To: The Chairman and Members of the Scrutiny Board (Councillors Pickard, Barber, Butcher, Davis, N Dirveiks, Forwood, Fox, Freer, Johnston, Lewis, May, M Moss, Payne, Y Stanley, and Turley)
For the information of other Members of the Council
For general enquiries please contact Emma Humphreys or Amanda Tonks on 01827 719221 or via e-mail: [email protected] or amandatonks@northwarks .gov.uk
For enquiries about specific reports please contact the officer name d in the reports.
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SCRUTINY BOARD AGENDA
2 December 2013
The Scrutiny Board will meet in The Chamber at The Council House, South Street, Atherstone on Monday, 2 December 2013 at 6.30pm.
AGENDA
1 Evacuation Procedure.
2 Apologies for Absence / Members away on official Council business.
3 Disclosable Pecuniary and Non-Pecuniary Interests. 4 Minutes of the Scrutiny Board held on 16 September 2013 (copy herewith) to be approved and signed by the Chairman.
PART A – ITEMS FOR DISCUSSION AND DECISION (WHITE PAPERS)
5 Making North Warwickshire A Safer Place 2012/13 – Report of the Chief Executive
Summary
This report informs Members of the work of the North Warwickshire Community Safety Partnership and provides an update on progress since December 2012. The report also requests Members to identify any areas for further investigation by the Scrutiny Board.
The Contact Officer for this report is Robert Beggs (719238).
6 Broadband Provision Update – Report of the Assistant Director (Corporate Services)
This report provides an update on the progress being made on the provision of broadband services. Members of the Coventry, Solihull and Warwickshire (CWS) Project Team will also present a project update to the Board and take Members questions.
The Contact Officer for this report is Linda Bird (719327).
7 Health Scrutiny Update – Verbal Report by the Chairman of the Scrutiny Board.
This verbal report seeks to update the Board on the NHS Warwickshire North Clinical Commissioning (CCG) Clinical Strategy. An update will also be provided on a Memorandum of Understanding produced by Warwickshire County Council to clarify the roles between Groups and the recently ratified Protocol developed by the Warwickshire Health Scrutiny Partnership Group.
JERRY HUTCHINSON Chief Executive NORTH WARWICKSHIRE BOROUGH COUNCIL
MINUTES OF THE SCRUTINY BOARD 16 September 2013
Present: Councillor Pickard in the Chair
Councillors Barber, Butcher, Davis, N Dirveiks, Forwood, Fox, Freer, Johnston, Lewis, May, M Moss, Y Stanley and Turley.
An apology for absence was received from Councillor Payne.
7 Disclosable Pecuniary and Non-Pecuniary Interests
None were declared at the meeting.
8 Minutes
The minutes of the meeting held on 10 June 2013, a copy having been previously circulated, were approved as a correct record and signed by the Chairman.
9 Food Premises Inspections
The Environmental Health Manager gave a presentation on the Food Premises Inspections carried out by staff in his Division.
10 Progress Report on Achievement of Corporate Plan and Performance Indicator Targets April 2012-March 2013
Members were informed of the progress with the achievement of the Corporate Plan and Performance Indicator targets overall for April 2012 to March 2013. Contextual and comparative information was also provided to assist the Board in determining any requests for further reports on specific service areas.
Resolved:
That the report be noted.
11 Health Scrutiny Update
The Chairman of the Board gave a verbal update on Health Scrutiny.
4/1
12 Future Scrutiny Projects
The Assistant Director (Corporate Services) provided a draft plan showing possible items for future Scrutiny Board meetings and sought Members’ views on the plan and their suggestions for further, future topics for the Board.
Resolved:
a That the draft plan attached as Appendix A to the report of the Assistant Director (Corporate Services) be approved; and
b That a report be brought to the next meeting of the Board on the provision of Broadband.
D Pickard Chairman
4/2
Agenda Item No 5
Scrutiny Board
2 December 2013
Report of the Chief Executive Making North Warwickshire a Safer Place 2013/14
1 Summary
1.1 This report informs Members of the work of the North Warwickshire Community Safety Partnership and provides an update on progress since December 2012. The report also requests Members to identify any areas for further investigation by the Scrutiny Board.
Recommendation to the Board
a That Members note the progress with the work areas of the
North Warwickshire Community Safety Partnership; and
b That Members identify any specific work areas of the partnership for further investigation.
2 Consultation
2.1 The Chairman of the Safer Communities Sub-Committee and the Opposition Spokesperson have been consulted on this report and any comments will be reported at the Scrutiny Board meeting.
3 Introduction
3.1 The Council is required to have a Committee that scrutinises the crime and disorder work of various organisations within the Borough. The Council has decided that this Committee will fulfil that requirement and that a number of additional members will be co-opted onto the Committee.
3.2 As a result therefore the following have been added to the Committee for this item:
The Chair of the Safer Communities Sub Committee and the opposition spokesperson.
Two representatives from the partner organisations within the Community Safety Partnership.
One representative from each of the Area Fora, to represent the Safer Neighbourhoods Police and Communities Together work that takes place at these.
5/1 2013/BR/006789
Two Members from the People’s Panel.
A youth representative.
3.3 The Scrutiny Board for this purpose met last in December 2012 and this report provides an update on progress with the work areas of the North Warwickshire Community Safety Partnership.
3.4 Attached at Appendix A is a spreadsheet table recently prepared for the North … Warwickshire Community Safety Partnership on the 7 November 2013. The table provides an overview of the current position against the objectives included in the Partnership Plan prepared by the North Warwickshire Community Safety Partnership. The Partnership has been in place in its current form since 1998 and its primary aim is to Make North Warwickshire a Safer Place. The partnership includes representatives from North Warwickshire Borough Council, Warwickshire County Council, Warwickshire Police, Warwickshire Fire and Rescue Service, National Probation Trust (Warwickshire), Warwickshire Drug and Alcohol Action Team and other organisations. The Police and Crime Commissioner is also regularly represented at the partnership meetings.
4 North Warwickshire Overview
… 4.1 The table at Appendix A shows the current progress against the objectives included within the partnership plan 2013/14 of the North Warwickshire Community Safety Partnership. Members will recall that previous reports to this Scrutiny Board have highlighted some of the key challenges and issues for North Warwickshire to sustain reductions in crime and disorder.
4.2 The key challenges included reliance on use of area based grant to fund community safety partnership interventions, how best to promote our case as a low crime area competing with demands from higher crime areas, the risk of a disproportionate fear of crime within local communities, the risk from cross border offending, a significant proportion of domestic abuse within our violent crime levels and spikes in domestic burglary often spread across the Borough.
4.3 The success achieved in reducing recorded crime levels has continued in 2012/13 and the current position in 2013/14 is also on track to sustain ongoing reductions. During 2012/13 the following results were achieved:
Violent crime 12% lower with 71 less victims Domestic burglary 18% lower with 51 less victims Vehicle crime 8% lower with 51 less victims Anti social behaviour incidents 10% lower with 241 fewer incidents Overall crime 12% lower with 459 less victims 4.3 The North Warwickshire Community Safety Partnership has seen successful reductions in a range of crime types since 2006/07 with only an upturn in the 2011/12 year. In the 2011/12 year North Warwickshire's overall crime
5/2 2013/BR/006789 increased by 236 crimes to 3758, a 6.7% increase. The successful results achieved in 2012/13 have addressed this upturn.
