safety are at the centre of everything the CCG commission. Poor performance in services where patients are waiting longer than required to access services may be a patient safety risk. Patient Engagement The inclusion of patient feedback in performance reporting is essential for Board assurance. Work is ongoing with colleagues in the Quality and Governance team to establish lines of reporting. Financial Financial risks associated with delivering key performance targets and delivering contracts in line with contract values. Sustainability None Workforce/Training Work to develop understanding of performance management RECOMMENDATIONS/ACTION REQUIRED:

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Item: 08 Enc: 06

The Governing Body is asked to: Note those areas where the current performance rating is below target and the remedial actions being taken to improve performance and mitigate risk.

Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken?  Has an equality impact assessment been undertaken?  Has a privacy impact assessment been completed?  Have partners / public been involved in design?  Are partners / public involved in implementation?  Are partners / public involved in evaluation? 

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NHS Stafford And Surrounds CCG - Constitution Report Referral to Treatment pathways RTT 18 weeks admitted adjusted Standard 90%

The percentage of admitted pathways Current 84.8% within 18 weeks for admitted patients YTD 84.8% whose clocks stopped during the period 69% 90% 111% 85 86 94 94 93 94 92 90 91 84 85 84 85 n/a 18 months annualised trend on an adjusted basis. (E.B.1) Month Apr-15 A M J J A S O N D J F M A P to Mar-15 99 Breaches out 650 admitted patients, the breaches are mainly within Trauma and Orthopaedics - 28 patients, Ophthalmology 18 patients, Other - 16 patients, ENT - 12 patients, General Surgery - 11 patients

RTT Non-admitted Standard 95% The percentage of non-admitted Current 98.0% pathways within 18 weeks for non- YTD admitted patients whose clocks 98.0% 88% 95% 102% 18 months annualised trend stopped during the period. (E.B.2) Month Apr-15 98 98 97 98 98 98 98 98 98 98 98 98 98 n/a A M J J A S O N D J F M A P to Mar-15 RTT Incomplete Standard 92% The percentage of incomplete pathways Current 95.4% within 18 weeks for patients on YTD incomplete pathways at the end of the 95.4% 78% 92% 106% 18 months annualised trend period. (E.B.3) Month Apr-15 94 94 96 97 96 97 96 97 96 95 95 95 95 n/a A M J J A S O N D J F M A P to Mar-15

Printed: 15/07/2015 Page 1 of 7 Prepared by Midlands and Lancashire Commissioning Support Unit NHS Stafford And Surrounds CCG - Constitution Report Diagnostic test waiting times Diagnostic Wait Standard 99% Current The percentage of patients waiting 6 98.9% weeks or more for a diagnostic test. YTD 98.9% 90% 99% 108% (E.B.4) 99 99 99 99 100 100 99 99 99 99 99 99 99 18 months annualised trend Month Apr-15 n/a A M J J A S O N D J F M A P to Mar-15 21 patients waiting 6 weeks or more, breakdown as follows:- 3 breaches at Birmingham Childrens Hospital - MRI 1 breach at Robert Jones and Agnes Hunt - MRI 1 breach at University Hospitals of Birmingham - Urogynamics 16 breaches at University Hospitals North Midlands - 4 Colonoscopy, 4 Flexi Sigmoidoscopy, 3 Sleep Studies, 2 Non Obstetric Ultrasound, 2 Gastroscopy and 1 Cystoscopy

A&E waiting time - total time in the A&E department Four hour wait Standard 95% Current 83.2% Percentage of patients who spent 4 YTD hours or less in A&E. (E.B.5) 81.7% 72% 95% 118% 18 months annualised trend Month May-15 88 83 86 87 82 89 83 77 79 81 80 81 83 n/a M J J A S O N D J F M A M #VALUE! to Mar-15 Royal Wolverhampton Hospital performance in May (94.0%) had deteriorated to below the 95% target from the April position (95.5%). UHNM performance in May (83.20%) saw an improvement from the April position (80.32%).

Printed: 15/07/2015 Page 2 of 7 Prepared by Midlands and Lancashire Commissioning Support Unit NHS Stafford And Surrounds CCG - Constitution Report Cancer waits - 2 week waits Urgent GP Referrals Standard 93% Current 96.0% Percentage of patients seen within two weeks of an urgent GP referral for YTD 96.0% 83% 93% 103% suspected cancer. (E.B.6) 95 97 97 95 95 98 96 97 98 95 95 95 96 n/a 18 months annualised trend Month Apr-15 A M J J A S O N D J F M A P to Mar-15 Breast Symptoms Referrals Standard 93%

Percentage of patients seen within two Current 89.5% weeks of an urgent referral for breast YTD symptoms where cancer was not 89.5% 71% 93% 115% 91 95 89 98 98 100 98 94 93 96 86 87 89 n/a 18 months annualised trend initially suspected. (E.B.7) Month Apr-15 A M J J A S O N D J F M A P to Mar-15

6 out of 57 patients were treated after the 14 day target, all 6 breaches occurred at University Hospitals North Midlands. 4 were due to patient choice and 2 due to no capacity Cancer waits - 31 days First Definitive Treatment Standard 96% Current 91.5% Percentage of patients receiving first definitive treatment within one month YTD 91.5% 0% 96% 192% of a cancer diagnosis. (E.B.8) 100 97 98 99 98 99 100 99 96 97 98 95 91 n/a 18 months annualised trend Month Apr-15 A M J J A S O N D J F M A P to Mar-15

4 out of 47 patients breached the 31 day target. 3 patients breached at University Hospital North Midlands - 1 Lung due to Capacity, 1 Gynaecology due to patient request, 1 Urological due to no capacity. 1 patient breached at University Hospitals Birmingham, this was a Urological patient and breached to capacity Subsequent surgery Standard 94%

Percentage of patients receiving Current 84.6% subsequent treatment for cancer within YTD 31-days, where that treatment is 84.6% 77% 94% 111% 93 100 100 92 93 89 100 100 88 100 93 86 85 n/a 18 months annualised trend Surgery. (E.B.9) Month Apr-15 A M J J A S O N D J F M A P to Mar-15

Printed: 15/07/2015 Page 3 of 7 Prepared by Midlands and Lancashire Commissioning Support Unit NHS Stafford And Surrounds CCG - Constitution Report

2 out of 13 patients breached the 31 day target. 1 patient breached at University Hospital North Midlands and 1 patient breached at University Hospitals Birmingham, both due to capacity. Drug Treatments Standard 98%

Percentage of patients receiving Current 100% subsequent treatment for cancer within YTD 31-days, where that treatment is an 100% 96% 98% 100% 100 100 100 100 100 100 100 100 100 100 100 100 100 n/a 18 months annualised trend Anti-Cancer Drug Regimen. (E.B.10) Month Apr-15 A M J J A S O N D J F M A P to Mar-15

Printed: 15/07/2015 Page 4 of 7 Prepared by Midlands and Lancashire Commissioning Support Unit NHS Stafford And Surrounds CCG - Constitution Report Cancer waits - 31 days

Radiotherapy Treatments Standard 94%

Percentage of patients receiving Current 96.7% subsequent treatment for cancer within 31-days, where that treatment is a YTD 96.7% 85% 94% 103% Radiotherapy Treatment Course. 100 100 98 100 100 100 100 100 100 100 100 97 97 n/a 18 months annualised trend (E.B.11) Month Apr-15 A M J J A S O N D J F M A P to Mar-15 Cancer waits - 62 days

Urgent GP referral Standard 85%

Current Percentage of patients receiving first 81.8% definitive treatment for cancer within YTD two months (62 days) of an urgent GP 81.8% 70% 85% 100% referral for suspected cancer. (E.B.12) 94 89 87 88 81 90 87 79 79 86 72 74 82 n/a 18 months annualised trend Month Apr-15 A M J J A S O N D J F M A P to Mar-15

4 out of 22 patients breached the 62 day target. 3 patients breached at University Hospitals North Midlands - 1 breast patient due to other treatment, 1 Gynae patient due to capacity, and 1 Lower GI patient due to patient being a complex case. 1 patient breached at University Hospitals Birmingham under Urology due to referral being received late. Screening service referral Standard 90%

Current Percentage of patients receiving first N/A definitive treatment for cancer within YTD 62- days of referral from an NHS Cancer N/A 40% 90% 140% Screening Service. (E.B.13) 100 100 100 100 100 100 100 89 100 60 100 33 n/a n/a 18 months annualised trend Month Apr-15 A M J J A S O N D J F M A P to Mar-15 Consultant upgrade Standard N.O.S.

Current 82 4% Printed: 15/07/2015 Page 5 of 7 Prepared by Midlands and Lancashire Commissioning Support Unit

NHS Stafford And Surrounds CCG - Constitution Report Current Percentage of patients receiving first 82.4% definitive treatment for cancer within YTD 62- days of a consultant decision to 82.4% 0% 50% 100% upgrade their priority status. (E.B.14) 100 100 82 100 91 95 100 95 100 90 100 89 82 n/a 18 months annualised trend Month Apr-15 A M J J A S O N D J F M A P to Mar-15

Printed: 15/07/2015 Page 6 of 7 Prepared by Midlands and Lancashire Commissioning Support Unit NHS Stafford And Surrounds CCG - Constitution Report Ambulance clinical quality

Ambulance Red 1 Standard 75%

Category A calls resulting in an Current 79.1% emergency response arriving within 8 minutes - Red 1 incidents: immediately YTD 74.5% 47% 75% 103% life threatening and the most time 77 47 53 78 73 69 72 55 65 71 72 71 79 n/a 18 months annualised trend benchmarking based on current critical. (E.B.15.i) Month May-15 M J J A S O N D J F M A M #VALUE! to Mar-15 month Ambulance Red 2 Standard 75%

Category A calls resulting in an Current 68.6% emergency response arriving within 8 minutes - Red 2 incidents: life YTD 70.2% 65% 75% 85% threatening but less time critical than 69 67 70 72 71 69 68 67 71 66 68 72 69 n/a 18 months annualised trend benchmarking based on current Red 1. (E.B.15.ii) Month May-15 M J J A S O N D J F M A M #VALUE! to Mar-15 month Ambulance Red 19 Standard 95%

Current 94.3% Category A calls resulting in an ambulance arriving at the scene within YTD 95.7% 87% 95% 103% 19 minutes. (E.B.16) 94 95 93 96 95 93 95 93 95 95 95 97 94 n/a 18 months annualised trend benchmarking based on current Month May-15 M J J A S O N D J F M A M #VALUE! to Mar-15 month

The Red 1 indicator has achieved the 75% standard with 79.1% performance. This equated to 34 patients out of a total 43 were responded to within 8 minutes.

The Red 2 indicator has failed to achieve the 75% standard with 68.6% performance. This equated to 500 patients out of a total 729 were responded to within 8 minutes.

The Red 19 indicator has failed to achieve the 95% standard with 94.3% performance. This equated to 728 patients out of a total 772 were responded to within 19 minutes.

Printed: 15/07/2015 Page 7 of 7 Prepared by Midlands and Lancashire Commissioning Support Unit Item: 10 Enc: 07

REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Tuesday 30th June 2015

Subject: Risk Register & Board Assurance Framework (BAF) Board Lead: Paul Simpson Officer Lead: Sally Young For For For For Recommendation:  Approval Ratification Discussion Information PURPOSE OF THE REPORT:

To present an updated position for the Risk Register and the Board Assurance Framework.

KEY POINTS: During 2014/15 further work was carried out to refine and develop the Risk Management systems and develop the Board Assurance Framework for both CCGs. An internal audit completed in January 2015 reviewed the progress made by the CCGs in developing and embedding its processes around the Assurance Framework, Risk Register and the processes being developed to ensure the Governing Bodies remain informed/updated of any risks being faced at an operational level for them to gain assurance that the CCGs will achieve its objectives.

As part of the update relevant papers were reviewed which included: • The Assurance Framework document; • The Corporate Risk Register; • Risk Management Strategy • Stafford & Surrounds CCG Governing Body papers; • Cannock Chase CCG Governing Body papers; • Joint Audit Committee papers; • Joint Finance, Performance and Contracts Committee papers; • Joint Quality Committee papers; and • Executive Management Team (EMT) papers.

The review concluded: The CCG has worked hard to develop its Assurance Framework and associated Risk Management arrangements to include the required components and we can confirm that the developed Assurance Framework will support the CCG’s Annual Governance Statement.

The Risk Register has a total of 46 risks. Of these there are 6 extreme risks, 34 high risks, 6 Page | 1

Item: 10 Enc: 07 moderate and no low risks. Risks are reported to the relevant committee and owned by an Executive Lead, who is responsible for updating the risks each month. The Risk Register is reviewed regularly at EMT. In line with the Audit Recommendations made, the Risk Register will be reviewed by the Governance Team with Executive Leads and Owners during June 2015. A training session will be held during the summer with staff on our risk management processes.

The Board Assurance Framework was approved by the Audit Committee in December 2015 and has been presented to each Governing Body in public as a standing item since. The BAF includes 10 overarching strategic risks for both CCGs. Two risks have the same score, these are contracting and performance and primary care, whilst the remaining eight risks have reduced. Executive leads update

these monthly and they are discussed at EMT on a regular basis.

RELEVANCE TO KEY GOALS A 10% reduction the levels of obesity against the expected prevalence A reduction in the proportion of people with undiagnosed disease from 30 – 10 %. A “levelling up” of health outcomes so that all The Risk Management Framework adopted by the residents experience the same health care CCG supports the delivery of the key goals. outcomes A reduction in excess winter deaths of 50% A reduction in unplanned admissions to hospital for people with Long Term Conditions of 50%

IMPLICATIONS Legal and/or Risk It is essential the CCG has sound risk management processes in place to support good governance across all work streams. CQC N/A Patient Safety N/A Patient Engagement N/A Financial N/A Sustainability N/A Workforce/Training N/A

RECOMMENDATIONS/ACTION REQUIRED:

The Governing Body is asked to: Note the updates for the Risk Register and the Board Assurance Framework.

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Item: 10 Enc: 07

Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken?  Has an equality impact assessment been undertaken?  Has a privacy impact assessment been completed?  Have partners/public been involved in design?  Are partners/public involved in implementation?  Are partners/public involved in evaluation? 

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Risk ID Associated Risks Strategic Risk Area Description of Risk Last Controls to Mitigate Last Action Comment Gaps in Assurance

CCG

Date

Score

Initial

Clinical Risk

Review

Current Current

Exec Exec Lead

Likelihood

Date Added Last Review

Current Risk

Date of Next Date Next of

Consequence Consequence

Source Risk of

Initial Risk Score Initial Likelihood BAF 001 181, 146, 141, 140, Financial Performance The CCG fails to deliver its 15/16 control total. This could relates to 5 3 15 4 3 12 Yes September 14 Single version of the Truth now produces monthly 18.05.2015 - Control total met. Still concerns that timelines for information to deliver single 25, 142 Non delivery of QIPP Programme for 15/16. reviews by Executive Management Team which identifies version of the truth not robust and concern follow through on Contract over performance on all acute and community contracts mitigating actions and monitoring progress. March 2015 - Further year end negotiations on-going particularly with actions slow due to capacity challenges. This is being mitigated within planned, unplanned care, specialised services and primary care. September 14 Monthly meeting AD/DoF to ensure achievement UHNM, RWT and Rowley. There remains a reasonably high degree of through new appointments. of control total on track. confidence that CCGs will deliver the 2014/15 control totals. Better Care Fund. Additional savings through reduction in emergency activity will be insufficient to cover costs of additional commitments 13.08.14 - Finance Performance & Contracting Committee has January 15 - Further £1.4m agreed with mental health trust (£1m non- through BCF. greater focus on contract performance. Commissioning lead recurrent contract variation and £400,000 non-recurrent underspend

CHC increased costs and number of placements. assigned to every contract. QIPP delivery structure in place. on out of area contract). Additional £400k on CHC, further contractual both

Finance

18/05/2015 18/06/2015 12/11/2014 Rowley Hall Contract - significant over performance. fines/penalties including information breaches being levied against Mid

National Framework for Continuing Health Care will increase Staffs. Director of Finance of Director expenditure. Risk share arrangements for funding nursing care and CHC care in Previous commentary archived. Nursing Homes not funded by other CCGs. Insufficient resources to deliver the National Stroke strategy. BAF 002 24, 53, 128, 138 Mid Staffordshire NHS Trust Dissolution/Transaction ImplementationLevels of funding of will stemming not cover the committed flow. costs on winter pressures. 4 5 20 2 4 8 yes 18.05.2015 Controls with us as most risks removed/down 19.04.2015 - Aspects of stemming the flow being progressed as part of 18.05.215: and Transition Risk that patients on waiting lists could be lost in transition and graded. the 15/16 FRP QIPP for Unplanned Care. UHNM providing £1m non- * Risk of dissolution costs falling to CCG fully mitigated. transfer of care. recurrent funding to support transformation programme. Team * Final transfer of major services will take place on the 18th May Additional costs from the dissolution will fall to the CCG. 15.04.2015 - Controls remain in place and have been enhanced focused on delivering 15/16 at present but work to commence once this 2015. through recruitment of extra children's nurses. years work programme established to look at long term financially *Finance for "Stemming the Flow" agreed and in place. sustainable service model. January 2015 - Team remains in place. UHNM agreed to fund * Ambulatory care unit Paediatric Service transfer on course for transition 1 May 2015. * Re-ablement 15.04.2015 - Assurance Panel for Paediatrics agreed transfer in May. CCG agreed to increase District Nursing resource, Stafford. 11.02.2015 - Acute Surgery transferred 9th February 2015. Previous commentary archived 12 January 2015 - Assurance measures delivered December for acute service and obstetrics. CCG reviewing assurance and signed off

transfers.

both

12/11/2014 18/05/2015 18/06/2015 Chief Officer

Commissioning Local Transition Board reviewing all material and singed off transfers.

Further support available over date or transfer.

All matters initiated in respect of Quality Impact Assessment report address.

Confirmation of transfer UHNM. CCG received growth over and above expected allocation.

Previous commentary archived

BAF 003 136, 124, 22, 139, Contract Management and Performance (Delivering Lack of effective collaboration with other CCGs to manage contracts 4 4 16 4 4 16 No March 2015 - 18.05.2015 - RWT contract led by Wolverhampton CCG continued 108, 44, 51, 27, 121 the NHS Constitution Standards, national targets and control expenditure effectively The 2015/16 contracting round has involved a significantly strong work relationship jointly managing the delivery of the contract. (DN some of these and legislative and compliance requirements) (DN higher level of collaboration amongst partner CCGs, supported Finalising collaborative agreement to precede to signing main contract. will need to shift) move this to Performance) by the additional capacity from the CSU (P Butterworth, C Harris), particularly in relation to the management of the UHNM - Contract is finalised and awaiting signature from UHNM. Wolverhampton contract. Collaborative agreement with Host proposed, awaiting feedback from This approach needs to be replicated with UHNM. host CCG. An improving working relationship and seeking better collaboration to manage the contract going forward. Host CCG is November 14 - Agreed to Joint integrated working across all contemplating in-housing contracting management which needs careful CCGs to manage contracts jointly with CSU for 15/16 to ensure consideration. standard terms are consistent across all contracts November 14 - Contract Board between all CCGs/CSU to set 19.04.2015 - Substantial progress made in engaging with two key acute standard contract terms in process of being set up. In year contracts/host CCGs (UHNM & RWHT). Teams in the process of mitigations to manage down contract costs through building long term effective working relationships with both host CCgs

procurement of specialist contract resource to drive out and providers and formalising through contract performance both

18/05/2015 18/06/2015 12/11/2014 unnecessary costs and apply contract terms rigorously in the last management structures for 2015/16.

Commissioning five months of 14/15 Key risk continues to be the need for a greater level of contract performance data. This is being led by the Finance Team in conjunction Finance of Director with CSU BI team.

March 15 - Rigorous contracting process in place with lead commissioners.

January 15 - Looking to strengthen internal capacity to ensure rigorous contract management into 15/16.

Previous commentary archived.

CC/SaS CCGs - BOARD ASSURANCE FRAMEWORK

Risk ID Associated Risks Strategic Risk Area Description of Risk Last Controls to Mitigate Last Action Comment Gaps in Assurance

CCG

Date

Score

Initial

Clinical Risk

Review

Current Current

Exec Exec Lead

Likelihood

Date Added Last Review

Current Risk

Date of Next Date Next of

Consequence Consequence

Source Risk of

Initial Risk Score Initial Likelihood BAF 004 135 Collaboration/Partnerships (DN specific to CHC) The collaborative commissioning arrangements for the CHC contract 4 4 16 3 4 12 No See mitigation to Associated risks 113 and 123 (closed). A new 18.05.2015 - Paperwork being prepared for submission to June The absence of a formal governance mechanism poses a do not currently include a formal governance mechanism which procurement process has been established for the CHC contract Governing Bodies for approval. potential Quality and Safety risk to patients. In addition the includes an established CMB and CQRM. and a Programme Board to oversee the management and associated risks of insufficient funding and lack of governance of CHC contract. A Governance Framework is in 19.04.2015 - Following CCG AO approval of recommendations for CHC commitment to risk sharing from Associate CCGs increases development which clarifies roles and responsibilities of lead and commissioning responsibilities, six Staffs CCGs have met to agree the the risk to patients. Associate CCGs and the formal establishment of a CMB and work programme to strengthen commissioning and governance CQRM. For nursing home residents specific mitigations are in arrangements. Proposals to be finalised beginning of May for place see risk 58. ratification at June CCG Governing Bodies.

15.04.2015 - CCG AO's approved new Governance arrangement in Both

18/05/2015 18/06/2015

12/11/2014 February 2015. Lead Officers currently implementing through IPA Commissioning

Programme Board. Director of Operations of Director

10.02.2015 - Document being presented to CCG AO Congress 19th February for discussion prior to submission to CCGs boards in March 2015 for ratification.

BAF 005 137, 147, 120, 119, Capability and Capacity The risk is the lack of capability and capacity to implement the KPMG 4 4 16 3 3 9 No 18.05.15 - Resource for May remains in place and 18.05.2015:Previous commentary archived. January 15 - SaS Governing Body asked for clinical leadership to 148, 48, 143, 133, Distressed Economy Report recommendations. functioning. * Preparation to remove Director 13/5/15 on transformation plan for be listed as an issue on the BAF under capability and capacity. 83 Lack of performance team. Staffordshire. CSU failing to deliver the quality of services required. November 14 - Further resource sourced for delivery group * A number of risks now adequately mitigated: - Performance team in place Winterbourne. and ongoing contract management. Continuing review of - Winterbourne resource allocated Local Authority capacity to deliver MCA/DOLS for vulnerable adults. capability and capacity overall joint integration work agreed - Contract team in place

Capacity to manage contracts. between CCGs in Northern footprint will further mitigate All CCGs

Corporate - Fully staffed local teams

12/11/2014 18/05/2015 18/05/2016 Key individuals not in post. risk - CCG at full capacity Chief Officer Lack of resilience from CSU to support provider CQRM. Lack of CCG capacity. October 14 Resource procured to support 15.04.2015 - Single transformation team being pursued for transaction/transition at MSFT. Staffordshire. BAF 006 184, 183, 34,131, Communications & Engagement Failure to appropriately communicate and engage with the public, 4 5 20 4 4 16 yes 20.05.2015 - Additioanl support from senior level Comms and 20.05.2015 - The development of a forward plan to prioritise work 20.05.2015 - Acknowledgement by CCG that there is a significant 21 partners and staff to deliver high quality safe services, constitutional Engagement specialist in place. Clarification for current comms streams and implement a strategic approach to comms and amount of work to do to communicate and engage with our and financial performance and engagement team on work streams and priorities. engagement has been approved by the Exec Management Team and population. the Comms and Engagement Committee. Full details of the plan to be 15.04.2015 - Review of resource base. Resources for shared at the Comms and Engagement Committee meeting on 23 June January 2015 - Further work with general population plan to Communications & Engagement being further enhanced at 2015. deliver senior level. 15.04.2015 - Cover for Communications & Engagement team agreed January 2015 and in place. * Continued development of internal comms.

* Discussion with ECS Staffordshire on developing 11.02.2015 - Commissioned Healthwatch/Engaging Communities 12 both

20/05/2015 20/06/2015 12/11/2014 communication and environment beyond MSFT transition, month risk of work to involve all CCGs/County Council to cover Better

transforming Cancer and End of Life, MIU to open agreed. Care Fund/General Commissioning and the Care Act. Comms & Engagement

Previous commentary archived. January 2015 - Ensures proactive communication to public through: Chief Executive to Assistant * Work Well. * Radio and media

Previous commentary archived. BAF 007 53, 133, 135, 147 Quality and Safety The is a risk that the CCG will be unable to fulfil its statutory duty to 5 4 20 2 4 8 Yes 01/12/2014 - UHNM - To mitigate the restrictive approach 18.05.2015 - Separate Assurance report on County is provided assure the quality and safety of Commissioned services. of a HoTs the CCG Quality team have negotiated a MOU, monthly. The UHNM CQRM is attended by the CCG QIL, GP Clinical As a result of clinical and financial sustainability issues, the services with UHNM where the majority of the quality metrics lead for Quality and the Director of Quality and Safety. The from MSHFT have now been transferred to new Providers. Some identified as high priority for the County Hospital (Stafford) outcomes and issues are reported in the CCG Quality and Safety services will transfer across Providers more than once. is specified These will be reported in a separate County report to the CCG Joint Quality Committee and the MB bad GBs. The CCG is not the lead Commissioner and will need to work through Quality Assurance Report to the CCG. Other measures The County Internal Quality Committee has been disbanded by North and Wolverhampton CCG's to assure SAS and CC Governing include: UHNM and the CCG will be raising this with UHNM and Bodies and the public of the quality and safety of those services. * CCG attendance at the County Hospital internal Quality considering the role of this committee in the assurance process. For the remainder of 2014/15 contract a CVO arrangement has been Committee meeting on a monthly basis Risk score will be reviewed once this is completed. imposed upon the CCG, which potentially restricts the CCG's ability to * CCG representation at the monthly TDA Clinical Oversight assure quality. Group (COG)where the TDA meet with the Nurse Directors 26.2.15 - County Some specific services are being transferred early. Two and Medical Directors of the receiving Provider Trusts. Cancellation of first post transfer UHNM CQRM in November (obstetrics/paediatrics) of which are highly contentious with the * CCG representation on the monthly UHNM CQRM followed by 3 consecutive cancellations of the County Internal

public. The CCG has to work with a range of statutory and local stake Quality Committee. Issue raised at December UHNM CQRM, Both

Quality holders to assure their safe and acceptable transition. Early Transition of Services - The CCG has developed an County ADNS and formal letter from GB to Lead CCG. Separate

18/05/2015 18/06/2015 12/11/2014 There are on going capacity issues within the CCG team itself in assurance process which involves an assessment framework County Assurance reports being received by this CCG. stoke site meeting those requirements. In addition to the resilience and and panel review for each of 4 early transitioning services - under severe pressure although County is relatively stable

sustainability of the CSU support to the CCG for those Providers; in obstetrics, paediatrics, critical care, acute surgery. although still using high number of agency staff. &Quality of Safety Director particular SSOTP. The governance frameworks for traditionally underdeveloped services- Economy Wide Assurance -Economy Wide Assurance - Early Transition Services - Transition and assurance process i.e. CHC, dementia require strengthening. There is economy wide scrutiny of the transition process proceeding as planned without incident with the exception of a The CCG functions are being undertaken within the context of a through the Local Transition Board (LTB) which meets near miss (no harm to patient) at the MLU due to ambulance potentially large scale, strategic change across Staffordshire. fortnightly and the Area Quality Surveillance Group (QSG) delay. Some changes to the process to integrate both the TDA which meets monthly. and the CCG framework.

