SWBCCG Board Meeting Action Register Wednesday 2Nd July 2014

Sandwell and West Birmingham Clinical Commissioning Group Governing Body Meeting Date: Wednesday 2nd July 2014 Time: 12.30 pm-15.20

Venue: Kingston House Room: Lancaster Suite, Carters Green

AGENDA Non-Confidential Item Subject Lead Time INTRODUCTION 1. Apologies for Absence Verbal Dr N Harding 12.30

2. Declarations of Interest Verbal Dr N Harding 12.35

To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item.

3. Minutes of Previous Meeting held on 4th June Enc 1 Dr N Harding 12.40 2014 4. Action Register Enc 2 Dr N Harding 12.45 5. Chairman’s Report Verbal Dr N Harding 12.50 6. Questions from the Public Verbal Dr N Harding 13.00 7. Performance 7.1 Quality and Safety Committee Report Enc 3 & 3a Dr Mukherjee 13.05 7.2 Finance Committee Report Enc 4 J Green 13.15 7.3 Performance Report Enc 5 J Green 13.25 7.4 Partnership Committee Report (bi-monthly) Enc 6 Dr Andreou 13.35 7.5 Strategic Commissioning and Redesign 7.6 Committee Report (no meeting) 7.7 Audit and Governance Committee Report (no meeting) 7.8 Organisational Development Committee Report (no meeting) 8. Governance and Business 8.1 Urgent Care Enc 7 Dr S Bath 13.45 8.2 Falls Review Enc 8 C Parker 13.55 8.3 Corporate Objectives Enc 9 (to follow) A Williams 14.05 8.4 Co commissioning Enc 10 A Williams 14.15 8.5 Continuing Healthcare Data Review Enc 11 R Thompson 14.25 8.6 Sign up to Safety Letter Enc 12 Dr N Harding 14.35 8.7 Declaration of Interest Register 2014/15 Enc 13 C Parker 14.45 8.8 Referral to Treatment Verbal J Green 14.55 8.9 Safeguarding Children Update Enc 14 G Kelly 15.05

9. Minutes of Committees for Information (All minutes available on CCG Website) 9.1 Finance and Performance Committee Minutes To follow All 15.15

9.2 Quality and Safety Committee Minutes Enc 15 9.3 Partnership Committee Minutes (no meeting) 9.4 Strategic Commissioning & Redesign (No Meeting) 9.5 Audit and Governance Committee Minutes (No Meeting) 9.6 Organisational Development Committee Minutes (no meeting) 10. Minutes of Locality Commissioning Groups for Information 10.1 Sandwell Health Alliance LCG Enc 16 10.2 Pioneers for Health LCG Minutes (None Ratified) 10.3 HealthWorks LCG Minutes Enc 17 10.4 Black Country LCG Minutes (No meeting) Enc 18 10.5 ICOF LCG Minutes Enc 19 11. ANY OTHER BUSINESS

12. DATE AND TIME OF NEXT MEETING Wednesday 6th August 2014 CLOSE OF MEETING 15.20

Resolution adopted from the Public Bodies (Admission to Meetings) Act 1960:

That those representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.

Guidance on Declarations of Interest

Definition of Interests

A Governing Body/Committee member has a personal interest if the issue being discussed at a meeting affects the well being or finances of the member, the member’s family or a close associate more than most other people who live in the area affected by the issue.

Personal interest are also things related to an interest the member must register such as outside bodies to which the member has been appointed by the CCG or membership of certain public bodies.

A personal interest is also a prejudicial interest if it affects the finances of the member, the member’s family or a close associate and which a reasonable member of the public with knowledge of the facts would believe it likely to harm or impair the member’s ability to judge the public interest.

Declaring interest

If a member has an interest, they must normally declare it at the start of the meeting or as soon as they realise they have the interest.

If a member has a personal and a prejudicial interest, they must not debate or vote on the matter and must leave the room.

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Minutes of the Governing Body Meeting held on Wednesday 4th June 2014 12:30-16:30 Boardroom, Kingston House

Present: Dr Nick Harding Chair Dr George Solomon Chair of Black Country LCG Dr Felix Burden Secondary Care Consultant Dr Sirjit Bath Vice Chair of Pioneers for Health LCG Mrs Claire Parker Chief Officer (Quality) Mr James Green Chief Finance Officer Dr Vijay Bathla Chair of Pioneers for Health LCG Ms Janette Rawlinson Independent Committee Member Mr Ranjit Sondhi Lay Member Mrs Julie Jasper Lay Member Dr Pri Hallan Vice Chair of Sandwell Health Alliance Dr Basil Andreou Chair of Sandwell Health Alliance LCG Dr Inderjit Marok Vice Chair of ICOF LCG Mrs Sharon Liggins Chief Officer (Partnerships) Ms Jyoti Atri Director of Public Health, SMBC Mr Jon Dicken Chief Officer (Operations)

In Attendance: Ms Lynda Scott Communications Lead Mrs Alison Hodgson Head of Quality Safety and Risk Miss Toni Welch Business Support

Apologies: Mr Andy Williams Dr Ram Sugavanum Dr Sam Mukherjee

1. Welcome and Introductions

Dr Nick Harding welcomed everybody to the meeting.

2. Declarations of Interest

No declarations of interest were raised. 3. Minutes of the previous meeting

Ms Janette Rawlinson requested that under the Questions from the Public section of the minutes it is accurately recorded whom the question has been received from. She also noted the misspelling of breech within the performance section.

Dr Felix Burden highlighted that on page 10 of the minutes, within the discussions surrounding prescribing in pregnancy; he has specifically mentioned the prescribing of Foliates and would like that recorded in the minutes.

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He also felt that the description of the VTE issues that he raised should be made clearer and picked up as an action going forward.

With these amendments, the minutes were agreed as an accurate record.

4. Actions and Matters Arising

 050314 School nurse workforce Ms Jyoti Atri explained that she had recently met with the Local Authority (Sandwell) regarding the change of service for School Nurses, informing that the current contract and service provision is held by NHS England. She informed that workforce figures were being looked at and that details would be held by the current commissioners. Mrs Claire Parker suggested that it may be best to invite representation from the school nurse provision to a future meeting to provide assurance. Dr Nick Harding requested that Mrs Claire Parker approach NHS England in writing to request further information and detail regarding the service and transition.

Following on from this Dr Basil Andreau asked for clarification regarding the process that Health Visitors are to follow with respect of prescribing vitamins to children, he also noted that Midwives should be prescribing vitamins to pregnant women, although this does not appear to be a universal and consistent approach. In response Ms Jyoti Atri explained that the vitamins prescriptions were means tested and that would be the reason that some mothers/children are not in receipt in Sandwell, she and Dr Nick Harding commented that the vitamin prescribing was a universal procedure in Birmingham. Discussion regarding the changes to the systems over the years and the shift in responsibility concluded with Ms Jyoti Atri offering to explore this issue further, although suggested that there may be work relating to monitoring to be undertaken on the Sandwell side to inform any desired changes to the universal method. Dr Nick Harding commented that this work and investigation would link into the on going peri natal workstream that had been agreed at previous meetings. With reference to this Ms Jyoti Atri also noted that Ms Liann Brookes had fed back that the Governing Body had suggested further education campaigns for Pharmacists may help to reduce infant mortality and increase folic acid prescribing etc.. She informed that the Local Authority and NHS England had agreed to co run 6 campaigns per annum, she suggested that this facility could be used.

 070514 IAPT Data Mr James Green updated that the IAPT raw data was due to be released on 20th June, leading him to anticipate the figures to be available in the August performance report. He also noted that clarification regarding the VTE data would be picked up within this.

 070514 Infant Mortality It was suggested that further areas were added to the dashboards that would allow monitoring of factors known to be reasons of infant mortality. Data such as Immunisations, Foliate prescribing, maternity care, smoking advice and gestational diabetes recording may help to identify areas of concerns and inform action plans to address the wider issue. Mrs Claire Parker commented that she would need to speak to informatics regarding changes to the dashboard, although Ms Jyoti Atri advised that due to the cross boundary issues and the data collection of the

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systems this may be a difficult implementation. It was agreed that Mrs Claire Parker and Ms Jyoti Atri would meet separately to discuss this matter. Dr Nick Harding felt that regular reporting of this should be made available to the Governing Body. Mrs Claire Parker also felt that there may need to be some project works completed around this data and area of concern. Dr Felix Burden suggested that some data should be collected around the things that we know are components to the mortality rates, e.g. smoking in pregnancy, foliate prescribing.

 070514 Legacy Documents It was highlighted that there were a number of PCT legacy contracts that remain in situ currently. All of which had been issued with new contracts under CCG conditions and the governance around these had been upheld and checked. There were continuations of contracts that had been renewed under STA’s (Standard Tender Agreements’) and timescales had been implemented to re procure these services. Ms Janette Rawlinson commented that there was a lack of awareness of these contracts amongst the Commissioning teams and that she had concerns for the commissioning and procurement processes of several of the services. Mr James Green assured that the CCG were currently looking at training for staff that will cover STA’s and the SFI’s (Standing Financial Instructions). Ms Janette Rawlinson commented that she had been in attendance at meeting where there has been uncertainty of the rolled over contracts, she suggested that the commissioning teams should be more aware of the timescales and the implications that this has upon the services that they commission. Mrs Alison Hodgson also offered further assurance that the contracts were being monitored and that commissioning managers were regularly checking contract legacy prior to investigating procurement options.

Action:  Mrs Claire Parker to approach NHS England and request further detail and information relating to the School Nurse service, workforce and transition.  Mrs Claire Parker and Ms Jyoti Atri to meet in order to look at the data sets required for the infant mortality reporting

5. Chairs Report

SWBH Clinical Leadership Event Dr Nick Harding informed that he had recently attended this event and noted that it had gone well. He informed that as a result there had been some good work being undertaken to underpin and implement effective leadership at the Trust.

Tower Hill Practice Attendees were informed that the new building for Tower Hill Practice had recently been opened and was impressive.

Clinical Leads The Clinical Leads for the CCG had now been confirmed and Dr Nick Harding advised that a renewed list was now available on the intranet.

IVF Policy The IVF Policy had now been ratified. Dr Nick Harding advised that changes to the eligibility of the service had been made to align SWB CCG with other local CCG’s, addressing the issue of ‘postcode lottery’ for IVF services.

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Specialised Commissioning Dr Nick Harding informed that all CCG’s had been asked to take part in a national debate regarding specialised commissioning. He advised that it was very likely that CCG’s would be part of commissioning specialised services for their population going forward.

OPD Modernisation Attendees were informed that Black Country LCG were taking forward the agenda for modernisation of Outpatients. This would include a shift to community based care. Dr Nick Harding informed that good progress was being made with this.

BCPFT Media Dr Nick Harding confirmed that the CCG were aware of issues being highlighted in the media with regards to Black Country Partnerships NHS Foundation Trust. He suggested that a formal leadership meeting would be arranged to allow discussions to address this matter and obtain assurances for action plans. He noted that the Trust remains rated green by Monitor currently.

Co Commissioning Primary Care Attendees were advised that all CCG’s had been asked express any interest in co commissioning primary care services. Dr Nick Harding confirmed that SWB CCG had agreed at Directors meeting that interest would be submitted, although decisions would not be made until further clarification around the expectations was disclosed. He noted that it was likely that CCG’s nationally would be required to take part in this in future however the risks would need to be monitored closely.

Dr Nick Harding went on to briefly highlight meetings regarding Strategic Planning and Units of planning as well as the opening of Portway. In conclusion he noted that two member GP’s had achieved FRCGP recently.

Discussion regarding co commissioning took place with Mr Ranjit Sondhi advising that he had worked with others to draft response to the request in preparation to submit expression of interest. Although he noted that information regarding the scope of work, challenges and proposed collaborative working methods had not yet been identified to the CCG. He did note that entering into such an arrangement with NHS England may have a lot of benefits for the CCG. Ms Janette Rawlinson commented that she was aware that the Birmingham LMC had confirmed that they were against any agreements, stating that the conflicts of interest would not be manageable. Although she went on to suggest that SWB CCG, having 4 Lay Members, were in a stronger position than many other CCG’s and she felt would be able to manage the conflicts. She also felt that a move to co commissioning may develop further ‘postcode lottery’ issues. Dr Nick Harding felt that devolution of specialised service commissioning may help to improve the quality and availability of services nationally. He also informed that a recent meeting that he had attended with Karen Helliwell of the area team had suggested that the decision to move forward with this had been made, although he assured that he would keep everyone up to date with developments. In response to query relating to other CCG’s appetite for this, Dr Nick Harding informed that the Birmingham CCG’s were uncertain of their position in this however Dudley were very keen to proceed. In conclusion, Mrs Sharon Liggins informed that the expression of interest had been submitted and the CCG would continue to consult and engage with members

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around this.

Dr Basil Andreau raised concern relating to the issues with the Portway Centre, noting that the practice had not yet moved into the complex and had been broken into again whilst waiting to do so. He felt that the delays with this were unacceptable and queried the reasons for this. Dr Nick Harding advised that the issues were being discussed with NHS England and they were out of the practice’s control currently, he informed that support was being offered the practice throughout this process.

Action:  Formal leadership meeting with BCPFT to be arranged to allow discussion to address matters and obtain assurance re the Monitor Letter and Trusts Action Plan.

The Governing Body resolved to:  Accept the report 6. Questions from the Public

There had been no questions from the public submitted.