4.4 During April to October 2013/14 recorded crime levels are showing the following position compared to 2012/13:
Violent crime 295 total to date down 4% Domestic burglary 130 total to date down 6% Theft from vehicles 215 total to date down 17% Theft of vehicles 55 total to date down 28% Anti social behaviour incidents 1299 total to date down 6%
4.5 The ongoing decreases in recorded crime are very pleasing especially considering the changes in resources experienced by all partners. The partnership is monitoring any emerging trends or spikes to ensure that appropriate interventions are put in place. For example the Borough is susceptible to cross border offenders and spikes in vehicle crime, domestic burglary can occur regularly. The Ward of Fillongley has been identified as a current hot spot area for these crime types in recent analysis prepared for the partnership.
4.6 Crime prevention measures are implemented in the areas that have been identified from analysis as being more at risk and offenders are actively monitored and subject to policing operations whenever possible.
5 Key Initiatives and successes during 2013/14
5.1 The partnership has been working on a number of key initiatives and a number of successes can be highlighted. These include the following:
Violent Crime Licensed premises which pose a problem with violent crime are monitored through a multi agency licensing group. This can lead to licensing reviews and enforcement action. Some successful impacts have been made including the revoking of a licence for a premise in Atherstone. This was an outcome of joint work with the Police and Trading Standards which identified positive test results of underage sales. There are no current hot spots identified for violent crime and the profile overall shows a high proportion of minor lower level assaults.
Domestic Abuse Support Services The county wide support services provided by Stonham Home Group are now becoming more embedded. A recent report prepared for the Warwickshire Safer and Stronger Partnership Board shows a positive number of referrals 235 (16%) being received from North Warwickshire during 2012/13.
The Early Intervention Outreach Support service provided by Families First (formally Warwickshire Domestic Violence Support Services) is no
5/3 2013/BR/006789 longer in place following the departure of the support worker to work at Hinckley and Bosworth Borough Council. A review of options for sustaining the additional locally based support is currently being carried out. Work has been carried out to ensure local agencies are aware what support is still available and to help signpost referrals appropriately.
Anti Social Behaviour The need for additional diversionary activities has reduced over the last year with only a small number of issues being identified regarding groups of young people causing nuisance. The ability to respond to any emerging problems which require diversionary activities is still available within the Community Development team. The Atherstone Skate Park project has ran successfully for over a year. The scope for ongoing provision of this facility is being reviewed. The Dob Em In scheme to help report incidents of motor bike nuisance has been promoted at our key areas. Motorbike nuisance has emerged as a significant proportion of the reported incidents of anti social behaviour. There are arrangements in place to assess the risk of vulnerability of victims to ensure high risk cases are subject to management plans and that repeated incidents are minimised. The use of mobile CCTV cameras has been enhanced with 12 additional Nomad CCTV cameras being deployed. The Nomad CCTV cameras use WiFi and 3G technology and this enables a more efficient use of Police Safer Neighbourhood teams. There are now a total of 19 mobile CCTV cameras available to be deployed. A Designated Public Places Order was implemented in Coleshill on the 7 June 2013. No incidents of note have been identified to date with the use of the order.
Serious Acquisitive Crime The partnership Special Interest Group continues to monitor and analyse any emerging trends and hot spot locations for vehicle crime, domestic burglary and robberies. Work has started to implement Automatic Number Plate Recognition cameras in key locations in the Borough. This will help tackle risks from cross border offenders. Be Safe crime prevention packs are distributed to victims of crime. The Atherstone Town Safe scheme has been successfully set up with local retailers and has achieved some notable successes with addressing shop lifting and other crimes.
Reducing Re-offending
The Warwickshire Integrated Offender Management scheme has successfully achieved reductions in reoffending rates of Warwickshire offenders. For North Warwickshire the current reoffending rates show a reduction from 23% in 2005 to 19.7% in 2010/11.
5/4 2013/BR/006789 An evaluation of the estimated cost savings from the scheme based upon a cohort of offenders shows that a cost saving of £31,622 per month can be predicted for the current 97 offenders in the scheme. The North Warwickshire IOM group meets monthly to consider the management of identified persistent and prolific offenders and emerging offenders. A recent conviction for a local Atherstone offender resulted in a sentence of 18 years for conspiracy to commit robbery. Work on rehabilitating offenders is also carried out with support available to address drug and alcohol misuse and provide assistance with housing, training and employment wherever possible to do so.
6 Summary
6.1 The North Warwickshire Community Safety Partnership has continued to achieve reductions in crime and disorder in the Borough. Successful interventions have been put in place. The partnership is facing difficult challenges to sustain the levels of reductions achieved. There are ongoing pressures with the availability of community safety grants and reductions in public sector resources. The challenge remains to ensure we can work effectively with the Police and Crime Commissioner to continue to build upon our successes.
6.2 Much of the success of the partnership has been as a result of good working relationships with the individual partners involved especially with the local Police officers and officers of the Council. A significant contribution to the work of the partnership is made by a number of Council departments including Housing, Streetscape, Environmental Health, Leisure and Community Development and Policy Support.
6.3 Members are requested to note the report and identify any areas for further investigation by the Scrutiny Board.
7 Report Implications
7.1 Finance and Value for Money Implications
7.1.1 The partnership currently receives £10,205 from the Community Safety Grant allocations for Warwickshire. During 2012/13 the partnership successfully bid for additional funding totalling £24,743 from the Warwickshire Police and Crime Commissioner Innovation Fund to help support initiatives including the Automatic Number Plate Recognition cameras, extending Town Safe Scheme, Junior Watch Scheme and a BIKE team. There are also additional allocations for county wide community safety activities totalling £399,737 and £100,734 for the other Warwickshire Community Safety Partnerships for 2013/14. The Council also contributes expenditure directly across the range of its services including for example the CCTV scheme, Community Development and many others.
7.2 Safer Communities Implications
7.2.1 These are set out in the report.
5/5 2013/BR/006789 7.3 Legal and Human Rights Implications
7.3.1 The responsibilities and duties for Community Safety Partnerships were originally specified in the Crime and Disorder Act 1998. There are a number of specific duties including the statutory requirement for the Council to work in partnership with other identified responsible authorities to reduce crime and disorder in the Borough. There have been a number of changes which have a bearing on how Community Safety Partnerships work which have been included within Section 5 of the Crime and Disorder Act 1998 as amended by section 97(3) of the Police Reform Act 2002 and section 108 of the Policing and Crime Act 2009.
7.4 Environment and Sustainability Implications
7.4.1 By working to reduce crime and disorder the partnership is contributing towards improving the quality of life for local residents, businesses and visitors to North Warwickshire. Crime levels and the fear of crime are regularly shown to be one of the most significant concerns for local residents and reductions in these will make significant contributions towards sustainable communities and help improve the local environment overall.
7.5 Risk Management Implications
7.5.1 The key risks for the partnership are identified within the strategic assessment prepared each year. The current key risks include the loss of area based grant funding, sustaining the achieved crime reductions on a downward trend, North Warwickshire being considered a lower priority area due to its low levels of crime and disorder, cross border offending particularly on vehicle crime, domestic burglary and business crime.
7.6 Equality Implications
7.6.1 The work of the partnership includes a number of activities which contribute towards equality objectives and promoting community cohesion. Some of the examples include setting up Race and Hate Crime Reporting Centres, tension monitoring, providing support services for victims of domestic abuse, intergenerational initiatives, rehabilitation of offenders and others. A more victim orientated approach has been implemented across Warwickshire for victims of anti social behaviour.