CC/SaS CCGs - BOARD ASSURANCE FRAMEWORK

Risk ID Associated Risks Strategic Risk Area Description of Risk Last Controls to Mitigate Last Action Comment Gaps in Assurance

CCG

Date

Score

Initial

Clinical Risk

Review

Current Current

Exec Exec Lead

Likelihood

Date Added Last Review

Current Risk

Date of Next Date Next of

Consequence Consequence

Source Risk of

Initial Risk Score Initial Likelihood 53, 133, 135, 147 Quality and Safety Royal Wolverhampton Trust - Please see BAF risk 007 which describes 5 4 20 3 4 12 Yes 01/12/2014 - 18.05.2015.- The issue of access to STEIS to view RWT serious the risk conditions relating to the transfer of MHSFT services to the Wolverhampton Trust - incidents for CC CCG has been raised at QSG and by the CC CCG receiver Trusts. The CCG has been unable to agree with the RWT an * CCG representation at the monthly COG where the Director for Strategy Planning who is also the lead commissioner MOU for the quality metrics which it was able to do with UHNM that Medical Director and Nurse Director for RWT are in for RWT; however access has still not been granted. Meeting to provided mitigation for the restrictive approach of a HoTs. The attendance. be arranged for the executive nurses for CC and Wolverhampton compare and contrast exercise conducted prior to transfer also *CCG representation at to meet to resolve this. Assurance and challenge is made through identified a greater distance between the quality monitoring schedule Early Transition of Services - The CCG has developed an the QRM by CCG representatives. risk score will be adjusted of RWT with UHNM and MSHFT. assurance process which involves an assessment framework following the meeting of the executive nurses. and panel review for each of 4 early transitioning services - obstetrics, paediatrics, critical care, acute surgery. Wolverhampton Trust

Economy Wide Assurance - There is economy wide scrutiny Dedicated quality team member agreed for this Trust who will Both

Quality of the transition process through the Local Transition Board attend CQRMs along with senior commissioning rep. This has

18/05/2015 18/06/2015 12/11/2014 (LTB) which meets fortnightly and the Area Quality increased the level of scrutiny and quality of written reports to Surveillance Group (QSG) which meets monthly. CCG. Provider not willing to produce separate report for Cannock

site. Support from Wolverhampton CCG for this and for CC CCG to &Quality of Safety Director have greater participation in the management of this provider is not available. This has been escalated to Area Team.

BAF 008 108,44,51,27,121 Delivery of NHS Constitution standards and Failure to deliver NHS Constitution Standards and therefore affect 3 4 12 2 4 8 yes April 14 - Monthly Performance monitoring of standards 18.05.2015 - Significant deterioration in performance in May has led to (DN add in from 3 compliance other regulatory standards patient care through Performance Lead, Contract Reviews, Executive senior officer meeting to understand and agree immediate recovery above) Team, AT Assurance and Governing Body Meetings plan. Key issues are an increasing complexity of frail elderly patients combined with the cessation of the WMAS diverts to RSUH and New Cross. Full recovery anticipated in June.

19.04.2015 - A&E achieved 95% in March 2015. Whilst performance continues to improve, further work to ensure long term sustainability achieved given planned changes in service provision and patient flows

resulting from implementation of the TSA recommendations

Both

18/05/2015 18/06/2015

12/11/2014 15.04.2015 - County Hospital achieved 95% in March 2015 ahead of Performance schedule. Continued improvement anticipated following operational

difficulties over Easter period. Operations of Director

10.02.2015 - Past three weeks A&E has performed over 95% following collaborative work across Stafford health economy.

Previous commentary archived.

BAF009 Primary Care The risk is that the capacity and man-power in primary care does not 3 4 12 3 4 12 Yes 20.05.2015 - Map of Medicine implemented in 40 practices 20.05.2015 - Two successful Prime Minister's Challenge Funding 20.05.2015 - Further work to engage practices in Prime meet the current and future requirements. The CCG is unable to and monthly monitoring in place. bids for both Stafford and Cannock CCGs. Four work streams: Ministers Challenge Fund in SaS. reduce variation in quality and activity in primary care * Workforce - SaS 01.04.2015 - Map of Medicine goes live in all 40 practices * Technology - SaS 11.02.2015 - Lack of capacity in Primary Care means that the * Extended 8am-8pm 7 days per week access to Primary Care - TSA recommendations may not be fulfilled. Previous commentary archived. SaS and CC * Developments - AVS, Frail Elderly, Dementia, etc. for SaS 11.02.2015 * Many small practices in Cannock Chase CCG Governance arrangements to be costed with CCG providers and * Networks and collaboration in a fledgling state NHSE. * Demographic "time-bomb" * Legitimate increase in demand and expectation 30.03.2015 - SaS CCG: Primary Care Strategy approved on the 17 February 2015, this includes workforce development and new

models of care. (CC CCG Primarcy Care Strategy was approved 03 both

20/05/2015 20/06/2015

27/11/2014 July 2014). Primary Care

11.02.2015 - Cannock Chase CCG : The three networks are now in Primaryof Director Care place and have developed business plans.

11.02.2015 - SaS CCG: Primary Care Strategy is going to SaS CCG for approval on the 17 February 2015, this includes workforce development and new models of care.

Previous commentary achieved.

CC/SaS CCGs - BOARD ASSURANCE FRAMEWORK Item: 11 Enc: 08

REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Tuesday 30th June 2015

Subject: Finance Report Month 2 (May 2015) Board Lead: Paul Simpson Officer Lead: Colin Groom For For For For Recommendation:   Approval Ratification Discussion Information PURPOSE OF THE REPORT:

The paper provides the Governing Body with the financial position of Stafford and Surrounds CCG for Month 2 of the financial year 2015/16, covering the period April 2015 to May 2015.

KEY POINTS:

1. This report sets out the in-year financial position at Month 2. This shows a surplus of £13k. 2. At this stage in the year, we are reporting that we will not spend more than the planned deficit for 2015/16 and are pursuing options to improve upon this position and eliminate the in year deficit. 3. The QIPP programme is forecast to achieve against target noting the ambition to identify further savings to help eliminate the in-year deficit.

RELEVANCE TO KEY GOALS A 10% reduction the levels of obesity against the expected prevalence A reduction in the proportion of people with undiagnosed disease from 30 – 10 %. A “levelling up” of health outcomes so that all Finance Plan supports delivery of key goals. residents experience the same health care outcomes A reduction in excess winter deaths of 50% A reduction in unplanned admissions to hospital for people with Long Term Conditions of 50%

Page | 1

Item: 11 Enc: 08

IMPLICATIONS Financial risk continues to be evaluated and monitored via the Finance Legal and/or Risk Performance and Contracts Committee. CQC None Patient Safety None Patient Engagement None Financial Surplus of £13k for the year to date Sustainability Supports financial sustainability and best value commissioning Workforce/Training None

RECOMMENDATIONS/ACTION REQUIRED:

The CCG Governing Body is asked to: - to note the position to date, the forecast achievement of plan and the ambition to eliminate the in year deficit - to note the year to date performance of the QIPP programme.

Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken?  Has an equality impact assessment been undertaken?  Has a privacy impact assessment been completed?  Have partners/public been involved in design?  Are partners/public involved in implementation?  Are partners/public involved in evaluation? 

Page | 2

Stafford and Surrounds CCG

Month 2 Finance report

1. Introduction

This is the report to the end of May (Month 2), predominantly based on Month 1 (April) contracting information. The availability of only one month’s performance data limits the confidence with which the year to date position can be calculated but as shown within the rest of this report, the contracting position contains a small underspend at this stage which provides assurance on the delivery of QIPP and the realistic aggregate value of the contracts that have been agreed with providers.

2. Planned in-year deficit

The planned in-year deficit for 2015/16 for Stafford and Surrounds is £7.222m, however the CCG is aiming to eliminate as much as possible of this deficit in year as part of the requirement to be in recurrent balance by next year and to begin to repay historically accumulated deficits. This ambition will require the identification of significant savings from across the contracting portfolio and other expenditure headings and these continue to be pursued via the Executive Management Team and CCG committee structure. The tables below show that as at month 2 the planned position was a year to date deficit of £1.173m and the CCG has slightly under spent against plan by £13k.

3. Financial position to Month 2

The summary Income and Expenditure position is shown in Table 1 below:

Table 1 - Stafford and Surrounds CCG Year to date Summary Financial Statement as at 31st May 2015 Annual Budget Budget Actual Variance £000's £000's £000's £000's

Acute Contracts 97,900 16,389 16,082 (308) Mental Health 16,083 2,681 2,686 5 Community Services 15,543 2,591 2,591 1 Continuing Healthcare 16,593 2,766 2,808 43 Primary Care Services 25,057 4,176 4,346 170 Other Programme Services 1,210 202 217 15 Reserves (967) (61) 0 61 Corporate Running Costs 2,960 493 493 (0) Corporate Non Running Costs 44 7 7 0

CCG Total Expenditure 174,423 29,243 29,230 (13)

Revenue Resource Limit prior to repaying previous year deficit (167,201) (28,070) (28,070) 0

In Year Position (Surplus)/Deficit 7,222 1,173 1,160 (13)

Repayment of previous year deficit 18,744 3,124 3,124 0

Cumulative Position (Surplus)/Deficit 25,966 4,297 4,284 (13)

This shows a year to date surplus against plan of £13k. The contract portfolio is £308k underspent at month 2 but validation of the contractual information is ongoing as a level of additional elective activity was anticipated in April as Trusts were targeting reductions in the waiting list after the numbers had grown at the end of the last financial year. The year to date overspend against continuing healthcare of £43k is being reviewed as the QIPP programme for CHC is currently slightly ahead of plan. Prescribing data for April is not due until the third week of June and therefore the overspend on Primary Care including prescribing (£170k) is likely to be overstated as no allowance has yet been made for QIPP delivery. The overspend on reserves (£61k) relates to an amount of anticipated QIPP that has not yet been reflected in relevant expenditure budgets. More detailed expenditure and QIPP analysis is contained within the Appendices to the report.

4. Running costs

CCG running costs are monitored separately within the Revenue Resource Limit. The position to date is breakeven and further analysis is contained within the appendices to the report.

5. Allocations

No allocation adjustments have been made beyond the baseline set in May, shown in table 2 below

Table 2 Revenue Resource Limit as at 31st May 2015 £000s

BCF 2,829 Initial CCG Programme Allocation 161,037 Brought Forward surplus/(deficit) (18,744) Initial CCG Running Cost Allocation 3,210 ETO/DTR Funding 125

Total Current Resource Limit - Programme & Admin 148,457

6. Contracting position at month 2

As identified above, we have contracting information to the end of April (Month 1) for the majority of contracts although validations are still ongoing due to the potential of underreporting of activity that always exists in the first months of the financial year.

The main contributors to the reported underspend of £308k against plan are University Hospital North Midlands (£243k), and Royal Wolverhampton Trust (£240k) Both providers are below plan with regards to elective activity as noted above. In addition, UHNM are also below plan for non elective activity as diversion of Ambulances to other providers due to the challenges at County hospital during the previous financial year will take some time to return to normal levels. Rowley Hall Hospital, an elective only provider is the only contract to report a slight overspend (£118k) as a result of the final confirmation of prior year activity. It is anticipated this contract will return to plan over future months.

7. QIPP progress

The Month 2 QIPP position indicate a slight shortfall against plan (£16k) The QIPP target for the year is £5.2m and approximately £4.4m of this has been formally written into the relevant provider contracts. The remaining targeted savings continue to be progressed to ensure full delivery of the programme and at this stage the CCG remains confident it will be able to deliver the planned programme and as identified above, is targeting further savings as the CCG aims to eliminate the in-year deficit.

The detailed programme is shown at Appendix 4.

8. Balance Sheet, Better Payment Policy Compliance, Cash

The Summary balance sheet (Statement of Financial Position) confirming the position at the end of the previous financial year and the year to date

31st Table 3 March 31st May Summary Statement of Financial Position 2015 2015 £000s £000s

Current assets: Trade and other receivables 6,598 9,111 Cash and cash equivalents 69 5

Total current assets 6,667 9,116

Current liabilities Trade and other payables (15,202) (16,772)

Total Assets Employed (8,535) (7,656)

Financed by Taxpayers’ Equity General fund (8,535) (7,656)

Total Taxpayers Equity (8,535) (7,656)

Performance against the Better Payment Practice Code (BPPC) for the year to date is shown below:

BPPC Compliance 2014/15 NHS BPPC Compliance 2014/15 Non NHS 100.0 100.0 99.0 95.0 98.0 97.0 90.0 96.0 85.0 95.0 Number Number 80.0 94.0 Value Value % Compliance 93.0 % Compliance 75.0 92.0 70.0 91.0 90.0 65.0 APR MAY APR MAY

The Better Payment Practice Code requires organisations to pay suppliers within 30 days, unless other terms are specified.

For cash management purposes, CCGs are set a maximum cash draw down (MCD) which is effectively a cash limit. At this stage in the year the MCD has not been confirmed but the CCG does not envisage any issues with Cash Management during the year.

9. Recommendations

The Governing Body is asked; • to note the position to date, the forecast achievement of plan and the ambition to eliminate the in year deficit • to note the year to date performance of the QIPP programme.

Paul Simpson Director of Finance 18th June 2015

Appendix 1 – Acute Services

Stafford and Surrounds CCG Financial Year 2015-16 Year to Date - Month 2 31st May 2015 Annual Forecast FOT Budget Actual Variance Budget Outturn Variance £000 £000 £000 £000 £000 £000 Acute Services NHS Contracts University Hospital North Staffordshire NHS Trust 10,187 9,944 (243) 61,122 61,122 0 Burton Hospitals Foundation Trust 47 30 (17) 281 281 0 Heart of England Founation Trust 39 39 0 233 233 0 Royal Wolverhampton Hospital Trust 3,299 3,059 (240) 19,796 19,796 0 Dudley Group of Hospitals 28 28 0 166 166 0 University Hospitals of Birmingham 90 90 0 541 541 0 Birmingham Womens 6 6 0 36 36 0 Derby Foundation Trust 26 26 0 154 154 0 Walsall Manor Hospital Trust 35 25 (10) 211 211 0 Birmingham Childrens Hospital 34 59 25 207 207 0 Royal National Orthopaedic 0 0 0 0 0 0 Robert Jones & Agnes Hunt 149 149 0 892 892 0 Shrewsbury & Telford Hospitals 76 76 0 456 456 0 Royal Orthopaedic 39 39 0 237 237 0 Sandwell & West Birmingham NHS Trust 25 25 0 149 149 0 South Warwickshire General Hospital 0 0 0 0 0 0 The Royal Marsden 0 0 0 0 0 0 George Elliot Hospital 0 0 0 0 0 0 University Hospitals Coventry & Warwickshire 0 0 0 0 0 0 University Hospitals Leicester 0 0 0 0 0 0 Worcester Acute 0 0 0 0 0 0 Nottingham University Hospital 0 0 0 0 0 0 Imperial College Healthcare 0 0 0 0 0 0 Contract Exclusions 45 45 0 269 269 0 Prior Year - Under / Over accrued 0 0 0 0 0 0 Other 0 0 0 0 0 0 Total NHS Contracts 14,125 13,640 (485) 84,750 84,750 0 Non NHS Contracts Rowley Hall 847 965 118 5,084 5,084 0 Alliance Medical 32 32 0 193 193 0 British Pregnancy Advisory Service 23 23 0 138 138 0 Midland Fertility Services 6 6 0 33 33 0 West Midlands Hospital 11 11 0 65 65 0 Nuffield Health 82 82 0 490 490 0 Wolverhampton Rd ENT 43 43 0 260 260 0 Spire Healthcare 18 18 0 107 107 0 The Movement Foundation 3 3 0 20 20 0 Specialised Services 98 98 0 585 585 0 Brewood Vasectomies 7 7 0 40 40 0 Prior Year - Under / Over accrued 0 0 0 0 0 0 Residual Private Providers 3 3 0 20 20 0 Other 0 0 0 0 0 0 Total Non NHS Contracts 1,172 1,291 118 7,035 7,035 0

West Midlands Ambulance 805 775 (29) 4,828 4,828 0

NCA's 227 227 0 1,360 1,360 0

Winter Pressures 143 149 6 855 855 0

QIPP's University Hospital North Staffordshire NHS Trust (18) 0 18 (374) (374) 0 Burton Hospitals Foundation Trust (0) 0 0 (4) (4) 0 Royal Wolverhampton Hospital Trust (56) 0 56 (465) (465) 0 QIPP not contractualised (7) 0 7 (84) (84) 0 Total QIPP's (82) 0 82 (928) (928) 0

Acute Services 16,389 16,082 (308) 97,900 97,900 0

Appendix 2 – Mental Health & Community Services

Stafford and Surrounds CCG Financial Year 2015-16 Year to Date - Month 2 31st May 2015 Annual Forecast FOT Budget Actual Variance Budget Outturn Variance £000 £000 £000 £000 £000 £000 Mental Health Services NHS Contracts Staffordshire & Shropshire NHS FT 2,206 2,206 0 13,234 13,234 0 North Staffs Combined HC Trust 44 44 0 266 266 0 Dudley & Walsall MH Partnership 0 0 0 2 2 0 Derby Healthcare NHS FT 12 12 0 69 69 0 Birmingham & Solihull NHS FT 6 6 0 39 39 0 Black County Partnership NHS FT 1 1 0 6 6 0 Staffordshire & Stoke on Trent PT 30 30 0 180 180 0 Contract Exclusions 9 9 0 55 55 0 Prior Year 0 0 0 0 0 0 Total NHS Contracts 2,308 2,308 0 13,851 13,851 0 Non NHS Contracts Starfish Mental Health Services 134 134 0 802 802 0 Midland Psychology 39 39 0 236 236 0 Carers Association 2 2 0 12 12 0 MENCAP 3 3 0 20 20 0 Staffordshire County Council 58 58 0 347 347 0 Alzheimers Association 5 5 0 33 33 0 Approach 1 1 0 6 6 0 Mental Health Assessments 0 5 5 0 0 0 Asist 2 2 0 11 11 0 Prior Year 0 (178) (178) 0 0 0 Total NHS Contracts 244 71 (173) 1,466 1,466 0 Learning Disabilities Placements 40 40 0 237 237 0 Staffordshire County Council Income (49) (49) 0 (295) (295) 0

Section 117's 35 35 0 208 208 0

Complex Placements 103 281 178 617 617 0

Mental Health Services 2,681 2,686 5 16,083 16,083 0

Stafford and Surrounds CCG Financial Year 2015-16 Year to Date - Month 2 31st May 2015 Annual Forecast FOT Budget Actual Variance Budget Outturn Variance £000 £000 £000 £000 £000 £000 Community Health Services NHS Contracts Staffordshire & SOT Partnership Trust 1,845 1,845 0 11,067 11,067 0 Walsall Manor Hospital Trust 112 112 0 673 673 0 Royal Wolverhampton Hospital Trust 38 38 1 226 226 0 Shropshire Community 6 6 0 35 35 0 Derbyshire Community NHST 0 0 0 0 0 0 Contract Exclusions 70 70 0 421 421 0 Prior Year 0 0 0 0 0 0 Other NHS 0 0 0 0 0 0 Total NHS 2,070 2,071 1 12,421 12,421 0 Non NHS Contracts Rowley House Nursing Home 48 48 0 289 289 0 Methodist Homes for the Aged 8 8 0 50 50 0 Equipment Loan Store 60 60 0 357 357 0 Better Care Fund 189 189 0 1,134 1,134 0 Brewood Dermatology 22 22 0 130 130 0 Stroke Association 2 2 0 13 13 0 Marie Curie 7 7 0 41 41 0 Other 0 0 0 0 0 0 Prior Year 0 0 0 0 0 0 Total Non NHS 336 336 0 2,014 2,014 0 Hospices Katherine House 115 115 0 688 688 0 Douglas MacMillan 31 31 0 187 187 0 Compton Hall 33 33 0 198 198 0 St Giles 3 3 0 20 20 0 Donna Louise 3 3 0 15 15 0 Prior Year 0 0 0 0 0 0 Total Hospices 185 185 0 1,108 1,108 0

Community Health Services 2,591 2,591 1 15,543 15,543 0

Appendix 3 – CHC, Primary Care, Other Programme & Corporate Services

Stafford and Surrounds CCG Financial Year 2015-16 Year to Date - Month 2 31st May 2015 Annual Forecast FOT Budget Actual Variance Budget Outturn Variance £000 £000 £000 £000 £000 £000 Continuing Care Services Continuing Care 2,128 2,209 81 12,769 12,769 0 CHC Risk 144 144 0 865 865 0 Funded Nursing Care 396 367 (29) 2,378 2,378 0 CSU Staff Charge 97 83 (13) 580 580 0 Prior Year 0 4 4 0 0 0

Continuing Care Services 2,766 2,808 43 16,593 16,593 0

Stafford and Surrounds CCG Financial Year 2015-16 Year to Date - Month 2 31st May 2015 Annual Forecast FOT Budget Actual Variance Budget Outturn Variance £000 £000 £000 £000 £000 £000 Primary Care Services Prescribing GP Prescribing 3,729 3,754 25 22,375 22,375 0 GP Prescribing Recharges / Rebates (65) (66) (1) (390) (390) 0 Central Topslice 95 95 0 569 569 0 Total Prescribing 3,759 3,783 24 22,554 22,554 0

Local Enhanced GP Services 109 258 148 657 657 0 Home Oxygen 53 53 0 320 320 0 Out of Hours 85 85 0 509 509 0 Medicines Management Team 41 41 (0) 247 247 0 Map of Medicines 8 0 (8) 50 50 0 Cannock Headache Clinic 3 0 (3) 17 17 0 GP IT 14 14 (0) 83 83 0

Commissioning Schemes Calprotectin 6 37 30 38 38 0 Hearing AQP 42 20 (22) 250 250 0 Glaucoma Referral Scheme 5 0 (4) 28 28 0 Cataract Referral Scheme 4 0 (4) 25 25 0 Primary Eye Assessment & Treatment 12 0 (12) 70 70 0 Acute Visiting Service 33 0 (33) 200 200 0 Mediaburst - Flo Meters 2 0 (2) 10 10 0 Other 0 0 0 0 0 0 Prior Year 0 56 56 0 0 0 Total Commissioning Schemes 103 113 9 621 621 0

Primary Care Services 4,176 4,346 170 25,057 25,057 0

Stafford and Surrounds CCG Financial Year 2015-16 Year to Date - Month 2 31st May 2015 Annual Forecast FOT Budget Actual Variance Budget Outturn Variance £000 £000 £000 £000 £000 £000 Other Programme Services Patient Transport Services - NSL 121 136 15 726 726 0 Patient Transport Services - Prior Year 0 0 0 0 0 0

NHS 111 81 81 0 484 484 0

Other Programme Services 202 217 15 1,210 1,210 0

Stafford and Surrounds CCG Financial Year 2015-16 Year to Date - Month 2 31st May 2015 Annual Forecast FOT Budget Actual Variance Budget Outturn Variance £000 £000 £000 £000 £000 £000 Corporate Costs Running Costs Pay Costs 244 266 23 1,461 1,461 0 Non Pay Costs 56 (1) (56) 333 333 0 CSU Costs 194 234 40 1,165 1,165 0 Income 0 (6) (6) 0 0 0 493 493 (0) 2,960 2,960 0 Non Running Costs Safeguarding 7 7 0 44 44 0

Corporate Costs 501 501 (0) 3,004 3,004 0

Appendix 4

QIPP Programme – Stafford and Surrounds CCG

Month 2 - May

Sche me Current Month PMO Report In Month In Month In Month YTD Target YTD Actual YTD ID Scheme Description Lead Phasing Target Actual Variance Savings Savings Variance Savings Savings Planned Care 1 First to follow up Mel Mahon M3-M12 - - 0 - - 0 2 PLCV Mel Mahon M1-M12 (40,191) (23,529) 16,662 (80,382) (47,057) 33,325 3 Referral Demand Management Mel Mahon M4-M12 (2,066) (891) 1,175 45,869 48,218 2,350 4 Daycase to OPPROC Mel Mahon M4-M12 - - 0 - - 0 5 Excess bed days Mel Mahon M1-M12 (8,282) (93) 8,190 (16,565) (186) 16,379 Planned Care Total (50,539) (24,512) 26,027 (51,078) 976 52,054 Unplanned Care 6 Admission avoidance Ashleigh Gibbs M1-M12 (29,290) (51,589) (22,299) (33,269) (66,606) (33,338) 7 A&E attendances Ashleigh Gibbs M1-M12 (6,729) (5,597) 1,132 (9,570) (7,960) 1,610 Unplanned Care Total (36,019) (57,186) (21,167) (42,839) (74,566) (31,727) Other 8 Continuing healthcare Rob Lusardi M1-M12 (92,003) (86,077) 5,926 (184,007) (172,155) 11,852 9 Pharmacy Lynn Millar M1-M12 (69,610) (85,000) (15,390) (143,520) (159,225) (15,705) Other Total (161,614) (171,077) (9,464) (327,527) (331,380) (3,853) 14/15 Full Year Effect 10 MSK Mel Mahon M1-M6 (24,279) (24,279) 0 (44,291) (44,291) 0 11 Section 256 Mel Mahon M1-M12 (2,512) (2,512) 0 (4,943) (4,943) 0 12 Voluntary Sector Grants Mel Mahon M1-M12 (250) (250) 0 (491) (491) 0 (27,041) (27,041) - (49,726) (49,726) - Grand Total (275,212) (279,816) (4,604) (471,170) (454,696) 16,474 Key Variance 10% adverse or greater 11 FOT has worsened relative to FOT in previous month Variance between breakeven and 10% adverse 0 FOT has remained the same as FOT in previous month Variance breakeven or favourable - 2 FOT has improved relative to FOT in previous month

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REPORT TO THE Clinical Commissioning Group Governing Body Meeting in Public TO BE HELD ON: Tuesday 30th June 2015

Subject: CCG 360o Stakeholder Survey 2015 - Summary Board Lead: Andrew Donald Officer Lead: Andrew Donald For For For For Recommendation:   Approval Ratification Discussion Information PURPOSE OF THE REPORT: To update Governing Body Members on:- • The feedback received following a survey of our stakeholders on working relationships with CCGs.