7. Quality & Safety Committee Report

In the absence of Dr Sam Mukherjee, Mrs Claire Parker updated the Governing Body with the Quality & Safety Committee Report. She informed that due to changes to the reporting cycles of both Clinical Quality Review meetings (CQRM’s), the Quality & Safety report was in fact the same report that had been submitted to the previous meeting. She explained that the Q&S committee had not yet seen the May data at their committee meeting and for that reason the Governing Body meeting in July would be presented with two reports, pertaining to May and June. Mrs Claire Parker proceeded by providing verbal update of the Q&S business.  There had been no new never events reported by SWBH since January 2014.  Falls with harm continue to be a trend throughout the incidents reported by providers. Mrs Claire Parker assured that this matter was being addressed and provided detail of provider visits and implementations to reduce these.  The Customer Care ‘John Lewis’ style had been reported in the HSJ (Health Service Journal) and she had subsequently been interviewed by them in response to this and to discuss how the concept can be implemented within the healthcare environment.  Mixed Sex Accommodation (MSA) breeches continue to be high at SWBH. This is thought to be in issue arising from the use of the newly implemented electronic bed management system. Although it could also be related to staff previously not reporting correctly. She assured that this issue would be picked up at the next CQRM and assurances requested.  The CCG are no longer signing off DOL’s (Deprivation of Liberty) as CCG’s are not required to do so any longer. Mrs Alison Hodgson reported that legal advice had been sort in relation to this matter and as a result action taken by the CCG in future will be to provide advise only.  Recent safeguarding assurance visit to BCH (Birmingham Children’s

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Hospital) had highlighted some very good practice, with Mrs Alison Hodgson reporting that the system being used incorporating a family evaluation.  Visit to Edward Street Hospital (part of BCPFT) to look at the implementation of the Fallsafe programme had also gone well. Mrs Alison Hodgson provided brief overview of the feedback recorded from both visits, noting that as a result of the fallsafe programme the provider had recognised areas of concern and were addressing these. She also recognised that the refurbishment of the hospitals under BCP FT was progressing well. She informed that reports of the visits would be provided at the next meeting.

Following update of the recent visits, Mrs Julie Jasper asked if Lay Members were able to attend future visits, she felt that further assurance would be provided if there were independent reviewers present. Mrs Alison Hodgson agreed that this would be possible and informed that she would request for dates of the visits to be distributed to the Lay members for consideration. In response to Mr Ranjit Sondhi’s query regarding unannounced visits, Mrs Alison Hodgson confirmed that these take place, adding that these are often carried out in response to themes identified from concerns.

With regards to the timeframe for reporting Never events Mrs Claire Parker advised that Never Events should be reported as soon as they happen, however there are instances that the Trust have missed the never event and it has been reported following audit that has identified the occurance.

Action:  Visit schedule dates to be circulated to Lay Members

The Governing Body resolved to:  Accept the report

8. Finance Report

Mr James Green presented the Finance report from month 1. He explained that there was little detail available on the expenditure within this month’s report due to the early position in the year. He informed that a statement for the year was available. He proceeded to provide brief overview of the report  Most of the contracts for the year had been agreed; however there were some that remained outstanding. He explained that this was due to the contracts being led by associate organisations where negotiations were yet to be concluded. Mr James Green hoped that issues would be resolved shortly and contracts signed.  QIPP had been set at £18m, with a £1m improvement element to identified schemes. Work to identify schemes has begun.  Risks had been identified and would be monitored monthly, Mr Green noted that there would be some contingency used to mitigate these  Cash balance was £351k spend  Better Payments (invoices paid) had exceeded target during April, which was a good start to the year. Ms Janette Rawlinson took the opportunity to congratulate the finance team, especially in meeting better payment targets, given the high volume of invoices

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processed. Although she went on the query the mental health expenditure, noting that this was low in relation to the new themes being addressed by the CCG. She requested further assurance regarding the accessibility of services given the lower expenditure. In response to Ms Janette Rawlinson’s queries Mr James Green explained that the mental health services had spent some non-recurrent funds last year in order to deliver recurrent savings going forward, this had been reflected within the allocations. He assured that services in this area had not been de commissioned to reduce the expenditure. Mr Jon Dicken added that details of this were available within the Operational Plan.

The Governing Body resolved to:  Accept the report

9. Performance Report

Mr James Green continued by providing overview of the Performance report. He began by drawing attentions to the poor performance of the A&E target in May and early June. He informed that work to address this issue was being led by Mr Jon Dicken, who assured that work with SWBH and other Trusts was underway and it was hoped that collectively an appropriate method could be agreed. He explained that SWBH had begun to address issues by putting on additional night staff, including consultants, to alleviate early morning delays. He highlighted that DTOC’s (Delayed Transfer of Care) were an issue and this would need to be addressed in collaboration with partner organisations. Other issues that had presented were highlighted as being the handling of breaches, an increasing number of Mental Health patients being held in A&E awaiting assessment and capacity issues throughout the sites. Mr Dicken noted the disappointment of the CCG at position currently. Mr James Green continued to provide overview as follows  The 18 week target continued to underperform at 90%. Revised action plans to address this issue were not being provided and the CCG were considering issuing exception report.  2 patients are above the 52 week target , 1 at HEFT and 1 at Westborne Clinic  17 breeches of MSA had been reported in April, it is thought that these are related to the Hyper Acute Stroke unit  Two thirds of the fines levied against the Ambulance service had been reinvested to assist service developments. WMAS will decide on how to spend this investment. Fines were due to the missing of red category performance indicators.

Discussions turned to the reported figures for the 62 day cancer waits, with Ms Janette Rawlinson highlighting that the report breakdown suggested 10/80, but the RAG rating box suggested 100% achievement. Mr James Green explained the report layout and informed that the 100% achievement related to the screening category, with the 10/80 relating to GP referrals. Ms Janette Rawlinson continued to express concern relating to the missing of the cancer target, to which Mr James Green informed that further monitoring and sanction of this had been implemented within the contract this year through the outcomes thermometer. Mrs Claire Parker advised that it was possible that patients could obscure this target due to patient choice. She advised that in some cases patients diagnosed with cancer did not

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wish to be treated and this decision would mean that treatment targets were affected.

Dr Felix Burden drew attentions to A&E Attendance, which noted that a proportion was available, however there was no proportion given within the paper. Ms Janette Rawlinson went on to query what plans were in place to address the number of re admissions being experienced. Mrs Claire Parker suggested that the Trust should be requested to audit the re admissions and develop action plans. Dr Nick Harding informed that the Trust have a workstream to address re admissions that is on going. Mrs Claire Parker felt that some of this data should be shared with commissioners as assurance.

Dr Basil Andreau highlighted issues with the cancer waits that his patients were experiencing. Mrs Claire Parker advised that this concerns or incidents should be reported through the Datix system which is monitored and trend analysed regularly to identify problems. It also forms the basis of challenge at CQRM (Clinical Quality Review Meeting’s). Ms Janette Rawlinson noted that there was no Cancer waits data available in the report from March, Q4 or year to date, she felt that there could be issues within that data that should be being challenged and taken forward before July. Both Dr Nick Harding and Mrs Claire Parker suggested that any anomalies in the performance data are highlighted as soon as possible to the Chief Officer to allow challenge to be directed to the Trust.

Action:  Dr Felix Burden to highlight area of discussion with Mr James Green for clarification.  Data and action plans to address re admission to be sought from the Trust

The Governing Body resolved to:  Accept the report

10. Annual Accounts

Mr James Green drew attentions to the Annual Accounts and apologised for the delay in circulating these. He informed that the accounts were due to be submitted and had previously been to Finance and Performance and Audit and Governance Committee(s) as well as being audited by both Internal and External auditors. He highlighted that the recommendation from the Audit and Governance committee was that the Governing Body approve the accounts.

Overview of the accounts was provided, although detail was available within the circulated paper.  Expenditure had been £16m  Surplus delivered above plan at £6.44m  Balance had been closed at £51.7m with £43.2m liabilities  Provision of £1.6m had been allocated which cover o £617k for CHC Claims and Appeals o Prescription Incentive schemes o BCH specialised services

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o Long stay patients o £593k Healthcare outside of provider base o £70k Contingent liability (where the CCG does not think the claim is valid) Mr James Green explained what the provisions had been allocated for and detail of the reasons for this. He went on to note that Auditors had given an unqualified opinion at this stage, which he explained was good. He also noted that the accounts had been assessed for value for money and use of resource; he informed that auditors had been happy with both assessment results.

Mr James Green went on to highlight that there had been six recommendations from auditors and drew attentions to these; he reported that these recommendations had been noted and action taken to address each. Mrs Julie Jasper informed that the accounts had been scrutinised several times and assured that the governance had been followed throughout. She took the opportunity to congratulate the finance team and to thank them for the hard work and efforts throughout last year. Although she also noted that the budget managers within the CCG had helped by ensuring good management of their finances. Ms Janette Rawlinson commented that she was impressed at the low staff absence rates reported, feeling this was excellent given the public sector averages. In conclusion to the item Dr Nick Harding asked the Governing Body to agree the annual accounts and the letter of representation.

The Governing Body resolved to:  Agree the Annual Accounts and letter of representation  Accept the report

11. Strategic Commissioning & Redesign Committee

Dr George Solomon provided update from the SCR Committee by briefly noting the topics covered within the last meeting. He noted that discussions regarding the Wednesbury project had taken place; the committee had ratified the conception policy and the community respiratory policy. For governance reasons Dr George Solomon explained that the Community Respiratory Policy had previously been presented to Finance and Performance; Business Planning and SCR committees and approved at the SCR Committee. Dr Solomon went on to inform that during discussions regarding how the committee works with the refocus and devolution of responsibility to LCG level, a new process/gateway construction had been agreed. To reflect this, the report of the committee with be redesigned to capture LCG level information and report on the Clinical programmes. He also informed that the Clinical Lead inductions had been completed recently, this will be followed up with one to one’s to discuss and set objectives for each lead.

The Governing Body resolved to:  Accept the report

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12. Partnerships Committee Report

Dr Basil Andreau provided update from the Partnerships Committee. He informed that the Push sites were based in areas of nurse teams and explained that there were 5 sites across Sandwell and 7 across West Birmingham. He commented that there had been meetings to discuss the objectives of the sites and the Better Care Fund. He noted that he was pleased with the set up at present.

Dr Andreau went on to briefly update the Governing Body with information regarding the Better Care Fund plans so far, noting that the Sandwell fund had been agreed, although the Birmingham fund was uncertain at present and that further discussions would be undertaken.

He also highlighted that the committee had discussed domestic violence and FGM (Female Genital Mutilation), which had been discussed at the Sandwell Health & Wellbeing Board, and had been surprised at the statistics within Sandwell and West Birmingham; noting that these suggested our population has the highest figures across the Midlands. Dr Andreau felt that GP’s need further training and awareness around these matters.

Discussions relating to the Birmingham Voluntary Sector Council (BVSC) project works were also mentioned during the committee meeting and the attendees had agreed that these projects should be considered to help the CCG achieve its aims for better community based care. Dr Andreau went on to highlight some of these projects and explained briefly the opportunities. He noted how some of these projects could link into the works being undertaken with the Better Care Fund.

Ms Janette Rawlinson informed that she had recently met with a representative of BVSC, who had advised that SWB CCG were currently the only CCG engaging with their works and projects. Ms Janette Rawlinson felt that this would be an opportunity to lead the way for the Birmingham population too.

The Governing Body resolved to:  Accept the report

13. Audit & Governance Committee

Mrs Julie Jasper presented the Audit & Governance report to the Governing Body, she began by highlighting discussions of the committee as highlighted within the report and informed that the CCG is currently involved in lots of patient experience work. She commented that she had requested a report regarding the extensive engagement work to be brought to a future meeting.

Mrs Julie Jasper commented that Mrs Sharon Liggins had also attended the committee to provide update on Section 75 and provide assurance that SWB CCG were on top of issues with this. A staff council discussion had also been undertaken, where the Committee were assured that the staff were happy and were involved with the work streams agreed. She went on to explain that the payments for the Medicines Management PDS had been discussed

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comprehensively; however Ms Liz Walker had also brought the paper to the Governing Body session for final agreement. Ms Jasper confirmed that the committee had been supportive of the scheme but had required sign off at Governing Body level to assure that the payments suggested were realistic and viable.

Mrs Julie Jasper informed that the CCG had provided full assurance against the Francis action plans and that the process was robust. Continuing Healthcare had been provided with moderate assurance, which is good. She informed that most CCG’s would have been provided a similar assurance level for the section.

She concluded that the annual accounts had received an unqualified opinion from external auditors, as had the annual report.

The Governing Body resolved to:  Accept the report

14. Organisational Development Committee

The committee had not met. 15. Urgent Care Report

Dr Sirjit Bath commented that the majority of the report had been discussed within the performance item as the issues being experience had impacted negatively on the overall performance levels recently. However he provided brief detail of the situation at present and highlighted that SWBH were currently undertaking a bed audit and work to identify issues within the discharge system would also be looking at Pharmacy delay and transport problems. Dr Sirjit Bath continued by informing that the 7 day working standards are being discussed at the urgent care network.

Other highlights of the report were reported as being changes to the GP front end at A&E, where the provider has now taken over the running of the system and issues with dental patients being directed to A&E for treatments.

Mr Jon Dicken reported that there was a meeting scheduled for 5th June to discuss the discharge pathway, where representation from all 7 local CCG’s was expected, he hoped that all those involved would agree upon a single method and pathway and that work to ensure the robustness of the pathway could commence. Ms Janette Rawlinson felt that there would be a number of the factors highlighted as contributing to DTOC’s were a little unreasonable, including equipment and plaster of paris. She felt that the systems within the hospital should be improved to capture a need for these early within the patient journey. Mr Jan Dicken agreed that some of the factors were a result of system issues that would need to be addressed to reduce the DTOC figures. Mrs Claire Parker also felt that there were some communication issues within the system, commenting that the Chief Pharmacist was not aware of problems with the TTO’s, she felt that other areas may have a similar problem and suggested that further work to ensure that the departments involved were aware of issues and were working to address these on a ward level also. Dr Felix Burden expressed concerns that it did not appear that addressing this matter through a top down method was working and suggested that efforts were revised to reflect a bottom up strategy, ensuring that the staff handling the situation

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were better prepared and informed. In response Mr Jon Dicken agreed that the Urgent Care Working Group was in fact a requirement of the CCG and although he supported the operational level involvement, the group were required to address matters through the Chief Executive level also. Ms Janette Rawlinson supported the operational level involvement and commented that there were various PMO methods that would assist the redressing of these issues.