7.8 Links to Council’s Priorities
7.8.1 The Council has a priority for crime and disorder of working with the Police, Parish Councils, the community and other partners to tackle crime and anti social behaviour.
The Contact Officer for this report is Robert Beggs (719238).
5/6 2013/BR/006789 Background Papers
Local Government Act 1972 Section 100D, as substituted by the Local Government Act, 2000 Section 97
Background Paper Author Nature of Background Paper Date No 1 Robert Beggs Report to Scrutiny Board 6 6 December 2012 – Making December North Warwickshire a Safer 2012 Place 2012/13.
5/7 2013/BR/006789 NWPI Crime Stats 13/14 Baseline Target Traffic Description Action Lead Priority 12-13 2013/14 Performance Light Comments
Violent Crime overall is slightly above the projected target level. There have been 19 most serious violent crimes in Reduce violent crime Police Violent Crime 257 258 257 Green this period mainly relating to domestic violence which is 3 above the projected level.
The Early Intervention Outreach worker provided by Families First (Formerly WDVSS) is no longer in place. The postholder has left to take up a similar post at Hinkley Borough Council. Interim arrangements have been put in place to ensure local agencies are aware to help signpost people to support provided via the Reduce domestic abuse NWBC/Police/WDVSS Violent Crime 24 56 24 Green county wide arrangements. Work is underway to assess options for future local provision taking into account a report on the delivery in North Warwickshire of the county wide support services provided by Stonham. The figure of incidents shown is only for quarter 1 as the current period is not yet available.
The figure shown is the number of domestic violence offences for quarter 1. The current period figure is not Reduce repeat incidents of Police Violent Crime 24 56 24 Green available as yet. Domestic Abuse The level of repeat incidents for high risks cases for North Warwickshire and Nuneaton & Bedworth areas is currently 5.6%. Baseline Target Traffic Description Action Lead Priority 12-13 2013/14 Performance Light Comments Violent Crime overall is slightly above the projected target level. There have Reduce alcohol related been 19 most serious violent crimes in NWBC Violent Crime 261 258 261 Amber violence this period mainly relating to domestic violence which is 3 above the projected level.
The figure shown is for overall violent crimes. No significant issues have been identified during the first two quarters relating to youth related NW Reduce Youth Related violence generally. Some incidents NWBC/WCC Violent Crime 261 258 261 Amber violence have occurred involving local known offenders. Responses have been made involving both the Police and NWBC Housing to address concerns from local residents.
The number of criminal damage crimes is continuing to be below the projected target level. Nothing of significance has been NW Reduce Criminal Damage NWBC Anti-social Behaviour 225 252 225 Green highlighted during this period except for some incidents of graffitti tags highlighted as a concern in Hartshill.
The current profile of asb incidents shows motorbike nuisance in a number of locations to be the main concern. No significant issues have NW Reduce youth related anti- been identified regarding youth related NWBC Anti-social Behaviour 1137 1050 1137 Amber social behaviour asb although some damage has been experienced at Abbey Green Park and Long Street Dordon during improvement works to the facilities and play equipment. Baseline Target Traffic Description Action Lead Priority 12-13 2013/14 Performance Light Comments The level of asb incidents overall are slightly above projected target level. Some increases in motorbike nuisance across the borough have been experienced. Priorities raised by the Area Forums have included motorbike nuisance at Baddesley and Baxterley, Arley and other areas. Some spikes in motorbike and car asb incidents also seen at Bassetts Pole / NW Address alcohol related Anti-social Behaviour 1137 1050 1137 Amber A38 Island which have involved joint anti-social behaviour Policing operations with Staffordshire and West Midlands forces. Work on implementing the engineering works for the gating order at Hams Hall is underway. No significant youth related asb hot spots are emerging although some damage has been seen at Abbey Green Park Polesworth during improvement works.
Area forums have raised motorbike nuisance issues as priorities in a number of locations including Baddesley and Baxterley and Arley. Distribution of the Dob em in literature NW Address the public is targeted at any priority locations. perception of anti-social NWBC/Police/WCC Anti-social Behaviour behaviour A community door knocking project in Atherstone and Mancetter will provide some feedback on any asb issues. 650 houses were visited with 148 questionaires completed a 23% return.
Baseline Target Traffic Description Action Lead Priority 12-13 2013/14 Performance Light Comments Changes have been implemented within the Police which have lead to a role of Harm Reduction Coordinator being established. This role will NW Support and identify support the process for the risk victims of anti-social Police-SNT Anti-social Behaviour 1137 1050 1137 Amber assessment of vulnerable victims and behaviour CSP the associated case management plans. The case management meeting held in July identified more cases and a follow up meeting has been arranged for the 25 October.
Domestic burglary and vehicle crimes are continuing to be on a downward trend in the first two quarters of 2013/14. The ward of Fillongley has been identified in the recent analysis for domestic burglary, burglary other NW To sustain the reductions and vehicle crime. Follow up work with already achieved in volume Police/NWCSP Serious acquisitive crime 350 420 350 Green Neighbourhood Watch will continue to crime encourage sign up to the caps messaging scheme. The analysis shows the crimes to be spread over the ward with no street hot spot locations. Further inteligence is required on the risks of cross border offenders in this area.
Vehicle crime offences continue to be on a downward trend in the first two quarters of 2013/14. Analysis prepared NW To sustain the reductions for the period between June and already achieved in vehicle Police - SNT Serious acquisitive crime 227 284 227 Green crime August 2013 shows the ward of Fillongley as a key location. Theft from vehicles accounts for 79% of the crimes. Baseline Target Traffic Description Action Lead Priority 12-13 2013/14 Performance Light Comments
An action plan has been written and agreed by NWNWA to increase membership in target areas of low Neighbourhood Watch participation. Actions are now being worked through - a recent restructure of NHW has slowed the process There has been 113 domestic burglaries in this period. Recent analysis shows the wards of Fillongley NW To sustain the reductions and Coleshill South as key locations already achieved in domestic CSP Serious acquisitive crime 113 120 113 Green during June and August. The majority burglary of the properties were secure and forced entry was used as the modus operandi. Some increases within specific wards are shown on the quarter 2 report with Fillongley, Atherstone and Coleshill prominent. Follow up with each victim is carried out to provide reassurance and crime prevention advice. Partnership funding is providing burglary packs to all victims
There were 10 reported robberies in this period. A significant conviction of NW To monitor the 3 offenders for a robbery in Atherstone Observatory/CSP Serious acquisitive crime 10 16 10 Green developing trend of robbery in June 12 has recently resulted in them receiving long sentences including 18 years for a local offender. Baseline Target Traffic Description Action Lead Priority 12-13 2013/14 Performance Light Comments
The measure shown is the proportion (%) of offenders who re-offend. This is calculated on a rolling 3 monthly basis. Target shows a reduction against a baseline figure of 23% starting in 2005. The Integrated Offender Management Scheme continues to work on the identified prolific and priority NW To reduce re-offending CSP Offender Management 20.6 22 20.6 Green offenders. There are currently 12 north warwickshire offenders subject to the scheme. The September scorecard shows the following position 7 in the community, 3 in custody, 1 removed from scheme and 1 to be adopted. There are currently some significant issues with some Atherstone based offenders who are subject to ongoing measures.