KEY POINTS: • To provide a wealth of data for CCGs to help with their ongoing organisational development, enabling them to continue to build strong and productive relationships with stakeholders. The findings can provide a valuable tool for all CCGs to be able to evaluate their progress and inform their organisational decisions. • To feed into assurance conversations between NHS England sub-regions and CCGs. The survey will form part of the evidence used to assess whether the stakeholder relationships, forged during the transition through authorisation, continue to be central to the effective commissioning of services by CCGs, and in doing so, improve quality and outcomes for patients.

RELEVANCE TO KEY GOALS A 10% reduction the levels of obesity against the expected prevalence A reduction in the proportion of people with undiagnosed disease from 30 – 10 %. A “levelling up” of health outcomes so that all residents N/A experience the same health care outcomes A reduction in excess winter deaths of 50% A reduction in unplanned admissions to hospital for people with Long Term Conditions of 50%

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IMPLICATIONS Legal and/or Risk N/A CQC N/A Patient Safety N/A Patient Engagement N/A Financial N/A Sustainability N/A Workforce/Training N/A

RECOMMENDATIONS/ACTION REQUIRED:

The Governing Body is asked to: That the CCG Governing Body notes the report.

Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken?  Has an equality impact assessment been undertaken?  Has a privacy impact assessment been completed?  Have partners / public been involved in design?  Are partners / public involved in implementation?  Are partners / public involved in evaluation? 

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Stafford and Surrounds Clinical Commissioning Group Governing Body Meeting

May 2015

1. Introduction to stakeholder relations for Stafford & Surrounds CCG Stafford and Surrounds CCG has a large number of relationships to manage including its relationship with its member practices. Relationships include those that: o form part of the CCG – member practices and their staff o monitor the performance and/delivery of the CCG – NHS England, HealthWatch, elected officials, media o monitor the performance of healthcare providers we commission services from– Monitor, Care Quality Commission, NHS Trust Development Authority o we work in partnership with – local authorities (county and district), voluntary sector, patient reference groups and other healthcare commissioners such as CCGs and NHS England o we represent – patients, carers, families using healthcare everyday and who we are accountable to as a statutory organisation

2. Overview to 2015 IPSOS Mori Stakeholder Survey

This is the second consecutive year that we have undertaken a survey of our stakeholders. The feedback will be used to help inform the way we manage our relationships and undertake our business.

2.1 Background and objectives

Clinical Commissioning Groups (CCGs) need to have strong relationships with a range of health and care partners in order to be successful commissioners within the local system. These relationships provide CCGs with on-going information, advice and knowledge to help them make the best possible commissioning decisions. The CCG 360o stakeholder survey is a key part of ensuring these strong relationships are in place. The survey allows stakeholders to provide feedback on working relationships with CCGs. The results from the survey will serve two purposes:

• To provide a wealth of data for CCGs to help with their ongoing organisational development, enabling them to continue to build strong and productive relationships with stakeholders. The findings can provide a valuable tool for all CCGs to be able to evaluate their progress and inform their organisational decisions. • To feed into assurance conversations between NHS England sub-regions and CCGs. The survey will form part of the evidence used to assess whether the stakeholder relationships, forged during the transition through authorisation, continue to be central to the effective commissioning of services by CCGs, and in doing so, improve quality and outcomes for patients.

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2.2 Methodology and technical details

• It was the responsibility of each CCG to provide the list of stakeholders to invite to o take part in the CCG 360 stakeholder survey. • CCGs were provided with a core list of stakeholder organisations (outlined in the table below) to be included in their stakeholder list. Beyond this however, CCGs had the flexibility to determine which individual within each organisation was the most appropriate to nominate. • They were also given the opportunity to add up to ten additional stakeholders they wanted to include locally (they are referred to in this report as ‘Wider stakeholders’). These included: Commissioning Support Units, Health Education England, lower tier local authorities, MPs, private providers, Public Health England, social care / community organisations, Voluntary Sector Council/Leader, voluntary / third sector organisations, local care homes, GP out-of-hours providers and other stakeholders and clinicians. • The survey was conducted primarily online via email invitations. Stakeholders who did not respond to the email invitation, and stakeholders for whom an email address was not provided, were telephoned by an Ipsos MORI interviewer who encouraged response and offered the opportunity to complete the survey by telephone.

2.3 Core stakeholder framework

GP member practices One from every member practice Health and wellbeing boards Up to two per HWB Local HealthWatch One per local HealthWatch Other patient groups Up to three NHS providers – Acute Up to two from each provider NHS providers – Mental health trusts Up to two from each provider NHS providers – Community health Up to two from each provider trusts Other CCGs Up to five Upper tier or unitary local authorities Up to five per LA

2.4 Survey response rates for Stafford & Surrounds CCG Fieldwork was conducted between 10th March 2015 and 7th April 2015. 32 of the CCG’s stakeholders completed the survey. The overall response rate was 64% which varied across the stakeholder groups shown in the table below.

Stakeholder Number invited to Completed Response rate take part survey GP member practices 14 9 64% Health and Well Being 2 1 50% Boards Local HealthWatch/ 4 3 75% patient groups NHS providers 10 5 50% Other CCGs 5 4 80% Upper tier or unitary 5 3 60% local authorities

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Wider stakeholders 10 7 70%

2.5 Interpreting the results

Within the survey, stakeholders were asked a series of questions about their working relationship with the CCG. In addition, to reflect each core stakeholder group’s different area of expertise and knowledge, they were presented with a short section of questions specific to the stakeholder group they represent.

• For each question, the responses to each answer are presented both as a percentage (%) and the number of stakeholders giving a certain answer, which are included in brackets (n). • The number of stakeholders answering (the base size) is stated for each question. The total number of responses is shown at the bottom of each chart and in every table. • For questions with fewer than 30 stakeholders answering, we strongly recommend that you look at the number of stakeholders giving each response rather than the percentage, as the percentage can be misleading when based on so few stakeholders. • This report presents the results from Stafford and Surrounds CCG's stakeholder survey. Throughout the report, ‘the CCG / your CCG’ refers to Stafford and Surrounds CCG. • Where a result for the ‘cluster’ is presented, this refers to the overall score across the 20 CCGs that are most similar to the CCG. For more information on the cluster and how this has been defined, please see Appendix A. • Where results do not sum to 100%, or where individual responses (e.g. tend to agree; strongly agree) do not sum to combined responses (e.g. strongly/tend to agree) this is due to rounding.

2.6 Using the results

• This report contains a summary section, a section on overall views of relationships and a section for each of the six assurance domains which show detailed breakdowns of responses to each question. • The overall summary slides show the results at CCG level for the questions asked of all stakeholders (i.e. only those in section 1 of the questionnaire). • This provides CCGs with an ‘at a glance’ visual summary of the results for the key questions, including direction of travel comparisons where appropriate. • The remainder of the report shows the results for all questions in the survey including any local questions where CCGs included them. The results for each question are provided at CCG level with a breakdown also shown for each of the core stakeholder groups where relevant. • This allows CCGs to interrogate the data in more detail. • The main report has been structured by the six assurance domains. There is also an additional initial section on overall engagement and relationships which contains the general questions that are not linked to specific domains. • At the end of each section of the main report, there is a table summarising the results, along with some comparative data for those questions asked of all stakeholders.

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2.7 Using the results – interpreting

• For some questions, data has been included in the reports to compare the results for the CCG with: • The CCG’s result in 2014 • The 2015 average across all CCGs in the CCG’s cluster • National CCG average in 2015 • The comparisons are included to provide a rough headline guide only and should be treated with caution due to the low numbers of respondents and differences in stakeholder lists. • Any differences are not necessarily statistically significant differences; a higher score than the cluster average does not always equate to ‘better’ performance, and a higher score than in 2014 does not necessarily mean the CCG has improved. • The comparisons offer a starting point to inform wider discussions about the CCG’s ongoing organisational development and its relationships with stakeholders. For example, they may indicate areas in which stakeholders think the CCG is performing relatively less well, for the CCG to discuss internally and externally to identify what improvements can be made in this area, if any.

3. 2015 Stafford & Surrounds CCG Survey Summary

Overall engagement and relationships

Following the guidance from IPSOS, due to the sample size we have as a CCG (32), for some results, this can result in quite big swings. This was a major year of change for the local health economy with the transition for Mid-Staffordshire trust to a new provider and the CCG put a major focus rightly on ensuring quality throughout this transition. The table below summarises the responses received against each of the six domains a CCG is assured against:

2014 2015 stakeholders stakeholders responded % responded % Overall engagement and relationship summary Extent of engagement by CCG in last 77% (30) 81% (26) 12 months Satisfaction with engagement by CCG 73% (27) 69% (22) in last 12 months Extent to which CCG listened to views 69% (27) 66% (21)

Extent CCG has taken on board Not comparable 66% (21) suggestions when provided Overall rating of working relationships 77% (30) 84% (27) with CCG Change in working relationship with 58% (22) 47% (15) CCG in last 12 months Domain 1 Are patients receiving clinically commissioned, high quality services? How effective are arrangements for 70% (7) 89% (8)

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membership participation and decision making within your CCG? How involved do you feel you are in 80% (8) 89% (8) CCG’s decision making process How confident are you to sustain two 60% (6) 78% (7) way accountability between CCG and member practices Approximately how often if at all do 60% say once a 67% say once a you have the opportunity for direct month month discussions with your CCG leaders To what extent do you agree or 100% (10) 100%) 9 disagree representatives from member practices are able to take leadership role within the CCG To what extent do you agree or --- 40% disagree quality of services key focus of contracts within the CCG How involved if at all would you say clinicians in CCG are in discussions about a) quality 80% b) service redesign 100% 2014 2015 Commissioning decisions and (responses) (responses) contribution to wider discussions Extent to which CCG engages right 64% (25) 72% (23) individuals/ organisations when making commissioning decisions Confidence in CCG to commission 67% (26) 59% (19) high quality services Understanding of reasons behind 69% (27) 84% (27) commissioning decisions Effectiveness of CCG’s 62% (24) 56% (18) communication about commissioning decisions Confidence that CCG’s plans will 56% (22) 59% (19) deliver continuous improvement in quality Extent to which CCG has contributed Not comparable 85% (32) to wider discussions in local health economy Monitoring quality of services 2014 2015 Confidence CCG effectively monitors 64% (25) 59% (19) quality of services it commissions Feel able to raise concerns about 87% (34) 91% (29) quality of local services within the CCG Confidence in CCG to act on 72% (28) 69% (22) feedback it receives about quality of services Plans and priorities Knowledge of CCG’s plans and 82% (32) 72% (23) priorities Have had opportunity to influence 67% (26) 53% (17)

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plans and priorities Comments on plans and priorities 51% (20) 47% (15) have been taken on board CCG effectively communicated its Not comparable to 63% (20) plans and priorities 2014 CCG’s plans and priorities are the 54% (21) 44% (14) right ones Improving patient outcomes is a core Not asked in 2014 81% (26) focus for the CCG Overall Leadership Leadership of CCG has necessary 67% (26) 75% (24) blend of skills and experience There is clear and visible leadership 85% (33) 84% (27) of the CCG Confidence in the CCCG to deliver its 56% (22) 69% (22) plans and priorities Leadership of the CCG is delivering 54% (21) 59% (19) continued quality improvements Confidence in leadership of CCG to 59% (23) 72% (23) deliver improved outcomes for patients Clinical leadership and quality of services Clear and visible clinical leadership of 77% (30) 50% (16) the CCG Confidence in clinical leadership to 54% (21) 56% (18) deliver plans and priorities Clinical leadership is delivering 49% (19) 50% (16) continued quality improvements Clinical leadership of CCG is Not asked in 2014 86% (18) delivering continued improvements to reduce local health inequalities

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4. Recommendations and action plan

Assurance Emerging themes Proposed action Domain Domain 1: • The majority of - Ensure all members are receiving Engagement and practices feel communications from the CCG relationships engaged – only one - Undertake members survey to practice reported identify ways in which they would they did not feel very like to be engaged involved - A number of pan-Staffordshire • All practices said programmes will enable improved they felt they were communications and able to take a understanding in 2015/16. leadership role within - During 2015/16, as the CCG the CCG if they moves to a more ‘normal’ year wanted to following changes, staff and • Two practices said members will make a concerted they were not very effort to ensure that more time is confident in systems given over to relationship to sustain two-way management – a number of accountability initiatives and ways of working between the CCG have already been identified and and practices put in place to achieve good partnership working for year ahead. - Domain 2: Are • Most stakeholders • A substantial information patients and the say they understand programme took place to support public actively the reasons for the changes with Mid-Staffordshire decisions that the provider transition to help keep engaged and CCG makes (84%) – patients informed about a involved? this is higher than complex set of changes the finding for CCGs • The CCG is refreshing its overall communications and engagement • Around half of approach for all stakeholders by stakeholders feel June 2015. A new website that the CCG together with social media effectively channels has gone live to help communicates strengthen communications and commissioning the way we engage as a CCG decisions however • The CCG plans to communicate clearly there is its annual review to all always room for households in the next few improvement. months and opportunities for • The majority of members of the public to get stakeholders say that involved in the work of the CCG the CCG involves on an ongoing basis. and engages with the right individuals and organisations when making commissioning decisions Domain 3: Are CCG • 78% of member • The pan Staffordshire programme plans delivering practices feel the office with an increased focus for CCG effectively joint commissioning will help

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better outcomes communicates its achieve this goal in 2015/16. for patients plans and priorities. • CCG to consider how we improve • Only 1 practice said knowledge of stakeholders they did not including member practices understand the around plans to reduce health financial implications inequalities. of the CCGs plans • Activities will include: • Four practices (44%) - CCG staff briefing; said they did not - member practices – consider a understand the board development session and _ CCGs plans to for the public include information reduce health in existing communications issued inequalities and two by CCG and opportunity for (22%) said they did questions at Annual General not understand the Meeting. CCGs plans to improve the health of the local population Domain 4: Does • The results for this • Planned communications and the CCG have section were on the involvement for member practices robust governance whole positive with and governance arrangements perception CCG is were being developed right at the arrangements fair and equitable. time of the stakeholder survey. It • Most stakeholders is hoped that members will now (60%) feel the be clearer about the position but monitoring of this feedback will be reviewed services is about and ensure that we communicate right well with our members on this • All member practices important agenda. feel very or fairly involved in co- commissioning discussions – a new agenda for CCGs to be leading although three practices are not confident that the CCG is taking the right steps to prepare for primary care co- commissioning. Domain 5: Are The response rates for this Continue to strengthen relationships with CCGs working in section were very low in stakeholders as part of our partnership with number – although those communications and engagement responses received – were planned programme in 2015/16. others? universally positive. Domain 6: Clinical Clinical leadership scores are Scores had been very high and it’s leadership similar to other CCG unclear why scores dipped this year. although visibility of clinical However with a newly appointed Chair, leader scores has dipped in that provides an opportunity to reengage 2015/16 from 77% to 50%. with member practices. Confidence in the clinical leadership of the CCG has increased slightly from 54% to 56%.

May 2015

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Shropshire and Staffordshire Area Team Anglesey House Wheelhouse Road Rugeley Staffordshire WS15 1UL

18th May 2015

Dr Ann-Marie Houlder, Chair, Mr Andrew Donald, Accountable Officer Stafford and Surrounds CCG Number 2 Staffordshire Place Stafford ST16 2LP

Dear Ann-Marie and Andy

Re: CCG Quarter 3 Assurance Thank you for meeting with members of NHS England on the 24th March 2015 to discuss the third quarter assessment of your CCG. This was split into three sections, the first section focused on Domain 3: delivery and outcomes, the second part on Domain 4: finance and governance, and the third part on Domains 5 & 6. Quality and Patient and Public Engagement domains continue to be assured and are progressing well, therefore discussions took place on those domains that were ‘assured with support’, with the CCG providing assurance on delivery between quarters 2 and 3. This letter sets out the key points arising from the discussion.

Part 1 – Domain 3: Delivery and outcomes

Referral to Treatment (RTT) NHS England acknowledged that the RTT headline standards had been delivered for the second consecutive quarter. However, the diagnostic standard had not been delivered in Q3 and we noted that a contract query had been raised and a RAP is in development for MRI and sleep studies. NHS England note the CCG’s concerns regarding delivery in Q4 resulting from the pressures generated by the increase in non-elective admissions in January and would like to be kept updated on the impact of the pressures experienced in January on performance

Urgent Care The performance at the County Hospital has continued below the 95% standard for a prolonged period despite the range of actions taken by the CCG. The CCG described the additional steps being implemented including the procurement of the Acute Visiting Service, the development of an Acute Assessment Unit, the Hospital at Home Service and Discharge to Assess. The recovery at County will form part of the UHNM recovery plan and will be managed through the North Staffordshire SRG of which the CCG is a member. The CCG were encouraged to continue to focus on the County performance while contributing to the wider system delivery.

Cancer All of the cancer standards, except the 62 day from GP referral to treatment, had been delivered in Q3. The CCG reported that the majority of the breaches are at UHNM and they are using contract levers to gain improvements and had raised concerns via the CQRM regarding the patient experience and were awaiting a response from the provider. All patients waiting over a 100 days for their definitive treatment have a RCA investigation carried out to identify whether harm has occurred and opportunities for improvement.

Dementia The dementia diagnosis rate for December was 54.88% and the latest information in January shows further improvement at 56.10%. The CCG expected to deliver a year-end total of approximately 60% and while they would not deliver the national ambition the progress was noted. The CCG were required to maintain the momentum until the standard was fully delivered.

Part 2 – Finance and Governance

Finance A Financial Recovery Plan is in place and the CCG is confident they will achieve their control total. The CCG has implemented the following mitigating actions; strengthened monthly financial monitoring processes to ensure everyone in the CCG is working to one set of figures and assumptions, bed closures at County Hospital, and a review of cost saving schemes to ensure they are on track to deliver. The CCG has also brought in additional contract management capacity to ensure the contracts with providers are being executed efficiently. As the FRP has been scrutinised and assured at the sub-regional and regional level we did not discuss the plan in detail. The review of the FRP will be on-going in 2015/16 and the CCG are asked to refresh their medium term FRP in quarter 4.

Governance You confirmed that the Secondary Care Consultant post on the Governing Body has again been advertised and an interview was planned for the following morning. In a note subsequent to the meeting the CCG confirmed that they have appointed Mr Doug Roberts to a joint post with Cannock Chase CCG which he commenced on the 1st April 2015.

Part 3 – Domains 5 & 6 – Partnership and Leadership and CCG Issues

Partnership working The CCG confirmed that they were actively engaged in the Collaborative Commissioning Congress which had been formed pan Staffordshire to respond to the recommendations identified by KPMG. While the CCG acknowledged that it had taken them some time to set up the Congress they reported that it was beginning to form an effective body for developing integrated commissioning plans for the CCGS & LAs. Within the next month or so it was anticipated that the Congress would agree their work plans for their six work streams.

Given the scale of the challenges in the Staffordshire economy for the CCG’s NHS England highlighted to the CCG that it is imperative for them to build capacity through collaboration and required them to ensure they maximised the pace and scale of the shared agenda. NHS England was pleased to hear of the progress and requested a copy of the work programme and its milestones for the next six months.

Leadership You gave an update on the leadership arrangements following the departure of the turn-around director and the management of change, including how the feedback from NHS England had been incorporated into your revised management structure. NHS England were pleased that the changes have strengthened clinical leadership but noted that there were still a large number of interim staff who were due to leave their posts at the end of March. The CCG gave assurances that all roles were now embedded within their permanent staff responsibilities and that the additional support they had secured from the CSU would be on-going

Better Care Fund (BCF) Progress on the Staffordshire Plan was acknowledged and it is anticipated that the plan would be rated as assured following the review by NHS England Midlands and East and the Taskforce. Andrew Donald noted that progress on the signing of the Section 75 agreement moving in the right direction but may not hit the end of March deadline. It was agreed that the Head of Assurance would seek guidance from the Taskforce and advise the CCG if any additional actions were required.

Primary Care Co-commissioning The CCG is confirmed as a Joint Commissioner for Primary Medical Care Services through a collaborative approach across the East Staffs & Cannock Chase CCGs (SES are not a partner to the arrangement but will act as an observer). This arrangement has the support of the membership. To enable the CCG to assume this role they are currently amending their Constitution and Governance Framework, etc.

Conclusion Enclosure 1 outlines the outcomes of the Domain ratings. Below are the actions arising from this meeting:

• Maintain the momentum to deliver the dementia standard • Progress the collaboration agenda at pace to free up staff capacity to deal with ongoing demands of the role. • Supply a copy of the Collaborative Commissioning Congress’s work programme and its milestones for the next six months. • The review of the FRP will be on-going in 2015/16 and the CCG are asked to refresh their medium term FRP in quarter 4. • NHS England North Midlands Finance Director to continue to hold monthly 1:1 meetings with Chief Finance Officer (CFO). • NHS England Head of Assurance to seek guidance from the BCF Taskforce and advise the CCG if any additional actions were required if the Section 75 was not signed by the end of March.

Thank you for meeting with us and for the open and constructive dialogue, I trust this letter provides an accurate summary of the discussions and clearly indicates the next steps.

Yours sincerely

Samantha Milbank Locality Director Staffordshire (Interim)

cc. Wendy Saviour Enclosure 1 – Stafford & Surrounds CCG – Q3 Domain Ratings

Domain Description Domain rating 1 Are patients receiving clinically commissioned, high quality Assured services?

2 Are patients and the public actively engaged and involved? Assured

3 Are CCG plans delivering better outcomes for patients? Assured with • A&E support

4 Does the CCG have robust governance arrangements? Assured with • Finance support

5 Are CCGs working in partnership with others? Assured with • Collaborative commissioning support

6 Does the CCG have strong and robust leadership? Assured with • Embedding the role of the turnaround director support

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REPORT TO: The Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Tuesday 30th June 2015

Subject: COPD Business Case Update Board Lead: Jonathan Bletcher Officer Lead: Ashleigh Gibbs For For For For Recommendation:  Approval Ratification Discussion Information

PURPOSE OF THE REPORT:

To update the Membership Board on the outcomes achieved since the COPD business case was approved by the Membership Board in May 2013.

KEY POINTS:

Since the cross-economy business case was approved in May 2013, emergency admissions for COPD have reduced by a forecast 34.7% (based on M10 SUS). The paper attached details the year on year reductions and the actions undertaken by the health economy to collaboratively support and manage patients with COPD.

RELEVANCE TO KEY GOALS A 10% reduction the levels of obesity against N/A the expected prevalence

A reduction in the proportion of people with N/A undiagnosed disease from 30 – 10 %.

A “levelling up” of health outcomes so that all N/A residents experience the same health care outcomes

A reduction in excess winter deaths of 50% N/A

A reduction in unplanned admissions to There has been a significant reduction in unplanned hospital for people with Long Term Conditions admissions for patients with COPD of 50% 1 | Page

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IMPLICATIONS Legal and/or Risk N/A CQC N/A Patient Safety Patients are managed safely in their own community Patient Engagement Patients were consulted in the business case Financial Better use of resources and patient management has resulted in a financial saving for the CCG Sustainability The service is sustainable Workforce / Training N/A

RECOMMENDATIONS / ACTION REQUIRED: The SAS CCG Governing Body is asked to: • Note the update

Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken?  Has an equality impact assessment been undertaken?  Has a privacy impact assessment been completed?  Have partners / public been involved in design?  Are partners / public involved in implementation?  Are partners / public involved in evaluation? 

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Cannock (Stafford)

Business Case Update COPD Emergency admissions

Background

As part of the Long Term Conditions programme the focus in 2012/13 was to look at condition specific pathways that had high volumes of emergency admissions with a view to making a reduction in those that were considered avoidable.

In 12/13 there were 368 COPD emergency admissions at a cost of £900k (296 COPD emergency admissions at a cost of £661k). The community service and secondary care were not integrated and there was little formal focus on an integrated approach. As a consequence of productive design and collaborative working the CCG are now forecast, based on month 10, to have 284 COPD emergency admissions at a cost of £586k, reducing (193 COPD emergency admissions at a cost of £441k).

Table 1 below shows the activity and cost reductions made from 12/13 to 14/15.

Table 1 CCG 2012 / 2013 2013 / 2014 2014 / 2015 FOT Activity Cost Activity Cost Activity Cost CANNOCK 368 £900,031 354 £792,006 284 £586,436 CHASE STAFFORD & 296 £661,044 228 £482,113 193 £441,102 SURROUNDS Grand Total 664 £1,561,074 582 £1,274,119 477.6 £1,027,538

A redesign task and finish group was set up which included clinicians and management from the Clinical Commissioning Group, SSOTP, MSFT and a primary care representative. The group designed the COPD pathways using NICE guidance and quality standards as the starting point at which to develop innovative care delivery.

The task and finish group developed a business case which shared the vision for COPD, there was an agreed focus that COPD in the majority should be managed by primary care or the community and early intervention during periods of exacerbation could significant reduce the risk of emergency admission. The business case outlined the expected activity and the cost of the proposed model. This was agreed and signed off by the boards of the CCGs, SSOTP and MSFT.

The new model of care for COPD

The new model gave every part of the pathway a focus and expectation. It is not possible to isolate one change in the pathway to the reduction in COPD emergency admissions, it is believed to be a collective effort of the following changes that were implemented post the business case sign-off

Ashleigh Gibbs, Senior Commissioning Manager

Primary Care • POINTS programme rolled out in primary care which up-skilled GP practices in the use of spirometry to diagnose COPD; • Self-management plans for COPD patients, rolled out as part of the innovations group, designed with the community respiratory team; • Nurse Clinical Collaborative focusing on COPD. This was attended by Practice nurses, Community Respiratory Team and Respiratory nurses from Mid Staffs FT. The programme covered respiratory assessment, consultation skills, inhalers, medication reviews, self-management, exacerbations and case studies; • Practices also identified patients suitable for “Flo” Simple telehealth1 and practices have been given pulse oximeters and thermometers with the aim to empower patients to take more responsibility for their health and wellbeing and seek to improve healthcare use across the different health sectors.

Community Care • Continued delivery of proactive care, including MDTs with GP practices and pulmonary rehab; • Step up of COPD patients went via the community instead of secondary care; • Consultant-led outpatient appointments for COPD patients as part of an MDT with the community respiratory nurse specialists; • Hot clinics for patients needing a rapid review by a Consultant; • Follow-up appointment from an emergency admission to be had in the community;

Secondary Care • CQUIN implemented to ensure all patients admitted with COPD were assessed and seen by a consultant in a timely manner (admission bundle); • CQUIN implemented to ensure all patients discharged following a COPD emergency admission have been referred to the appropriate follow-on services including follow-up in the community, smoking cessation, pulmonary rehab, community oxygen services (discharge bundle); and • Decommissioned COPD outpatients in a secondary care setting and re-commissioned in the community via the community respiratory team with Consultant oversight and access.

Conclusion

The redesign of the COPD pathway and integration of patient management has resulted in a 22.7% reduction in COPD emergency admission activity over two years (34.7% reduction in COPD emergency admission activity over two years). Table 2 shows the percentage reduction in activity year on year.

1 Simple telehealth (STH) is the multi-award winning, NHS inspired and owned, telehealth solution. STH is designed to enable patients to take responsibility for the monitoring and shared management of their own condition, treatment, or lifestyle. Simple telehealth encompasses FlorenceTM the friendly interface & ‘persona’, technical assets, methodologies, global patents, business cases, clinical protocols, and an open and honest approach to sharing best practice across health and social care.