The Governing Body resolved to:  Accept the report 16. Annual Report Ms Jenny Fullard explained that the Annual Report had been amended to reflect the comments and feedback that had previously been submitted. She noted that the red text within the document was to highlight changes to this version for the auditor’s ease of reference. Mrs Julie Jasper assured that the report had been scrutinised at the Audit Committee and that the committee had been confident that all the requirements had been met and disclosures were all accurate. The Governing Body resolved to  Accept the report

17. Prescribing Development QIPP Scheme

Due to all GP’s conflicts of interest Mr Ranjit Sondhi took the Chair for this item.

It was decided that GP’s present could participate with discussions for this item, however decision would be taken by those with no interests.

Ms Liz Walker and Dr Gwyn Harris were in attendance at the meeting to obtain agreement for the payment figures suggested within the proposed PDS. Ms Liz Walker explained that the PDS was essential to the QIPP challenge of Medicines Management; she also noted that the scheme had been supported by other committees, including Finance & Performance, Audit and Quality & Safety.

Mr James Green reported that he had been involved with the financial aspects of this scheme and was in support of the scheme overall. He also mentioned that the scheme had been supported by LCG’s. Dr Felix Burden commented that he was in support of this scheme. He noted that historically the prescribing schemes had always been helpful in the CCG’s achievement of QIPP. He felt that the payments proposed within the scheme were reasonable; however he suggested that in future an approximate time and staff involvement in schemes be highlighted to help individuals calculate an appropriate level of remuneration. He went on to ask if Medicine Management had any other schemes to address waste or high drug usage. Mr Richard Nugent was keen to discover where these scheme ideas were generated. In response Dr Gwyn Harris informed that nationally NICE (National Institute of Clinical Excellence) produced lists of possible improvements to be made, he went on to note that from this list schemes that are possible to implement and generate savings for the CCG are identified and schemes derived. He suggested that there were many schemes that would be possible to implement over time. In response to Mrs Julie Jasper’s concerns that GP’s may be being paid twice for

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what should be within their role, Dr Nick Harding assured that with regards to this scheme, GP’s were not paid for this activity under their contracts. Ms Janette Rawlinson queried the behavioural change possibility of this scheme and commented that she would like to see more schemes that make changes going forward, not only for the duration of the scheme. Mrs Claire Parker informed that the schemes were often response to clinical changes and assist clinicians with these adaptions.

In conclusion to discussions the PDS scheme payments and the scheme were agreed.

The Governing Body resolved to:  Agree the proposed payments  Agree the PDS  Accept the report

18. Any Other Business

 Q4 Assurance Dr Nick Harding informed that the CCG would be undertaking its Quarter 4 Assurance meeting with the Local Area Team (LAT) on Monday 9th June. He explained that as part of this meeting the LAT had informed that they would be referring to the results of the recent 360 survey and would be requesting assurance relating to the feedback received. Due to the timing of the results and the meeting cycle, Dr Harding apologised that the results were not able to be shared with the Governing Body prior to the Q4 meeting and he suggested that the results were circulated to members for information prior to discussions. He also advised that Lay Members were welcome to attend the Q4 meeting should they wish. It was agreed that details of the meeting would be circulated.

 Nurse Specialist role Ms Janette Rawlinson enquired as to the recruitment to the Nurse Specialist role given that Ms Margot Warner had recently resigned from the post. Dr Nick Harding assured that the advertisement was due to be published on NHS jobs shortly.

 Governing Body Papers Ms Janette Rawlinson requested that changes/additions to papers were detailed when revised papers are issued. She explained that she had spent some time identifying changes to the papers that had been distributed for this meeting.

 Health Futures UTC College Ms Janette Rawlinson enquired as to why the CCG were not listed as being involved with this project. She informed that other partners of the CCG were listed and expressed her concern that the CCG were not taking advantage of the opportunity, especially given that the college will be just a short distance away from the CCG base. No Governing Body members in attendance were aware of the College plans or project Ms Rawlinson was referring to.

Enc 1

19. Minutes of the Committees

14.1 Finance & Performance Committee 14.2 Quality & Safety Committee 14.3 Strategic Commissioning & Redesign Committee 14.4 Audit & Governance Committee

The Governing Body resolved to:  Note the contents of all the minutes  Accept the minutes as accurate records of the meetings

20. Minutes of the LCG Board Meetings

15.1 Sandwell Health Alliance LCG 15.2 Pioneers for Health LCG 15.3 Healthworks LCG 15.4 ICOF LCG .

The Governing Body resolved to:  Accept the minutes of all the meetings as accurate.

21. Date and Time of the Next Meeting

The next Governing Body meeting will be held on 2nd July 2014 in the Lancaster Suite, Carters Green Business Centre, High Street, West Bromwich, from 12:00 to 16:00.

Enc No. 2 SWBCCG Board Meeting Action Register Wednesday 2nd July 2014

Action By Whom Deadline / Comment / Response Date update Completed

050314/040314 Matters Arising Health visiting workforce and performance Claire Parker June 2014 Claire Parker to ask current to be added to the agenda in future. provider for the information.

To approach NHS England and request Claire Parker August further details and information relating to 2014 School Nurse Services, workforce and transition.

To look at the datasets required for infant Claire August mortality reporting. Parker/Jyoti Atri 2014 050314 Quality Report To ensure that a falls paper was compiled Claire Parker July 2014 On agenda and presented to a future Governing Body meeting to provide detail of the works carried out to address this matter.

070514 Action Register - Stroke Review To bring a paper on Primary Review Nighat Hussain August Strategy 2014

Action By Whom Deadline / Comment / Response Date update Completed

070514 Performance Report Data will be published 20th June To clarify timescales for IAPT data being James Green June 2014 and will be included in the available. July/August report

070514 Infant Mortality Measurable data sets to be identified by all partners and regular reporting of these to commence.

Medication in early pregnancy and Claire Parker complications to be covered at next PLT

To consider how to provide information to Pharmacists regarding education to Claire Parker pregnant ladies. 070514 Minutes of Meetings To ensure the CSU contracts team are James Green May 2014 aware of the legacy status of contracts that are being rolled over. 040614 Chairs Report BCPFT – to arrange a formal leadership Dr N Harding July 2014 meeting to allow discussion and assurance on the action plan following the Monitor letter.

040614 Quality Report To share dates of proposed announced Alison Hodgson June 2014 visits with Lay Members and Independent Committee Members.

Action By Whom Deadline / Comment / Response Date update Completed

040614 Performance Report Question raised by Dr F Burden to be Dr F Burden June 2014 forwarded to James Green for a response.

Data and action plan to address re Claire Parker June 2014 admissions to be sought from Sandwell and West Birmingham Hospitals.

Enc 3

Sandwell & West Birmingham CCG Quality Report April 2014

Page 1 of 19

Contents

Item Page Executive Summary 3 Chief Officer’s Summary Never Events New Serious Incidents Serious Incident Trends Sandwell & West Birmingham CCG Summary 4 GP Reporting Rates GP Reporting by Severity Incident Reporting Rates per LCG Incident Reporting Rates per LCG, weighted by Population Trends by Service Area Complaints & Concerns A Patient’s Story Provider Visits Sandwell & West Birmingham Hospitals 7 STEIS Incidents Trends Complaints & Concerns A Patient’s Story Performance Analysis Black Country Partnerships 12 STEIS Incidents Trends Complaints & Concerns West Midlands Ambulance Service & NHS 111 14 STEIS Incidents Trends Complaints & Concerns Other Provider Services 17 STEIS Incidents Trends Complaints & Concerns Nursing/Care Homes 18 STEIS Incidents Complaints & Concerns Infection Prevention Update Appendix 1 Continuing Healthcare Update Appendix 2 Medicines Management Update Appendix 3 Risk Register Update Appendix 4 Infection Prevention – End of Year Report Appendix 5

Page 2 of 19

Executive Summary This page summarises the information from this month’s Quality Report – May 14.

Chief Officer’s Summary Chief Officer – Quality will present a verbal report at the meeting.

Claire Parker, Chief Officer for Quality

Never Events There have been zero Never Events so far this year. In 2013/14, there were six Never events in total. No Never Events have been reported since 3/1/2014.

STEIS Incidents The following table shows the number of new, closed and never events for this month: Clinical Commissioning Group Provider Services CCG – GP Care/Nursing Home CCG BCP NHS 111 Other Providers SWBH WMAS Total New 2 1 4 1 8 Closed 1 1 4 2 8 Never Events 0

STEIS Trends The following table shows any the current status of any trends by type per provider from April 2013 to this month: Clinical Commissioning Group Provider Services

CCG – GP Care Home CCG BCP NHS 111 Other Providers SWBH WMAS Pressure Ulcers ↓ Falls ↑ ↓ Unexpected Death ↑ Ward Closure ↓ Infections ↑ Ambulance Delays ↑

Page 3 of 19

Sandwell & West Birmingham CCG Data contained in this report is up-to-date and includes all data pertaining to April 2014.

GP Reporting Rates The following chart shows the numbers of incidents reported by GPs per month since April 2013. As incident reporting culture becomes more embedded within an organisation, the numbers of reported incidents should show an initial rise before plateauing.

GP Incident Reporting by Severity The following chart shows the severity of incidents reported each month. As incident reporting culture becomes more embedded within an organisation, the percentage of Major/Catastrophic incidents is expected to fall.

100% 5 1 2 2 1 2 1 4 3 6 90% 10 11 18 11 13 8 80% 13 22 9 8 12 70% 17 60% 67 Major 50% 26 63 20 Moderate 40% 32 18 27 29 24 Minor 44 24 30% 11 21 Insignificant 20% 10% 9 11 7 7 3 9 3 3 5 4 0% 1 1 2 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr 2013 2014

Page 4 of 19

Incident Reporting Rates per LCG The following table shows a breakdown of the reporting rates of each LCG for the last six months, by numbers of incidents reported.

Month Black Country Healthworks ICOF Pioneers 4 Health Sandwell Health Alliance Total Nov – 13 14 4 2 1 19 40 Dec – 13 14 3 4 5 15 40 Jan – 14 13 7 1 3 14 38 Feb – 14 6 9 3 0 28 46 Mar – 14 14 12 2 0 20 48 Apr – 14 4 13 0 1 27 45

Incident Reporting Rates per LCG, weighted by Population The following table shows a breakdown of the reporting rates of each LCG for the last six months. Here, the amount of incidents reported is weighted against the respective LCG population size.

E.g. Black Country LCG has a population of 122,000 patients, representing 23% of the overall population of Sandwell & West Birmingham CCG, therefore, it’s fair to expect that that roughly 23% of the incidents reported per month are reported by this LCG.

Red boxes indicate months where incident reporting has fallen below the lower 25% quartile range of expected reporting. Green boxes indicate months where incident reporting has risen above the higher 25% quartile range of expected reporting.

Black Country Healthworks ICOF Pioneers 4 Health Sandwell Health Alliance Pop. 122,000 Pop. 110,000 Pop. 109,000 Pop. 45,000 Pop. 145,000 Month 23% of CCG 21% of CCG 20% of CCG 9% of CCG 27% of CCG Nov – 13 35.00% 10.00% 5.00% 2.50% 47.50% Dec – 13 34.15% 7.32% 9.76% 12.20% 36.59% Jan – 14 34.21% 18.42% 2.63% 7.89% 36.84% Feb – 14 13.04% 19.57% 6.52% 0.00% 60.87% Mar – 14 29.17% 25.00% 4.17% 0.00% 41.67% Apr – 14 8.89% 28.89% 0.00% 2.22% 60.00%

We can see from the data collected so far that Sandwell Health Alliance (SHA) has the highest relative incident reporting rate within the CCG. Their LCG population accounts for 27% of the overall CCG population, but, on average, report 47% of all incidents reported per month.

Trends by Service Area The table below shows the top five types of incident that have been reported by GPs since April 2013 to date, by service responsible. Trends are calculated over a rolling 12 month period.

Service Responsible General Practice SWBH Other Providers Records, Communication & Records, Communication & Records, Communication & 1 114 124 25 Information Information Information Medication Appointments, Discharge & Medication 2 57 32 5 Transfers Violence, Aggression & Self Diagnosis & Tests Appointments, Discharge & 3 32 27 3 Harm Transfers 4 Health & Safety 20 Medication 21 Diagnosis & Tests 2 Appointments, Discharge & Clinical Care Clinical Care 5 16 18 2 Transfers (Assessment/Monitoring) (Assessment/Monitoring)

Page 5 of 19

Provider Visits This month we conducted the following Quality Assurance Visits.

Service Site Date Comment SWBH P3/P4 30/4/2014 Visited Sandwell General Hospital Priory 3 and 4, to look at the general level of care offered to patients. Patients interviewed were all very positive towards the service they received. Minor issues were discovered regarding medication storage; labelling of male/female bays – all problems resolved immediately by ward staff.

Complaints & Concerns The following graph shows the number of Complaints and Concerns received about SWB CCG GP Practices in the last 12 months. The CCG Customer Care Team resolve to reduce the number of formal complaints being made against SWB CCG Practices by attempting to address any issues that are raised in an informal way.

Complaint 8 Concern

0 May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr 2013 2014

Themes The table below shows the themes of complaints that have been made against services directly provided by Sandwell & West Birmingham CCG. Complaints received by Sandwell & Birmingham CCG pertaining to Provider Organisations are featured later in this report.