The community door knocking project will NW To reduce the high provide some information on perception. Safe In perceptions of crime and Police Public Perception postcards have been used previously at any disorder events to help guage public perception of crime and disorder.
Hate Crime report prepared for the NW Special Interest Group shows 7 NW Supporting stronger reported hate crimes during April communities by developing to August 2013. Six relate to racial NWBC Public Perception 7 10 7 Green community cohesion hate crime offences and one measures homophobic. No repeat victims have been identied from the hate crimes overview. Agenda Item No 6
Scrutiny Board
2 December 2013
Report of the Assistant Director Broadband Provision Update (Corporate Services)
1 Summary
1.1 This report provides an update on the progress being made on the provision of broadband services.
Recommendation to the Board
That members consider the information provided by the CSW BDUK team in Appendix 1 and during their presentation and highlight any areas for further scrutiny.
2 Background
2.1 At its meeting on the 16 September members of Scrutiny Board asked for an update on and the opportunity to scrutinise the progress of the Coventry, Solihull and Warwickshire (CSW) Broadband UK (BDUK) project.
2.2 The government has made £530 million available to support the roll-out of basic broadband (2Mb) to properties with no, or very poor, provision and to help support the delivery of Superfast Broadband to 90% of properties.
2.3 An initial allocation of £4,070,000, BDUK grant, was made by the Government to the CSW sub region. Authorities were required to match fund the grant. This Council, at its Resources Board meeting in February 2013 approved the provisions of £197,868 as the match funding sought from it to help improve broadband provision in the Borough.
2.4 The contract for the provision of the fibre infrastructure was awarded to BT.
3 Report
3.1 The Briefing Note produced by the CWS Project Team and provided as . . . Appendix 1 gives an overview of the current situation. Members of the Project Team will present a project update to the Board and take members questions.
6/1 4 Report Implications
4.1 Environment and Sustainability Implications
4.1.1 The improvement of broadband services within the Borough will help support people to live, work and learn in our rural communities. The lack of adequate internet provision may affect people’s decisions to move to the area or may encourage businesses to relocate from the Borough, thus affecting the sustainability of local communities.
4.1.2 The lack of broadband provision also means people are unable to use online services and have to travel to get the services they need.
4.2 Equalities Implications
4.2.1 Poor or no broadband service can prevent people from accessing information and services resulting in them being less well informed, having fewer opportunities and missing out on more effective ways of managing their businesses, life and finances. The impact of this lack of internet service is known as the “digital divide”
4.3 Links to Council’s Priorities
4.3.1 Investment in the Broadband infrastructure in order to provide better internet services contributes directly to the Council’s priority to improve access to services.
The Contact Officer for this report is Linda Bird (719327).
Background Papers
Local Government Act 1972 Section 100D, as substituted by the Local Government Act, 2000 Section 97
Background Paper Author Nature of Background Date No Paper
6/2 Agenda Item 6
Appendix A
Briefing Note – 25th October 2013
Background
The CSW Broadband project aims to roll out a fibre network across Coventry, Solihull and Warwickshire to enable the provision of superfast broadband.
This is essential if we are to avoid a “digital divide” whereby those living in urban areas are able to achieve far higher internet connections speeds and more reliable services at lower cost than those living in the rural areas, as is currently the case. The digital divide hits particularly hard as those areas that experience poor or no broadband services are often the same areas where there is no or poor public transport, no local shop, post office or pub, and often no mobile phone signal either. In many areas 2Mbps is an aspirational speed with .5Mbps or even dial up speeds being common. This means that those living in rural areas are often unable to work remotely, to run businesses, to shop online or to do internet banking, to order prescriptions online or so many of the day-to-day activities that we take for granted in the 21st century.
The impact of the digital divide is already being felt in the local economy with people making choices about where to live based on the availability of broadband and businesses being forced to relocate so as to compete in an increasingly global economy. These issues will escalate unless addressed quickly.
CSW Broadband aims to address these issues by installing a high quality wholesale fibre network infrastructure that will enable a range of Internet Service Providers to offer broadband, telephony and other superfast-enabled packages, such as TV, gaming, telecare, business applications on demand etc.
Throughout the project the strategic ambitions have always been to:
Benefit the maximum number of citizens Remove the barrier of connectivity for businesses to do business in the sub-region Ensure a network deployment that contributes the most to the underlying fibre infrastructure across the sub-region
By not defining specific areas that the roll-out must address, the above criteria will be met and the sub-region will achieve the best value for money with the funds available CSW Broadband have contracted with BT to provide the fibre infrastructure. This consists of a fibre network that reaches from the telephone exchanges out into the communities. At the moment the copper network is distributed via cabinets that sit by the side of the road. The new network will require an additional cabinet to be placed alongside (or very close to) the existing cabinet. The old cabinets are simply a means of distributing the copper cabling to each property and then aggregating it at a central point to run back to the exchange. The new cabinets will be fed from the exchange by a fibre connection and will link to the existing cabinet so that the final part of the connection to the property is via the existing copper network.
The new cabinets will contain complex equipment and will require power and cooling and so are both larger than the existing cabinets and more complex to install.
Leigh Hunt – CSW Broadband 25/10/13 | We have done a lot better out of our procurement than many other areas. As a result of the excellent intelligence that we were able to collect through our extensive network of Local Broadband Champions we have a good understanding of the broadband challenges that are being experienced in our communities.
Because of the data we hold we did not have to simply accept what we were offered and we robustly challenged the assumptions made throughout the procurement process. As a result we were able to draw down an additional £750,000 funding, bringing the total to £14.5m
What North Warwickshire can expect from the project
Best value for money from the fibre roll-out Benefiting the maximum number of citizens in North Warwickshire for the available funds Contribute to the underlying fibre infrastructure in North Warwickshire by following BT's roll-out model Costs of deployment will be controlled through a premise cap so money will not be “burned” in expensive hard to reach places, thus ensuring the strategic ambitions are met Marketing activities to encourage high take-up which could trigger claw-back of funds for re-investment Benefit from overspill of coverage in other areas both within and outside the project area
What North Warwickshire can’t expect from the project.
To prioritise one area over another which will lead to higher costs and reduced coverage or to influence the roll-out in any way that will negatively impact the overall outcomes of the project Capital funding to be directed from other authorities in the project area To influence phasing of the roll-out
A presentation will be given to members on 2nd December which will include an overview of the project and an explanation of how the network will be rolled out.