Ashleigh Gibbs, Senior Commissioning Manager

Table 2

CCG 2012 / 2013 / 14/15 % difference % difference % difference 2013 2014 FOT from 12/13 to from 13/14 from 12/13 13/14 to 14/15 to 14/15 CANNOCK 368 354 284 -3.8% -19.7% -22.7% CHASE STAFFORD & 296 228 193 -23.0% -15.3% -34.7% SURROUNDS

The success of the reduction is attributed to the multi-disciplinary approach taken to redesign the pathway and the subsequent patient management.

Ashleigh Gibbs, Senior Commissioning Manager Item: 16 Enc: 13

REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Tuesday 30th June 2015

Subject: CCG Workforce Report 2014/15 Board Lead: Andrew Donald Officer Lead: Sally Young For For For For Recommendation:  Approval Ratification Discussion Information

PURPOSE OF THE REPORT:

To note the report, which contains summary workforce information relating to the directly employed workforce of Stafford & Surrounds and Cannock Chase Clinical Commissioning Groups.

KEY POINTS:

This report contains summary workforce information pertaining to the directly employed workforce of Stafford & Surrounds and Cannock Chase Clinical Commissioning Groups.

The report has been broken down into several sections, each focussing on a key workforce theme. The data presented has largely been extracted from the CCGs’ ESR (Electronic Staff Record) database. Statutory / Mandatory training information has been extracted from the Skills for Health eLearning website.

The core sections of this report will be refreshed and re-published to the committee on a quarterly basis. On a less frequent basis, key sections of interest will be expanded to provide further analyses. The latest data available pertains to the workforce position at the end of Quarter 4 2014/15 (31st March 2015)

Overall, the CCGs’ employed workforce initially grew rapidly and then stabilised since the CCGs’ inception in April 2013. The employed workforce at 31st March 2015 stands at 57.06 FTE which represents a 46% increase on the opening position of 39.19 FTE at 1st April 2013.

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Item: 16 Enc: 13 RELEVANCE TO KEY GOALS A 10% reduction the levels of obesity against N/A the expected prevalence

A reduction in the proportion of people with N/A undiagnosed disease from 30 – 10 %.

A “levelling up” of health outcomes so that all N/A residents experience the same health care outcomes

A reduction in excess winter deaths of 50% N/A

A reduction in unplanned admissions to N/A hospital for people with Long Term Conditions of 50%

IMPLICATIONS Legal and/or Risk N/A CQC N/A Patient Safety N/A Patient Engagement N/A Financial N/A Sustainability N/A Workforce / Training The CCG needs a resilient work force that is fit for purpose

RECOMMENDATIONS / ACTION REQUIRED: The CCG Governing Body is asked to: To note the report, which contains summary workforce information relating to the directly employed workforce of Stafford & Surrounds and Cannock Chase Clinical Commissioning Groups.

Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken?  Has an equality impact assessment been undertaken?  Has a privacy impact assessment been completed ?  Have partners / public been involved in design?  Are partners / public involved in implementation?  Are partners / public involved in evaluation? 

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Stafford & Surrounds and Cannock Chase Clinical Commissioning Groups Workforce Report to Organisational Development Committee – Quarter 4 2014/15

Introduction This report contains summary workforce information pertaining to the directly employed workforce of Stafford & Surrounds and Cannock Chase Clinical Commissioning Groups.

The report has been broken down into several sections, each focussing on a key workforce theme. The data presented has largely been extracted from the CCGs’ ESR (Electronic Staff Record) database. Statutory / Mandatory training information has been extracted from the Skills for Health eLearning website.

The core sections of this report will be refreshed and re-published to the committee on a quarterly basis. On a less frequent basis, key sections of interest will be expanded to provide further analyses. The latest data available pertains to the workforce position at the end of Quarter 4 2014/15 (31st March 2015)

Section 1 – Staff In Post The tables below indicate the total CCG staff in post, expressed in Full-Time Equivalent (FTE) terms, at the end of the last nine reportable months. The staff in post position at 31st March 2015 has also been disaggregated by internal CCG Department / Team, to give an indication of the functions to which the workforce is currently assigned.

Overall, the CCGs’ employed workforce initially grew rapidly and then stabilised since the CCGs’ inception in April 2013. The employed workforce at 31st March 2015 stands at 57.06 FTE which represents a 46% increase on the opening position of 39.19 FTE at 1st April 2013.

Stafford & Surrounds and Cannock Chase CCGs Staff in Post April 2014 – March 2015

Change from Baseline of Month FTE 39.19 FTE @ 01.04.2013

Apr 14 52.88 34.94% May 14 51.71 31.95% Jun 14 50.97 30.07% Jul 14 50.99 30.12% Aug 14 52.49 33.94% Sep 14 55.49 41.60% Oct 14 55.14 40.71% Nov 14 53.97 37.71% Dec 14 55.17 40.78% Jan 15 55.98 42.86% Feb 15 56.26 43.56% Mar 15 57.06 45.60%

Stafford & Surrounds and Cannock Chase CCGs Staff in Post - Trend 60.00

50.00

40.00

30.00 FTE

20.00

10.00

0.00 Jul 13 Jul 14 Jan 14 Jan 15 Jun 13 Jun 14 Oct 13 Oct 14 Apr 13 Apr 14 Sep 13 Feb 14 Sep 14 Feb 15 Dec 13 Dec 14 Dec Aug 13 Aug 14 Nov 13 Nov 14 Mar 14 Mar 15 May 13 May 14

Stafford & Surrounds and Cannock Chase CCGs Staff in Post by Department / Team at 31st March 2015

FTE Staff in Post Department / Team 31/03/2015

CCCCG CEO/Board 1.55 CCCCG Clinical Support 5.00 CCCCG Macmillan Project 4.03 CCCCG Medicines Management - Clinical 2.30 CCCCG Performance 1.00 CCCCG Primary Care Support 1.70 CCCCG Quality Assurance 1.00 SaSCCG Admin & Business Support 8.80 SaSCCG CEO/Board 8.45 SaSCCG Clinical Support 2.20 SaSCCG Finance 3.00 SaSCCG Medicines Management - Clinical 2.00 SaSCCG Operations Management 2.43 SaSCCG Performance 3.00 SaSCCG Quality Assurance 3.00 SaSCCG Strategy and Development 2.00 SaSCCG Urgent Care Support 5.59 Total 57.06

In terms of grade-mix, the “Christmas-tree” chart below provides a visual representation of the shape of the workforce in terms of pay reward. The vast majority of staff are paid under Agenda for Change (AfC) terms and conditions. For the Non-agenda for Change groups, Medical (Non-AfC) includes the CCG GP Board Members, Clinical Leads and Research Leads. The VSM (Non-AfC) group includes the CCG Accountable Officer, Chief Financial Officer, Nursing & Quality Director, CCG Lay Member and Procurement Patient Champions.

Stafford & Surrounds and Cannock Chase CCGs Staff 31/03/2015 - By Pay Band

VSM (Non-AfC) Other (Non-AfC) Medical (Non-AfC) AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1

From a demography perspective, the chart below provides an age profile analysis of the CCGs’ employees.

Stafford & Surrounds and Cannock Chase CCGs Staff 31/03/2015 - By Age Band 16.00 14.00 12.00 10.00

8.00 FTE 6.00 4.00 2.00 0.00 16 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70+ Years Years Years Years Years Years Years Years Years Years Years Years Old Old Old Old Old Old Old Old Old Old Old Old

Section 2 – Leavers and Turnover The table below indicates the number of employees who have left the CCGs during the period April 2014 to March 2015

Monthly Month Leaver FTE Turnover Rate Apr 14 0.00 0.00% May 14 1.00 1.91% Jun 14 1.00 1.95% Jul 14 0.00 0.00% Aug 14 0.00 0.00% Sep 14 0.00 0.00% Oct 14 3.00 5.42% Nov 14 2.00 3.67% Dec 14 1.00 1.83% Jan 15 0.18 0.33% Feb 15 0.00 0.00% Mar 15 1.70 3.00% Total 9.88

For the most recent, reportable 12 month period (April 2014 to March 2015), the CCGs had an annual turnover rate of 18.30%. This is slightly higher than most NHS organisations and ranks the CCGs as the third highest (sixth lowest) in a direct comparison with seven peer CCG organisations also supported by NHS Midlands and Lancashire Commissioning Support Unit.

Apr 14 - Mar 15 CCG Cumulative Turnover Rates - April 2014 to March 2015

18.54% CCG Turnover Rate 20.00% 18.30% 18.65% 18.00% SaS & CC 18.30% 16.00% 14.97% 14.00% 12.15% 12.09% CCG 2 5.67% 12.00% 10.00% 7.78% CCG 3 7.78% 8.00% 5.67% 6.00% CCG 4 14.97% 4.00% 2.00% CCG 5 12.15% 0.00% CCG 6 12.09% CCG 7 18.54% CCG 8 18.65% Overall Peer 14.53% Group

Of the 9.88 FTE leavers during the period April 2014 to March 2015, the most frequently cited reason for departure is Voluntary Resignation – Other/Not Known, accounting for 6.18 FTE of the total, followed by Voluntary Resignation – Relocation (1.00 FTE), Voluntary Resignation – Promotion (1.00 FTE), Voluntary Resignation – Work/Life Balance (1.00 FTE) and Employee Transfer (0.70 FTE)

Stafford & Surrounds and Cannock Chase CCGs Leavers - FTE by Reason Apr14 - Mar15 7.00 6.00 5.00 4.00 3.00 2.00 1.00 0.00

Section 3 – Sickness Absence The table below indicates the CCGs’ sickness absence rates for April 2013 to March 2015. The sickness absence rate is defined as the percentage of ‘FTE Days’ lost from those that were available to be worked within the period in question. Sickness rates for earlier months have been recalculated and refreshed within the table below based on the latest ESR absence records.

Apr 13 May 13 Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 3.04% 1.44% 1.41% 0.12% 1.88% 2.63% 2.43% 1.32% 1.22% 1.22% 0.83% 0.24% Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14 Nov 14 Dec 14 Jan 15 Feb 15 Mar 15 1.21% 1.61% 1.55% 0.19% 1.18% 0.00% 4.03% 3.27% 2.05% 2.59% 2.81% 2.07%

Monthly sickness rates have fluctuated since April 2013, but have generally been lower than the national NHS trend. Sickness rates are traditionally higher during the period October to March than the period April to September, mainly due to an increase in seasonal ailments.

For the most recent, reportable 12 month period (April 2014 to March 2015), the CCGs had a cumulative sickness absence rate of 1.91%. This ranks the CCG in sixth highest (third lowest) place in a direct comparison with seven peer CCG organisations also supported by NHS Midlands and Lancashire Commissioning Support Unit.

Apr 14 - CCG Cumulative Sickness Rates - April 2014 to March 2015 Mar 15

Sickness 5.00% 4.64% CCG 4.50% Rate 3.74% 4.00% SaS & CC 1.91% 3.50% 3.09% 2.96% 2.74% 3.00% CCG 2 3.74% 2.50% 1.91% 2.00% 1.55% CCG 3 3.09% 1.50% 1.04% 1.00% CCG 4 1.55% 0.50% CCG 5 4.64% 0.00% CCG 6 1.04% CCG 8 2.96% CCG 9 2.74% Overall Peer 2.88% Group

The CCGs’ monthly sickness absence rates are represented graphically as :-

Stafford & Surrounds and Cannock Chase CCGs - Monthly Sickness Absence Rates 4.50% 4.00% 3.50% 3.00% 2.50% 2.00% 1.50% 1.00% Sickness Rate Sickness Absence 0.50% 0.00% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 13 13 13 13 13 13 13 13 13 14 14 14 14 14 14 14 14 14 14 14 14 15 15 15

In terms of sickness absence episodes, the tables below indicate the total number of days lost each month by Sickness Reason and by Duration Category of Episode.

Days Lost to Sickness Month Absence Apr 14 19 May 14 26 Jun 14 24 Jul 14 3 Aug 14 19 Sep 14 0 Oct 14 48 Nov 14 42 Dec 14 35 Jan 15 44 Feb 15 44 Mar 15 37 Total 341

Days Lost in last 12 Months due to Sickness Absence by Reason Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Reason Apr 14 May 14 Total 14 14 14 14 14 14 14 15 15 15 Blood Disorder 0 0 0 0 0 0 0 0 0 0 0 0 0

Cancer 0 0 0 0 0 0 0 0 0 0 0 0 0

Chest & respiratory problems 0 0 0 0 0 0 0 0 0 0 0 5 5

Cold, Cough, Flu - Influenza 2 2 1 1 2 0 4 0 2 5 5 0 24

Dental and oral problems 0 0 0 0 0 0 0 0 0 0 0 0 0

Ears, Nose and Throat 0 0 0 0 0 0 0 0 0 0 0 0 0

Eye problems 0 0 0 0 0 0 0 2 0 0 0 1 3

Gastrointestinal problems 0 0 3 0 0 0 2 5 2 4 0 8 24 Genitourinary & 17 0 11 2 0 0 16 0 0 4 11 0 61 gynaecological disorders Headache/Migraine 0 0 1 0 0 0 0 1 0 0 0 4 6 Heart, cardiac & circulatory 0 0 0 0 0 0 0 0 0 0 0 0 0 problems Infectious diseases 0 0 0 0 0 0 0 0 0 0 0 0 0

Injury, fracture 0 0 0 0 17 0 0 0 0 0 0 0 17

Musculo-skeletal 0 0 0 0 0 0 0 0 0 0 0 0 0

Nervous system Disorders 0 0 0 0 0 0 0 0 0 0 0 0 0 Other known causes - not 0 0 0 0 0 0 0 0 0 0 0 0 0 elsewhere classified Pregnancy related disorders 0 24 8 0 0 0 0 0 0 0 0 0 32

Skin disorders 0 0 0 0 0 0 0 0 0 0 0 0 0

Stress/Anxiety/Depression 0 0 0 0 0 0 26 34 31 31 28 19 169

Unknown 0 0 0 0 0 0 0 0 0 0 0 0 0

Overall 19 26 24 3 19 0 48 42 35 44 44 37 341 Stress/Anxiety/Depression is the most prominent reason for days lost and accounts for 50% of all sickness absence during the period April 2014 to March 2015 Days Lost in last 12 Months due to Sickness Absence by Duration Category

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Duration Category Apr 14 May 14 Total 14 14 14 14 14 14 14 15 15 15 Long-Term (28+ Days) 0 24 8 0 0 0 26 30 31 31 28 19 197 Medium-Term (8 - 27 Days) 17 0 11 0 15 0 16 0 0 4 11 0 74 Short-Term (1 - 7 Days) 2 2 5 3 4 0 6 12 4 9 5 18 70 Overall 19 26 24 3 19 0 48 42 35 44 44 37 341

Stafford & Surrounds and Cannock Chase CCGs - Days Lost in Month due to Sickness Absence - by Duration Category 60

50 6 40 9 5 12 16 4 4 11 Short-Term (1 - 7 Days) 30 0 0 18 20 Medium-Term (8 - 27 Days) 20 5 2 0 4 31 31 Long-Term (28+ Days) 11 26 30 28 10 24 17 15 19 8 0 0 30 0 0 Apr May Jun 14 Jul 14 Aug Sep Oct Nov Dec Jan 15 Feb Mar 14 14 14 14 14 14 14 15 15

Section 4 – Statutory and Mandatory Training Compliance

Following the removal of the Skills for Health Statutory and Mandatory training resource, and previous inaccuracies around the completion of courses, no further reporting will be undertaken on Statutory and Mandatory training compliance until the new ESR Self-Service systems has been rolled out to the CCGs.

This system will have the benefit of directly linking training to each employee’s record, providing absolutely comprehensive data around the compliance status of each individual. The next Quarterly report will re-include data pertaining to Statutory and Mandatory training compliance and will incorporate any verified historic training records carried forward from the previous Skills for Health resource. Item: 17 Enc: 14

REPORT TO THE Clinical Commissioning Group Governing Body Meeting TO BE HELD ON: Tuesday 30th June 2015

Subject: Shared Parental Leave Policy Board Lead: Andrew Donald Officer Lead: Sally Young For For For For Recommendation:  Approval Ratification Discussion Information

PURPOSE OF THE REPORT:

To note the change in legislation that allows shared parental leave with effect from 1st April 2015 and ratify the policy.

KEY POINTS:

This policy outlines the statutory right to take shared parental leave (SPL) to care for a child due to be born or placed for adoption on or after 5th April 2015. It also outlines the arrangements and notification requirements before a period of SPL and the entitlement to pay during SPL.

This policy is designed to provide a framework across the Organisation for a consistent and timely to approach for eligible parents whose babies are due or who will be adopt a child on or after 5th April 2015.

The policy is intended to promote an employee’s awareness of their rights and entitlements should they wish to opt into shared parental leave. Eligible mothers/adopters will be able to volunteer to end their maternity/adoption leave and/or pay early to create leave and pay which they can share with the child’s father or their partner as shared parental leave and pay. This will give families more choice over how they look after their children in the first year.

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Item: 17 Enc: 14 RELEVANCE TO KEY GOALS A 10% reduction the levels of obesity against N/A the expected prevalence

A reduction in the proportion of people with N/A undiagnosed disease from 30 – 10 %.

A “levelling up” of health outcomes so that all N/A residents experience the same health care outcomes

A reduction in excess winter deaths of 50% N/A

A reduction in unplanned admissions to N/A hospital for people with Long Term Conditions of 50%

IMPLICATIONS Legal and/or Risk N/A CQC N/A Patient Safety N/A Patient Engagement N/A Financial This will need monitoring. Sustainability N/A Workforce / Training The CCG will need to comply with the policy.

RECOMMENDATIONS / ACTION REQUIRED: The CCG Governing Body is asked to: To note the change in legislation that allows shared parental leave with effect from 1st April 2015. To ratify the policy.

Not KEY REQUIREMENTS Yes No Applicable Has a quality impact assessment been undertaken?  Has an equality impact assessment been undertaken?  Has a privacy impact assessment been completed?  Have partners / public been involved in design?  Are partners / public involved in implementation?  Are partners / public involved in evaluation? 

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Stafford & Surrounds Clinical Commissioning Group

SHARED PARENTAL LEAVE POLICY

Agreed at Governing Body

Date: …………………………………………………………………..

Signature: ……………………………………………………………. Chair Stafford & Surrounds CCG Designation: ………………………………………………………….

Review Date: ………………………………………………………….

Shared Parental Leave Policy

HR Policy: HR Date Issued: Date to be reviewed: Periodically or if statutory changes are required

Page 1 of 20

Policy Title: Shared Parental Leave Policy

Description of Amendment(s): New Policy for all employees This policy will impact on: All staff. Financial Implications: No change. Policy Area: HR

Version No: 1 Issued By: Author: Document Reference: Effective Date: 05/04/2015 Review Date: Impact Assessment Date:

APPROVAL RECORD

Committees / Groups / Individual Date

Consultation: CCG’s including local partnership forums t.b.c

Management / Staff Side t.b.c National CCG Partnership Forum

Approved by Committees: Management / Staff Side t.b.c National CCG Partnership Forum

National CCG Sub-committee t.b.c (approved on behalf of the BSA and CB)

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CONTENTS

1.0 POLICY STATEMENT 4

2.0 INTRODUCTION 4

3.0 ELIGIBILITY CRITERIA FOR SHARED PARENTAL 4 LEAVE

4.0 ENTITLEMENT TO SHARED PARENTAL LEAVE 5

5.0 NOTIFICATION OF ENTITLEMENT 6

6.0 CONTINUOUS LEAVE NOTIFICATIONS 6

7.0 DISCONTINUOUS LEAVE NOTIFICATIONS 7

8.0 REVOKING NOTICE TO CURTAIL MATERNITY 8 LEAVE OR VARY SHARED PARENTAL LEAVE

9.0 WRITTEN TAKEN CONFIRMATION 8

10.0 SHARED PARENTAL LEAVE IN TOUCH DAYS 8

11.0 SPECIAL CIRCUMSTANCES 9

12.0 RETURN TO WORK 10

13.0 FIXED TERM CONTRACTS OR TRAINING 11 CONTRACTS

14.0 ACCRUAL OF ANNUAL LEAVE 11

15.0 WORKING WHILST ON SHARED PARENTAL 11 LEAVE 16.0 PENSION 11 17.0 EQUALITY 11

18.0 MONITORING & REVIEW 11

APPENDIX A NOTICE OF ENTITLEMENT AND INTENTION TO TAKE SHARED PARENTAL LEAVE

APPENDIX B DECLARATION OF OTHER PARENT

APPENDIX C NOTICE TO VARY A PERIOD OF SHARED PARENTAL LEAVE

APPENDIX D LETTER ACKNOWLEDGING NOTICE OF DISCONTINUOUS LEAVE

APPENDIX E LETTER DECLINING A PERIOD OF DISCONTINUOUS LEAVE

APPENDIX F EQUALITY IMPACT ASSESSMENT Page 3 of 20

HR POLICIES

SHARED PARENTAL LEAVE

1. Policy Statement 1.1 This policy outlines the statutory right to take shared parental leave (SPL) to care for a child due to be born or placed for adoption on or after 5th April 2015. It also outlines the arrangements and notification requirements before a period of SPL and the entitlement to pay during SPL.

1.2 This policy is designed to provide a framework across the Organisation for a consistent and timely to approach for eligible parents whose babies are due or who will be adopt a child on or after 5th April 2015.

1.3 The policy is intended to promote an employees awareness of their rights and entitlements should they wish to opt into shared parental leave. Eligible mothers/adopters will be able to volunteer to end their maternity/adoption leave and/or pay early to create leave and pay which they can share with the child’s father or their partner as shared parental leave and pay. This will give families more choice over how they look after their children in the first year.

2. Introduction

2.1 Shared Parental Leave (SPL) is designed to enable parents to share leave and to take time off work in a more flexible way.

2.2 For parents of children born or matched for adoption on or after the 5th April 2105 will be able to choose how they share the care of their child during the first year after birth. Mothers will still take at least the initial two week following the birth, following that they can choose to end the maternity leave and the parents can opt to share the remaining leave as flexible parental leave.

2.3 SPL and pay will be available to birth mothers and adopters and the child’s father/the mother’s or adopter’s partner. “Partner” means a person who the mother or adopter is married to or in a civil partnership with; or a partner who the mother or adopter is living with. SPL and pay will also be available to the intended parents in surrogacy arrangements where they qualify for adoption leave and/or pay.

2.4 SPL and pay will be created where an eligible mother or adopter chooses to bring their maternity or adoption pay or maternity allowance to an end early. This is called “curtailing” maternity or adoption leave. The untaken weeks or maternity or adoption leave can be taken as SPL if the mother/adopter or their partner is eligible for this – up to a maximum of 50 weeks.

3. Eligibility criteria for SPL

3.1 If an employee deciding not to take her full maternity leave entitlement, she and the father/partner will be able to opt in to shared parental/maternity leave.

 Employees must have been continuously employed for at least 26 weeks by the end of the Page 4 of 20

15th week before the expected week of childbirth or at the week in which the main adopter was notified of having been matched for adoption with the child (known as the ‘relevant week’)  Employees must remain continuously employed until the week before any shared parental/maternity leave starts.  The mother has curtailed her entitlement to Maternity Leave or has returned to work.  They already have or expect to have main responsibility for caring for the child  The mother is entitled to statutory maternity leave

In addition, the other parent must:

 have at least 26 weeks’ employment (employed or self-employed) out of the 66 weeks prior to the relevant week  have average weekly earnings of at least £30 during at least 13 of the 66 weeks prior to the relevant week

3.2 Employment and Earnings test.

Continuity of employment test Employment and earnings test

The individual has worked for the same In the 66 weeks leading up to the baby’s employer for at least 26 weeks at the end of expected due date/matching date, the the 15th week before the child’s expected person has worked for at least 26 weeks and due date/matching date and is still working earned an average of at least £30 (as of for the CCG at the start of each leave period. 2015) a week in any 13 weeks.

3.3 There will be occasions where only one parent is eligible. For example a self-employed parent will not be entitled themselves but they may still pass the employment and earnings test so their partner, if they are an employee, may still qualify.

3.4 To qualify for Statutory Shared Parental Leave (ShPP) an employee needs to have met the ‘continuity of employment test’ and their partner must meet the ‘employment and earnings test’, just like SPL. In addition, the employee must also have earned above the ‘Lower Earnings Limit’ in the eight weeks leading up to and including the 15th week before the child’s due date/matching date and still be employed with the same employer at the start of the first period of ShPP. 3.5 ShPP will be created when the eligible mother or adopter chooses to bring their maternity or adoption pay or maternity allowance to an end early- this is called reducing the maternity or adoption pay period on the maternity allowance period. The untaken maternity or adoption pay or maternity allowance will become available as statutory shared parental pay – up to a maximum of 37 weeks.

4 Entitlement to Shared Parental Leave 4.1 If an employee is eligible and they or their partner end maternity or adoption leave and pay (or Maternity Allowance) early, then they can:

 take the rest of the 52 weeks of leave (up to a maximum of 50 weeks) as Shared Parental Leave (SPL)

 take the rest of the 39 weeks of pay (up to a maximum of 37 weeks) as Statutory Shared Parental Pay (ShPP)

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4.2 The maximum amount of leave that can be shared between the parents is 50 weeks. The leave can be taken 12 months following the birth of the child, but cannot begin earlier than two weeks following the child’s birth. 4.3 A mother must take a minimum of 2 weeks’ maternity leave following the birth (4 if she works in a factory).

4.4 ShPP is paid at the rate of £139.58 a week from 5th April 2015 or 90% of an employee’s average weekly earnings, whichever is lower.

5.0 Notification of entitlement to Shared Parental Leave

5.1 The employee must notify their line manager in writing of their intention to give notice of curtailment at least 8 weeks prior to the start date of SPL. If the individual’s right to work is via a Certificate of Sponsorship they must also notify the Human Resources Department in order to ensure compliance with UKBA regulations. If the child is born more than eight weeks early, this notice period can be shorter. Employees must complete form Appendix A and the other parent must complete Appendix B. Both forms will need to be signed, completed and handed to their line manager before SPL can be approved.

5.2 Line managers can ask for more information within 14 calendar days of receiving the notice. They can ask for:  a copy of the birth certificate (if one is avaliable)  a declaration of the place and date of birth (if the birth hasn’t been registered yet)  the name and address of your partner’s employer or a declaration that your partner has no employer

If you’re adopting, your line manager can ask for the:  name and address of the adoption agency  date you were matched with the child  date the child will be start to live with you  name and address of your partner’s employer or a declaration that your partner has no employer  If a request is made then these details must be provided within 14 calendar days.

6.0 Continuous leave notifications

6.1 A notification can be for a period of continuous leave i.e. a number of weeks taken in a single unbroken period of leave (i.e. six weeks in a row).

6.2 An employee has the right to take continuous block of leave notified in a single notification, providing their request;

A. does not exceed the total number of weeks of SPL available to the employee and B. They have given at least eight weeks’ notice to their line manager.