SWB CCG Team Theme/Trend Continuing Healthcare Funding Requests that have been denied/rejected by CHC Team Continuing Healthcare Communication Issues between patient/patient advocates and CHC Team Continuing Healthcare Late Assessments for CHC funding

A Patient’s Story To be featured in May’s Report.

Page 6 of 19

Sandwell & West Birmingham Hospitals Data contained in this report is accurate up to and including April 30th 2014.

STEIS Types & Status The following chart breaks down the serious incidents pertaining to SWBH from April 1st 2014 by type and current status.

Stop Clock Stop +45d Overdue

Removed

Pending

Not yet due Not +45d Overdue Extension

- – - –

– – –

Open Open Open Closed Closed Closed Closed Closed Cmnsr Lead Not SWB Total STEIS Types Open Adverse Media Coverage or Public concern Org/NHS 1 1 Allegation against HC Professional (Assault) 1 1 2 C.Diff & Health Care Acquired Infections 2 5 3 10 Communicable Disease & Infection Issue 2 2 Confidential Information Leak 1 1 2 Delayed Diagnosis 4 1 1 2 8 Drug Incident (General) 1 2 3 Failure to Act upon Test Results 1 3 1 5 Maternity Service 1 1 2 4 Maternity Services - Intrauterine Death 1 1 Maternity Services - Maternal Unplanned Admission to ITU 1 1 Maternity Services - Unexpected Neonatal Death 1 1 MRSA Bacteraemia 3 2 2 7 Pressure Ulcer Grade 3 2 1 28 19 50 Screening Issues 1 1 2 Security Threat 1 1 Slips/Trips/Falls 2 1 26 7 36 Sub-optimal care of the deteriorating patient 1 3 5 9 Surgical Error 3 3 Unexpected Death (general) 2 2 Unexpected Death of Inpatient (not in receipt) 1 1 Ward Closure 1 6 3 10 Wrong Site Surgery 1 1 2

Trends The main serious incident trends for SWBH are:

 Pressure Ulcers (Grade 3 or 4)  Slips/Trips/Falls – (Patient Falls resulting in Serious Harm)  Ward Closures  C.Diff & Health Care Acquired Infections

Page 7 of 19

Pressure Sores

Pressure Sore Trends The following line graph shows the number of Trust acquired Grade 3 or 4 Pressure Sores that have occurred per month since April 2013. Future graphs will plot this data against the total amount of Pressure Sores acquired within Trust care. This will enable us to better understand the relative proportion of Grade 1-2 ulcers to those that are Grades 3 or 4 and also assess the impact of trust wide initiatives to reduce Pressure Ulcer occurrence using the most up-to-date data available.

Pressure Sore Trends per Ward When a pressure sore is recorded on STEIS, the reporting organisation also has to designate the ward/location where the pressure ulcer was acquired. Shown below are the top nine locations where Grade 3-4 Pressure Sores were acquired since April 2013.

SWBH - Sandwell - Not Specified 9 (PT) Patient's Home 8 SWBH - City - Not Specified 4 SWBH - City - D18 3 SWBH - City - Critical Care Unit 3 SWBH - Sandwell - Critical Care Unit 3 SWBH - Sandwell - Priory 5 2 (Sandwell) - Residential Home - Unknown 2 SWBH - Sandwell - Lyndon 4 2 Page 8 of 19

Patient Falls

Patient Fall Trends The following graph shows the number of Serious Patient Falls that occurred within Trust care for the last 12 months. Future charts will show data divided into patient falls that resulted in minor harm and those that resulted in fractures or serious harm. Patient falls causing serious harm that happen with a healthcare setting are STEIS reportable.

Patient Fall Trends per Ward When a Serious Patient Fall is recorded on STEIS, the reporting organisation also has to designate the ward/location where the Patient Fall occurred. Shown below are the top ten locations where serious Patient Falls occurred since April 2013.

SWBH - Sandwell - Priory 3 4 SWBH - City - MAU 3 SWBH - City - Not Specified 3 SWBH - Sandwell - Priory 2 2 SWBH - Sandwell - Priory 4 2 SWBH - City - Emergency Department 2 SWBH - Sandwell - Newton 1 2 SWBH - Sandwell - Not Specified 2 SWBH - Rowley - Henderson Ward 2

Page 9 of 19

Complaints & Concerns

Complaints Trends The chart below shows the relative number of complaints by ‘type’ that SWB CCG are handling in respect of services provided by SWBH since April 2013 to date. We can see that main trends are: 1) All Aspects of Clinical Treatment, 2) Attitude of Staff, and 3) Complaints in respect of Admissions, Discharges and Transfer Arrangements.

Admissions, discharge and transfer Others, 3 arrangements, 7

Communication/infor mation to patients (written and oral), 3

Attitude of staff, 7 All aspects of clinical treatment, 14

Appointments, delay/cancellation (out-patient), 3

SWBH Complaints Summary The following chart shows the most recent SWBH Complaints data from the Corporate Dashboard. Figures shown in red indicate instances where the target has not been met.

No. of Complaints Received formal and link) 948

No. of Active Complaints in the System (formal and link) 210

No. of First Formal Complaints received / 1000 episodes of care 0.73

No. of Days to acknowledge a formal or link complaint (% within 3 working days after receipt) [Threshold 100%] 99%

No. of responses which have exceeded their response date (% of total active complaints) [Target 0%] 41%

No. of responses sent out 67 Oldest' complaint currently in system 127

Page 10 of 19

Performance

Mixed Sex Accommodation The chart shows the comparative MSA incidents that have occurred in SWBH and other local Acute Trusts, based on the most recent data available to Sandwell & West Birmingham CCG.

Provider Name APRIL HEART OF ENGLAND NHS FOUNDATION TRUST 0 SANDWELL AND WEST BIRMINGHAM HOSPITALS NHS TRUST 36 THE DUDLEY GROUP NHS FOUNDATION TRUST 0 THE ROYAL WOLVERHAMPTON NHS TRUST 0 UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST 0 Total 36

Diagnostics patients waiting >6 wks – April 2014 The following chart shows the performance figures of SWBH in meeting the 6 weeks target in relation diagnostic procedures. The target level in each instance is >1%.

Area % (Target <1) Numerator Denominator Echocardiography 3.37% 7 208 Colonoscopy 2.99% 5 167 Flexi Sigmoidoscopy 8.33% 6 72 Cystoscopy 21.93% 25 114 Gastroscopy 2.28% 5 219

Corporate Quality Performance Report - Exceptions The following table highlights indicators that have failed to meet the target based on the most recent data submitted by SWBH.

NHS Constitution Indicator List Threshold Frequency Jan – 14 Feb - 14 CB_B15_02 Ambulance >=75% Monthly 74.7% 72.8% clinical quality – Category A (Red 2) 8 minute response time

Page 11 of 19

Black Country Partnerships Foundation Trust Data contained in this report is accurate up to and including 20th April 2014..

STEIS Types & Status The following chart breaks down the serious incidents pertaining to SWBH from April 1st 2013 to date, by type and current status.

Stop Clock Stop Removed +45d Overdue

Pending

Not yet due Not +45d Overdue Extension

- – – –

– – –

Open Open Open Closed Closed Closed Closed Closed Cmnsr Lead Not SWB Total STEIS Types Open Abscond 2 1 3 Accident Whilst in Hospital 1 1 Admission of under 18s to Adult Mental Health Ward 1 1 1 1 4 Allegation against HC Professional 1 1 Assault by Outpatient (in receipt) 1 1 Attempted Suicide by Inpatient (in receipt) 1 1 Attempted Suicide by Outpatient (in receipt) 1 1 Communicable Disease & Infection Issue 1 1 Homicide by Outpatient (in receipt) 1 1 Other 1 1 2 Saefguarding Vulnerable Child 1 1 Security Threat 1 1 Serious Incident by Inpatient (in receipt) 1 1 Serious Self Inflicted Injury Outpatient 1 1 Slips/Trips/Falls 2 2 4 Suicide by Outpatient (in receipt) 1 1 Suspected Suicide 1 1 Unexpected Death of Community Patient (in receipt) 3 1 2 2 4 12 Unexpected Death of Community Patient (not in receipt) 2 2 Unexpected Death of Inpatient (in receipt) 1 1 2 Unexpected Death of Outpatient (in receipt) 1 1 Ward / Unit Closure 1 1 2 Ward Closure 1 1

Trends The main serious incident trends for BCP FT are:

 Unexpected Deaths of Community Patients (in Receipt of Mental Health Services)  Admissions of Under 18s to Adult Mental Health Wards

Trend data regarding Admissions of Under 18s to Adult Mental Health Wards Page 12 of 19

Unexpected Deaths of Community Patients

Unexpected Deaths of Community Patients Trends The following line graph shows the number of Unexpected Deaths of Community Patients that have occurred per month since April 2013.

Complaints & Concerns

Complaints Trends The chart below shows the relative number of complaints by ‘type’ that SWB CCG are handling in respect of services provided by Black Country Partnerships FT since April 2013. We can see that main trends are: Complaints in respect Admissions, Discharges and Transfers; and All Aspects of Clinical Treatment.

Concerns There has been one concern reported so far in relation to Black Country Partnerships. This related to an expression of concern that a patient’s one-to-one care was stopped, seemingly with no explanation.

Page 13 of 19

West Midlands Ambulance Service & NHS 111 Data contained in this report is accurate up to and including 30th April 2014.

STEIS Types & Status The following chart breaks down the serious incidents pertaining to SWBH from April 1st 2013 to date, by type and current status.

ot yet due ot

Stop Clock Stop Removed +45d Overdue

Pending

N +45d Overdue Extension

- – – –

– – –

Open Open Open Closed Closed Closed Closed Closed Cmnsr Lead Not SWB Total STEIS Types Open Adverse Media Coverage or Public concern Org/NHS 1 1 2 Allegation against HC non-professional 1 1 Allegation against HC Professional (Assault) 1 1 Ambulance (General) 2 2 3 4 11 Ambulance Accidental Injury 1 1 Ambulance Delay 3 2 5 NHS Direct Incident 1 1 2 Safeguarding Vulnerable Adult 1 1 Unexpected Death (general) 1 1

Trends The main serious incident trends for BCP FT are:

 Ambulance (General)  Ambulance Delays

The STEIS category ‘Ambulance (General)’ is a nationally defined ‘type’ of Serious Incident, used to describe generic serious incidents pertaining to Ambulance services.

The type of ‘Ambulance (General)’ incidents reported by WMAS are quiet wide ranging, from problems with advice given at call centres to aspects of clinical care delivered by paramedics.

Page 14 of 19

Ambulance Delays

Ambulance Delays Trends The following line graph shows the number of Ambulance Delays that have occurred per month since April 2013.

Analysis of Ambulance Delay Incidents (May 2014) In March 2014, Sandwell & West Birmingham CCG conducted an analysis of the Serious Incidents that involved Ambulance Delays between April 2013 and May 2014.

Patterns and trends were discovered in regard to communication issues between callers, call centres and paramedics.

To support recent SIs received by the CCG- notably the three from Shropshire that related to complaints around delays, WMAS have been asked – through the CQRM agenda- to review annual incident/complaint data and report back on the themes/actions being taken to address delays in particular.

Sue Green (Director of Nursing and Quality) and Marie Tideswell (Head of Patient Experience) are the two leads for this and should be reporting back for June’s meeting.

Page 15 of 19

Complaints & Concerns

Complaints Trends The chart below shows the relative number of complaints by ‘type’ that SWB CCG are handling in respect of services provided by WMAS/NHS 111 since April 2013. We can see that main trends are: Complaints in respect of the Attitude of Staff within the service.

Concerns There has been one concern reported so far in relation to WMAS/NHS 111. This related to an expression of concern that the patient’s condition was not considered to be an emergency by the paramedic in attendance.

Page 16 of 19

Other Provider Services Data contained in this report is accurate up to and including 30th April 2014.

STEIS Types & Status The following chart breaks down the serious incidents pertaining to Other Provider Services from April 1st 2013 to date, by type and current status.

Stop Clock Stop Removed +45d Overdue

Pending

Not yet due Not +45d Overdue Extension

- – – –

– – –

Open Open Open Closed Closed Closed Closed Closed Cmnsr Lead Not SWB Total STEIS Types Open Tipton Care Organisation Allegation against HC Professional 1 Other 1 Sedgeley House Hospital Slips/Trips/Falls 1 Home Oxygen Service Home Oxygen 1

Trends No trends have been identified pertaining to other provider services.

Complaints & Concerns

Complaints Trends The chart below shows the relative number of complaints by ‘type’ that SWB CCG are handling in respect of services provided by Other Provider Services since April 2013. We can see that main trends are: Complaints in respect of the Attitude of Staff within the service, and All Aspects of Clinical Treatment.

Concerns There have been three concerns raised about Other Provider Services. The themes are outlined below:

 Uncertainties over what services are supplied by providers

 Uncertainties regarding Provider complaints process

 Clinical concerns raised regarding the processes employed by Other Provider when delivering clinical care

Page 17 of 19

Nursing/Care Homes Data contained in this report is accurate up to and including 30th April 2014.

STEIS Types & Status The following chart breaks down the serious incidents pertaining to Other Provider Services from April 1st 2013 by type and

current status.

Stop Clock Stop Removed +45d Overdue

Pending

Not yet due Not +45d Overdue Extension

- – – –

– – –

Open Open Closed Closed Closed Closed Closed Cmnsr Lead Not SWB Total STEIS Types Open

Slips/Trips/Falls 2 1 1 4

Patient Falls involving Serious Injury and Pressure Ulcers are the most common types of incident associated with Nursing/Care Homes. Sandwell & West Birmingham CCG has been collecting Serious and Non-Serious Incident data from local Care/Nursing Homes - on a voluntary basis - in order to help establish a good Incident Reporting culture for Care/Nursing Homes in the local area. Evidence suggests that the better the culture of reporting and learning from incidents, the fewer serious incident occur. Sandwell & West Birmingham CCG also helps support Care and Nursing Homes with Table Top Reviews and Root Cause Analysis investigations. These processes help consolidate learning from incidents into better clinical practice.