Leigh Hunt – CSW Broadband 25/10/13 | Vision for quality: A framework for action - technical document Contents
1.0 Foreword 2
2.0 Population needs and the context for change 4
3.0 Background 6
4.0 The case for change and our proposals for the different service areas: 7
4.1 Urgent, Emergency Care and Emergency General Surgery 7
4.2 Cardiovascular disease, Stroke & TIA, Heart Failure 8
4.3 Frailty 9
4.4 End of Life 10
4.5 Mental Health 10
4.6 Dementia 11
4.7 What else we have to commission 12
4.8 Equality impact assessment of each change 12
5.0 Engagement 14
6.0 Framework for action 16
7.0 CCG Pledges 19
Vision for quality: A Framework for Action 1 1.0 Foreword
We are NHS Warwickshire North Clinical based health and social care services, in order Commissioning Group (CCG), established that patients get improved outcomes. on 1 April 2013 to commission most health In developing this strategy we have therefore services, other than primary care and agreed three key principles for commissioning specialised services, for our local population. improvements: This is our strategy to improve the quality and safety of services, provide better health • Our services should be provided as locally as outcomes for our patients and a more possible, as long as they are safe, high quality, positive patient and carer experience. meet the standards in the NHS Constitution and can achieve the best health and care We established in our Integrated Plan 2013 outcomes for our population. However, this -2016, our ambition to develop a collective Vision will not affect our patients’ rights to choose to for Quality with our 28 member GP practices, receive services elsewhere. representatives of our local population and health and social care providers. We prioritised four • Our services should be available seven days a service areas for improvement, namely urgent week and we need a plan to achieve this. and emergency care; care for those who are frail, including services for those at the end of their • It is acceptable for our patients to travel to life; dementia care; and mental health care in specialist services if the right standard of care hospital. Clinicians from our member practices cannot be achieved locally. have led this work. We recognise that commissioning can only drive We are acutely aware of the concern that has change if we define the best, safest practice for been raised on quality following the Keogh a patient pathway and then ensure that this, review and the George Eliot Hospital (GEH) being and only this, is the practice and quality we pay placed in “special measures”. Alongside this we for. The context within which we need to make have heard that the public and local GPs believe improvement is one of unprecedented clinical that we need to retain local hospital services and financial challenge for the NHS as a whole, delivered from the George Eliot site in Nuneaton (as defined in the NHS England Call to Action), if we are to attain the right access and best meet as well as a period of radical local change and local needs. They appreciate that not everything improvement for the George Eliot Hospital staff. can be delivered locally but they want a vibrant, It is clear that more of the same simply will not local, safe service that works well with local GPs, do. the more specialist hospitals, and community-
Vision for quality: A Framework for Action 2 To complete the detailed design work and then Over the next two years, we will build on what achieve the improvements we desire, we need we have already started to redesign and improve clinical leaders who can inspire improvement, services for those who are frail or who have a transparency and learning, applied with rigour mental illness or who need care for dementia. and without blame - alongside real patient engagement to shape development of the new We are committed to getting the best care that pathways. we can with the funding that is available. Only by putting patients first, working together and As a new Clinical Commissioning Group in our expecting and achieving transparency and first year of operation, our Framework for Action co-operation, can we harness all of our resources is phased so that we can ensure the right level to most effectively and efficiently deliver these of engagement in addressing the immediate improvements. priorities of urgent and emergency care first.
Dr Heather Gorringe Andrea Green Chair, Warwickshire North CCG Chief Officer, Warwickshire North CCG
Vision for quality: A Framework for Action 3 2.0 Population need and the context for change
Population needs Context for change We commission services for people living in We received an allocation of £195m for 2013/14 the two boroughs of North Warwickshire and to buy all except the most specialised services Nuneaton and Bedworth. The needs of our in hospitals, health services in the community, population, as described in the local Joint mental health services and packages of Strategic Needs Analysis and the Director of continuing healthcare. Public Health report, are summarised below: Lifestyle: we need to improve lifestyle options The George Eliot Hospital has been making to reduce smoking, increase active lifestyles and improvements to reduce mortality rates reduce obesity and alcohol consumption. The over the last couple of years. Following the annual update shows increasing prevalence in the comprehensive review of hospital quality of care last two. and treatment led by Sir Bruce Keogh, no issues needing immediate escalation or resolution Vulnerable communities: we need to reduce were identified. However, four areas were inequalities, support growing numbers of those identified for urgent action by the Hospital Trust. with physical and sensory disabilities and develop We have used this evidence to take immediate safeguarding services to best support those action to gain assurance regarding the quality involved. of care this year and to inform this strategy. As Ill health: we need to change services to address well as this, the Hospital Trust has identified the growing number of people with one or more the need to secure a partner through either a long term conditions. franchise arrangement or working with another provider to secure long term clinical and financial Mental well-being: the positivity indicator sustainability. from last year’s Quality of Life Survey shows that eight of the 11 areas with the poorest positivity The area served by Warwickshire North CCG has in Warwickshire are in our CCG area, although historically seen a number of financial challenges Nuneaton and Bedworth also had some of the with respect to healthcare funding and costs for best scores. care continue to grow year on year. With the Children and young people: we need to scale of the national economic challenge, we improve educational attainment and outcomes do not expect that our financial allocation will for looked after children. improve for the foreseeable future. Therefore, we Old age and frailty: needs are increasing with are focused on making the most of our financial the ageing population. More timely access to resources to ensure that our population has high treatment and support can help keep people quality healthcare. However, we need to be clear independent longer and be less costly. Dementia that we may need to make some tough decisions is forecast to increase significantly over the next if we cannot afford all of the improvements to 25 years and this is mainly, but not exclusively, which we aspire. related to old age.
Vision for quality: A Framework for Action 4 We have developed our Vision for Quality with full engagement of our 28 member GP practices, through a range of discussions with members of the public and representatives from local voluntary organisations. We have also conducted two patient surveys specifically on stroke rehabilitation and urgent and emergency care. More than 250 individual comments from the public and 450 comments from voluntary sector representatives have been collated and analysed to inform the Vision for Quality on “What’s working well?” “What’s not working well?” and “What’s important for the future?”
Area covered by Warwickshire North CCG. Allocation in 2013/14 c£195m
Austrey Staffordshire Warwickshire North CCG
Warton Atherstone Leicester General Hospital Polesworth Leicestershire Nuneaton
Dordon Coleshill Heart of England Bedworth Middleton Atherstone NHS Foundation Trust Birmingham Kingsbury Birmingham Children’s Hospital NHS Foundation Trust Coventry and Rugby CCG Coventry Solihull University Hospitals Coventry and Population: 62,014 Warwickshire NHS Trust Rugby Nuneaton Kenilworth
Royal Leamington Spa Coleshill Population: 125,252 Henley in Aden Warwick Southam
Great Corley Bedworth Stratford upon Avon Northamptonshire Packington Alcester
South Warwickshire CCG
Shipston on Stour Oxfordshire
Gloucestershire
Vision for quality: A Framework for Action 5 3.0 Background
We should feel proud of our local NHS as • more people are living longer with more thousands of people get a high quality, effective complex conditions; service free at the point of delivery every day. However, we know that there are times when • increasing costs of service provision whilst the service is not good enough and sometimes it fails in doing the best for our patients. We will • rising expectations of quality of care and not tolerate these failures and will commission patients’ increasing expectation in terms of services that are safe, provide the best outcomes choice and living independently for as long as and can continue to improve as the standards of possible; service evolve. • systemic fragmentation between services We are committed to obtaining the best care we persists, although the issues have been known can for our patients, with the funding we have and available. We want to avoid wasting resources as this will impact on the services we can buy • building support for self-management of more for others. As your local NHS we have to make chronic and long term conditions, rather than evidence-based decisions with you, about what the paternalistic medical models of care. will improve your health outcomes and what will not. Here in Warwickshire North, in addition to the above challenges, we have a population What is clear from developing our strategy is that suffering from significant inequalities more of the same simply will not do. We need neighbourhoods. to think and commission differently if we are to secure safe, modern, high quality services and There is a difference of 11 years life expectancy healthcare as locally as possible. for men and seven years life expectancy for In developing our strategy we needed to women between the best and worst areas. We understand the changing context within have a population that is served by too few GPs which we are trying to secure the best for our and a small local hospital that is looking for a population, so that we could assess whether the partner in order to secure long term viability current services we are commissioning remain and, as of mid-July 2013, is in special measures appropriate or not. following the Keogh review.