6.3 An employee may submit up to three separate notifications for continuous periods of leave, although more maybe accepted if mutually agreed with your line manager. Employees that have asked for a single continuous period of leave are entitled to take it.

7.0 Discontinuous leave notifications

7.1 A single notification may also contain a request for two or more periods of discontinuous Page 6 of 20

leave, (i.e. a set number of weeks of leave over a period of time, with breaks between leave periods where the employee returns to work. line managers should consider requests for discontinuous leave but retains the right to refuse such a request.

7.2 Where a request for discontinuous leave is made by an employee, there will be a 14 day discussion period during which a meeting to discuss the detail of the request will be arranged. The meeting will be made with the aim of agreeing an arrangement that meets both the needs of the employee and the service.

7.3 If a discontinuous leave pattern is refused the employee may;

A. withdraw the request without detriment on or before the 15th day after the notification was given; or B. Take the total number of weeks requested the notice in a single continuous block.

If the employee does not withdraw their request, the discontinuous leave notification automatically defaults to a period of continuous leave.

7.4 If the employee chooses to take the leave in a single continuous block, the employee has until the 19th day from the date the original notification was given to confirm when they would wish the leave period to commence. Leave cannot commence prior to eight weeks from the date the original notification was submitted. If the employee does not choose a start date then the leave will begin on the first leave date requested in the original notification.

7.5 Upon receipt of such notification(s), the line manager should arrange to discuss, the request with the employee at the earliest opportunity, please use letter in Appendix D. Where a notice is for a single period of continuous leave or where a request for discontinuous leave can be approved without further discussion a meeting may not be necessary.

7.6 Where a meeting does take place, although not part of a formal procedure, the employee may request to be accompanied by a trade union representative or colleague (not acting in a legal capacity). The request will be considered. Where a meeting is required it should take place in private and be arranged in advance.

7.7 The purpose of the meeting is to discuss in detail, the leave requested and what will happen while the employee is away from work. Where the request is for discontinuous leave the discussion may focus on; a. how the leave proposal could be agreed; b. whether a modified arrangement could be agreed and; c. what the outcome may be if no agreement is reached.

7.8 Once a decision is reached, the line manager must confirm in writing using (Appendix E) whether the request has been accepted or rejected, notify the employee in writing and forward it to Human Resources.

7.9 Each request for discontinuous leave will be considered on a case-by-case basis taking into account the needs of the service. Agreement of a request will not set a precedent or create the right for another employee to be granted a similar pattern of SPL. A request may be granted in full or part; i.e. the line manager may propose a modified version of the request for consideration. Employees should be notified of the outcome of their request at the earliest opportunity but no later than 14 days following receipt of their notification.

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7.10 Employees can give up to three notices of their intention to take leave. If a notice is withdrawn because a leave pattern cannot be agreed between line manager and employee, it does not count towards this limit.

8.0 Revoking notice to curtail maternity or adoption leave or vary SPL

8.1 If an employee has given notice to curtail their maternity or adoption leave they may revoke (withdraw) the notice only if they have not returned to work, the curtailment date has not passed and one of the following circumstances apply:

 Where it is discovered in the 8 weeks following the notice that neither the mother/adopter not their partner has any entitlement to shared parental leave or pay.

 In the event of the death of the partner

 (for mother only) If the notice was given before the birth, and the employee revokes her maternity leave curtailment notice in the six weeks following the birth.

8.2 If the employee revokes their notice in the first two instances, there is no further opportunity to opt into SPL at a later date for the same child.

8.3 If an employee revokes their maternity leave curtailment notice within 6 weeks of the birth in the last of the above circumstances will be able to opt into SPL at a later date with the same partner. Employees will either return to work and give notice of entitlement to SPL; or give another notice to curtail their maternity leave. Employee’s may give notice or vary their SPL by using Appendix C.

9.0 Written Confirmation 9.1 When notified, the Human Resources Department will provide written confirmation of the following: A. the employees paid and unpaid leave entitlement B. Periods of leave agreed C. The number of booking notifications remaining to the employee. D. The need for the employee to give at least eight week’s notice if he/she wishes to vary or cancel the agreed and booked period(s) of SPL.

10.0 Shared Parental Leave in Touch days (SPLIT)

10.1 Subject to agreement with the line manager, each employee can work up to 20 Shared Parental Leave in Touch days (SPLIT) during SPL without losing the entitlement to ShPP and without bringing the SPL to an end. Any days of work will not extend the SPL period.

10.2 Before going on SPL, the manager and the employee should agree any voluntary arrangements for keeping in touch during the employee’s SPL including:

A. Any voluntary arrangements that the employee may find helpful to help him/her keep in touch with developments at work and, nearer the time of his/her return, to help facilitate his/her return to work; B. Keeping the manager in touch with any developments that may affect his/her intended date of return; C. Confirming how the employee will be informed of any pay rises, bonuses and job vacancies which occur during his/her period of SPL.

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10.3 To facilitate the process of SPLIT days it is important that the manager and employee have an early discussion to plan and make arrangements for SPLIT days before the employee’s SPL takes place.

10.4 Any work carried out on a day or part of a day shall constitute a day’s work for these purposes.

10.4 The employee will be paid at their basic daily rate for the hours worked less appropriate ShPP payment for KIT days worked

11.0 Special Circumstances

11.1 Early Birth

11.1.1 Where an employee’s child is born before their expected due date and the employee had booked to take SPL (within the first eight weeks of the due date), the employee may take the same period of time off after the actual birth without having to provide eight weeks’ notice. In such circumstances the employee must submit a notice to vary their leave as soon as is reasonably practicable (Appendix C). The notice will not count as one of the employee’s three notifications.

11.1.2 Leave arranged after the first eight weeks of the due date remains bound by an eight-week notice requirement to vary leave dates. If the child is born more than eight weeks before the due date and the notice of entitlement to SPL and/or a notice to book SPL have not yet been submitted, there is no requirement to provide eight weeks’ notice prior to the start of the leave providing all other eligibility and notification criteria have been met. Notices must be given as soon as is reasonably practicable after the actual birth.

11.2 Death of the child before or during birth, or within the first year

11.2.1 If the child dies before the employee has submitted a notice of entitlement to take SPL then the employee cannot opt into SPL as the qualifying conditions include caring for a child. In such circumstances the mother/adopter will remain entitled to maternity/adoption leave and the mother’s partner may still qualify for statutory paternity leave.

11.2.2 If the employee has opted into SPL and have booked leave, the employee will still be entitled to take the booked leave. No further notice to book leave can be submitted and only one variation notice can be submitted to either reduce a period of leave or to rearrange a discontinuous leave arrangement into a single block of leave.

11.2.3 An employee who is absent on SPL may cancel agreed SPL and return to work by giving their line manager eight weeks’ notice of their return to work.

11.3 Partner no longer caring for the child

11.3.1 If the employee’s circumstances change and the employee is no longer be responsible for caring for the employees entitlement to both SPL and ShPP will immediately cease. The employee is responsible for advising their line manager and Human Resources.

11.3.2 Where the employee has SPL arranged within eight weeks of their entitlement ceasing, the line manager may require the employee to take the leave where it is not reasonably practicable for the line manager to have their employee back at work, (i.e. where cover has been arranged). Any weeks of SPL arranged after eight weeks of their entitlement ceasing must be cancelled. If the parent, who is no longer caring for the child has any SPL leave entitlement outstanding, the remaining parent (providing they continue to care for the child) Page 9 of 20

will be able to transfer the leave into their own entitlement providing they are able to provide a signed notification from the other parent confirming a variation of leave entitlement.

11.4 Death of a parent during the child’s first year

11.4.1 If either parent dies or the other parent is taking, or is entitled to SPL then they will continue to be eligible. Any SPL that was due to be taken by the deceased parent may be transferred to the other parent (subject to meeting the eligibility criteria).

11.4.2 In such circumstances it may be necessary for the remaining parent to take a further period of SPL or to vary pre-agreed SPL. If eight weeks notice cannot be provided then notice may be given as soon as is reasonably practicable. If the employee has already provided three notices to take leave, the employee will be allowed to submit one further notice to book/amend SPL.

12.0 Return to Work

12.1 An employee who has notified their intention to return to work is not required to give any further notification of return. If the employee wishes to return to work earlier than the expected return date, the employee must provide a written notice (Appendix C) to vary the leave and must give at least eight weeks’ notice.

12.2 This notice will count as one of the employee’s three notifications. If the employee has already used three notifications to book and/or vary leave then the CCG is not required to accept the notice to return early but may choose to do so where reasonably practicable.

12.3 Following receipt of a notification to return early the manager must send a copy of Appendix C to the Human Resources Department (within two working days) to allow any changes to be recorded on ESR. The Human Resources Department will then forward the documentation to Payroll prior to the employee’s return to work.

12.4 Following SPL the employee is entitled to return to the same job providing the employee’s aggregate total statutory maternity/paternity/adoption leave and SPL amounts to 26 weeks or less. The same job is the job they occupied immediately before commencing leave and the most recent period of SPL, on the same terms and conditions of employment as if they had not been absent.

12.5 If their maternity/paternity/adoption leave and SPL amounts to 26 weeks or more in aggregate, the employee is entitled to return to the same job they held before commencing the last period of leave or, if this is not reasonably practicable, to another job which is both suitable and appropriate and on terms and conditions no less favourable.

13.0 Fixed-Term Contracts or Training Contracts

13.1 An employee subject to a fixed-term or training contract who meets the eligibility criteria set out in section 3 above will have his/her contract extended so as to allow him/her to receive the 50 weeks Shared Parental Leave and Shared Parental Pay providing the employee has submitted the required notifications prior to the end of the fixed term contract and they continue to meet the continuity of employment test and employment and earnings test

14.0 Accrual of Annual Leave/Public Holidays

14.1 Annual leave will continue to accrue during shared parental leave and where possible should be taken during the relevant holiday year.

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14.2 Where the amount of accrued leave would exceed the normal carry over provisions, the manager and employee should agree arrangements for the leave to be taken either prior to or immediately following the SPL period.

14.3 Bank Holiday leave is not accrued whilst on paid or unpaid SPL.

15.0 Working whilst on Shared Parental leave

15.1 Any employee considering undertaking any paid work, excluding SPLIT Days whilst on shared parental leave must contact Payroll to ascertain what impact this may have on the shared parental pay they receive.

16.0 Pension

16.1 Contributions will be deducted from salary as normal during paid SPL and continue to be payable during unpaid leave. On return to work, arrears of contributions will be recovered and deducted from salary over an agreed period of time.

17.0 Equality

17.1 In applying this policy, the Organisation will have due regard for the need to eliminate unlawful discrimination, promote equality of opportunity, and provide for good relations between people of diverse groups, in particular on the grounds of the following characteristics protected by the Equality Act (2010); age, disability, gender, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, and sexual orientation, in addition to offending background, trade union membership, or any other personal characteristic.

17.2 An Equality Impact Assessment has been carried out and can be found in Appendix F.

18.0 MONITORING & REVIEW

18.1 The policy and procedure will be reviewed periodically by Human Resources in conjunction with operational managers and Trade Union representatives. Where review is necessary due to legislative change, this will happen immediately.

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Appendix A - Notice of entitlement and intention to take shared parental leave

Employees with a child due to be born or placed for adoption on or after 5th April 2015 who wish to take shared parental leave (SPL) to share the main caring responsibilities with the other parent/partner must submit this form to their Manager and HR at least eight weeks before the start date of the first period of SPL.

Please refer to the company’s policy Shared Parental Leave Policy for further information before completing this form.

Section 1 – Basic Details

Employee name

Department/Organisation

Personal Number

Continuous service date in NHS

Child’s expected date of birth/date of placement for adoption

Child’s actual date of birth/date of placement for adoption (if known)

Start date of mother/main adopter’s maternity/adoption leave (or pay period*)

End date of mother/main adopter’s maternity/adoption leave (or pay period*)

* the start and end dates of the statutory maternity/adoption pay or maternity allowance period if the mother/main adopter is not entitled to statutory leave.

Section 2 - Shared Parental Leave Details

The total amount available is 52 weeks minus the number of weeks’ leave/pay already taken by the mother/main adopter according to the dates given in the previous section.

Total number of weeks’ SPL available

Number of weeks’ SPL you intend to take

Number of weeks’ SPL the other parent intends to take Start and end dates of SPL that you intend to take

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Section 3 - Shared Parental Pay Details

The total amount of shared parental pay (ShPP) which may be available is 39 weeks minus the number of weeks’ pay already taken by the mother/main adopter according to the dates given in Section 1.

Total number of weeks’ ShPP available

Number of weeks’ ShPP you intend to claim Number of weeks’ ShPP the other parent intends to claim Indication of start and end dates of your ShPP periods

Section 4 – Employee notice of curtailment of maternity/adoption leave

Complete this section if you are the employee named in this notice and you are the mother or main adopter. You must give at least eight weeks’ notice of your curtailment date. If you are entitled to maternity leave the curtailment date must be at least two weeks after the birth of your child (four weeks if you work in a factory).

I wish my maternity/adoption leave to end on ______(insert date).

Section 5 – Employee declaration

I confirm that I meet the following conditions:  I am the mother, father, or main adopter of the child, or the partner of the mother or main adopter  I have (or share with the other parent) the main responsibility for the care of the child and I am taking SPL in order to care for the child  I have at least 26 weeks’ continuous service at the 15th week before the expected week of birth or at the week in which the main adopter was notified of having been matched for adoption with the child (known as the ‘relevant week’)  I intend to be in continuous employment until the week before any SPL is taken  (If I am claiming shared parental pay) I have average weekly earnings equal to or above the Lower Earnings Limit over the eight week period ending with the relevant week  I agree to inform the company immediately if I cease to meet the conditions for entitlement to SPL or ShPP.

If you are the mother/main adopter:  I have submitted a curtailment of maternity/adoption leave notice by completing Section 4 above

Signed – Employee Date

Signed – Manager Date

Signed – Human Resources Date

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Appendix B– Declaration of other parent

Name

Address

National Insurance Number

I confirm that I meet the following conditions:  I have least 26 weeks’ employment (employed or self-employed) out of the 66 weeks prior to the 15th week before the expected week of birth or at the week in which the main adopter was notified of having been matched for adoption with the child (known as the ‘relevant week’)  I have average weekly earnings of at least £30 during at least 13 of the 66 weeks prior to the relevant week  I agree to inform your employee immediately if I cease to meet the two conditions above  I consent to your employee taking SPP and ShPP as set out in Sections 2 and 3 above.

If you are the mother/main adopter:  I have curtailed my maternity leave and pay/adoption leave and pay/maternity allowance or will have done so by the time your employee starts shared parental leave

I consent to you processing the information contained in this declaration.

Signed ………………………………………. Date………………………………………..

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Appendix C - Notice to cancel or vary a period of shared parental leave

Please complete and return this form to your Line Manager and HR department.

Use this form to cancel or vary a period of shared parental leave (and pay if applicable) as follows:  Vary the start or end date of a period of leave/pay, giving at least eight weeks’ notice before both the new date and the original date  Vary or cancel the amount of leave requested, giving at least eight weeks’ notice before the leave is due to start  Request that a single period of leave become discontinuous periods, or vice versa.

A variation will count as one of your three periods of leave notices unless:  it is made as a result of the child being born earlier or later than the expected week of childbirth  the company has requested the variation  the company has agreed to accept more than three periods of leave notices.

If you are requesting a variation in shared parental pay entitlement the other parent must also sign this form to signify consent to the variation.

Name of employee

Name of other parent

Original shared parental leave dates to be varied or cancelled:

Start date End date Number of weeks

New shared parental leave dates:

Start date End date Number of weeks

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New shared parental pay (ShPP) details (if applicable):

Number of weeks’ ShPP you have claimed/intend to claim

Number of weeks’ ShPP the other parent has claimed/intends to claim

Indication of start and end dates of your ShPP periods

I confirm that I agree to the variation(s) detailed above.

Signature of employee:

Date:

Declaration of other parent (if the number of weeks’ shared parental pay is changing)

I confirm that I agree to the variation(s) detailed above.

Signature of other parent:

Date:

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Appendix D

Name date Address Address Address

Private and Confidential

Dear –name-

RE: Letter acknowledging notice of discontinuous leave

Thank you for submitting your notice of entitlement and intention to take shared parental leave. The details you have provided are for discontinuous leave and you have indicated to take leave on the following dates:

You have confirmed that you wish the following dates provided on your form to be taken as binding:

As the dates you have identified as part of your notification are not continuous; I would like to meet with you on XXXX to discuss your request and alternative options. If no agreement is reached within two weeks of the period of leave notice being submitted you can:  take the discontinuous periods of leave requested in one continuous block, beginning on the original start date  take the continuous block starting on a new date, as long as the new date is later than the original start date, and you notify the company of the new date within five days of the two week period referred to above  withdraw the request at any time up to the 15th day after it was originally made. If the request is withdrawn in these circumstances it will not count as one of your three requests.

You are entitled to be accompanied to this meeting by a trade union representative or colleague (not acting in a legal capacity).

Please remember to give at least eight weeks’ notice of any additional period of leave requests, or any requests to vary periods of leave.

Yours sincerely,

[Insert name] [Insert job title]

CC Assistant HR Business Partner

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Appendix E

Name date Address Address Address

Private and Confidential

Dear –name-

RE: Letter declining a period of shared parental leave

Further to our meeting on (insert date) where we discussed your notification for discontinuous shared parental leave. I am writing to confirm the outcome following our discussion.

The dates you have identified as part of your binding period of leave notice are not continuous and we are unable to agree to them. In our meeting we discussed alternative options, but agreement to an alternative pattern of leave has not been reached because [insert reasons why the pattern of leave requested cannot be accommodated].

Given that we have not reached agreement, you have the following options:  To take the discontinuous periods of leave requested in one continuous block, beginning on the original start date  To take the continuous block starting on a new date, as long as the new date is later than the original start date, and you notify the company of the new date within 19 days of the original request  To withdraw the request at any time up to the 15th day after it was originally made. If the request is withdrawn in these circumstances it will not count as one of your three requests  To submit another period of leave request.

Please confirm your decision to me in writing as soon as possible.

Please contact me if there is anything you would like to discuss in more detail.

Yours sincerely,

[Insert name] [Insert job title]

CC Assistant HR Business Partner

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Appendix F – Equality Impact Assessment

Each to add their own

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Enclosure 15-1

FINANCE, PERFORMANCE AND CONTRACTS (FPC) COMMITTEE

Thursday 19 February 2015 2.00 pm – 5.00 pm Trentham Suite, Number 1, Staffordshire Place, Stafford ST16 2LP

MINUTES

y

Members: 20/11/14 18/12/14 22/01/15 19/02/15 19/03/15 Quorac ‘P’ = Partial Attendance Paul Woodhead (PW)     Chair – Lay Member Michael Brookes (MB)   x  Head of Contracts, CSU Martin Flowers (MF) x x Associate Director of Finance Dr Gary Free (GF)   P x Clinical Lead Dr Paddy Hannigan (PH)  x x x Clinical Lead Dr Anne-Marie Houlder (AMH)  x   CCG Chair – S&S Dr Mohammed Huda (MH)  x   Clinical Lead Rob Lusuardi (RL) x x x x Director of Operations Dr Johnny McMahon (JM)   x x CCG Chair – CC Lynn Millar (LM) x x x x Director of Primary Care David Pearsall (DP)    x Lay Member

Colin Groom (CG) Half members plus Director or Deputy Director of Finance x   x Deputy Director of Finance Paul Simpson (PS)   x  Director of Finance

In attendance: Alex Bennett (AB) x x x x Director of Performance Shirley Goodchild (SG) P P Commissioning Manager Angela Hopper (AH) x  x P ASH Consultancy Mark Jones (MJ)     Senior Commissioning Manager Mel Mahon (Savage) (MM)  x x x Senior Commissioning Manager Claire McHugh – Minutes (CLM) x   x

AMENDED AND APPROVED: 19/03/2015

Page 1 of 13

Enclosure 15-1

y

Members: 20/11/14 18/12/14 22/01/15 19/02/15 19/03/15 Quorac ‘P’ = Partial Attendance Executive Assistant Matthew Sanzeri (MS)  x x x Business Manager – CHC Team Andrew Tanner (AT)   Deputy Director of Operations Sarah Turner (ST)   x P Senior Information Analyst Martin Wakeley (MW) x  x x Transition Director

Action

1. Welcome by the Chairman The Chair welcomed everyone to the meeting.

2. Apologies

Gary Free Rob Lusuardi will be represented by Andrew Tanner Johnny McMahon Lynn Millar David Pearsall Colin Groom Paddy Hannigan

3. Minutes of Previous Meeting – 22 January 2015

3.1 The minutes were approved as an accurate and true record of the meeting held on 22 January 2015.

3.2 Actions Reference 73 MB advised the following for each provider for 2014/15 - an offer had been made to UHNM with regard to a year end settlement date and UHNM had asked for further information which had now been drafted to respond to them. He confirmed that an offer would be made RWT the following week. For Walsall MB confirmed that we would be continuing with contract as it stands. SSOTP nothing would be happening on this contract until a review at year end. A plan had been agreed plan for last quarter. Mental Health Trust – MB confirmed that there were ongoing discussions at the moment for that contract. For 2015/16 MB advised that the national tariff had been rejected by the NHS Foundation Trusts. MB further advised that a proposal had been given by NHS England and Monitor for providers to have a choice of 2 tariffs – we are currently awaiting an outcome of this which leaves a challenge in getting contracts agreed

AMENDED AND APPROVED: 19/03/2015

Page 2 of 13

Enclosure 15-1

Action by the end of March. PS confirmed that they had assumed a tariff in the FRP. PS confirmed that the meeting with the Regional Team last week, we were able to demonstrate that our plans were reasonable and well backed up. MB confirmed that any variations on the tariff were to be signed off by Monitor. MB advised that a letter from NHS England confirmed that the majority of extra costs would be borne by NHS England and would offer targeted additional funding support to CCGs to help offset some of the pressures arising.

ACTION: All actions that have been marked as COMPLETED from January CLM and before to be removed from the active actions list.

4. Conflicts of Interest

There were no additional conflicts of interest to declare.

Finance, Performance and Contracts Committee (FPC) – Terms of 5. Reference (ToR) PW explained that there were only a couple of minor changes with the roles identified within Section 3 ‘Membership’ (Director of Transition and other changes to job titles) and that the Terms of Reference needed to reflect the changes. The following amendments to also be included:-

4. Chair – the wording ‘elected’ lay members to be removed.

Under Membership – wording to be changed for Deputy Chair – Director of Finance to be removed and replaced with Lay Member. Only one Lay Member and not shared between Stafford & Surrounds & Cannock – this sentence to be removed. ACTION: CLM to make changes to the ToR CLM

The Finance, Performance and Contracts Committee therefore APPROVED the revisions to the Terms of Reference. 6. Medicines Management QiPP Group – Terms of Reference (ToR) MH spoke on behalf of Sam Buckingham, who was unable to attend the meeting.

MH explained that the joint Medicines Management QiPP Group was held across Stafford & Surrounds and Cannock Chase and was a sub-group of the Finance, Performance and Contracts Committee within the CCG structures. MH confirmed the key priorities of the group.

MH confirmed that it had been identified that there were no current Terms of Reference agreed for the group and therefore the tabled ToR had been produced for approval by the FPC Committee.

PW questioned about the QiPP budget for medicines management. PS advised that he would check this and confirmed that this would be in relation to stemming growth. PW reiterated that it should be reflected in the budget.

AMENDED AND APPROVED: 19/03/2015

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Enclosure 15-1

Action PS suggested that perhaps a report should be brought back to the committee from the medicines management QiPP, as they were a sub-committee of the FPC committee. AMH pointed out that under the ToR, there was reference to Quality and whether or not this should be a sub-committee of Quality. PW agreed that this would need to be checked. ACTION: PS to confirm with SY and LM whether Medicines Management PS QIPP Group should be a sub-committee of FPC or Quality.

The FPC Committee therefore agreed that confirmation would need to be sought whether this group would come under FPC or Quality.

7. BOTOX (Botulinum Toxin Type A) Treatment for Chronic Migraine SG explained the background behind the business case being presented to the Committee. NICE recommends the use of BOTOX as a possible treatment for preventing headaches in those adults with chronic migraine that meet the appropriate technology appraisal guidance.

SG advised that the business case proposed the introduction of a community- based chronic migraine injection clinic to be operated by Dr Paul Ballinger at The Colliery Practice in Cannock as an extension of the current Cannock Headache Service, and the current savings that could be gained by treating patients with BOTOX in primary care, as opposed to secondary care.

SG advised that there would probably be 5 patients a year having a course of 2 treatments and an average saving of £1,500.

AMH also identified that her challenge was not in respect of Dr Ballinger but in respect of how responses will be made nationally. In addition, AMH does not feel that her question regarding clinical governance is answered. This is a matter for Quality to address and discussion followed regarding AQP.

AMH challenged how responses will be made nationally – the whole service should be commissioned properly and should be going out to AQP. She felt that we could be challenged as it was only one practice offering the service and not being opened out to other practices and the headache service as a whole. PS agreed with AMH and that he was not comfortable in approving this at the moment without confirmation the way in which it had been commissioned.

AMH also asked about where the clinical governance was for this service. PW advised that this was looked at September and it had been a rolling contract since 2011 and it was agreed at that time to extend the contract to the end of March 2016.

Addendum: 19/03/2015: Action (ref. 82) required by PW to raise BOTOX and clinical governance with Quality on behalf of FPC.

The FPC Committee therefore DECLINED the business case and would review again as part of the re-procurement in March 2016.

SG left the meeting

AMENDED AND APPROVED: 19/03/2015

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Enclosure 15-1

Action

8. 2015/16 Plan/Draft Budgets PS explained that the purpose of this report was to provide the committee with the draft financial plan and budget summary for 2015-16 and that it had been reviewed by the Executive Management Team and had formed the basis of the draft 2015-16 plan submitted to NHS England

PS confirmed that the content of the plan formed the basis of a recent confirm and challenge session led by Dr Paul Watson, Regional Director attended by CCG officers. During this session, the CCGs were able to demonstrate the basis and provide assurance on the QIPP programme and other identified efficiencies. Formal confirmation that the planned deficits would be supported by NHS England was yet to be received but it was anticipated following the formal submission of the operational plan at the end of February 2015.

PS advised that both of the CCGs had planned in year deficits in 2015-16 (£5.1m Cannock, £5.8m Stafford) which represented a significant improvement on the 14-15 projected deficits of £8.6m Cannock and £9.2m. He explained that the improvement was driven by the planned QIPP programme and a series of additional efficiency opportunities that have been progressed since the initial submission of the Financial Recovery Plan in November 2014.

PS advised that, at this stage, the plan was still a work in progress and that we needed to get agreement in place with the providers and get the QiPP programmes approved.

PW commented that his initial observations were that we now had nearly £10m of non-recurrent benefits in order to reach the control total and asked if we were confident in obtaining the control total. PS confirmed the situation was extremely challenging and that he had a reasonable amount of confidence in obtaining the control total given the amount of savings necessary whilst the target of 16/17 to deliver a recurrent surplus was still achievable. It would take up to 6 years to repay the historic deficit.