The following chart shows the incident reporting rate of Care/Nursing Homes since April 2013.

We can see that the reporting rate for incidents has been increasing since December 2013. This increased followed a initiative by Sandwell & West Birmingham CCG to promote Incident Reporting within Nursing/Care home settings.

Page 18 of 19

Complaints & Concerns

Complaints Trends The chart below shows the relative number of complaints by ‘type’ that SWB CCG are handling in respect of services provided by Other Provider Services since April 2013. We can see that main trends are complaints in respect of All Aspects of Clinical Treatment.

Concerns There have been three concerns raised about Other Provider Services. The themes are outlined below:

 Uncertainties over what level of care should be provided

 Environmental concerns raised about Care Home, as well as issues raised regarding how well patients were being observed by staff.

 Concerns regarding training level of staff in regard to the setting up and operation of specialist equipment.

Page 19 of 19

Enc 3a

Sandwell & West Birmingham CCG Quality Report May 2014

Page 1 of 19

Contents

Page 2 of 19

Executive Summary This page summarises the information from this month’s Quality Report – May 14.

Chief Officer’s Summary Chief Officer – Quality will present a verbal report at the meeting.

Claire Parker, Chief Officer for Quality

Never Events There have been zero Never Events so far this year. In 2013/14, there were six Never events in total. No Never Events have been reported since 3/1/2014.

STEIS Trends The following table shows any the current status of any trends by type per provider from April 2013 to this month: Clinical Commissioning Group Provider Services

CCG – GP Care Home CCG BCP NHS 111 Other Providers SWBH WMAS Pressure Ulcers ↓ Falls ↑ ↔ Unexpected Death ↑ Infections ↑ Ambulance Delays ↓

Page 3 of 19

Sandwell & West Birmingham CCG Data contained in this report is up-to-date and includes all data pertaining to 31st May 2014.

100% 5 1 2 2 1 2 1 2 4 3 6 90% 11 18 10 13 11 16 80% 13 22 8 9 8 12 70% 17 60% 67 Major 50% 26 Moderate 63 20 39 40% 32 18 27 29 24 Minor 44 24 30% 11 21 Insignificant 20% 10% 9 11 7 7 9 3 9 3 3 5 4 0% 1 1 2 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May 2013 2014

Page 4 of 19

Incident Reporting Rates per LCG The following table shows a breakdown of the reporting rates of each LCG for the last six months, by numbers of incidents reported.

Month Black Country Healthworks ICOF Pioneers 4 Health Sandwell Health Alliance Total Dec – 13 14 3 4 5 15 40 Jan – 14 13 7 1 3 14 38 Feb – 14 6 9 3 0 28 46 Mar – 14 14 12 2 0 20 48 Apr – 14 4 13 0 1 27 45 May - 14 8 11 2 1 44 66

Black Country Healthworks ICOF Pioneers 4 Health Sandwell Health Alliance Pop. 122,000 Pop. 110,000 Pop. 109,000 Pop. 45,000 Pop. 145,000 Month 23% of CCG 21% of CCG 20% of CCG 9% of CCG 27% of CCG Dec – 13 34.15% 7.32% 9.76% 12.20% 36.59% Jan – 14 34.21% 18.42% 2.63% 7.89% 36.84% Feb – 14 13.04% 19.57% 6.52% 0.00% 60.87% Mar – 14 29.17% 25.00% 4.17% 0.00% 41.67% Apr – 14 8.89% 28.89% 0.00% 2.22% 60.00% May - 14 12.12% 16.67% 3.03% 1.52% 66.67%

Service Responsible General Practice SWBH Other Providers Records, Communication & Records, Communication & Records, Communication & 1 111 137 97 Information Information Information Appointments, Discharge & 2 Medication 62 35 Medication 42 Transfers Violence, Aggression & Self 3 33 Diagnosis & Tests 29 Diagnosis & Tests 12 Harm Appointments, Discharge & 4 Health & Safety 20 Medication 21 10 Transfers Appointments, Discharge & Clinical Care Clinical Care 5 16 21 5 Transfers (Assessment/Monitoring) (Assessment/Monitoring)

Page 5 of 19

Provider Visits This month we conducted the following Quality Assurance Visits.

Service Site Date Comment WMAS Hub 20/5/2014 Overview of services. Please see Appendix 5 for further details.

Page 6 of 19

Sandwell & West Birmingham Hospitals Data contained in this report is accurate up to and including 31st May 2014.

STEIS Types & Status The following chart breaks down the serious incidents pertaining to SWBH from April 1st 2014 by type and current status.

Stop Clock Stop +45d Overdue

Removed

Pending

Not yet due Not +45d Overdue Extension

- – - –

– – –

Open Open Open Closed Closed Closed Closed Closed Cmnsr Lead Not SWB Total STEIS Types Open Adverse Media Coverage or Public concern Org/NHS 1 1 Allegation against HC Professional (Assault) 1 1 1 2 C.Diff & Health Care Acquired Infections 2 4 3 9 Communicable Disease & Infection Issue 2 2 Confidential Information Leak 1 1 2 Delayed Diagnosis 4 1 2 7 Drug Incident (General) 1 1 2 Failure to Act upon Test Results 1 1 1 3 Maternity Service 1 1 2 4 Maternity Services - Intrauterine Death 1 1 Maternity Services - Maternal Unplanned Admission to ITU 1 1 Maternity Services - Unexpected Neonatal Death 1 1 MRSA Bacteraemia 2 1 1 1 5 Pressure Ulcer Grade 3 3 1 20 18 42 Screening Issues 1 1 2 Security Threat 1 1 Slips/Trips/Falls 5 1 22 7 35 Sub-optimal care of the deteriorating patient 1 2 4 7 Surgical Error 3 3 Unexpected Death of Inpatient (not in receipt) 1 1 Ward Closure 5 2 7 Wrong Site Surgery 1 1

Trends The main serious incident trends for SWBH are:

 Pressure Ulcers (Grade 3 or 4)  Slips/Trips/Falls – (Patient Falls resulting in Serious Harm)  C.Diff & Health Care Acquired Infections

Page 7 of 19

Pressure Sores

SWBH - Sandwell - Not Specified 9 (PT) Patient's Home 8 SWBH - City - Not Specified 4 SWBH - City - D18 3 SWBH - Sandwell - Lyndon 4 3 SWBH - City - Critical Care Unit 3 SWBH - Sandwell - Critical Care Unit 3 (Sandwell) - Residential Home - Unknown 2 SWBH - Sandwell - Priory 5 2

Page 8 of 19

Patient Falls

SWBH - Sandwell - Priory 3 4 SWBH - City - MAU 3 SWBH - City - Not Specified 3 SWBH - Sandwell - Not Specified 2 SWBH - City - Emergency Department 2 SWBH - Sandwell - Priory 2 2 SWBH - Sandwell - Priory 4 2 SWBH - Rowley - Henderson Ward 2 SWBH - Sandwell - Newton 1 2

Page 9 of 19

Complaints & Concerns

SWBH Complaints Summary The following chart shows the most recent SWBH Complaints data from the Integrated Quality & Performance Report.

Page 10 of 19

Performance

Area % (Target <1) Numerator Denominator Echocardiography 3.37% 7 208 Colonoscopy 2.99% 5 167 Flexi Sigmoidoscopy 8.33% 6 72 Cystoscopy 21.93% 25 114 Gastroscopy 2.28% 5 219

Corporate Quality Performance Report - Exceptions The following table highlights indicators that have failed to meet the target based on the most recent data submitted by SWBH.

NHS Constitution Indicator List Threshold Frequency Jan – 14 Feb - 14 CB_B15_02 Ambulance >=75% Monthly 74.7% 72.8% clinical quality – Category A (Red 2) 8 minute response time

Page 11 of 19

Black Country Partnerships Foundation Trust Data contained in this report is accurate up to and including 31st May 2014.

STEIS Types & Status The following chart breaks down the serious incidents pertaining to BCP FT from April 1st 2013 to date, by type and current status.

d d

Stop Clock Stop Remove +45d Overdue

Pending

Not yet due Not +45d Overdue Extension

- – – –

– – –

Open Open Open Closed Closed Closed Closed Closed Cmnsr Lead Not SWB Total STEIS Types Open Abscond 2 1 3 Accident Whilst in Hospital 1 1 Admission of under 18s to Adult Mental Health Ward 1 1 1 3 Allegation against HC Professional 1 1 Assault by Outpatient (in receipt) 1 1 Attempted Suicide by Inpatient (in receipt) 1 1 Attempted Suicide by Outpatient (in receipt) 1 1 Homicide by Outpatient (in receipt) 1 1 Other 1 1 Security Threat 1 1 Serious Incident by Inpatient (in receipt) 1 1 Serious Self Inflicted Injury Outpatient 1 1 Slips/Trips/Falls 1 4 5 Suicide by Outpatient (in receipt) 1 1 Suspected Suicide 1 1 Unexpected Death of Community Patient (in receipt) 3 3 1 2 4 13 Unexpected Death of Community Patient (not in receipt) 1 2 3 Unexpected Death of Inpatient (in receipt) 1 1 Unexpected Death of Outpatient (in receipt) 1 1 Ward / Unit Closure 1 1 2 Ward Closure 1 1 Safeguarding Vulnerable Child 1 1

Trends The main serious incident trends for BCP FT are:

 Unexpected Deaths of Community Patients (in Receipt of Mental Health Services)  Slips/Trips & Falls Resulting in Serious Harm

Page 12 of 19

Unexpected Deaths of Community Patients

Unexpected Deaths of Community Patients Trends The following line graph shows the number of Unexpected Deaths of Community Patients that have occurred per month since April 2013.

3.5

3 3

2.5

2 2

1.5

1 1 1 1 1

0.5

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Jul Jul

Jan Jan

Jun Jun

Oct Oct

Apr Apr

Feb Sep Feb Sep

Dec Dec

Aug Aug

Nov Nov

Mar Mar

May May 2013 2014

Complaints & Concerns

Page 13 of 19

West Midlands Ambulance Service & NHS 111 Data contained in this report is accurate up to and including 31st May 2014.

STEIS Types & Status The following chart breaks down the serious incidents pertaining to WMAS/111 from April 1st 2013 to date, by type and current status.

Stop Clock Stop Removed +45d Overdue

Pending

Not yet due Not +45d Overdue Extension

- – – –

– – –

Open Open Open Closed Closed Closed Closed Closed Cmnsr Lead Not SWB Total STEIS Types Open Adverse Media Coverage or Public concern Org/NHS 1 1 2 Allegation against HC non-professional 1 1 Allegation against HC Professional (Assault) 1 1 2 Ambulance (General) 1 1 3 6 11 Ambulance Accidental Injury 1 1 Ambulance Delay 3 2 5 NHS Direct Incident 1 1 2 Safeguarding Vulnerable Adult 1 1 Unexpected Death (general) 1 1

Trends The main serious incident trends for WMAS/111 are:

 Ambulance (General)  Ambulance Delays

The STEIS category ‘Ambulance (General)’ is a nationally defined ‘type’ of Serious Incident, used to describe generic serious incidents pertaining to Ambulance services.

The type of ‘Ambulance (General)’ incidents reported by WMAS are quiet wide ranging, from problems with advice given at call centres to aspects of clinical care delivered by paramedics.

Page 14 of 19

Ambulance Delays

Ambulance Delays Trends The following line graph shows the number of Ambulance Delays that have occurred per month since April 2013.

Patterns and trends were discovered in regard to communication issues between callers, call centres and paramedics.

Sue Green (Director of Nursing and Quality) and Marie Tideswell (Head of Patient Experience) are the two leads for this and should be reporting back for June’s meeting.

Page 15 of 19

Complaints & Concerns

Page 16 of 19

Other Provider Services Data contained in this report is accurate up to and including 31st May 2014.

STEIS Types & Status The following chart breaks down the serious incidents pertaining to Other Provider Services from April 1st 2013 to date, by type and current status.

Clock

Stop Stop Removed +45d Overdue

Pending

Not yet due Not +45d Overdue Extension

- – – –

– – –

Open Open Open Closed Closed Closed Closed Closed Cmnsr Lead Not SWB Total STEIS Types Open Tipton Care Organisation Allegation against HC Professional 1 Sedgeley House Hospital Slips/Trips/Falls 1 Home Oxygen Service Home Oxygen 1

Trends No trends have been identified pertaining to other provider services.

Complaints & Concerns

Concerns There have been three concerns raised about Other Provider Services. The themes are outlined below:

 Uncertainties over what services are supplied by providers

 Uncertainties regarding Provider complaints process

 Clinical concerns raised regarding the processes employed by Other Provider when delivering clinical care

Page 17 of 19

Nursing/Care Homes Data contained in this report is accurate up to and including 30th April 2014.

STEIS Types & Status The following chart breaks down the serious incidents pertaining to Nursing/ Care Homes from April 1st 2013 by type and current

status.

Stop Clock Stop Removed +45d Overdue

Pending

Not yet due Not +45d Overdue Extension

- – – –

– – –

Open Open Open Closed Closed Closed Closed Closed Cmnsr Lead Not SWB Total STEIS Types Open

Slips/Trips/Falls 2 1 1 4

The following chart shows the incident reporting rate of Care/Nursing Homes since April 2013.

Page 18 of 19

Complaints & Concerns

Complaints Trends The chart below shows the relative number of complaints by ‘type’ that SWB CCG are handling in respect of services provided by Nursing/ Care Homes since April 2013. We can see that main trends are complaints in respect of All Aspects of Clinical Treatment.