We face a number of challenges: Our CCG Integrated Plan sets out the need to develop a vision for quality in four priority areas: • accelerating advances in medical science which mean that treatments are improving and • Urgent and emergency care, including acceptable standards are continuously evolving; emergency general surgery, Stroke services and Cardiovascular Disease • increasing evidence that for some conditions better outcomes are achieved by having a • Frailty, including when people come to the End smaller number of more specialised services; of Life
• medical workforce challenges for GPs and • Dementia hospital doctors; • Mental Health in hospital
Vision for quality: A Framework for Action 6 4.0 The case for change and our proposals
4.1 Urgent and emergency care - The case for change
The demand for urgent and emergency care has Public confidence in alternatives to A&E changed. The public told us that there is confusion and a There has been a growth in the number of people lack of awareness and/or confidence in telephone using the services alongside an increase in the advice. This results in confusion in how to access number of GP consultations. Local evidence the right services quickly and there is no standard shows just over 46,000 people attend the George service offering clear information to support Eliot Hospital (GEH) A&E in a year and around patient choices. 10,000 attend University Hospitals Coventry and Warwickshire NHS Trust (UHCW), with a small The 111 service launched in April has not number attending Leicester and Heart of England achieved its aim of making the system simple and A&E departments. 49% of A&E attendances able to guide good choices. at GEH could have been treated in a different setting. The Royal College of Emergency Medicine Some services difficult to deliver in smaller has identified that primary care centres, hospitals co-located with emergency services could There is increasing recognition that some services manage 15% to 30% of existing workloads. may be difficult to deliver in smaller centres. New local standards have been agreed for Workforce challenges alongside 24/7 working emergency general surgery across Coventry and Nationally, it has been identified that there Warwickshire providers with the aim of ensuring is a challenge in the number of emergency consistent standards of care. Audit against these consultants or middle grade doctors available is yet to be completed. and the latest national evidence shows a clear need for the involvement of senior doctors in Higher mortality rates at weekends acute services 24 hours a day, seven days a week. Across England there are higher mortality rates at The Keogh review at the George Eliot Hospital weekends for those admitted as an emergency. identified a need for some improvements in The Keogh desktop review identified some higher clinical cover out-of-hours and a need for a mortality rates for emergency medical admissions robust plan for seven day working. at the George Eliot Hospital.
Variability of experience in primary care both in and out-of-hours Members of the public and voluntary agencies described variability in primary care and variability of expectation of services. There is also a lack of continuity of handover between primary care in and out-of-hours, both nationally and locally. •
Vision for quality: A Framework for Action 7 Our proposals for improvement • Lead the design of a 24/7 urgent and emergency care service specification located on the George Eliot Hospital site that better meets the needs of patients, sustains high quality services that are able to accommodate future changes in demand and provides an opportunity for training and development in a multi-faceted urgent and emergency care service.
• A single point of contact for all urgent and emergency attendees on the GEH site that streams patients to the most appropriate urgent or emergency team.
• A 24/7 general medical service; this would bring together the walk-in element of the service currently provided at Camp Hill GP Led Health Centre (without affecting the core GP and other services) and the current out-of-hours service provided at GEH.
• Medical assessment services designed for those who are frail or who need a complex medical assessment, and links with community health and social care.
• Ambulatory services for those who don’t need admission.
• Acute psychiatric liaison and assessment.
• An A&E service for those who need this.
• Ensure that any emergency general surgery services provided at the George Eliot Hospital are part of a clinical network, so that services can be retained locally over the longer term should that be the right thing to do.
4.2 Cardiovascular disease, Stroke & TIA, Heart Failure
• Nationally, more people are surviving heart • Elements of the new stroke services do not attacks and heart disease as treatments meet the latest best practice standards e.g. improve - placing greater demands on acute fewer people are on the stroke register than and primary care to support chronic illness. expected; outcomes for patients are not currently available collectively; some stroke • Locally, there are high numbers of people services are led by stroke specialists but not whose lifestyle means they are at greater risk always provided by them. of cardiovascular disease due to smoking, obesity, inactivity and alcohol consumption. • Locally, there is no pathway in place for heart • failure services and there is a lack of cardiac • There is under-diagnosis or under-reporting rehabilitation for those with heart failure. of cardiac heart disease in primary care in our population.
Vision for quality: A Framework for Action 8 Our proposals for improvement
• Improve the identification of patients at risk of cardiovascular disease, improve primary and secondary prevention and develop a pathway for heart failure including cardiac rehabilitation services that build on the existing community gyms and provide some specialist services and support when required.
• Commission Transient Ischaemic Attack (TIA) services from a provider of specialist stroke care and commission additional stroke rehabilitation services in the local area.
4.3 Frailty and long term conditions - The case for change • Over the next 20 years, the number of people • Attendance at A&E is associated with the aged 85 and over is set to increase by two- higher likelihood of admission for older people thirds, compared with a 10% growth in the and they are likely to stay in hospital longer. overall population. • Commissioning evidence-based integrated • Recent reports from Patients UK, the Care health and social care teams will help to deliver Quality Commission, the National Confidential safe, effective and high quality holistic care for Enquiry into Patient Outcome Death frail people. (NCEPOD) and the Health Service Ombudsman • Over the last three years there has been highlighted that there are major deficiencies significant growth in emergency admissions to in the care of older people in acute hospitals, the George Eliot Hospital from residential ranging from issues around privacy to homes, and there has been a general increase preoperative care. in more frail, elderly people arriving in A&E.
Our proposals for improvement
• Identify the frail and elderly who are most at risk and co-ordinate their care more effectively by commissioning integrated health and social care teams and additional geriatrician care, both in and out of hospital.
• Design integrated health and social care teams to work with the hospital.
• Design integrated health and social care teams to work in the community.
Vision for quality: A Framework for Action 9 4.4 End of life care - The case for change
• Locally, we have fewer people on end of life • The public has asked for better information to care registers than expected. help people to make choices and be fully • Nationally, it is estimated that whilst a number involved in planning early enough to ensure of patients express a wish to die in their place the individual has the best chance to of choice, only a small proportion actually participate. achieve this. • The public and clinicians have highlighted the • Clinicians have told us that we need to improve role of carers and their part in supporting training and literature on end of life, and people to live and die in their place of choice training for professionals on communicating which must be valued and supported. Formal with people when they or their loved one are health and social care services need to better in their last year of life. empower carers.
Our proposals for improvement
• Continue the work we started this year on identification of people in the last year of life, supporting more people to die in their place of choice with better co-ordinated services.
• Ensure that the integrated health and social care teams support this co-ordination.
4.5 Mental Health - The case for change
• Locally, GPs are unclear of how the mental • There are insufficient diagnostic services for health service clusters operate. adults presenting with autism.
• There is no local community eating disorder • Gaps have been identified in mental health pathway. promotion messages to support people living well when they have low level mental health • The transition for adolescents from Child and needs. Adolescent Mental Health Services (CAMHS) into adult services is poor.
Our proposals for improvement
• Continue to mobilise improvements being led by the Arden-wide clinical commissioning reference group to ensure GPs understand the system and the other points made above better, as progress appears too slow.