PW asked when the FRP would be finalised and whether there would be a better picture in March. PS confirmed that the FRP paper would be taken to Governing Bodies in March and there would be more clarity following the meetings with the Area Team the following Monday.

MB advised the Committee that providers had until 4th March to reply to Monitor as to which tariff they had been chosen. Therefore, the Committee would know what the tariff would be by the next meeting in March. It was agreed that delegation to chairs may have to be granted to sign off, in view of the timings of the Governing Body meetings.

PW mentioned the medicines waste campaign and should this not be provided for in the budget. MH confirmed that meds management was variable and changed all the time. It was agreed that this issue should be raised with LM.

AMENDED AND APPROVED: 19/03/2015

Page 5 of 13

Enclosure 15-1

Action

The Finance, Performance and Contract Committee NOTED the contents of the report.

9. Contracts Month 8 MB confirmed that both Cannock Chase and Stafford & Surrounds CCGs had over performed at Month 8 (Cannock circa £670,000 and Stafford & Surrounds £730,000). However, MB explained that this was based on the assumption that the financial consequences of poor performance with regard to National and Local Performance Requirements at Mid Staffordshire Hospital was currently being applied at the maximum level of 2.5% of the contract value and the 10 information breaches are secured following the closure of the contract.

MB advised on each of the contracts as follows:-

Royal Wolverhampton Hospital The month 8 position for the contract for Cannock Chase CCG was that it is over performing financially by £623,807 and by £370,797 for Stafford & Surrounds CCG.

He explained that the provider had not achieved the following standards: • Percentage of admitted patients starting treatment within a maximum of 18 weeks from referral • Percentage of A&E attendances where the patient was admitted, transferred or discharged within 4 hours of their arrival at an A&E department • Percentage of patients waiting no more than 31 days for subsequent treatment where that treatment is surgery • Percentage of patients waiting no more than two months (62 days) from urgent GP referral to first definitive treatment for cancer • Percentage of patients waiting no more than 62 days from referral from an NHS screening service to first definitive treatment for all cancers • Rates of Clostridium difficile • All handovers between ambulance and A&E must take place within 30 minutes

He confirmed that all of the above would result in a financial consequence for the provider.

University Hospital of North Midlands The month 8 position for the contract for Cannock Chase CCG is that it is over performing by £263,000 and by £1.5m for Stafford & Surrounds CCG.

He explained that the provider had not achieved the following standards: • Percentage of A&E attendances where the patient was admitted, transferred or discharged within 4 hours of their arrival at an A&E department. • Waiting times less than 6 weeks from Referral for a diagnostic test • Cancelled Operations for non-clinical reasons • Trolley Waits in A&E

AMENDED AND APPROVED: 19/03/2015

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Enclosure 15-1

Action MB confirmed that all of the above would also result in a financial consequence for the provider.

CQUIN • Quarter 1 & 2 CQUIN performance forecast 90% achievement

Walsall Healthcare MB explained that problems with data still continue and that the contract was showing a current under performance against the year to date plan. He explained that the provider had stated that this was a true reflection of the position, but the position would likely return to plan over the second half of the year, due to the ongoing validation issues which had been seen as part of the contract in the first 6 months of the contract year.

MB confirmed that the provider had not achieved the following standards: • Percentage of admitted patients starting treatment within a maximum of 18 weeks from referral – failed to report nationally • Waiting times less than 6 weeks from Referral for a diagnostic test • Percentage of A&E attendances where the patient was admitted, transferred or discharged within 4 hours of their arrival at an A&E department. • Percentage of patients waiting no more than two months (62 days) from urgent GP referral to first definitive treatment for cancer • All handovers between ambulance and A&E must take place within 30 minutes

He explained that all of the above would also result in a financial consequence for the provider.

CQUIN

However, the provider had achieved all its CQUINs apart from: • The Tissue Viability scheme to meet the zero tolerance to category 3 pressure ulcers • Dementia & Delirium for the screening element

MB confirmed that the financial consequences for these providers had not been built into the plan and that we would need to look at month 9 to be able to see what could be planned for in the future. MB mentioned that from a contractual perspective, he felt that the CCGs in a good position.

Burton Hospitals For Cannock Chase CCG the contract was currently over performing by £458k and Stafford & Surrounds CCG was underperforming by £33,271 at Month 8.

MB confirmed that this provider had achieved all of their Q2 CQUIN targets.

South Staffordshire and Shropshire Healthcare The month 8 position for the contract for Cannock Chase CCG was under performing by £90,341 and Stafford & Surrounds CCG was over performing by £157,468. MB confirmed that the provider had achieved all its contractual standards. MB explained that the provider had agreed a number of financial

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Action rebates due to service redesign valued at circa £300,000 for each CCG, which had not been reflected in the figures above.

CQUIN • Q2 targets achieved and is currently forecasted to achieve the full year CQUIN commitment

Staffordshire and Stoke on Trent Partnership Trust The month 8 position for the contract for Cannock Chase CCG was over performing by £4,308 and Stafford & Surrounds CCG by £6,462.

MB explained that the provider had not achieved the following standards:

• Percentage of MICATS patients having their first appointment within 4 weeks of referral – we will review performance in January • Percentage of admitted patients starting treatment within a maximum of 18 weeks from referral

CQUIN • Q2 targets achieved

West Midlands Ambulance Service WMAS overall deliver the requisite performance standard, but the performance at a local level is below target, due to the rural nature of the CCGs footprint. The month 8 position for the contract for Cannock Chase CCG is that it is over performing by £49,654 and under performing by £29,579 for Stafford & Surrounds CCG. The provider did not achieve one standard within the contract, however local performance is significantly below the providers overall performance.

CQUIN

• Q2 targets achieved

PW raised his concerns with regard to the contracts and year to date figures.

MB advised that we should be successful on 10 of the 12 information breaches.

Financial consequences at various Trusts such as Dudley and Wolverhampton

had not been included and these would be reported in month 10. PS asked for

clarity on the unsighted figures and whether they were a benefit or a risk. MB

confirmed they would be a benefit to the CCGs.

PS confirmed that he would present a business report on referral rates to the

committee. He advised that a colleague from Nottinghamshire CCGs had

already produced such a report and would obtain a copy of what they had done

which he would bring to the next meeting in March.

PS ACTION: PS to present a business report to the Committee in March (including information about referral rates)

AH arrived at 3.25pm

AMH asked about the over performance at Rowley. AT informed the committee

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Action that they had a performance review the following week to discuss this issue with them.

The Finance, Performance and Contract Committee NOTED the contents of the report.

10. CCG Performance Report – November 2014 AT confirmed that in the last few days he had received Month 9 data (December 2014) and would like to focus on these figures rather than those in the report produced for the meeting.

AT advised the Committee that RTT & cancer waits targets had been raised to red and would potentially fail their targets for the remainder of the year.

He advised that CC was 88% and SAS was 98%. UHNM would be under 90%.

As a consequence with not hitting targeted 90% the money could well be withdrawn.

Monitor & NHS England wrote back to providers and would be seeking additional providers.

62 days for cancer – CC 85%; SaS delays in the transfer of patients to Stoke 80%. PW commented that these were high and seeking to do something about this and asked if it was principally UHNM. AT responded that it was although there were also issues at Wolverhampton.

AT confirmed that there were daily discussions through the CSU to find out what was happening with performance. PW confirmed that missing these targets is it a clinical risk – AT agreed that these would be picked up by the CQRM meetings.

MB confirmed that the whole country was struggling to achieve these targets.

PW asked if this was recoverable – AT advised that they had remedial plans in place in order to recover from this position.

PW asked if AT would be able to give assurance as to where we were with the performance at the next meeting on 19th March. AT confirmed that he would.

The Finance, Performance and Contract Committee NOTED those areas where the current performance rating is below target and the remedial actions being taken to improve performance and mitigate risk.

11. Finance Report – January 2015 PS advised a lot of the Finance Report had already been covered earlier in the meeting. He reiterated that he was confident that we would reach the control total for this year.

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Action

PS explained that a year-end deal with UHNM had been produced and an offer had been made although a number of questions had come back to be addressed. He confirmed that they would also be making an offer to Wolverhampton and that there may be further financial benefits coming through.

PS felt that there was a higher degree of confidence that we would deliver the control total and that we were on track to achieve it. PS confirmed that the position would be much clearer once we got to Month 11.

AMH left the meeting at 16:00

The FPC Committee therefore NOTED the contents of the report.

12. QiPP

12.1 QiPP 2014/15 Programme Review

AT updated on the financial position of the QIPP programme as follows:

Governance, Monitoring & Reporting • Monitoring – QIPP schemes were monitored weekly through the PMO office and where exceptions were highlighted, PMs were requested to provide mitigating actions and assurance on deliverables. At month end an update and forecast against plan is to be completed by the 1st of each month to include financial assumptions by month, year to date and year end • Reporting – the PMO report would be completed by the end of the 1st week of the month in line with the requirements for the FPC

AT advised that the position as at Month 10 across the two CCGs was that the total QIPP programme had been assessed to be under plan. However, subject to the receipt of validated activity and finance information individual QIPP project leads have provided a forecast for each scheme position. AT confirmed that next year they would be a lot stricter on the reporting of the QIPP schemes.

AT confirmed that we were currently exceeding the risk reserve allocated within the financial plan for SaS CCG (£1,151,063).

The FPC Committee NOTED the contents of the report.

12.2 Financial Recovery Plan (FRP)

AH updated the committee regarding the PIDs for both planned and unplanned care. AH explained that a financial tracker had been developed which would be owned by the finance team going forward.

AH explained that the slides spell out the FRP and the gaps that needed to be bridged. AH advised that the PID summary sheets and tracker would be presented to the Governing Bodies for them to sign off in March. AH made the point that the unplanned PIDs were going to be difficult to implement, but there

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Action was a greater level of confidence around the CCGs ability to deliver the planned PIDs as requirements would be contractualised where possible.

AH explained that delivery teams for each of the work streams were in place as shown in organisation charts; the work streams have officer leadership from Rob Lusuardi and Jonathan Bletcher.

AH advised that management processes and reporting arrangements had being finalised at the first FRP Checkpoint meeting on 17 February 2015.

AH advised that incentive opportunities/transformation fund were being considered but the Chair noted his concerns about the use of incentives.

4.20pm ST arrived

PW asked who would be approving the incentive payments to GPs. AH responded that this would be up for discussion with the Membership Board. It was noted that these incentive plans had not been confirmed or agreed at present. MH confirmed that it would be better to sell the initiatives to members.

The FPC Committee therefore NOTED the documents presented and received accompanying verbal report.

AH left the meeting 4.30pm

13. WMAS Performance Update AT advised that the performance gap between Cannock and the Black Country continued to be on a red status.

Overall WMAS performance for the region showed that the provider is on target to meet their 75% performance threshold for Red 1, 8 minute response times. For Cannock Chase they are at 74.6% YTD and for Stafford & Surrounds they are at 65.7%.

For Red 2, 8 minute responses WMAS are slightly below the threshold of 75% with Cannock Chase responses at 71.3% and Stafford & Surrounds at 69.3%.

For Red 2 19 minute responses WMAS are above the threshold of 95% with Cannock Chase responses at 93.9% and Stafford & Surrounds at 94.4%.

Since October each month’s performance had been adversely affected due to Industrial Action being taken by a number of WMAS staff and the receipt of Force Majeure Notices (GC28). The declining performance has led to the issue of a number of Contract Query Notices and Activity Query Notices to Month 9 and a series of actions are agreed in response to the notices and a Joint Investigation is taking place at local health economy levels (LHE) to support the production of Remedial Action Plans (RAPs) to plan for recovery and sustainability of performance post the IA period. The RAP for Staffordshire will be approved at the next divisional meeting at the end of this month and will

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Action specifically focus on diverting activity away from A&E conveyance.

He advised that the CCGs were aware of these issues with WMAS. AT advised that activity for SAS & CC areas there was a planned an additional increase of 4.5% growth. PW asked if they were taking ambulances out which would have a further impact on response rates.

The Finance, Performance and Contracts Committee NOTED the contents of the report

14. Refinement Hub ST advised the Committee that there was no one overall referral management service but were looking at specialty specific e.g. - we have got MICATS and PEAT services (PEAT from April) - Derm and ENT being re-procured in next 6 months and would see these as assessment and treatment services in community. - Also looking at other specialties for example Gastro - linking to work with RWHT - This would be a rolling programme and linked to main specialties as part of planned care programme/QIPP/FRP.

MICATS have seen a reduction in onward referrals into secondary care in their first quarter only 23% have been forwarded compared to 60% from previous service, the plan was 30%.

Map of Medicine – ST gave an update on the training that had been organised eg. SAS PLT, IF’s, Super users. St mentioned the work being done by Gary Free and Marianne Holmes on reviewing quick start pathways and that these would be loaded by the 3rd week in March and we were building up library of referral templates to be loaded to standardise/automate processes. MH mentioned he had had a cancellation on April’s PLT that could be used for Map of Medicine demonstration. ST agreed to inform Sharon ST Smith. However, ST confirmed that they were confident it would be operational by April 2015 and MH agreed.

ST left the meeting 3.40

15. Risk Register Review

It was agreed by all that the Risk Register needed to be updated and also the 18 weeks and 62 days waits would need to be included.

PS confirmed that an updated Risk Register would be presented at a future PS meeting of the Committee as it required a major review

16. Forward Plan

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Action WMAS – 4 months’ time

17. Any Other Business There being no further business, the Chair closed the meeting.

14. Next Meeting

Date: Thursday 19 March 2015 Time: 2.00 pm – 5.00 pm Venue: To be confirmed

AMENDED AND APPROVED: 19/03/2015

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FINANCE, PERFORMANCE AND CONTRACTS (FPC) COMMITTEE

Thursday 19 March 2015 2.00 pm – 5.00 pm Dining Room, County Buildings, Martin Street, Stafford ST16 2LP

MINUTES

y

Members: 20/11/14 18/12/14 22/01/15 19/02/15 19/03/15 23/04/15 21/05/15 25/06/15 23/07/15 20/08/15 24/09/15 22/10/15 24/11/15 Quorac ‘P’ = Partial Attendance Paul Woodhead (PW)      Chair – Lay Member Michael Brookes (MB)   x   Head of Contracts, CSU Martin Flowers (MF) x x Associate Director of Finance Dr Gary Free (GF)   P x  Clinical Lead Dr Paddy Hannigan (PH)  x x x  Clinical Lead Dr Anne-Marie Houlder (AMH)  x    CCG Chair – S&S Dr Mohammed Huda (MH)  x    Clinical Lead Rob Lusuardi (RL) x x x x x Director of Operations Dr Johnny McMahon (JM)   x x P CCG Chair – CC Lynn Millar (LM) x x x x x Director of Primary Care David Pearsall (DP)    x x Lay Member

Colin Groom (CG) Half members plus Director or Deputy Director of Finance x   x x Deputy Director of Finance Paul Simpson (PS)   x   Director of Finance

In attendance: Alex Bennett (AB) x x x x x Director of Performance Shirley Goodchild (SG) P P x Commissioning Manager Angela Hopper (AH) x  x P P ASH Consultancy Mark Jones (MJ)      Senior Commissioning Manager Mel Mahon (Savage) (MM)  x x x x Senior Commissioning Manager Claire McHugh – Minutes (CLM) x   x  Executive Assistant

Amended and Approved: 23/04/2015 Page 1 of 6

Enclosure 15-2

y

Members: 20/11/14 18/12/14 22/01/15 19/02/15 19/03/15 23/04/15 21/05/15 25/06/15 23/07/15 20/08/15 24/09/15 22/10/15 24/11/15 Quorac ‘P’ = Partial Attendance Matthew Sanzeri (MS)  x x x x Business Manager – CHC Team Andrew Tanner (AT)    Deputy Director of Operations Sarah Turner (ST)   x P x Senior Information Analyst Martin Wakeley (MW) x  x x Transition Director

Action

1. Welcome by the Chairman

PW welcomed those present to the meeting.

2. Apologies

Rob Lusuardi who is represented by Andrew Tanner Lynn Millar David Pearsall

Committee was informed that David Pearsall has tendered his resignation as a Lay Member.

3. Minutes of Previous Meeting – 19 February 2015

14:09 Angela Hopper joined the meeting.

3.1.1 Item 7. BOTOX (Botulinum Toxin Type A) Treatment for Chronic Migraine GF raised the matter of BOTOX and advised caution with regard to procurement of future provision. PW noted the concerns and recommended that items are taken on a case by case basis.

AMH identified that her challenge was not in respect of Dr Ballinger but in respect of how responses will be made nationally. In addition, AMH does not feel that her question regarding clinical governance is answered. This is a matter for Quality to address and discussion followed regarding AQP.

Action: PW will raise BOTOX and clinical governance with Quality on PW behalf of FPC.

3.1.2 Item 9. Contracts Month 8 PS explained that he will make a business report to FPC in April 2015, it will include information about referral rates.

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Enclosure 15-2

Action 3.1.3 With the adjustments identified above, the minutes were approved as an accurate and true record of the meeting held on 19 February 2015.

3.2 Actions 3.2.1 Ref 81: Risk Register Review PS will do a review of the risk register to identify what is/is not required.

3.2.2 Ref 80: Refinement Hub AMH/JM confirmed that this has been presented at PLTs and the action is now complete.

3.2.3 Ref 79: Contracts Month 8 PS explained that he will present a business report that will include information relating to referral rates.

Forward Plan: Business Report – April 2015 (PS)

3.2.4 Ref 78: Medicines Management QiPP ToR It has been confirmed that Medicines Management Terms of Reference should be approved by Quality, not FPC as presented in February 2015. This action is now complete.

3.2.5 Ref 72: Risk Register Review This action can be recorded as complete as PS is doing further work on the risk register (see action ref: 81).

4. Conflicts of Interest

PW declared a conflict of interest as he will be standing as a candidate in the local and national election in May 2015.

PH is employed by Methodist Homes and declared a conflict of interest.

There were no additional conflicts of interest to declare.

5. Finance, Performance and Contracts Committee (FPC) Business Report

PS presented the paper that has been produced by AT and reminded members that this report has been devised following discussions at previous FPC. The proposal is that this could be brought into use from May 2015.

PS welcomed feedback from members so that the report can be improved prior to May 2015 FPC when it is hoped the template will be put into practice. AT agreed with PS presentation and asked for comments.

AMH expressed the importance of taking information in context, the difference in patients and other variables. JM asked what will be done with the information and how it will be presented to practices without judgement. It is important for practices to ask questions of themselves, rather than the CCG promoting the

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Enclosure 15-2

Action debate.

Discussion followed regarding the methods of engaging practices. It was noted that the information within the report is already shared at Membership Boards. It was noted that the existing report does not show trends, whether it is on/off plan. AT confirmed that the data shows the year to date position.

The proposed report does not yet include the Contracts reporting and PS explained that there is still further work to do on the report.

PS also asked members to note that the report is designed to include all aspects ie, not just GP referrals. He noted that currently, reporting is not shared regarding eg, HR but there was a suggestion that reporting regarding HR would be more appropriate for Executive Management Team (EMT), not FPC.

PS asked FPC to consider what information is useful and how frequently should reporting be done eg, could GP referrals be reported quarterly?

MB advised caution regarding ownership of information shared, it is important that the organisation is clear where responsibility lies eg, which Committee is responsible for reviewing HR issues. PS agreed explaining the Terms of Reference (ToR) do not identify who has responsibility for particular areas.

PW explained that recovery plans have been identified previously but the detail has not been shared.

Further work will be done on the Business Report with consideration for the issues discussed at the meeting.

6. Financial Recovery Plan (FRP)

AH presented the report. The unplanned care model has been approved by providers.

PS informed members that good progress has been made with regard to contracts discussions. A revised medium term financial plan must be submitted to Area Team on 20/03/2015 and work will be done to substantiate changes. The FRP submitted in November 2014 had less detail and the Area Team now want figures assigned to the Plan.

Both CCGs are confident that the correct level of activity is being provided.

15:00 Angela Hopper and Johnny McMahon left the meeting.

PS attended a meeting with Directors of Finance for NHS England and Area Team (Ros Francke) regarding achieving the control total which is to be resubmitted.

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Action

Discussion followed regarding reducing activity and producing pathways that will improve management of patients within primary care.

7. Contracts Month 9

MB presented the paper.

Discussion followed regarding lack of performance information and PH asked if there is a risk that information provided in April 2015 will present an unexpected expense. MB reassured the meeting that this has been given consideration and should not be an issue.

MH asked whether Walsall commissioners have been approached and MB explained that work has been done since Quarter 1. There has been a delivery plan with regard to data being provided to a deadline.

8. CCG Performance Report – December 2014

AT presented the reports. AT explained that there is a new contract in place for Ambulance Services in 2015/16 and this will significantly reduce the service but should not affect the response times.

GF asked why the CCG are responsible for payment of transfer of patients between hospitals. This raised the question regarding the CCG responsibility for paying for transport of patients between transitional units.

Action: AT to confirm whether transfer of patients between hospitals AT is part of the patient transfer contract.

AT confirmed that all contract levers are being applied. MH questioned why some providers continue to breach targets and MB suggested that it is possible the national contract levers are not substantial enough.

9. Finance Report

PS presented the report. PS brought Members attention to the item within Appendix 1 “Further impact of UHNM year end outturn” (value £1.057m) and explained the background for this. PS is in discussion with Chris Adcock, Director of Finance – UHNM.

AMH asked why UHNM are failing in some targets when it appears that they have a degree of flexibility regarding their finances following their discussions with PS. PS explained that flexible finances are non-recurrent.

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Action

10. QIPP 2014/15 Programme Review

AT presented the paper and there were no particular items of note or discussion.

11. Risk Register Review

CLM identified that she had a very positive response from Officers regarding updating the risk register and as discussed previously PS will review the Register for the next meeting.

12. Forward Plan

PS will present his business report in April 2015.

13. Any Other Business

There were no further matters for discussion.

14. Next Meeting

Date: Thursday 23 April 2015 Time: 2.00 pm – 5.00 pm Venue: Room 001 – Second Floor, Number 1, Staffordshire Place, Stafford ST16 2LP

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Enclosure 15-3

FINANCE, PERFORMANCE AND CONTRACTS (FPC) COMMITTEE

Thursday 23 April 2015 2.00 pm – 5.00 pm Second Floor, Room 1, Number 1, Staffordshire Place, Stafford ST16 2LP

MINUTES

y

Members: 20/11/14 18/12/14 22/01/15 19/02/15 19/03/15 23/04/15 21/05/15 25/06/15 21/07/15 20/08/15 22/09/15 20/10/15 19/11/15 Quorac ‘P’ = Partial Attendance Paul Woodhead (PW)       Chair – Lay Member Michael Brookes (MB)   x    Head of Contracts, CSU Martin Flowers (MF) x x Associate Director of Finance Dr Gary Free (GF)   P x   Clinical Lead Dr Paddy Hannigan (PH)  x x x  x Clinical Lead Dr Anne-Marie Houlder (AMH)  x    x CCG Chair – S&S Dr Mohammed Huda (MH)  x     Clinical Lead Rob Lusuardi (RL) x x x x x x Director of Operations Dr Johnny McMahon (JM)   x x P P CCG Chair – CC Lynn Millar (LM) x x x x x x Director of Primary Care David Pearsall (DP)    x x Lay Member Diana Smith P Lay Member

Colin Groom (CG) Half members plus Director or Deputy Director of Finance x   x x x Deputy Director of Finance Paul Simpson (PS)   x   P Director of Finance

In attendance: Alex Bennett (AB) x x x x x x Director of Performance Shirley Goodchild (SG) P P x x Commissioning Manager Angela Hopper (AH) x  x P P ASH Consultancy Mark Jones (MJ)      Senior Commissioning Manager Mel Mahon (Savage) (MM)  x x x x x Senior Commissioning Manager

Approved – 21/05/2015 Page 1 of 7

Enclosure 15-3

y

Members: 20/11/14 18/12/14 22/01/15 19/02/15 19/03/15 23/04/15 21/05/15 25/06/15 21/07/15 20/08/15 22/09/15 20/10/15 19/11/15 Quorac ‘P’ = Partial Attendance Claire McHugh – Minutes (CLM) x   x   Executive Assistant Matthew Sanzeri (MS)  x x x x x Business Manager – CHC Team Andrew Tanner (AT)     Deputy Director of Operations Sarah Turner (ST)   x P x  Senior Information Analyst Martin Wakeley (MW) x  x x Transition Director

Action

1. Welcome by the Chairman

PW welcomed those present to the meeting and thanked everyone for attending.

2. Apologies

Paddy Hannigan Anne-Marie Houlder Rob Lusuardi who is represented by Andrew Tanner for the purpose of the meeting. Lynn Millar who will be represented by Sarah Turner for the purpose of the meeting.

3. Minutes of Previous Meeting – 19 March 2015

3.1 3.2.4 Ref 78: Medicines Management QIPP ToR There is an error, the sentence should read: “It has been confirmed that Map of Medicine Medicines Management Terms of Reference should now be approved by Quality, not FPC, as presented in February 2015…”

With the appropriate amendment above, the minutes were approved as a true and accurate record of the meeting.

3.2 Actions

3.2.1 Ref: 82 – BOTOX (Botulinum Toxin Type A) Treatment for Chronic Migraine PW has written to Quality Committee and understands that it will be presented at Quality Committee on 23/04/2015.

3.2.2 Ref: 79 – Contracts Month 8 The Business Report has been developed further; a draft will be presented at the

Approved – 21/05/2015 Page 2 of 7

Enclosure 15-3

Action meeting and from May 2015 the report will be used as the standard template. This action is now complete.

14:07 Paul Simpson and Diana Smith joined the meeting

4. Conflicts of Interest

PW declared that he is a parliamentary candidate for the elections in May 2015.

5. Finance, Performance and Contracts Committee (FPC) Business Report

AT presented the paper which will bring together the key contractual, financial and performance reports to provide greater cohesion. This is the second draft and the recommendation is that this will be developed further to become a live report in May 2015 and additional reports will be an appendix if necessary to provide greater detail by exception.

PS reported that he had been party to a teleconference with Area Team: CC and S&S CCGs have now been formally returned to the management of the Area Team (from Regional Team). The Quarterly Assurance will still take place and discussions are taking place regarding monthly updates to ensure that QIPP programmes, control totals etc are on track to deliver to plan.

AT explained that the new process will assist in continual monitoring in preparation of the assurance process. MH expressed concern that previously the requirements have been changed but AT confirmed that the requirements will now be fixed enabling the CCG to report appropriately.

MB has reassurance from Dawn Wickham, Service Director at CSU, that the systems are in place to ensure appropriate reporting by the CSU.

AT identified that there is an additional assurance regarding planning and suggested that the report be used at FPC when the information has been received from Area Team.

AT identified that PW had previously asked what will be achieved from report and AT has added ‘Actions to Address Key Business Risks’ to ensure that issues are not missed when they have arisen.

PS suggested that further discussion could be given to the information relating to the constitution.