Concerns There have been three concerns raised about Other Provider Services. The themes are outlined below:

 Uncertainties over what level of care should be provided

 Environmental concerns raised about Care Home, as well as issues raised regarding how well patients were being observed by staff.

 Concerns regarding training level of staff in regard to the setting up and operation of specialist equipment.

Page 19 of 19

Sandwell and West Birmingham CCG Enc 2 Finance and Performance Committee

Report Topic: Finance and Activity Report as at 31st May 2014

Report From: James Green – Chief Finance Officer

Date: 2nd July 2014

Purpose of the Report To provide information to the committee on the financial performance of the CCG for the 2014/15 financial year.

Forecast year-end surplus of £6.3m, against a plan of £6.3m. Proposed increase to planned 2014/15 surplus from £6.3m to £8m. Year-to-date QIPP £2.1m (Planned £2.6m). Key Issues Summary Forecast QIPP £16m (Plan £15.8m) Forecast running cost expenditure of £11.2m, within the running cost allowance of £12.7m.

Members of the Finance & Performance Committee are asked to:

Recommendations 1. Discuss the content of the report; 2. Approve the contents of the report and associated risks.

1. Executive Summary – CCG Assurance Financial Performance Commentary

Self No. Indicator Assessment The table opposite is part of the CCG assurance framework used by NHS England to assess the financial performance of CCGs. The Underlying recurrent surplus overriding performance is rated as amber/green. 1 2.84% Surplus - year to date performance - The underlying surplus is calculated by taking the forecast financial position and removing non-recurrent elements. The underlying 2 Variance 0.14% surplus is 2.84% of programme expenditure. This attracts a green Surplus - full year forecast - Variance rating. 3 0.00% The year-to-date surplus is rated as green, as the favourable Management of 2% NR funds within variance from plan is 0.14%. 4 agreed processes Yes The forecast outturn surplus is rated as green, as both the planned QIPP - year to date delivery and forecast outturn is £6.3m. 5 91% QIPP delivery to-date is under planned levels by £0.5m, attracting QIPP - full year forecast 6 101% an amber/green rating. However, full achievement of £16m is expected by year-end. Activity trends - year to date 7 100% Running Costs Allowance is forecast at £11.2m for 2014/15, within the Running Cost Allowance ceiling of £12.7m. Activity trends - full year forecast 8 100% Risks will be managed throughout the year, to ensure the CCG to meets financial targets. At present a mitigation plan exists in Running Costs 9 88.3% respect of all financial risks. Clear identification of risks against Indicator 10 financial delivery and mitigations met in full

Overall: <3 Primary indicators are A/R Amber/Green

2. Proposed Increase the CCG’s 2014/15 Surplus

Post Month-end

After the closure of the month 2 accounting period, the CCG had the opportunity to increase its 2014/15 planned surplus. Following an internal review of budgets and other financial factors, the CCG has taken advantage of this opportunity and increased its forecast surplus for the year. The CCG’s has submitted a revised financial plan to NHSE, increasing the annual surplus from £6.3m to £8m. However, this increase has yet to be formally confirmed by NHSE Area Team. The entire £8m surplus will be repaid to the CCG in future years. The key reasons for this increase are:-

To increase the amount of financial resource available to the CCG in 2015/16 and future years. A request from NHSE to increase the CCG’s surplus. NHSE had been unable to achieve a balanced 2014/15 financial position across Birmingham, Solihull and the Black Country without support from CCGs.

The repayment of this higher surplus will help the CCG manage an increasingly difficult financial climate in future years.

3. Financial Position

Year to Date Forecast Budget Variance Budget Variance Service Area £000's Actual £000's £000's £000's Actual £000's £000's Acute 56,703 56,774 71 341,384 341,031 (353) Community 15,627 15,691 64 93,765 93,595 (170) Mental Health & Learning Difficulties 12,790 12,803 13 76,741 76,522 (219) Prescribing 13,742 13,544 (199) 82,453 82,249 (204) Required Surplus and Reserves 1,502 449 (1,053) 18,944 13,776 (5,168) Running Costs 1,898 1,825 (73) 11,390 11,204 (186) SWB CCG Total 102,263 101,086 (1,177) 624,678 618,378 (6,300)

Commentary

Surplus Analysis The CCG’s year-end forecast surplus is currently £6.3m. £7,000

£6,000 The year-to-date surplus is £1.2m. This is £0.1m ahead of plan. £5,000

A more detailed breakdown of the financial position can be £4,000 found in Appendix 1 of this document. £3,000

At this stage of the year only limited financial and contractual £2,000 information is available from providers. £1,000

£0

4 Original Plan Actual

4. Prescribing Performance

Commentary Prescribing - Year to Date • The overall prescribing budget for 2014/15 is £82.5m.

• At month-end closedown, prescribing data for April

Actual £000's had not been received from the Prescription Budget £000's Pricing Authority.

• A budget surplus of £0.2m has been forecast for the year.

13,400 13,500 13,600 13,700 13,800 • ScriptSwitch savings for the year-to-date are estimated at £88k. ScriptSwitch - Cumulative Savings • Following the month-end closedown, April’s PPA £100,000 £90,000 information became available. This information is £80,000 consistent with the month-end accruals. £70,000 £60,000 £50,000 • Cost pressure/financial impact of the new NICE £40,000 guideline for atrial fibrillation – some estimates £30,000 £20,000 have a potential pressure of up to £3.5m. £10,000 £-

5. Quality Innovation Price Productivity (QIPP)

Year to Date Outturn Commentary 1.60 10.00 The CCG’s overall QIPP target for the year is 9.00 1.40 £15.8m (excluding health economy wide QIPP, 8.00 1.20 7.00 such as, PbR tariff deflator). 1.00 6.00 0.80 5.00 The year-to-date achievement is £2.1m against a 4.00 0.60 target of £2.6m. 3.00

0.40 2.00 0.20 1.00 The forecast outturn is £16.0m against a plan of - - £15.8m. £m's

Plan Actual Plan Actual

QIPP Financial Performance Recurrent schemes Non Recurrent schemes Total schemes Plan Actual Variance Plan Actual Variance Plan Actual Variance Original Plan £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s Transactional 8,732 8,732 0 0 0 0 8,732 8,732 0 Transformational 2,731 2,731 0 0 0 0 2,731 2,731 0 Other 0 0 0 4,365 4,550 185 4,365 4,550 185 Total QIPP Schemes 11,463 11,463 0 4,365 4,550 185 15,828 16,013 185 Health economy wide QIPP 20,184 20,188 3 0 0 0 20,184 20,188 3 Total CCG & Health Economy QIPP 31,647 31,651 3 4,365 4,550 185 36,012 36,201 188

Supplementary Schemes Other 0 0 0 0 (188) (188) 0 (188) (188) Total CCG & Health Economy QIPP 0 0 0 0 (188) (188) 0 (188) (188)

Total Overall QIPP 2013/14 31,647 31,651 3 4,365 4,362 (3) 36,012 36,013 0

6. Statement of Financial Position

May-14 £ Commentary

PPE 14,760 The actual cash balance was £74k at the Accumulated Depreciation 0 Net PPE 14,760 end of May.

Intangible Assets 0 Intangible Assets Depreciation 0 Accounts receivable includes accrued income from CCGs relating to lead Net Intangible Assets 0 Investment Property 0 commissioning with West Midlands Non-Current Assets Held for Sale 0 Ambulance Trust in respect of NHS 111. Non-Current Financial Assets 0 Other Receivables Non-Current 0 Accounts payable main items include Tax, Total Other Non-Current Assets 0 National Insurance and pension Non-Current Assets 14,760 contributions, together with general Cash 74,311 accruals, NHS accruals and Prescription Accounts Receivable 3,276,466 Pricing Authority (prescribing) charges. Inventory 0 Investments 0 Retained earnings represent cash Other Current Assets 0 allocation draw down to date, net of Current Assets 3,350,777 expenditure incurred. TOTAL ASSETS 3,365,537

Accounts Payable 37,569,242 Accrued Liabilities (245,770) The CCG will undertake regular balance sheet reviews during the year. Short Term Borrowing 0 Current Liabilities 37,323,472

Non-Current Payables 0 Non-Current Borrowing 0 Other Liabilities 0 Long Term Liabilities 0 General Fund 0 Share Capital 0 Revaluation Reserve 0 Donated Assets Reserve 0 Government Grants Reserve 0 Other Reserves 0 Retained Earnings incl. In Year (33,957,935) Total Taxpayers Equity (33,957,935)

TOTAL EQUITY + LIABILITIES 3,365,537

7. Cash Efficiency

Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's ACTUAL BANK BALANCE 0 351 0 0 0 0 0 0 0 0 0 Funding from DH 40,224 40,000 0 0 0 0 0 0 0 0 0 Adjustments to main funding 8,500 8,600 0 0 0 0 0 0 0 0 0 Total cash available 48,724 48,951 0 0 0 0 0 0 0 0 0 less net payments at CITI DIRECT 48,416 48,865 0 0 0 0 0 0 0 0 0 less net payments at BANKLINE (43) 11 0 0 0 0 0 0 0 0 0 Total net payments 48,374 48,877 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Closing BANK BALANCE 351 74 0 0 0 0 0 0 0 0 0 Actual % of closing balance (compared to opening balance 10.36% 9.40% plus drawdown)

Commentary

SWB CCG has remained within its cash limits throughout the first two months of the year.

The CCG had a closing balance of £0.074m at the May month end.

Cash management has improved significantly since this time last year, with in-month cash requirements being more aligned to cash usage.

8. Better Payment Practice Code

Invoice Invoice BPPC Commentary Invoice Amount % Amount Count % Passed Amount BPPC Paid Count (Passed) Passed (Passed) £000's Period £000's • The CCG aims to pay 95% of all valid invoices Apr-14 1,151 1,094 95.05% £48,804 £47,927 98.20% within 30 days. May-14 955 908 95.08% £48,515 £43,909 90.51% Jun-14 • During April, 1,151 invoices were registered Jul-14 with a combined value of £48.8m. Aug-14

Sep-14

Oct-14 • BPPC performance for April showed 95% of Nov-14 these invoices were paid within 30 days, with Dec-14 98% of value paid on time. Jan-15 Feb-15 • During May, invoices were registered with a Mar-15 combined value of £48.5m. Total 2,106 2,002 95.06% 97,319 91,836 94.37% Invoices paid • BPPC performance for May showed 95% of 100.00% these were paid within 30 days with 91% of 98.00% % Passed value paid on time. 96.00%

94.00% % Amount 92.00% Passed 90.00% % Target 88.00%

86.00%

9. Conclusion

In conclusion, the key points to note from this report are:-

The Sandwell and West Birmingham CCG overall Revenue Resource Limit (annual budget) is £625m.

The CCG is forecasting a surplus of £6.3m for the financial year.

It is proposed the CCG’s annual surplus be increased since last month (was £6.3m). The increased surplus will be repaid to the CCG for use in future years.

The CCG has a significant QIPP challenge (£16m) in 2014/15.

Risks will be managed throughout the year, to ensure the CCG to meets financial targets. At present a mitigation plan exists in respect of all financial risks.

The overall financial climate remains challenging.

10. Recommendations

Members of the Finance and Performance Committee are asked to:

1. Discuss the contents of the report; 2. Approve the contents of the report and associated risks.

Contact Officers

James Green – Chief Finance Officer – [email protected]

David Hughes - Deputy Chief Finance Officer – [email protected]