• Ensure that as part of our urgent and emergency care services, we build on the work commissioned from the Arden Mental Health Acute Team (AMHAT) to improve access to mental health services.
Vision for quality: A Framework for Action 10 4.6 Dementia care - The case for change • There are estimated to be around 4,143 people • Carers identified a network of service offerings living with dementia in the North Warwickshire from health, social care, benefit agency and CCG area, with only 1,345 already with a voluntary agencies, but no-one providing diagnosis. co-ordination.
• Care for people with dementia in hospital • Specific concerns were raised about potential settings remains a challenge. Carers sometimes risks to the Phoenix Group, however, on find visiting times too restrictive and care investigation, it was confirmed that homes sometimes have problems with “This is me” records not being used whilst people are in hospital.
Our proposals for improvement
• Improve diagnosis and post-diagnosis support for patients with dementia, utilise the Arden Mental Health Acute Team (AMHAT) more effectively so that needs are identified at emergency attendance/admission and work with social care and health colleagues to improve care co-ordination in integrated teams once in place.
Vision for quality: A Framework for Action 11 4.7 What else we have to commission to achieve the improvements
The scale and pace of change that we want to achieve will require us to commission providers differently, and we believe there are two key changes needed to what we do now:
Our proposals for improvement
• Commission greater clinical networking across hospital providers, as this will allow us to achieve our ambition of keeping services local where they are safe and deliver the right standard of care. For hospital services, we propose to facilitate a series of clinical discussions, specialty by specialty, about how we achieve the best clinical networks that can sustain local services where it is safe to do so. Our focus is on getting the right outcomes for patients and carers, which will have an impact on healthcare providers, but not be driven by the providers’ needs.
• Explore fully the opportunities we have to use different commissioning and contracting arrangements to get the greatest health improvements for our population with the funding we have available. Other commissioners use “prime contractor”, “integrated care” and “year of care” arrangements in order to innovate and to share financial risks so that care is optimised.
Although we have not explored children’s services as part of our main developments, we also need to oversee the final implementation of the new paediatric assessment service at the George Eliot Hospital, then explore how the additional doctors and specialist nurses can best benefit our most needy children in the community and primary care.
4.8 Equality Impact Assessment
An equality impact assessment for each of the improvements has been completed and action plans are being completed as part of the CCG’s revised Equality, Diversity and Human Rights Strategy and Equality Delivery System to be presented to the Governing Body in November 2013.
Vision for quality: A Framework for Action 12 5.0 Engagement - How did we engage and with whom?
Patient and public feedback More than 250 individual comments were collated in response to the questions: what’s We undertook two patient surveys, one on stroke working well? what’s not working well? and rehabilitation and one on urgent and emergency what’s important for the future? Output of this care, which were both publicised, made available feedback has been fed into the commissioning online and sent to GP practices. In addition, for intentions for the Vision for Quality. stroke, we distributed the surveys via the Stroke Association and local support groups. For urgent and emergency care, we carried out the survey Voluntary sector feedback We held a voluntary sector workshop on 19 June in public places in Nuneaton and Bedworth and 2013 and the day was attended by more than 60 North Warwickshire. individuals representing 44 organisations. At this event our GPs, staff and partners from the county On 29 April 2013 the CCG held a patient council also facilitated four tables on the topics of workshop event at Bedworth Civic Hall for mental health, dementia, stroke and frailty. members of the Patient Reference Group, Healthwatch and core members from the More than 450 individual comments were voluntary sector such as Warwickshire Race collated in response to the questions: what’s Equality Partnership. The event was attended by working well? what’s not working well? and 30 people and provided a valuable opportunity what’s important for the future? to listen to people’s views and experiences on end of life, urgent and emergency care, dementia At both events attendees had the opportunity of and stroke. Each workshop was led by a clinician sitting on two out of the four facilitated sessions. and a facilitator who gave an overview on each subject before inviting attendees to give their views.
Copies of patient packs from the workshop were sent to all 28 GP practices and additional feedback was gathered and fed in to the clinical strategy.
Vision for quality: A Framework for Action 13 GP feedback • Dr Andrew Arnold (Medical Director GEH) The CCG held 12 fortnightly clinical sessions • Debbie Martin (Locality Manager, Rural North with representatives from its GP practices. Warwickshire, South Warwickshire Foundation Information packs on the respective clinical areas Trust) were sent out to each of the 28 practices prior to the clinical sessions. Each of the eight service • Katie Herbert (Dementia Commissioner, areas were considered at the sessions with some Warwickshire County Council) discussed on more than one occasion. Some were used as consolidation sessions to ensure all • Dr Sharon Binyon (Medical Director, Coventry representatives were in agreement with the key and Warwickshire Partnership Trust) messages. • Dr Rob Holmes (Associate Medical Director, At the sessions, where it added value to the Coventry and Warwickshire Partnership Trust) debate, we had visiting speakers to give expert and Dr A Atta (Associate Medical Director, input which included: Coventry and Warwickshire Partnership Trust) • Professor Matthew Cooke (Professor of Clinical Systems Design at the University of Warwick) Provider trusts The CCG chief officer and chair have met with • Mr Martin Lee (Medical Director, NHS England, chief executives and medical directors from our Arden Area Team) respective providers on a number of occasions to brief them on the work of the clinical strategy. • Bie Grobert (General Manager, Integrated This includes GEH, UHCW, SWFT and Coventry Adult Services North and East, South and Warwickshire Partnership Trust. Warwickshire Foundation Trust) In addition, lead managers and medical staff from • Wendy Hampshire (Locality Manager, the providers attended an urgent and emergency Nuneaton and Bedworth, South Warwickshire care workshop in June 2013 to discuss the Foundation Trust) proposed model.
Vision for quality: A Framework for Action 14 6.0 Framework for action
We have to prioritise our actions to make sure • embedding and building the capability of that we get the right people involved in agreeing the CCG, as a new collective commissioning and making the improvements we want, most membership organisation. of which involve many organisations currently operating separately. We need to make these improvements with our current funding as there is no new funding In addition, Warwickshire North CCG is a available for health. Therefore, we need to make relatively small Clinical Commissioning Group and efficiencies so that we can afford improvements, a significant amount of our resource this year has new drugs and other technologies that are necessarily been focused on: known to deliver better outcomes.
• getting the strategy right with full engagement At this time, social care funding is also under of member GP practices, stakeholders and pressure and none of us know yet the full impact public representatives; of the recession and the welfare reform on our communities and third sector organisations. • achieving assurance that the care our patients receive at the George Eliot Hospital is of the Table 1 below sets out how we will involve our right quality in light of the Keogh review; and partners and the public in this final draft report.
Table 1 September 2013 Action Purpose
1 September Final draft report sent to key partners, Comments back by 16 September commissioners and providers requesting comments
2 September Report back to CCG Public and Patient Group
5 September Discussion at local Health and Wellbeing Group Comments back by 16 September
13 September Discussion with MPs Briefing on the proposed improvements
25 September Introduction at Health and Wellbeing Board Discussion on commissioning intentions November 13
26 September WNCCG Governing Body meeting Agree the Vision for Quality and Framework for Action
31 October Public and voluntary sector event Share plans for improvement
Vision for quality: A Framework for Action 15 Chart 1 below shows the next steps in four main areas in order to prepare to implement changes in four key work streams up until the end of March 2014, and in the first few months in 2014/15.