AT invited further questions from the Committee. MB confirmed to PW that the report does cover the areas that he needs, however, there may be occasion where Committee seek for greater detail regarding specific providers/issues.

Discussion followed regarding the consistency of reporting for a period ie, if Contracts report on Month 10, Finance and Performance reporting should also be for Month 10.

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Action

Action: MB to discuss BI with CSU MB

6. Contracts Month 10

MB presented the report to the Committee. MB highlighted some particular issues regarding Walsall Healthcare and there are challenges which MB identified will be a risk. An example of the challenge is that Walsall are not reporting on their 18 week Referral to Treatment (RTT). It is not clear whether this is because the system is not robust or for some other reason.

MH asked if there is an option to advise GPs that Walsall have issues which may prevent GPs recommending Walsall as a choice. AT advised caution that the 18 week RTT is a problem nationally and if patients are directed away from Walsall, there may an impact for other local providers.

MB confirmed that Area Team is involved with the issues regarding Walsall Healthcare. Issues identified are being addressed at CQRM which is attended by Val Jones.

PW asked what this Committee can do to support the resolution of the issues with Walsall. PS suggested that PW contact Quality Committee to identify the concerns of the CCG.

Action: PW to write to Quality Committee to raise the concerns PW regarding Walsall Healthcare

DS asked if there are mechanisms to inform other CCGs of the concerns/issues regarding Walsall. MB explained that there is a regular forum where neighbouring CCG meet to identify issues/concerns.

Addendum: JM asked for detail of the earlier discussion relating to Walsall Healthcare and suggested that a meeting between AO for the CCGs and CCG Chairs and PS suggested that the starting point should be raising the issue with Quality Committee.

7. CCG Performance Report – January 2015

AT presented the reports for CC and S&S. A remedial action plan is to be produced for West Midlands Ambulance Service (WMAS).

PW asked if there is any action that can be taken with regard to the 62 Day Cancer Waits and AT explained there is difficulty because CC and S&S are not lead providers. PW explained that he is concerned that this has been raised for some time and AT explained that he is to provide a report identifying some of the issues arising.

Concern was raised about the assurance process and the need to identify why things have not happened.

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Action

AT informed the meeting that a formal request for more information on the long waits has been made.

Action: AT to provide Committee with an update regarding WMAS AT and 62 Day Wait

Finance Report: Initial Report on Month 12 Position and Achievement of 8. Control Total

PS presented the report and shared with the Committee that the Control Total has been delivered. PS identified that this is an achievement for both CCGs resulting from hard work of the Finance Team, staff within the CCGs and members of the Committee who have repeatedly supported the work of the organisation to achieve the control total.

Action: Control Total 2014/15 news to be shared at Membership CG Boards

PW commended the CCG in achieving the Control Total and identified concern regarding lessons learned and how this achievement can be maintained. PS identified that plans will now be produced and explained that Andrew Donald was at an Accountable Officer (AO) meeting on 22/04/2015 to discuss the request from Regional Office to take forward the Transformation agenda across Staffordshire. The Regional Office have offered support of a position across the Staffordshire CCGs. The AOs will present to the Regional Director, Paul Watson on the 14 May, to identify how the challenges will be addressed.

Committee congratulated Finance and the CCG on achieving the Control Total.

15:35 Johnny McMahon joined the meeting

9. QIPP 2014/15 Programme Review

AT presented the report. AT highlighted the lessons learned from 2014/15 and a summary is provided in the Business Report. There are some delays in the milestones for 2015/16.

JM asked if the contract has been agreed with Royal Wolverhampton Trust (RWT) and University Hospitals of North Midlands (UHNM) and PS explained that there have been some recent developments with regard to UHNM which Rob Lusuardi is negotiating. PS confirmed that RWT contract is almost complete in its negotiation.

MB reported that the negotiation discussions have been co-operative with RWT and this is not reflected at UHNM.

JM highlighted that if the appropriate areas are not identified within the contracts then QIPP will not be met.

Approved – 21/05/2015 Page 5 of 7

Enclosure 15-3

Action

10. Risk Register Review

PS updated Committee:

10.1 Ref: 146 Better Care Fund PS discussed the risks around BCF and recommended that it is carefully monitored, recommending that it is included in AT business report.

Action: AT to report on BCF within the Business Report AT

10.2 Ref: 144 Integrated Community Equipment Store PS explained the history behind this risk and suggested that it be raised with his CFO colleagues.

Action: PS to raise Integrated Community Equipment Store at CFO PS meeting 24/04/2015

10.3 Ref: 140 Rowley Hall Contract MH suggested that one reason that patients choose Rowley Hall is because they first appointments are within a short time frame, whilst UHNM has unknown timescales for first appointment.

10.4 Ref: 139 Walsall Healthcare Trust This had been discussed at length in the meeting and it was agreed that it should be reviewed by FPC in September 2015.

PS identified that there are risks that are critical and that they will need to be focussed upon.

10.5 Ref: 141 Continuing Healthcare (CHC) PS updated the Committee about a piece of work by the fraud team following concerns from the Committee with regard to claims for patients who had died and/or were no longer receiving care. The work was commenced early 2015 and the report is almost complete. PS has been advised that the report identifies some difficult issues.

CCGs have been making a contribution towards a national budget to accommodate the CHC claims. CCGs have now been informed that the claims must be processed more quickly with completion within 18 months. It was previously thought that the process would take 5-6 years. Unfortunately, the additional cost will be significant and this has not been accommodated in plans. PS proposes to raise this at the CFO meeting on 24/04/2015.

Forward Plan: BCF/CHC to be an agenda item within the Risk CLM Register each month

11. Forward Plan

62 Day Wait – May 2015

Approved – 21/05/2015 Page 6 of 7

Enclosure 15-3

Action

12. Any Other Business

12.1 Report from FPC to Governing Bodies The items to be highlighted to Governing Bodies are: . Control Total . Cancer Waits . Walsall

Action: CLM to prepare report to Governing Bodies CLM

14. Next Meeting

Date: Thursday 21 May 2015 Time: 2.00 pm – 5.00 pm Venue: Boardroom, Greyfriars Therapy Centre, Greyfriars Business Park, Frank Foley Way, Stafford ST16 2ST

Approved – 21/05/2015 Page 7 of 7

Enclosure 15-4

Cannock Chase and Stafford & Surrounds Clinical Commissioning Groups Audit Committee

Wednesday 22 April 2015 1.00 pm – 4.00 pm CCG Boardroom, Number 2, Staffordshire Place, Stafford ST16 2LP

/05/2015 7 22/04/2015 2 Attendee Role Quoracy 22/07/2015 14/10/2015 09/12/2015

Neil Chambers Lay Member  (NC) CC and S&S CCGs

Paul Gallagher Chair - Lay Member  (PG) CC CCG Ruth Goodison Lay Member x

(RG) S&S CCG Lay Member S&S David Pearsall (DP) CCG Chair) Lay Member S&S Jean Harrison (JH) P CCG Lay Member Diana Smith (DS) 

S&S CCG Chair plus one Member; or

Paul Woodhead Lay Member Two Members (in the absence of  (PW) CC CCG In Attendance Representative(s) Baker Tilly  named below Internal Auditors Representative(s) CW Audit Services X named below Representative(s) Grant Thornton P named below External Auditors Claire McHugh – Executive Assistant  Minute Taker (CLM) CC and S&S CCGs Governance Manager Tracey Revill (TR)  CC and S&S CCGs Director of Finance Paul Simpson (PS)  CC and S&S CCGs Head of Governance Sally Young (SY)  CC and S&S CCGs

Representative Organisation Mike Riley Baker Tilly Avtar Sohal Grant Thornton Chris Williams Baker Tilly

Eric Talbot, Statutory and Financial Reporting Lead, attended for part of the meeting from CSU

Amended and Approved: 27 May 2015 Page 1 of 10

Enclosure 15-4

Action 1. Apologies

Caine Black John Roberts

2. Conflicts of Interest

PW declared that he is running as a parliamentary candidate.

Review: a. Minutes from Previous Meeting held on 18 March 2015 3. b. Action Points c. Committee Highlights for Governing Body

3(a) Minutes from Previous Meeting held on 18 March 2015

The venue on the minutes is incorrect, the meeting took place in the Boardroom at Number 2, Staffordshire Place.

PG applauded the prompt production of the minutes which enable the Audit Committee to function more efficiently.

13:10 Mike Riley joined the meeting

3(b) Action Points

3.2.1 Ref 19 (now 41): Apologies – Lay Member Portfolios Costings are currently being produced for the recruitment of additional lay members. SY proposed that this could be resolved by end June 2015.

3.2.2 Ref 20 (now 40): External Update – Section 19 Communications will be arranged and complete by June 2015. PS questioned why this could not be dealt with during the pre-election period.

13:13 Avtar Sohal joined the meeting

AS reported that he is not aware that other CCGs are awaiting completion of the pre-election period to complete the Section 19 action. AS/PS confirmed that the pre-election period should not prevent a communication being published.

Action: EMT to determine what information should be published SY with regard to Section 19 External Auditors to be invited to Governing Bodies. SY

3.2.3 Ref 21 (now 39): Internal Audit – Key Financial Systems The meeting took place and this action is now complete.

3.2.4 Ref 22 (now 38): Internal Audit – Benchmarking This is regarding the attendance of external auditors and the request for a benchmark to identify how our CCGs compare to other CCG. AS explained that work is being done to consider what other CCGs are doing.

Action: AS to ask John Roberts to identify a timeline for AS

Amended and Approved: 27 May 2015 Page 2 of 10

Enclosure 15-4

Action benchmarking against other CCGs

3.2.5 Ref 23 (now 37): Internal Update - Internal Audit This action is now complete: Internal Audit Plan was shared with Executive Management Team 25 March 2015.

3.2.6 Ref 24 (now 35): Internal Update - Internal Audit Plan Feedback This action is complete and comments will be reported directly to Baker Tilly.

3.2.7 Ref 27 (now 32): Audit Tracker This is now complete, CW is working on this and reporting directly to SY.

3.2.8 Ref 28 (now 31): Annual Reporting and Annual Accounts This action is complete: the document will be available on 06/06/2015 and will be published at that time.

13:25 Jean Harrison joined the meeting

3.2.9 Ref 30 (now 29): Forward Business Cycle/Plan PS/SY confirmed that further work is required on this. Discussion took place regarding whether a self-assessment has been completed for Audit Committee.

Action: CW will provide examples of templates to SY by 08/05/2015 CW New CCG Chairs to be invited to future Audit Committee – 22 July 2015 SY

3.2.10 Ref 8 (now 21): CSU Assurance Eric Talbot will be attending the meeting to identify how to provide assurance to Audit Committee.

3(c) Committee Highlights for Governing Body

Committee agreed that the template produced by TR is very useful and should continue to be used.

4. External Audit – Update

AS reported that there has been no significant activity.

5. Internal Audit – Update

The meeting moved to item 5(e)

5(e) Better Care Fund (BCF) Preparedness & Governance Process

This has been done in preparation for the risk sharing agreement that will be signed by all parties. The audit review recommendations have been agreed by Andrew Donald, Chief Officer, as lead for Staffordshire CCGs. Andrew Donald is co-ordinating a response with the other CCGs with support of Mills and Reeve Solicitors, Staffordshire County Council and their legal department.

NC asked about the risks identified on page 4 of the document (item 1.4 – Recommendations Summary) and PS explained that because this is at the early stages, issues will be addressed at the first Partnership Board on 28 April 2015.

Amended and Approved: 27 May 2015 Page 3 of 10

Enclosure 15-4

Action

MR confirmed that the information is prepared in readiness. SY confirmed that the Partnership Board must have attendance from Accountable Officer for each CCG or their named deputy plus a representative for Staffordshire County Council.

PS identified that the next BCF audit is 2016/17 and there is consideration that this should be done sooner.

Forward Plan: October 2015 – review BCF CLM

The meeting moved to item 5(f) and (g)

5(f) Cannock Chase – Information Governance Toolkit 5(g) Stafford & Surrounds – Information Governance Toolkit

MR identified that there is nothing further to add to the report. He explained that there is a minimum level 2 that must be achieved and both CCGs have achieved this.

Discussion followed regarding the ‘understated’ and it was agreed that this may be a reflection of the CCGs understanding of the audit.

JH asked for clarity regarding the ‘not reviewed’ and MR confirmed that a decision had been made internally not to review those areas.

Action: Items shown as ‘not reviewed’ should be reviewed and SY confirmed by e-mail from CCG

5(a) Cannock Chase – Draft Annual Report 5(b) Stafford & Surrounds – Draft Annual Report

CW identified that this is still draft and presented the report. Overall there is a positive opinion for both CCGs and CW invited the Committee to bring questions.

NC asked for an overview of what opinions could have been arrived at. CW identified page 4, Item 5a, paragraph 2.2. The opinions could have been identified as amber or red but it was deemed appropriate that green be awarded.

PS asked about benchmarking regarding other CCG and MR confirmed that locally both CCGs are in line but he was not able to report against national benchmarking.

CW confirmed to NC that Baker Tilly have received full co-operation from colleagues. PS asked if lay members have met with auditors independently of CCG members. This has taken place and MR confirmed that this should occur, at least, annually.

Forward Plan: May 2015 – Lay Members meet with Internal/External CLM Auditors and Counter Fraud immediately prior to the Audit Committee meeting on 27th May.

JH asked about S&S under 2.2 where a ‘however’ is identified and MR explained that it would be exceptional for recommendations not to be identified.

Amended and Approved: 27 May 2015 Page 4 of 10

Enclosure 15-4

Action

5(c) Annual Internal Audit Plan for 2015/16 – Cannock Chase 5(d) Annual Internal Audit Plan for 2015/16 – Stafford & Surrounds

MR presented the reports. Appendix A is the 3 year proposal and this will be the focus identifying the key areas for the year. Timings are proposed only. MR highlighted that the fee will require approval.

PG asked if there is a discount with respect to the fees as the auditors have two CCGs. There is a contract a contract in place which is due for renewal in two years.

CW confirmed that the assurances provided are based on a daily rate and where work can be completed across the two CCG, this is factored into the fee. CW also confirmed that the Bradford assurances are required for both CCGs.

PS confirmed that it would be expected that a tender process for internal audit would be undertaken prior to renewal of contract. PS identified that the Committee may want to consider value for money.

PS shared feedback from a previous meeting: - Appendix B needs to reflect that the 3 elements co-exist. - Procurement Audit: there are a number of substantial procurement exercises in 2015/16 and suggested that the audit should be brought forward.

MR asked if there would be additional days required, or whether the 96 days will accommodate any additional work.

Action: Baker Tilly to provide proposal regarding additional audit Baker requirements for procurement. Tilly

NC raised the issue of finances and whether there is some value to auditors providing additional support to identify areas where money can be saved. NC asked for assurance that the CCGs are working successfully across the neighbouring CCGs.

PS suggested that there may be some value to consider raising this with all of the CCGs and he will raise this with Chief Finance Officer colleagues at their monthly meeting.

PS explained that CCGs in Staffordshire have been asked to identify how to address the deficit by Dr Paul Watson, Regional NHS and Auditors may want to consider this. JH agreed that early preparation may be preferable for this situation.

SY will be reporting back to Baker Tilly with feedback from the meeting.

Action: SY to provide feedback to Baker Tilly regarding the report SY

Forward Plan: July 2015 – Consider the plan and any necessary CLM updates

The Committee agreed to approve the Annual Internal Audit Plan for 2015/16 for both CCGs subject to the amendments outlined in the feedback from the meeting.

Amended and Approved: 27 May 2015 Page 5 of 10

Enclosure 15-4

Action

6. Board Assurance Framework (BAF)

SY provided an update and reported that BAF has been to every Governing Body since January 2015. SY confirmed that all Directors are updating the BAF monthly. The control total for 2014/15 has been met and there are risks that will be adjusted to reflect this.

PW suggested that BAF001 should be updated and discussion followed regarding closed BAF and how they are monitored.

PG reported that CSU will be attending Communications and Engagement Committee on 28/04/2015 (BAF006). Concern was raised with regard to CSU delivering against plans. SY identified that there are now clear targets and milestones for CSU.

NC congratulated the CCG on achieving the BAF. SY confirmed that TR is supporting officers to own the BAF. NC/PG identified that it was agreed that risk owners will be held to account for their actions and should be invited to attend Audit to discuss their risks.

Discussion followed regarding the perceived priorities and it was agreed that Communications and Engagement has a high profile through other meetings/committees and as such, Primary Care should be addressed as a priority.

Forward Plan: July 2015 – Primary Care BAF. Lynn Millar to be CLM invited to attend and report back on BAF009 October 2015 – Communications and Engagement – CLM Lynda Scott/Charlotte Bradley

Action: SY to inform Andrew Donald that Audit Committee SY will be holding BAF Officers to account

a. Declaration of Interest Update 7. b. Gifts and Hospitality Update

7(a) Declaration of Interest Update

All declarations have been received from all the practices. Dr Anne-Marie Houlder has produced a letter to be sent to GP Practices in S&S. There has been a practise of sending out the requests quarterly but SY explained that the practicalities mean that responses are received just as requests go out again.. It was asked if the requests be sent out half yearly.

The Audit Committee agreed that requests for Declarations of Interest will be made every 6 months.

Action: NC to meet with TR to review Declaration of Interests NC/TR

7(b) Gifts and Hospitality Update

No declarations have been made since the last meeting. There is still a ‘nil’ return. It was suggested that this be done every 6 months in line with the

Amended and Approved: 27 May 2015 Page 6 of 10

Enclosure 15-4

Action Declarations of Interest.

The Audit Committee agreed that requests for Declarations of Interest will be made every 6 months.

NC expressed concern that no declarations have been made and JH asked if employees are clear what represents gift or hospitality.

8. Local Counter Fraud Specialist Progress Report

This item is carried forward in the absence of Caine Black.

PG expressed concern that representation has not been made at the Committee, particularly when there are some key matters including Continuing Healthcare (CHC).

CW reported that he had attended an Audit Committee meeting at another CCG and Paul Westwood had said that the report on the CHC had been completed . PS commissioned the report following information shared at Finance, Performance and Contracts Committee (FPC) in November 2014.

Action: SY to request the report from Paul Westwood to be shared with PS first and then distribute prior to next Audit SY Committee if available

Dependent on the outcome of the report, it may be necessary to have an Extra- Ordinary Audit Committee and SY suggested that it may be valuable to have a shared Extra-Ordinary Audit Committee if neighbouring CCGs are involved and it was agreed that this could be valuable.

MR brought to the attention of the Committee that each lead CCG will need to identify within their contracts that counter fraud arrangements should be in place. There is new guidance with regard to this. SY confirmed that detail regarding this is included within the report.

9. Audit Recommendation Tracker Update

TR presented the Tracker which is being updated monthly.

10. Annual Reporting and Annual Accounts Update

Annual Accounts submission date is lunchtime 23/04/2015. The CCGs have achieved control total for both CCGs.

PS shared some of the detail regarding end of year agreements and identified some of the legacy issues that have been resolved.

AS asked that final submissions are copied to him to ensure that compliance for submission has been achieved.

Action: PS to advise Finance to copy AS into final submission. PS

SY updated Committee on the position of the Annual Report which will be submitted on Friday 24/04/2015. The full version will be available on the website.

Amended and Approved: 27 May 2015 Page 7 of 10

Enclosure 15-4

Action

PG identified that the Baker Tilly benchmark report should be considered before submitting the Annual Report.

11. Annual Information Governance (IG) Report 2014/15

SY presented the paper for ratification. SY congratulated Clair Fleet and TR on the work that they have completed with regard to Information Governance. Unfortunately, Clair Fleet is leaving the organisation and PW extended his thanks on behalf of the Committee for all the work that she has undertaken.

Action: NC to write to Clair Fleet on behalf of Audit Committee to NC thank her for the work she has undertaken

NC asked for clarity as the numbers are the same for both CCG but it was confirmed that this is correct as the work required to deliver the target was conducted in parallel for both CCGs.

12. Continuing Healthcare (CHC) – Update

This item was addressed within item 8 of the agenda.

The meeting moved to Item 14 of the agenda

14. CSU Internal Audit Report

PS explained why Eric Talbot has been invited to the meeting. Auditors confirmed that they have not seen a report previous to this meeting.

15:25 Eric Talbot, CSU, joined the meeting

The Committee introduced themselves to ET. ET explained that both CCG are on target for submission by midday 23/04/2015. Following the year end exercise for 2013/14 lessons learned have been identified and problems overcome and there has been a much smoother process this year.

ET asked PS if he identified any issues and/or concerns. PS asked for his personal thanks to be recorded to the team for their hard work. He has identified a shift regarding the working arrangements for a much smoother process. This is testimony to the hard work that Colin Groom and his team have undertaken.

The national deadline for Service Auditor Report (SAR) report is 19 May 2015. Testing has been taking place and work has been taking place with Deloittes, issues have been identified and escalated quickly. Information is now going through the Deloitte review process and indications are that the reports will be submitted on time, if not before.

SY questioned why the deadline is so late, given that the deadline for Annual Reports is 24/04/2015. ET explained that these are national targets. SY asked how other neighbouring CCG are reporting given the target dates.

ET confirmed to PS that when Deloitte have approved the reports, they are distributed to Chief Finance Officers. PS suggested that the Annual Report should identify that when the submission was made, the information was not

Amended and Approved: 27 May 2015 Page 8 of 10

Enclosure 15-4

Action available.

MR reminded the Committee that there are some earlier reports that will be available and this may support the work that SY is doing on the Annual Report.

NC asked ET if there are any areas of Fraud that should be brought to the Audit Committee’s attention. He explained that concern has arisen because the CCG will be asked to sign off reports without full knowledge. ET explained that, to his knowledge, he is not aware of anything of concern.

Control weaknesses are also identified in the weekly report from Deloitte to CSU.

Committee noted that at the time of the meeting, the second set of SARs have not been issued and the Committee will need the opportunity to reflect on the findings.

Return on Investment – Report from the Programme Management Office 13. 31.03.15

PS presented the paper which identifies what financial benefit was achieved as a result of employing the services of those within the Programme Management Office (PMO).

PS noted that there has been some development of ideas with regard to the QIPP programme going forward. The Redesign and Transformation slide is of particular interest/value.

PS identified that the support of Patrick Butterworth has been of particular use to Rob Lusuardi to identify areas for savings etc. PS agreed that the team has been of great benefit to the CCGs.

NC confirmed that the document is a self-assessment of the work of the PMO. NC asked how the CCG will take forward this approach and are good practice/ideas and thoughts being worked through. PS explained that some of the areas are being taken forward.

It was previously agreed that there would be a number of themes identified as ‘cross economy schemes’. PS explained that some of this work will feed into this.

PG queried whether the original approval was with respect to funding the team until 31/03/2015. Martin Wakeley remains on a part time/short term basis and if the original approval was until 31/03/2015 then this needs to be reviewed.

Action: SY to check whether the approval for funding of Martin SY Wakeley was until 31/03/2015 and address if necessary

The Committee noted the contents of the report.

15. Items to Report to Governing Body

Items to be reported to Governing Bodies: • Declarations of Interest and Gifts & Hospitality - 6 month review • Systems are very positive • Receipt of the Annual IG Reports for both CCGs for 2014/15

Amended and Approved: 27 May 2015 Page 9 of 10

Enclosure 15-4

Action • Receipt of the draft Internal Audit Reports outlining ‘significant assurance’ (subject to confirmation).

16. Any Other Business

No other matters for discussion.

SY suggested that a larger venue be sourced for the May Audit Committee owing to the content of the agenda.

Action: CLM to source larger venue for Audit Committee in May 2015 CLM

17. Next Meeting

Date: Wednesday 27 May 2015 Time: 1.00 pm – 5.00 pm Venue: White Room, County Buildings, Martin Street, Stafford ST16 2LP

Amended and Approved: 27 May 2015 Page 10 of 10

Enclosure 15-5

Joint Communications & Engagement Sub Committee Tuesday 24th February 2015 CCG Boardroom, Number 2, Staffordshire Place

Present Diana Smith (DS(Chair)) Lay Member, S&S CCG Jane Cannell (JC) District PPG Member S&S Clive Cropper (CC) Practice Lead, CC CCG Paul Gallagher (PG) Lay Member, Patient and Public Involvement Tamsin Parker (TP) Head of Communications and Engagement, CSU Sally Young (SY) Assistant to Chief Executive

In attendance Laura McGarvie Executive Assistant (Minute Taker)

Action

1. Apologies Ruth Goodison Hester Parsons Steve Platt 2. Minutes of the Last Meeting –

The minutes of the last meeting was discussed and amendments were made as follows:

Page 2 – clarify the section on the myth buster and the purpose of developing this.

Page 5 – addressing the issues which we face and emphasis the challenges of the CCG

Membership Scheme – two actions missing

Transition – action?

Page 6 – dates and times of next meetings? GB members of SAS have yet to be consulted. This is due to FPC committee meeting not having time to review appropriate figures before the GB commences this will then impact on other meetings. Action – definitive email with definitive dates to be sent and send as meeting request?

3. Action List The action list was updated.

Engagement table has been raised as am item on agenda

Sian Huszaik – invite has been sent and contact made.

4. Declaration of Conflict of Interests These were distributed to those required to complete the forms that were present at the meeting. 5. Comms Update (enc04) TP gave a brief background to the report. It is anticipated that the document will form the work basis for the communications team and the committee was asked to RAG rate the document appropriately.

NHS111 and the Cancer & EoL Project have not been included as this is picked up by other communication’s team members.

The following points were noted: • This will be the action plan and form the basis of a work plan for TP/AE. • This will be a standing agenda item to each committee. • This is up-to-date as of today but priority will be given to the website and annual reports. • Page numbers to be added to document. • AE to draft impact assessment, this has to be shared with Angela Hopper for trial. AE • Remove names on the document for sharing with a wider audience, retain for C&E team. LSc agreed to share some examples. LSc

AE raised concern over the intranet site and the internal communications with the practices. Each practice now has a generic account to access the intranet site. A Red Flag highlight on internal comms was raised. TP TP would like to undertake a survey to all GP staff and CCG staff to see how they would like to be communicated with. This will allow insight into whether changes are required.

An additional column to show RAG-rated priority and timescale will be added to the document.

PG asked if information is being received back from teams and assurance gained on what outcomes have come from the actions.

Communications impact assessment for projects on implications and the likely impact on the comms plan are to be introduced. This were to be available in April but it was noted by the committee that this would be too late for this to be a deadline, and required to be undertaken sooner. It was agreed that the communications impact assessment template would be produced by AE/TP this week.

SY to take the issue of “feedback” to EMT to say that AE/TP is not receiving the information to time. SY

PG asked if the “lessons learnt from MIU” document had been completed as not seen. TP will forward a copy of this to PG. TP

Any feedback around the document to be fed back to TP.

LSc highlighted that the volume of resource needed to undertake work required. ALL She advised we need to work smarter i.e. social media uses less resource but has a big impact, and large meetings may use a lot of resource and have little impact.

2

This was noted by the committee.