Appendix 1 Full Year Outturn

Cost Centre Description Budget £000's Actual £000's Variance £000's Budget £000's Actual £000's Variance £000's PLANNED CARE 0 0 0 0 0 0 URGENT CARE 475 456 (19) 2,850 2,563 (286) MATERNITY SERVICES 0 0 0 0 0 0 AMBULANCE SERVICES 2,714 2,715 1 16,670 16,671 1 ACUTE COMMISSIONING 50,794 50,931 137 305,393 305,636 243 ACUTE CHILDRENS SERVICES 1,638 1,663 25 9,981 10,129 148 WINTER PRESSURES 0 3 3 0 3 3 NCAS/OATS 638 638 0 3,830 3,830 0 COMMISSIONING SCHEMES 247 247 0 1,480 1,480 0 INTERPRETING SERVICES 197 121 (75) 1,180 718 (462) ACUTE ELDERLY SERVICES 0 0 0 0 0 0 LONG TERM CONDITIONS 0 0 0 0 0 0 SUB TOTAL: ACUTE 56,703 56,774 71 341,384 341,031 (353) COMMUNITY SERVICES 9,120 9,111 (9) 54,722 54,690 (32) CHC ADULT FULLY FUNDED 2,708 2,708 0 16,248 16,248 (0) FUNDED NURSING CARE 952 1,022 70 5,715 5,715 0 COMMISSIONING - NON ACUTE 243 275 33 1,456 1,581 125 OUT OF HOURS 558 563 5 3,350 3,350 0 NHS 111 218 232 13 1,311 1,324 13 LOCAL ENHANCED SERVICES 347 372 25 2,081 2,106 25 REABLEMENT 157 134 (23) 940 787 (153) WHEELCHAIR SERVICE 258 241 (17) 1,550 1,421 (128) PALLIATIVE CARE 141 151 10 844 825 (19) HOSPICES 169 157 (12) 1,014 983 (31) INTERMEDIATE CARE 180 176 (4) 1,080 1,053 (28) OXYGEN 138 138 (0) 829 826 (2) CARERS 137 140 3 819 838 18 SAFEGUARDING 82 80 (2) 494 503 9 CONTINUING HEALTHCARE ASSESSMENT & SUPPORT 165 134 (31) 993 968 (24) EXCEPTIONS & PRIOR APPROVALS 30 21 (8) 179 174 (5) COUNSELLING SERVICES 0 0 0 0 0 0 CHC CHILDREN 0 1 1 0 1 1 CHC AD FULL FUND PERS HLTH BUD 23 33 10 140 198 59 RECHARGES 0 1 1 0 1 1 PROGRAMME PROJECTS 0 0 0 0 1 1 SUB TOTAL: COMMUNITY 15,627 15,691 64 93,765 93,595 (170) MENTAL HEALTH CONTRACTS 5,091 5,112 20 30,549 30,406 (143) MENTAL HEALTH SERVICES - ADULTS 3,078 3,073 (5) 18,466 18,459 (7) LEARNING DIFFICULTIES 1,825 1,825 0 10,948 10,948 0 MENTAL HEALTH SERVICES - OLDER PEOPLE 1,307 1,307 0 7,840 7,840 0 MENTAL HEALTH SERVICES - OTHER 758 759 1 4,546 4,502 (44) CHILD AND ADOLESCENT MENTAL HEALTH 569 570 0 3,417 3,417 1 IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES 134 130 (4) 805 779 (26) MENTAL HEALTH SERVICES - COLLABORATIVE COMMISSIONING 0 0 (0) 0 0 0 DEMENTIA 6 6 0 35 35 0 MENTAL HEALTH SERVICES - NOT CONTRACTED ACTIVITY 23 23 0 135 135 0 SUB TOTAL: MENTAL HEALTH & LEARNING DIFFICULTIES 12,790 12,803 13 76,741 76,522 (219) PRESCRIBING 13,658 13,458 (200) 81,948 81,739 (209) MEDICINES MANAGEMENT - CLINICAL 84 85 1 506 510 5 SUB TOTAL: PRESCRIBING 13,742 13,544 (199) 82,453 82,249 (204) CORPORATE COSTS & SERVICES 554 504 (50) 3,323 3,024 (299) STRATEGY & DEVELOPMENT 403 367 (36) 2,417 2,422 5 CHAIR AND NON EXECS 252 298 46 1,513 1,513 (0) FINANCE 137 156 19 822 829 8 QUALITY ASSURANCE 121 161 40 728 803 75 PATIENT AND PUBLIC INVOLVEMENT 106 121 16 634 671 38 CLINICAL SUPPORT 81 60 (21) 486 486 (0) IM&T 9 17 7 56 58 2 ESTATES AND FACILITIES 50 55 4 302 307 4 CONTRACT MANAGEMENT 42 27 (15) 253 239 (14) MEDICINES MANAGEMENT 14 14 0 85 86 2 EQUALITY AND DIVERSITY 12 11 (1) 70 65 (6) EDUCATION AND TRAINING 15 20 5 89 89 0 RISK MANAGEMENT 90 0 (90) 542 542 0 PROCUREMENT 0 0 0 0 0 0 ADMIN PROJECTS 12 15 3 70 70 (0) SUB TOTAL: RUNNING COSTS 1,898 1,825 (73) 11,390 11,204 (186) PLANNED SURPLUS 1,050 0 (1,050) 6,300 0 (6,300) COMMISSIONING RESERVE (243) (246) (3) 8,474 9,606 1,132 RECHARGES NHS PROPERTY SERVICES LTD 695 695 0 4,170 4,170 0 NON RECURRENT PROGRAMMES 0 0 0 0 0 0 SUB TOTAL: REQUIRED SURPLUS AND RESERVES 1,502 449 (1,053) 18,944 13,776 (5,168) Grand Total 102,263 101,086 (1,177) 624,678 618,378 (6,300)

Enc 3

Report Topic: Key Indicators Performance Report – as at April/May 2014/15

Report From: James Green – Chief Finance Officer

Date: 30th June 2014

To provide information to the Board on the performance of the CCG against key Aim of Report indicators for the 2013/14 financial year.

A&E and Urgent Care Discussion Points RTT >52 weeks Mixed Sex Accommodation

Members of the Committee are asked to:

RECOMMENDATIONS 1. Discuss the content of the report 2. Approve the contents of the report

1 Key messages

CCG summary: Our lead roles and responsibilities:

A&E and Urgent care – In 2013/14 Sandwell and West Birmingham CCG is the lead commissioner on;

• 4 hr waits 94.5% for May NHS 111 across the West Midlands. . WMAS across the West Midlands Home Oxygen across the West Midlands. RTT and Mixed Sex Accommodation - Urgent care for the Black Country

• First exception notice issued to SWBH with 4% withholding of monthly actual value, circa £750 per month. The Trust to provide detailed remedial action plans with revised trajectories across all Sandwell and West Birmingham CCG is leading the reconfiguration of Stroke return to treatment targets and mixed sex accommodation. services across Birmingham and the Black Country on behalf of all commissioners. Diagnostics - Stroke • The Trust to share detailed action plans for resolution of performance for all ‘oscopies’. Our significant CCG redesign projects are;

Community Nursing Diabetes Right care right here – As part of the partnership programme an ongoing process of redesigning services with a stronger Community focus.

Performance

3 Balanced Scorecard – Domain assessment

CCG Balanced Scorecard

Are people getting good quality care? A/G

Are patients rights under the NHS Constitution being promoted? A/R

Are Health Outcomes improving for local people? A/R

Are CCG’s commissioning services within their financial allocations? A/G Domain

Are conditions of the CCG authorisation being addressed and removed (where relevant)? G

Indicator Key

Indicator RAG rating Green – all 'NO' responses Amber/Green – One or more 'YES' responses but action plan in place that successfully mitigates patient risk Amber-Red – One or more 'YES' responses and no action plan in place / plan does not successfully mitigate patient risk Red – Enforcement action is being undertaken by the CQC, Monitor or TDA and the CCG is not engaged in proportionate action planning to address patient risk.

4 Are people getting a good quality of care?

Indicator

Sandwell and Provider West Birmingham Black Country West Midlands NHS Trust Partnership FT Ambulance FT NHS 111 Has local provider been subject to enforcement action by the CQC? N N N -

N N N - Has local provider been flagged as a 'quality compliance risk' by Monitor and/or are requirements in place around breaches of provider licence conditions? Has local provider been subject to enforcement action by the NHS TDA based on 'quality' risk? N N N - Does feedback from the Friends and Family test (or any other patient feedback) indicate any causes for concern? N N N - Has the provider been identified as a 'negative outlier' on SHMI or HSMR? N N N - Do provider level indicators from the National Quality Dashboard show that: MRSA cases are above zero? Y N N - The provider has reported more C difficile cases than trajectory? N N N - MSA breaches are above zero Y N N - Does the provider currently have any unclosed Serious Untoward Incidents (SUIs)? Y Y Y Y Has the provider experienced any 'Never Events' during the last quarter? Y N N - CCG: Clinical Governance Does the CCG have any outstanding conditions of authorisation in place on clinical governance? N Has the CCG self-assessed and identified any risks associated with the following: Concerns around quality issues being discussed regulary by the CCG governing body? N Concerns around the arrangements in place to proactively identify early warnings of a failing service N Concerns around the arrangements in place to deal with and learn from serious untoward incidents and never events N Concerns around being an active participant in its Quality Surveillance Group N N If there was an emergency event in the last quarter, has the CCG self-assessed and identified any areas of concern on the arrangements in place for dealing with such an event? Has the CCG self-assessed and identifed any risk to progess against its Winterbourne View action plan? N

5 NHS - Operation England al Lower Providers Trend CCG Trend Indicator Frequency standard threshol Data source/Month d

Ambulance response times The total number of category A red 1 incidents, which resulted in an emergency response p Monthly 75% 70% 82% p 90.8% q arriving at the scene of the incident within 8 minutes. The total number of category A red 2 incidents, which resulted in an emergency response Monthly 75% 70% 77.7% p 81.3% q WMAS May / SWBCCG May arriving at the scene of the incident within 8 minutes. The total number of calls resulting in an ambulance arriving at the scene of the incident within 19 Monthly 95% 90 97.2% u 99.4% q minutes. Ambulance handover times City 96 q Handovers of over 30 minutes Monthly 2897 q Sandwell 48 p WMAS May / SWBH May City <15 mins 7 u Handovers of over 1 hour Monthly 117 p Sandwell 1 p Ambulance Crew clear times City 1 p Crew clear - delays of over 30 minutes Monthly < 15 mins 178 q Sandwell 10 q WMAS May / SWBH May City 0 u Crew clear delays of over 1 hour Monthly <15 mins 2 u Sandwell 0 u

Category A incidents – All three categories were met in May for both the CCG and WMAS as a whole. 6 individual CCGs failed the national targets in May and these were outside of the Birmingham & Black Country region. Handover times - For WMAS as a whole, ov er 30 minute handovers increased in May by over 200 but remain below the end of March position. Over 60 minute handovers reduced slightly in May from 133 to 117. Trusts with the most over 60 minute handovers were Russell’s Hall and Heartlands with 28 each and Hereford County with 10. The rest spread across the patch. Individually both City and Sandwell sites had a increase in over 30 minute handovers. Crew Clear times – For WMAS as a whole, over 30 minute crew clears increased slightly in May. There were 2 over 60 minute crew clears, 1 at Birmingham Children’s and 1 at Good Hope. Individually, City site had 1 delay over 30 minutes and Sandwell had 10, both had no over 60 minute delays.

6 NHS - Operation England al Lower Providers Trend CCG Trend standard threshol Frequency Data source/Month Indicator d

A&E waiting times <4 hours Cumulative A&E waiting time - Percentage of patients who spend 4 hours or less in A & E >=95% - 94.5% q - SWBH May (Type I,II,&III) YTD Provider A&E attendees Cumulative A&E attendees - Type 1 - 27143 q - SWBH May (Type I) YTD Cumulative A&E attendees - All 37867 q - - SWBH May (Type I,II,&III) YTD

Trolley waits in A&E over 12 hours Weekly 0 - 0 u SWBH May

Non-elective FFCEs

YTD Number of G&A non-elective FFCEs in the period Monthly - - 5,150 p SWBCCG Apr 5,262

A&E – Performance in April reached 96% but during May the number over 4 hours increased significantly from 138 in the last week of April to 309 in the last week in May , therefore, the percentage over 4 hours failed to achieve the national target. There are 3 main reasons for the underperformance, firstly, 34% consultant vacancies in emergency medicine and which weren’t covered sufficiently in May. Secondly, growth in the number of delayed transfers which has a demonstrable effect and finally, an increase in the number and length of stay of mental health patients impacting on capacity and flow.

There continued to be no trolley waits over 12 hours.

Non-Elective activity – The two year operational plans are in the process of being amended nationally due to the vast discrepancies between forecast outturn, which was used to set the original plans, and the actual outturn. At the end of April the CCG was within the revised plan. May data will be available on 27th June and a verbal update will be given.

NHS - Operation England al Lower Providers Trend CCG Trend standard threshol Indicator Frequency d Data source/Month

All First Outpatient Attendances YTD All first outpatient attendances (consultant-led) in general and acute specialties Monthly - - - 10,952 p SWBCCG Apr 9,352 Diagnostic test waiting times

Number of patients waiting 6 weeks or more for a diagnostic test (15 key diagnostic tests) at the Monthly 1.0% - 0.96% q 1.87% q SWBH Apr / SWBCCG May end of the period

The percentage of non-admitted pathways within 18 weeks for non-admitted patients whose clocks stopped during the period

The number of non admitted pathways within 18 weeks for non admitted patients whose clocks Monthly 95% 90% 96.31% q 96.45% q SWBH Apr / SWBCCG Apr stopped during the period.

All first outpatient attendances - The CCG are in the process of revising the plan for outpatient attendances and therefore performance at the moment has not been RAG rated. Diagnostic test - SWBH – April saw a slight decline with 78 out of 8110 patients waiting over 6 weeks, 60 of these were for SWB almost half were in cystoscopy (27). The Trust are to share detailed action plans for resolution of performance for all ‘oscopies’. Diagnostic tests - CCG – There has been an increase in the number waiting over 6 weeks in both April and May with both months failing to meet the national target. In April there were 101 patients over 6 weeks and in May 158. Out of the 158, 103 were at SWBH. Oscopy scanning at SWBH still has the majority of long waits but MRI’s at B’ham Children’s remains a problem. RTT non-admitted CCG - 237 patients out of a total of 6673, 200 of these were waiting at SWBH. Problem specialties continued to be Cardiology with an increase to 37 waiting over 18 weeks and 22 of these over 26 weeks. T & O which had almost doubled to 56 over 18 weeks and 23 over 26 weeks. Also the ‘Other’ category saw a marked increase to 41 over 18 weeks and 11 over 26 weeks. There were no over 52 week non-admitted waits in April. RTT non-admitted SWBH – 267 out of a total of 7245 waited over 18 weeks, problem specialties continued to be Cardiology with 48 waiting over 18 weeks, 29 of which had waited >26 weeks, this is a marked increased on any month last year. T&O also had 48 over 18 weeks, 26 over 26 weeks which was similar to the levels experienced last year . There were a number of other specialties with patients waiting over 18 weeks including Dermatology, ENT and General Surgery but these were all coming down from the end of March position. There were no over 52 week non-admitted waits in April.