Chart 1
By December 2013, it will be clear if any formal public consultation is necessary. We will engage the public, patient representatives and key stakeholders in our discussions and proposed changes and ensure that we meet our duties to undertake formal consultation where this is required.
Vision for quality: A Framework for Action 16 Year 1 Year 2 Year 3
A&E A&E A&E
• Implement U&E model of care, dependent on option chosen through Options • Continue with further implementation • Further implementation of U&E Appraisal. of urgent and emergency model of model of care (consider capacity • CCG to be part of retender for 111 and out of hours taking model into account. care. in mental health, community • Design and implement a patient education programme. and social care teams).
Emergency General Surgery Emergency General Surgery Emergency General Surgery
• Develop formal clinical networking arrangements for Emergency General • Implement formal clinical networking • Further implementation of U&E Surgery. arrangements for Emergency General model of care (consider capacity • Publish first Annual Report for Emergency General Surgery. Surgery. in mental health, community and social care teams).
Cardiovascular Disease, Heart Failure, Stroke, TIA Cardiovascular Disease, Heart Failure, Stroke, Cardiovascular Disease, Heart TIA Failure, Stroke, TIA • Maintaining the provision of NHS Health Checks in all GP practices in • Ensure workforce to deliver the pathway • Commission Community Warwickshire North, targeting specific groups. is sustainable and integrated across Rehabilitation Service. • Improve Quality of Outcomes Framework performance against relevant community and secondary care. indicators, especially blood pressure. • Procure a cardiac rehabilitation service. • Agree and implement a heart failure pathway. • Commission more lifestyle management • Standardise referral pathways and referral forms (for the heart failure pathway) if necessary. to improve the quality of referral through the GP pathway system. • Commission Early Supported Discharge • Ensure the echo waits are reduced to two weeks in line with NICE guidance. service. • Production of an annual report by the stroke and cardiology service at GEH. • Design Community Rehabilitation • Public Health to ensure sufficient capacity in lifestyle management to meet Service. increased demand. • Improve identification of patients at risk of cardiovascular disease and stroke. • Production of cerebrovascular disease annual report. • Receive first cerebrovascular disease annual report. • Centralise treatment of transient ischaemic attack patients at UHCW. • Design Early Supported Discharge Service.
Frailty Frailty Frailty
• Implementation of integrated working between health, social care and voluntary • Receive inaugural Annual Plan for Frailty. • Teams working as a cohesive sector. • Geriatricians working in the community unit around the patient and • Training plan for nursing homes, linking with community team training. and linking directly with primary care. across primary and secondary • Implementation of Specialist Medical Assessment Team (Frailty) in Urgent care. Care Centre. • Appointment of geriatricians.
End of Life End of Life End of Life
• Implement risk stratification and prognostic indicator tools in GP practices to • Increase the number of patients on • Further improve integration identify people at risk of dying in the next year. palliative care registers to 0.8% per between primary, community • Develop information to support clinicians to have end of life care and DNACPR practice. and secondary care to identify discussions, including cardiopulmonary resuscitation. • 80% of patients on the palliative care patients in hospital who wish • Increase in number of patients on palliative care registers to 0.4%. register will have their preferred place of to die in their usual place of • Improved integration between primary, community and secondary care to care identified and recorded. residence. identify patients in hospital who wish to die in their place of residence. • Improved communication between • Ensure each patient on the register has a care plan for their last year of life primary and secondary care DNACPR and a record of the plan is on EPaCCS. procedures. • Commence phase one of implementation of EPaCCS. • Further improve integration between primary, community and secondary care to identify patients in hospital who wish to die in their usual place of residence. • Complete implementation of EPaCCS.
Mental Health Mental Health Mental Health
• Improve communication across primary and secondary care (via CQUIN). • Improved co-ordination of patients with • Improved local Eating Disorder • Implementation of one referral point into the Partnership Trust which also dual diagnosis. Service via NHS England. provides urgent specialist advice for GPs from a psychiatrist. • Capacity and demand exercise for • Improved support to GPs to • Arden Mental Health Acute Team working as a part of the UCC. Arden Mental Health Acute Team. enable improved management • Consider all providers in pathway development including voluntary sector of eating disorders. and produce clear information for patients and carers.
Dementia Dementia Dementia
• Agree and implement a pathway between health, social care and voluntary • Robust post-diagnosis support in place. • Review services against sector, publish on dementia portal. • Increase in Admiral nurses/dementia population need. • Agree CT scan pre-referral as one stop shop. advisors as part of community teams. • Increased identification of dementia in primary care and acute via DES and CQUIN. • Review access to services to ensure • Development and use of dementia information pack. equality of access. • Map capacity of Arden Mental Health Acute Team (AMHAT) to support patients admitted to hospital who have dementia.
Vision for quality: A Framework for Action 17 CCG Pledges 2014-2017
1. Urgent and Emergency Care and Emergency General Surgery Patients will be able to access the right professional for their needs in a timely way. We will, in collaboration with acute, community, out of hours and social care providers, and with engagement of the public, design an Urgent Care Centre, located on the GEH site, which will be co-located with A&E.
We will work with our patients to ensure they are clear about the available services and how to access them, and we will ask them to ensure they only access these services when they are really needed.
2. Emergency General Surgery We will ensure that emergency general surgery for our patients is carried out in a hospital which can provide safe and effective care as defined in the new standards adopted.
3. Cardiovascular disease We will ensure that our patients who are at risk of developing cardiovascular disease are identified and offered lifestyle management services.
We will commission a cardiac rehabilitation service for our patients with heart failure to ensure they have the best chance of a full recovery.
4. Stroke services We will commission our acute stroke services from a specialist centre where care is safe and effective, in line with regional guidance. We will ensure that, following treatment, patients are provided with appropriate levels of rehabilitation to ensure their on-going recovery and independence as close to home as possible.
5. Frailty We will ensure that our frail patients have access to geriatricians who will work closely with community teams and social care teams coordinating and supporting care at home and hospital if needed.
6. End of life care We will ensure our patients who are approaching the end of their lives are identified and offered a holistic assessment. We will work with them and their families to ensure that our planning gives them the best opportunity to die in the place of their choosing.
7. Mental health We will ensure that our patients who are admitted to hospital with a mental health problem are supported by the Arden Mental Health Acute Team and linked in with appropriate services when necessary
8. Dementia We will ensure that our patients who are diagnosed with dementia are provided with effective and robust post-diagnosis support including information and access to dementia advisors.
Vision for quality: A Framework for Action 18 This document is part of the Warwickshire North Clinical Commissioning Group’s Vision for Quality clinical strategy.
The Vision for Quality clinical strategy is formed of a series of chapters:
• Vision for Quality - provides a general overview of the strategy • Engagement - which provides an overview of the work we have undertaken to discuss and be informed by the views of the public, patients and clinicians
These are supported by a series of chapters that provide more detailed information on the individual health service areas:
• Urgent, emergency care and emergency general surgery • Cardiovascular disease, stroke, transient ischaemic attack and heart failure • Frailty • End of life • Mental health • Dementia
Vision for quality: A Framework for Action 19 Address: NHS Warwickshire North CCG Room 1 Lewes House College Street Nuneaton CV10 7DJ
Tel: 02476 865243 @ Email: [email protected] Web: www.warwickshirenorthccg.nhs.uk