It was agreed that between now and April the plan will be set up, CSU resources will be reviewed by TP/LSc and a mapping exercise will be undertaken. TP/LSc

PG asked what can be done to promote more members of the public attending the Governing Body meetings in public.AE explained a press release did go out prior to meetings. 6. Annual Report It was noted that the report action plan was brought to the last meeting.

CSU have developed a template to use for the annual report. SY asked for this to LSc be shared with the group.

Examples of stories which will be in the annual report were shared with the group.

DS asked what topics the annual report will cover this year. TP responded that there is strict guidance on what the content can contain and TP would share this TP with DS.

LSc highlighted the annual report for 2012/13 did not allow sufficient time for promoting work done and need to do more promotion for this year. This was noted.

PG noted that the CCG received criticism last year around the amount of money spent on producing a glossy style magazine for the 2012/13 annual report and what was the CCG thoughts on this year? TP responded that due to the financial situation, this will be given careful consideration. LSc informed the committee that Walsall gave a four page summary to the newspaper which was printed and sent out for residents as a supplement to the newspaper. If the newspaper format was sought then this would detail where funding and money was spent etc.

TP suggested that at the AGM we should undertake printing of the newspaper summary format and remind the audience that we have listened to their concerns from the previous annual report and AGM and that this year we have done a cheaper version of the report.

7. Annual Conference SY asked for the Comms & Engagement team to be involved in planning the event.

AE requested that a market place style to engage and promote networking. This was noted.

Stafford groups now have a script for consistent information which can be shared through different networks.

PG asked who the target audience for the conference was. AE responded that this is for both District & Network PPGs as well as Practice PPGs.

DS asked around themes. PG responded that this should be communication focussed.

3

DS asked the committee what it is that we want the PPG’s to do. PG explained we need to know what we want from a practice PPG and a network PPG, and develop an understanding of what they are, what they want to achieve, and how this will be undertaken. This was noted.

It was noted that a primary care strategy review of 7 day access was undertaken and this will be fed back into the primary care team.

Content for the event can be worked upon over the next couple of months.

The event should be a joint event so that the network PPG’s which include the voluntary sector mingle with the district PPG’s of both Stafford and Cannock. PG agreed with this concept but highlighted that the sharing of venues on an annual basis would be required i.e. Stafford this year for venue and Cannock next year for venue.

SY will lead on this and it was agreed that a separate group will meet outside this meeting to take actions forward.

8. Website

A demonstration of the new website was given and AE was thanked for her input.

Members were disappointed with the time taken to get this up and running when delivery had been promised in three months initially.

The following points were noted during discussion:

• Finishing touches are being applied and launch date is awaited. • Fewer tabs across the top and fewer clicks to find items with more simplification. • Latest news content will be updated prior to launch. • All of the links currently showing on the demo page will not be seen. • SY asked for this to go to EMT as well as come back to this committee. • When the new site is ready for launch, training can be given to a range of SY team members to upload board papers onto the site or add additional information if required. • Generic contact details at CSU for any items which require being uploaded/removed from website will be forwarded to SY. • Everyone is responsible for the ownership of the website. LSc • Press releases and meeting dates are essential to be up-to-date for website.

It was noted that the current website is still out of date, as within the news feed it still shows that UHNM is declaring a major incident. AE responded that items are not removed from the news feed as when new items are added then this would drop down.

9. Membership Schemes AE updated that at the last committee it was suggested that a re-launch of the membership schemes.

• Leaflet will be re-branded and a further print-run will be undertaken in April. • Alignment to areas of interest will be matched to those in the operational

4

plan, which will highlight any new conditions which are currently not covered or whether areas are required to be broken down further. • Database has been cleansed by a member of the CSU C&E team. • Recruitment boost required.

Clarity was sought around the newsletter? AE responded that this has been TP distributed in December. TP was asked to check whether this has been sent out in December or January. 10. Cancer & EoL PG attended event at Yarnfield which he felt was disappointing. This was to go through a document used for bidding system. It was highlighted that there is a need for patient champions to be engaged and participate in the south with more publicity. LSc will pick this up on comms for feedback. LSc

SY was disappointed to hear this news, as presentation was given to GBs which gave focus on opportunities that the programme could bring.

The following actions were noted:  AE was asked to collate responses for future engagement of members’. AE

 Website has been redesigned to separate cancer and end of life, and LSc LSc to share.

 Peter Snowdon to attend April meeting to give an update on comms & LSc/TP engagement for cancer & eol.

 LSc to find out who patient champion members are? LSc

 Arrangements for annual conference. SY 11. Draft Quality & Inclusion Report SY gave a brief background to the report and the following points were noted:

• Equality and inclusion advice has not been purchased from CSU as part of the services provided. • This requires a lot of work to be undertaken and SY asked for some help All and support for what we do and target within the communities and the staff. • The report is joint for both CCGs. • The Committee was asked for this to be signed off subject to amendments from PG. This was Agreed • Costings are being made for CSU support.

SY asked for comments to be sent by Thursday which will be included in the GB report papers which will be sent out on Thursday this week. Comms Stoke & North Staffs have undertaken training on how to use EDS with the GB Team and staff. We need to consult with our groups on EDS when hosting events. 12. Stakeholder Map AE gave a brief background to the papers.

• This is a general stakeholder map, which should be revisited for each project set. • Engagement table – this identifies difficulties as well as success. Similar

5

exercise required with all identified on the map. • Hard to quantify for degree of success if part of a campaign.

The Chair requested that this be brought back to future meeting to plot. This was Agenda agreed. 13. CCG Updates Transition –The Comms & Engagement strategy was shared. Updates will be shared electronically; the prospectus will be funded again and distributed using UHNM money. The committee responded that they were glad to hear this news. SY explained that at the Rugeley PPG meeting last week this was raised as not satisfactory.

The issue over Wolverhampton not wanting to participate in the initial prospectus was raised.. TP responded that this will be the same prospectus which will be re- delivered. Wolverhampton have developed their own newsletter in the interim which had been shared with Cannock Chase CCG practices. LSc will pick this up LSc and respond to PG out with the meeting.

Medicines Waste Campaign – this has now started and is still on-going.

360 Stakeholder Survey – there are strict guideline on who can be engaged. Agenda The CCG is on target to do this work and an update will be brought back to a later meeting 14. Strategy This was noted for information. 15. Any Other Business LMcG will be the admin support for this meeting and TP will be the strategic lead.

CC CCG Chair - JMcM is retiring as a GP and can no longer be chair of CC CCG. TP will work on comms for this on announcement of new chair. Interviews will be held after next week. TP

SAS Governing Body 17/3 – the Regional Team are hosting a workshop of Patients in Control which will be held at Beacon International Centre, Stafford and members of the Committee are invited to attend. A date has not been set for Cannock.

Innovations training programme – TP will have a place on this module.

Chase Gazette – PG asked for TP to forward emails on getting a story in the glossy magazine and will then ask to meet with the editors. TP CC Patient Network –meeting on Thursday, proposal to group that start putting a CCG questionnaire together for both CCG and network. PG is supportive of this work and volunteered to help. The questionnaire is issued once per year. This will Bench-mark what people know about the CCG. SY would like this to be issued and the results collated before the annual conference so results could be shared there. LSc asked if encouragement to respond by incentivising would be option. This would be considered.

There was no other business and the meeting was closed. 10. Date and Time of Next Meeting

Dates: Tuesday 28 April 2015 Tuesday 30 June 2015

6

Tuesday 25 August 2015 Tuesday 27 October 2015 Tuesday 15 December 2015 Times: 1.00 pm – 3.00 pm Venue: CCG Boardroom, Number 2, Staffordshire Place, Stafford ST16 2LR

7

Enclosure 15-6

Communications & Engagement Committee Meeting 28th April 2015 – 1:00pm Drawing Room, County Buildings, Stafford, ST16 2LP

Present Names Title Ruth Goodison (Chair) Lay Member (SAS CCG) Paul Gallagher Lay Member (CC CCG) Diana Smith Lay Member (SAS CCG) Sally Young Assistant to Chief Executive (CC CCG & SAS CCG) Lynda Scott Senior Partner, Communications & Engagement Service (CSU) Dawn Rayson Communications & Engagement Manager (CSU) Charlie Bradley Communications & Engagement Service Partner (CSU) In Laura McGarvie Executive Assistant, CC CCG & SAS CCG attendance

1.0 Apologies Action Jane Cannell, Hestor Parsons, Tamsin Parker, Adele Edmondson

The meeting was confirmed at Quorate. 2.0 Conflicts of Interest None to note. 3.0 a. Minutes from previous meeting held on 24th February 2015 Page 3, Item 5 - PG asked for clarity and the press release requires to go out earlier advising of the GB meetings. This was noted.

Page 6, Item 15 - Myth Buster – LSc will now deal with this and pursue.

SY asked if RG could help change the minutes from 27.01.15 – agreed.

The dates for the meetings which are proposed have changed to 20th June, 18th August, 20th October and then 15th December. The committee was asked if they are happy to approve the change of the dates. This was agreed.

The minutes were agreed as an accurate record of the meeting.

b. Action points from previous meeting held on 24th February 2015 The Action list was updated.

4.0 Communications & Engagement Re-launch DR/CB were introduced to the group and brief backgrounds to their positions were given.

SY gave thanks to the comms team for the work to date in supporting the production of the annual report.

CB gave a brief background to the presentation which was circulated and the following points were noted:

• Objectives for the next 4 months were given which included development of the team, strengthen pro-active and stakeholder engagement – this covers both internal and external drivers.

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Enclosure 15-6

• More proactive use of the media was required to be incorporated as an objective – August this was agreed. A report was asked to come back to the August meeting to 2015 monitor progress. • C&E monthly report will be produced for the purpose of this committee on a bi- monthly basis. This will be a standing agenda item on the GB meeting agenda, and go to EMT. • PGa asked for a more standard approach to press releases to be adopted for a formal response from all board members. • Programme Office to be added to structures. • Google analytics will be included in the reports and this can be tailored to specific requirements. • Campaigns will be included for awareness. Teams to provide themes. Develop a more forward view to develop with teams the important things that we can foresee happening and focussing upon for future. • Better expert patient groups required to be set-up.

• Tweet schedule would be set-up by marketing department at comms for broadcasting these awareness topics. PGa reinforced that the infrastructure

requires to be resilient as CC in last month sent out 4 tweets, SOT 44 tweets and

SAS 10 tweets of which 6 were from the latest GB meeting.

• RG noted that clearer titles were required as Conversation Stafford and Call to

Action were unclear headlines with nothing obviously clear to do with health.

• More involvement with local messages linked to national campaigns needed.

Features could be planned into papers which could be run.

• New C&E strategy required to be produced. • CB to develop the RAG rating for the plan which will be integrated into report each month. • LSc asked for co-commissioning to be added as a priority workstream, along with the relationship workings with member practices. This was noted.

Oregon – this is a project which is being rolled out across Staffordshire on scoring of prioritisation of treatments.

DR gave an overview of the media plan and the following was noted:

• More proactive messages required to be communicated along with reactive media. • Social media is not utilised as widely as it could be. • The digital landscape document will be implemented and a copy of the live link will be circulated to the committee members.

Proactive media – need to start drip feeding information more in advance to the public on DR where we are spending and investing the public money.

Media Digest – this comes out once per day providing automatic searches on different topics and it was confirmed that members could receive this. It was asked if this could be used to feed the tweets in our own version.

No stakeholder event or partnership working has been undertaken but this will commence shortly.

Half day event for stakeholders to be organised to tie in priorities and underpinning the work required to be done.

Tweets – There can be sensitivities on tweets. The Committee need to have a sense of how resources are being used and where these are in place. More contingencies to be built in for access to websites and tweeting.

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Enclosure 15-6

Stafford FM is now available on-line. CB/DR will pick this up. New magazine called “Feel Good Stafford” is also a possible link-in as delivered to DR households. DR to explore.

5.0 Annual Report This has now been submitted in draft to NHS England along with the annual accounts and annual statement for both CCGs. The annual report has been produced differently this year and starts with a public summary and has been split into nine sections. This has not been shared yet with members but SY SY will share with GB members in the next week. PGa asked if the comments had been picked up by Grant Thornton survey for 2013/14 and had these been incorporated. This has not yet been actioned but SY/LSc will relook at this LSc/SY for the next final version. The Annual Reports and Accounts will be available on the website, and a message will be displayed for members of the public to request hard copies if printing facilities to members of the public are not available. A wrap around version will developed for local newspapers which will be delivered to all households. RG asked if there was an easy read version for covering equality and diversity – LSc LSc confirmed that there will be a public summary but a proper easy read has not been devised but LSc will look into this. RG re-iterated that this would be a good equality & diversity initiative.

SY confirmed that this year’s operational plan is written in more user friendly language which has been incorporated into the report.

PGa asked if we work towards the plain English kitemark? LSc responded that the standards are checked but this is not against the kitemark.

6.0 Website Two new websites have been launched, problems have been extensive and Adele Edmondson is working through these.

Some of these problems have been links on the website that were not functioning; policies which were saved in the wrong areas and not the latest versions. Admin staff supporting each of the teams within the CCG will be responsible for the upkeep of their team pages DR and contents. Training to staff will progress shortly.

7.0 Relationships with the Press – Strategic RG asked if all the press could be negotiated with to have a monthly health matters page including the free press. LSc responded that once the planner is in place then this would be something which could be picked up on a monthly basis.

RG asked for this to be explored with the media for a monthly inclusion which would have corporate identity of blue NHS logo in messages.

DR asked if all members of the Committee had been media trained – members agreed they had been trained.

PG added that if the myth buster was produced then this could be incorporated into the articles. This was noted.

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Enclosure 15-6

8.0 CCG Updates The control total has been reached, and we are in a better place for 2015/16 than we were but were not underestimating the challenge.

9.0 Any Other Business Revised Meeting Schedule This was agreed.

Postponed District PPG SY/RG will resolve this outside the meeting.

Membership Scheme Membership scheme members asked for an update – LSc will ask Christina to do a PGa/LSc briefing paper and asked for an invite to be sent to Christine for this meeting.

Government Elections Is there a plan in place with the forthcoming elections and messages to “buy-in” newly LSc appointed councillors with the healthy campaigns? LSc will pick this up with AD.

There was no other business to note and the meeting closed.

10.0 Date and Time of Next Meeting 23rd June 2015 at 1:00pm until 3:00pm 1st Floor Meeting Room Number 2 Staffordshire Place, Stafford, ST16 2LP

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Enclosure 16 Acronyms

1. A&E Accident & Emergency 2. ADNS Advanced Diploma in Nursing Studies (UK) 3. ADP Accelerated Development Programme 4. AED Automated External Defibrillator 5. AHP Allied Health Professional 6. ALAN Adult Literacy and Numeracy 7. ALE Auditors Local Evaluation 8. ALOS Average Length of Stay 9. ANNP Advanced Neonatal Nurse Practitioner 10. AO Accountable Officer 11. APMS Alternative Provider Medical Services 12. AQP Any Qualified Provider 13. ASD Autism Spectrum Disorder 14. AVS Acute Visiting Service 15. BADGER Birmingham and District General Emergency Rooms 16. BAF Board Assurance Framework 17. BCF Better Care Fund 18. BCHFT Birmingham Children’s Hospital NHS Foundation Trust 19. BEN Birmingham East and North PCT 20. BHFT Burton Hospital NHS Foundation Trust 21. BNP Brain Natriuretic Peptide 22. BOTOX Botulinum Toxin Type A 23. BPAS British Pregnancy Advisory Service 24. C&E Communications & Engagement 25. CAG Commissioning Advisory Group 26. CAMHS Children and Adolescent Mental Health Service 27. CAS Clinical Assessment Service 28. CB Commissioning Board 29. CBSA Commissioning Business Support Agency 30. CC Cannock Chase 31. CCG Clinical Commissioning Group 32. Cdiff Clostridium Difficile Infection 33. CEO Chief Executive Officer 34. CGA Comprehensive Geriatric Assessment 35. CHAI No longer in existence 36. CHC Continuing Health Care 37. CHI No longer in existence 38. CHKS Leading provider of healthcare intelligence and quality improvement services 39. CHPP Children’s Health Promotion Programme 40. CHRT Crisis Home Resolution Team 41. CIAMs Commissioning Investment Asset Management Strategy 42. CIG Clinical Informatics Group 43. CIP Cost Improvement Programme 44. CMT Contract Management Team 45. CNST Clinical Negligence Scheme for Trusts 46. CoE Care of the Elderly 47. COG Clinical Oversight Group 48. COPD Chronic Obstructive Pulmonary Disease 49. CPAG Clinical Policies Advisory Group 50. CPN Community Psychiatrist Nurse 51. CQC Care Quality Commission 52. CQINS Cancer Quality Improvement Network System 53. CQRM Clinical Quality Review Meetings 54. CQUIN Commissioning for Quality and Innovation 55. CRL Capital Resource Limit 56. CRT Crisis Response Team 57. CSIP Clinical Services Improvement Programme 58. CSU Commissioning Support Unit Enclosure 16 59. CSW Clinical Support Worker 60. CWG Clinical Working Group 61. D&V Diarrhoea & Vomiting 62. DC Day Care 63. DCC Direct Clinical Care 64. DES Direct Enhanced Service 65. DIPC Director of Infection Prevention & Control 66. DN District Nurse 67. DoH Department of Health 68. DOLS Deprivation of Liberty Standards 69. DPA Data Protection Act 70. DPD Dental Practice Division 71. DPP Developing Patient Partnerships 72. DQF Data Quality Facilitator 73. DRS Dental Reference Service 74. DTC Delayed Transfer of Care 75. EAU Emergency Admissions Unit 76. ECDL European Computer Driving Licence 77. ECIST Emergency Care Intensive Support Team 78. ED Emergency Department 79. EDD Expected Discharge Date 80. EDS Equality Delivery System 81. EL Elective 82. EMS Escalation Management System 83. EMSA Eliminating Mixed Single Sex Accommodation 84. EMT Executive Management Team 85. ENT Ear Nose Throat 86. EOL End of Life 87. EPO Emergency Planning Officers 88. EPR Electronic Patient Record 89. ESR Electronic Staff Record 90. EWISS Emotional Well Being in Stafford & Surrounds 91. EWTD European Working Time Directive 92. F&P Finance and Performance 93. FE Frail Elderly 94. FET Funding Exceptional Treatment 95. FFT Friends and Family Test 96. FIG Financial Improvement Group 97. FIMS Financial Information Management System 98. FIT Funding Individual Treatment – now FET 99. FNOF Fractured Neck of Femur 100. FOI Freedom of Information 101. FPC Finance Performance & Contract Committee 102. FRP Financial Recovery Plan 103. GAAP Generally Accepted Accounting Principles 104. GB Governing Body 105. GDC General Dental Council 106. GDS General Dental Services 107. GMS General Medical Services (Practice) 108. GP General Practitioner 109. GPWSI GP with special interest 110. GSF Gold Standard Framework 111. HALO Hospital Ambulance Liaison Officer 112. HCAI Healthcare Associated Infections 113. HCC No longer in existence 114. HEFCE Higher Education Funding Council for England 115. HEFT Heart of England Foundation NHS Trust 116. HFMA Healthcare Financial Management Association 117. HIS Health Informatics Service 118. HOT Heads of Terms Enclosure 16 119. HPS Health promoting Schools 120. HPSS Health promoting Schools Scheme 121. HR Human Resources 122. HRG4 Healthcare Resource Group 4 123. HROD Human Resources Organisational Development 124. HSJ Health Service Journal 125. IAPT Improving Access to Psychological Therapies 126. ICG Infection Control Group 127. ICSI Intracytoplasmic Sperm Injection 128. IFR Independent Funding Request 129. IFRS International Financial Reporting Systems 130. IG Information Governance 131. IM&T Information Management and Technology 132. IP Inpatients 133. IPC Infection Prevention & Control 134. IPR Individual Performance Review 135. IQT Improving Quality Team 136. ISA Intermediate Support Assistant 137. ISFE Integrated Single Financial Environment 138. ITT Invite to Tender 139. IV Intravenous Therapy 140. IVF Intravenous Fertilisation 141. IWL Improving Working Lives 142. JCI Joint Clinical Investigation 143. JCU Joint Commissioning Unit (SCC) 144. JSNA Joint Strategic Needs Assessment 145. JSP Joint Staff Partnership 146. KPI(s) Key Performance Indicator(s) 147. KPMG Global Network of Profession Firms providing audit, tax and advisory services 148. LAA Local Area Agreement 149. LCCB Local Collaborative Commissioning Boards 150. LCP Liverpool Care Pathway 151. LDD Learning Disability and/or Difficulty 152. LDP Local Delivery Plan 153. LES Local Enhanced Service 154. LETB Local Education and Training Board 155. LH Local Hospital 156. LHE Local Health Economy 157. LIN Local Intelligence Network 158. LMC Local Medical Council 159. LMS Local Medical Services 160. LOC Local ophthalmic Committee 161. LQR Local Quality Indicator 162. LSP Local Strategic Partnership 163. LTB Local Transition Board 164. LTC Long Term Conditions 165. LTFM Long Term Financial Model 166. M&L CSU Midlands & Lancashire Commissioning Support Unit 167. MAT Maternity 168. MAU Medical Assessment Unit 169. MB Membership Board 170. MCA Mental Capacity Act 171. MCD Maximum Cash Drawdown 172. MDT Multidisciplinary Team 173. MFCA Multi Factorial Comprehensive Assessment 174. MHRA Medicines & Healthcare products Regulatory Agency 175. MICATS Musculoskeletal Integrated Clinical Assessment & Treatment Service 176. MICOT Minor Injuries Community Outreach Team 177. MIU Minor Injuries Unit 178. MLU Midwife-led Unit Enclosure 16 179. MOI Memorandum of Information 180. MORI (Market & Opinion Research International) 181. MOU Memorandum of Understanding 182. MPIG Medical Practice Income Guarantee 183. MRSA Meticillin-Resistant Staphylococcus Aureusis Infection 184. MSFT Mid Staffordshire NHS Foundation Trust (now part of UHNM as County Hospital) 185. MSK Musculoskeletal 186. MUR Medicine Use Review 187. NCAS National Clinical Assessment Service 188. NCB National Commissioning Board (now known as NHS England) 189. NCT National Childbirth Trust 190. NEDs None Executive Directors 191. NEL Non-Elective 192. NES National Enhanced Service 193. NHQAC Nursing Home Quality Assurance Group 194. NHS National Health Service 195. NHSE NHS England 196. NHSU NHS University 197. NICE National Institute for Clinical Excellence 198. NICU Neonatal Intensive Care Unit 199. NMC Nursing and Midwifery Council 200. NRPSI National Register of Public Service Interpreters 201. NSL Non Urgent Patient Transport Provider 202. NTDA NHS Trust Development Authority 203. OBD Occupied Bed Days 204. OD Organisational Development 205. OFSTED Officer for Standards in Education, Children’s Services & Skills 206. OOH Out of Hours, also Out of Hospital 207. OP (D) Outpatients (Department) 208. OT Occupational Therapist 209. PA Programmed Activities 210. PAED Paediatrics 211. PALS Patient Advice and Liaison Service 212. PASS Professional Advice and Support Service 213. PAU Paediatric Assessment Unit 214. PBC Practice Based Commissioning 215. PBR Payment By Results 216. PC Planned Care 217. PCR Patient Charge Revenue 218. PCT Primary Care Trust 219. PCTDS PCT Dental Service 220. PEAT Patient Environment Action Team (now known as Place) 221. PEC Professional Executive Committee 222. PHSO Public Health Service Ombudsman 223. PID Project Initiation Document 224. PII Period of Increased Incidence 225. PiP Partners in Paediatrics 226. PIS Prescribing Incentive Scheme 227. PLCV Procedures of Limited Clinical Value 228. PLT Protected Learning Time 229. PM Practice Manager 230. PMO Programme Management Office 231. PMS Personal Medical Services 232. POPP Partnerships for Older People Projects 233. PPG Patient Participation Group 234. PPI Patient and Public Involvement 235. PPI (prescribing) Proton Pump Inhibitors 236. PPV Post Payment Verification 237. PQQ Pre Qualifying Questionnaire 238. PRF Patient Report Form Enclosure 16 239. PRISM Personnel Resource Information System for Management 240. PROMs Patient Related Outcome Measures 241. PT Physical Therapist 242. PTL Patient Target List 243. PU Pressure Ulcer 244. PWSI Pharmacist with Special Interest 245. QIA Quality Impact Assessment 246. QIF Quality Improvement Framework 247. QIL Quality Improvement Lead 248. QIP Quality Improvement Programme 249. QIPP Quality, innovation, productivity and prevention. 250. QOF Quality and Outcomes Framework 251. QSG Quality Surveillance Group 252. QSISM Quality and Safeguarding Information Sharing Group 253. RAG Red Amber Green 254. RAP Remedial Action Plan 255. RCA Root Cause Analysis 256. RIA Risk Impact Assessment 257. RIO Electronic Care System 258. RRL Revenue Resource Limit 259. RSUH Royal Stoke University Hospital 260. RTT Referral to Treatment 261. RWT Royal Wolverhampton Hospital Trust 262. SALT Speech & Language Therapist 263. SARC Sexual Assaults Referrals Centre 264. SAS Stafford and Surrounds 265. SCBU Special Care Baby Unit 266. SCC Staffordshire County Council 267. SCIO Staffordshire Consortium of Infrastructure Organisations 268. SCR Strategic Change Reserve 269. SCWP Social Care Workforce Planning 270. SDB Service Delivery Board 271. SDIP Service Delivery Improvement Plan 272. SI Serious Incident 273. SIB Service Improvement Board 274. SIC Statement of Internal Control 275. SIRO Senior Information Risk Officer 276. SLAM Service Level Agreement Model 277. SPA Supporting Programmed Activities 278. SPEC Strategic Public Engagement Committee 279. SSHLF South Staffordshire Health Libraries Federation 280. SSOTP Staffordshire & Stoke on Trent Partnership Trust 281. SSPAU Short Stay Paediatric Assessment Unit 282. SSSFT South Staffordshire & Shropshire Foundation Trust 283. SSSHFT South Staffs & Shropshire Healthcare Foundation Trust 284. SUI Serious Untoward Incident(now known as SI’s) 285. SUS Secondary User Services 286. TDA Trust Development Authority 287. TOR Terms of Reference 288. TSA Trust Special Administrator 289. TV Team Tissue Viability Team 290. UCC Urgent Care Centre 291. UDA Units of Dental Activity 292. UHB University Hospital Birmingham 293. UHNM University Hospitals of North Midlands NHS Trust 294. UHNS University Hospital North Staffordshire 295. UOA Units of Orthodontic Activity 296. VAT Value Added Tax 297. VFM Value for Money 298. VO Variation Order Enclosure 16 299. VT Vocational Trainee 300. WCC World Class Commissioning 301. WHT Walsall Hospitals Trust 302. WIC Walk in Centre 303. WMAS West Midlands Ambulance Service 304. WMQRS West Midlands Quality Review Service 305. WMSCG West Midlands Strategic Commissioning Group 306. WRES Workforce Race Equality Standard 307. WTE Whole Time Equivalent 308. WUCTAS Wolverhampton Urgent Care Triage Access Service 309. YTD Year to Date