NHS - Operational England Providers Trend CCG Trend standard Lower Indicator Frequency threshold Data source/Month

The percentage of admitted pathways within 18 weeks for admitted patients whose clocks stopped during the period on an adjusted basis The number of admitted pathways within 18 weeks for admitted patients whose clocks stopped Monthly 90% 85% 90.02% q 88.85% q SWBH Apr / SWBCCG Apr during the period on an adjusted basis. Mixed Sex Accommodation Breaches

Minimise breaches Monthly <1 <10 43 q 37 q SWBH May / SWBCCG May

Delayed Transfers of Care

Number of patients with a Delayed Transfers of Care Monthly Minimum - 24 u - - SWBH May

Risk assessment of hospital-related Venious Thromboembolism

Incidence of hospital-related venous thromboembolism (VTE) - SWBH Monthly - 98.3% q - SWBH Mar

Cancelled operations Reduce The percentage of elective admissions cancelled at the last minute for non clinical reasons and Cumulative from 0.31% p - SWBH YTD @ Q4 not offered another binding date within 28 days 13/14

RTT admitted CCG – 324 patients out of a total of 2906 waited over 18 weeks, again just below the national target, but within the NHSE amber threshold. In the main these continued to be T & O, General Surgery, Ophthalmology and ‘Other’ specialties. The majority at SWBH but also the CCGs patients at Heart of England, UHB and ROH failed to meet the national target when both ROH and UHB Trusts achieved the target as a whole Trust. There were no over 52 week waiters in April. RTT admitted SWBH – 328 out of a total of 3287 waited over 18 weeks, which was just within the national target. Problem specialties continued to be T & O with 105 waiting over 18 weeks, 67 of which waiting over 26 weeks. General Surgery with 45 waiting over 18 weeks and 12 over 26. Also, Ophthalmology with 56 over 18 weeks and 11 over 26 weeks, although this was quite a reduction form the numbers in March. There were no over 52 week waiters in April. Mixed sex accommodation SWBH - As previously reported, the introduction of an electronic bed management system in the two problematic areas of coronary care and stroke have resulted in a higher than expected number of MSA breaches at SWBH. As anticipated, this has resulted in 36 breaches at Sandwell General in April and 40 in May, 3 of these were at City hospital. It is worth noting that to date there have been no breaches since the end of May. For the CCG, there were 32 breaches in April, all at Sandwell General and 37 in May, 35 of these were at Sandwell and 2 at City Hospital. Delayed Transfers SWBH – At midnight on the last Thursday of the reporting period In May, 24 patients had a delayed discharge and this amounted to 694 days. Cancelled Operations – No change in data since the last report. YTD there were 646 operations cancelled at SWBH with just 2 patients not being offered another binding date within 28 days.

NHS - Operation England al Lower Providers Trend CCG Trend Frequency standard threshol Data source/Month Indicator d

The percentage of incomplete pathways within 18 weeks for patients on incomplete pathways at the end of the period The number of incomplete pathways within 18 weeks for patients on incomplete pathways at Monthly 92% 87% 92.67% q 93.09% p SWBH Apr / SWBCCG Apr the end of the period

RTT Incomplete pathways >52 week waits

The number of people waiting on an incomplete pathway more than 52 weeks from the referral Monthly 0 10 1 u 0 p SWBH Apr / SWBCCG Apr date.

Elective FFCEs

Number of G&A elective ordinary admission FFCEs in the period Monthly - - 789 SWBCCG Apr Number of G&A daycase FFCEs in the period Monthly - - 3,647 SWBCCG Apr Total number of G&A elective FFCEs in the period Monthly - - 4,436 q SWBCCG Apr

RTT incomplete CCG – 1,945 patients out of 28,133 were waiting over 18 weeks at the end of April. In the main this was attributable to T & O, ‘Other’ and Cardiology and three quarters of these were at SWBH, the remainder spread across the patch. RTT incomplete SWBH – 2,246 out of 30,640 patients were waiting over 18 weeks with 639 of those waiting over 26 weeks. Problem specialties were ‘Other’ with 486 waiting over 18 weeks and 130 over 26 weeks. T & O with 461 waiting over 18 weeks and 164 over 26 weeks. Cardiology with 287 over 18 weeks and 95 over 26 weeks, although this was a marked reduction on the March position. Ophthalmology with 228 over 18 weeks and 27 over 26 weeks, this was quite and increase in both categories compared to March. Also, ENT, General Surgery and Oral Surgery all had over 100 patients waiting over 18 weeks.

1 incomplete patient waited >52 weeks in General Surgery – This patient was a Cross City CCG patient and was incorrectly listed following a diagnostic investigation.

Elective FFCEs – The CCG are in the process of revising the plan for elective admissions and therefore performance at the moment has not been RAG rated.

10 NHS - Operation England al Lower Providers Trend CCG Trend standard threshol Data source/Month Indicator Frequency d

Cancer waits – 2 week wait

Maximum two-week wait for first outpatient appointment for patients referred urgently with Monthly 93% 88% 93% q 94.4% q suspected cancer by a GP SWBH Apr / SWBCCG Apr Maximum two-week wait for first outpatient appointment for patients referred urgently with Monthly 93% 88% 93.2% q 93.8% q breast symptoms (where cancer was not initially suspected)

Cancer waits – 31 days

Maximum one month (31-day) wait from diagnosis to first definitive treatment for all cancers Monthly 96% 91% 98.6% q 97.6% p

Maximum 31-day wait for subsequent treatment where that treatment is surgery Monthly 94% 89% 100% u 95.5% q Maximum 31-day wait for subsequent treatment where that treatment is an anti-cancer drug SWBH Apr / SWBCCG Apr Monthly 98% 93% 100% u 100% u regimen Maximum 31-day wait for subsequent treatment where that treatment is a Radiotherapy Monthly 94% 89% 100% u 100% u Treatment Course

Cancer waits – 62 days

Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for Monthly 85% 80% 89.3% q 89.5% p cancer Maximum 62-day wait from referral from an NHS screening service to first definitive treatment Monthly 90% 85% 100% u 100% u SWBH Apr / SWBCCG Apr for all cancers Maximum 62-day wait for first definitive treatment following a consultant’s decision to upgrade Monthly - - 100% u 93.8% q the priority of the patient (all cancers)

CCG position - 2 week wait - 46 patients out of 900 waited over 2 weeks, from the exception reports the majority of which were at SWBH and were a result of patient choice.. The . remainder where at Dudley Group (3), Walsall (3) & UHB (1). 3 breast symptom patients waited over 2 weeks, all were at SWBH and were again a result of patient choice. 31 day cancer waits – 4 patients out of 149 waited over 31 days from diagnosis to 1st treatment, all were at UHB , 3 urological cancers were delayed due to capacity issues and the fourth one was an upper gastrointestinal and was cancelled due to transplant activity. 62 Day Cancer waits – 10 patients out of 80 waited over 62 days from urgent GP referral to 1st treatment, 5 at UHB for various reasons, 4 at SWBH through patient choice and the remaining one at Walsall whose treatment plan had to be changed causing a delay. Provider position – SWBH - 2 week waits – 43 out of 832 patients waited over 2 weeks for their 1st outpatient appointment and 3 out of 135 for breast symptoms referrals. 31 and 62 day waits – all indicators achieved 100% at SWBH in March.

11 NHS - Operation England al Lower Providers Trend CCG Trend Frequency standard threshol Data source/Month Indicator d

HCAI measure (MRSA)

Monthly SWBH May / SWBCCG May Number of Meticillin resistant Staphylococcus aureus (MRSA) bacteraemia <1 - 0 p 1 q (YTD) Quality premium impact

HCAI measure (Clostridium difficile infections)

Number of Clostridium difficile infection for patients ages 2 or over on the date the specimen Monthly SWBH May / SWBCCG May 18 - 5 p 19 p was taken. (YTD) Quality premium impact

Mental health Improved access to Psychological services - Moving to recovery Quarterly 50.0% - 73.0% p - BCPFT - data at December. Improved access to Psychological services - People entering treatment Quarterly >=plan - - 4.1% Data at Q3

Care Programme approach (CPA) The number of people under the adult mental illness specialties on CPA who were followed up (either by face to face contact or by phone discussion) within 7 days of discharge from a Quarterly 95% - 96.7% q BCPFT Q4 psychiatric in-patient facility.

MRSA - No breaches in April, 1 breach for the CCG in May which was a non-acute assignment recorded at SWBH. Cdiff - In April there were 3 breaches at Sandwell General, all attributable to SWB CCG. There were 2 breaches in May, one at Sandwell General and one at City Hospital. Only one of these was attributable to SWB CCG. The CCG had 12 breaches in April, 4 acute, 3 at SWBH and 1 at Heart of England and 8 non-acute, 7 recorded at SWBH and 1 at DGOH. There were 7 breaches for the CCG in May 2 acute, 1 at SWBH and 1 at UHB and 5 non-acute, 3 at SWBH and 2 at UHB. In following–up information regarding individual patient incidents, it has come to light that there is a discrepancy between the numbers reported to F&P and those reported to the CCG’s Quality Group. This is now being investigated and a full update will be given at the next meeting. IAPT performance remains an issue for the CCG. The CSU are in the process of analysing monthly data from the NHS Information Centre, in advance of the national quarterly data, but definitions are proving to be difficult. There is a long time lag in the publication of the national data and we are still awaiting the final Q4 performance.

12 Outcomes framework and Everyone counts - CSU Performance Data (reporting parameters)

BASELIN PREVENTING PEOPLE FROM DYING BASELINE Plan Plan Plan Plan Plan Threshold Frequency E JAN FEB MAR Q4 YTD Comments PREMATURELY IC April JAN FEB MAR YTD CSU

1a.i Potential Years of Life Lost (PYLL) from causes considered amenable to health care - adults Reduce Annual - CY 2,599.40 IC Baselines updated @ September 2013

1a.ii Potential Years of Life Lost (PYLL) from causes considered amenable to health care - children and young people Reduce Annual - CY 563.70 IC Baselines updated @ March 2014

1b.i Life Expectancy at 75 - males Increase Annual - CY Baseline currently at LA level, needs discussion.

1b.ii Life Expectancy at 75 - females Increase Annual - CY Baseline currently at LA level, needs discussion.

1.1 Under 75 mortality rate from cardiovascular disease Reduce Annual - CY 84.39 IC Baselines updated @ September 2013

Under 75 mortality rate from 1.2 Reduce Annual - CY IC Baselines updated @ September 2013 respiratory disease 35.02

1.3 Under 75 mortality rate from liver disease Reduce Annual - CY 23.22 IC Baselines updated @ September 2013

1.4 Under 75 mortality from cancer Reduce Annual - CY 130.53 IC Baselines updated @ September 2013

1.4.i One-year survival for all cancers in adults 15+ Increase Annual - CY 1996 to 2011 data publication is at England level

1.4.ii Five-year survival for all cancers in adults 15+ Increase Annual - CY 1996 to 2006 data publication is at England level

1.4.iii One-year survival for breast, lung and colorectal cancer in adults 15+ Increase Annual - CY 1996 to 2011 data publication is at England level

1.4.iv Five-year survival for breast, lung and colorectal cancer in adults 15+ Increase Annual - CY 1996 to 2006 data publication is at England level

Annual Baselines at CCG level to be published by HSCIC 1.5(L) Under 75 mortality rate in people with serious mental illness Reduce financial year Dec 2013

Baseline currently at PCT & LA level, needs 1.6.i(L) Infant mortality Reduce Annual - CY discussion.

Baseline currently at PCT & LA level, needs 1.6.ii(L) Neonatal mortality and stillbirths Annual - CY discussion.

1.6.iii(Pl) Five year survival for all cancers in children ? 1990 to 2006 publication is at England level

1.7(Pl) Reduced premature mortality in people with learning disabilities NK NK Placeholder - IC working on indicator development

BASELIN BASELINE Plan Plan ENHANCING QUALITY OF LIFE FOR THE PEOPLE WITH LONG TERM CONDITIONS Threshold Frequency E JAN FEB MAR Q4 YTD Comments IC April JAN CSU

2(ID) Health related quality of life for people with long-term conditions Increase Bi-annual Baseline currently at LA/PCT level, needs discussion.

IC CCG latest Baseline is for July 11- March 12 2.1(ID) Proportion of people feeling supported to manage their condition Increase Bi-annual 60.78% therefore excluded. CSU baseline taken from GPPS July 12- March 13.

2.2(L) Employment of people with long-term conditions Reduce Gap Quarterly 2006 to 2013 publication is at LA level

New baseline for 12/13. IC baseline is DSR bur CSU 2.3.i(L) Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) Rolling Annual Reduce Monthly 1,143.90 776.08 890.84 879.58 baseline is just rate per 100.000 pop. Definition changed to 'all ages'.

New baseline for 12/13. IC baseline is DSR bur CSU 2.3.ii(L) Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Rolling Annual Reduce Monthly 583.00 599.05 529.64 516.81 baseline is just rate per 100.000 pop.

Indicator in development data currently at LA/PCT 2.4(ID) Health-related quality of life for carers Increase Bi-annual level

2006 to 2013 publications currently at LA/England 2.5(L) Employment of people with mental illness Reduce gap Quarterly level

Baseline updated from 11/12 to 12/13 but only 2.6i(L) Estimated diagnosis rate of people with dementia Increase Annual 48.7% available at England average level.

An indicator on the effectiveness of post-diagnosis care for people with dementia in sustaining independence and 2.6ii(Pl) ? ? Placeholder - IC working on indicator development improving the quality of life

13 BASELIN BASELINE Plan Plan Plan Plan Plan Plan HELPING PEOPLE TO RECOVER FROM EPISODES OF ILL HEALTH OR FOLLOWING INJURY Threshold Frequency E JAN FEB MAR Q4 YTD Comments IC April JAN FEB MAR Q4 YTD CSU

New baseline for 12/13. IC baseline is DSR bur CSU Emergency admissions for acute conditions that should not usually require hospital 3a(L) Rolling Annual Reduce Monthly baseline is just rate per 100.000 pop. Definition admission 1,720.70 1,106.28 1,804.23 1,806.48 changed to 'all ages'

No CSU baseline comparison at present as historical re-admissions data has not been mapped to CCG.IC 3b(L) Emergency readmissions within 30 days of discharge from hospital Reduce Monthly 12.85 6.48% 7.48% 6.95% Baseline 2010/11 update released March 2013 added March 2014

3.1i(L) Hip replacement Reduce Monthly 0.397 Updated baselines for 2011/12 - December 2013

3.1ii(L) Knee replacement Reduce Monthly 0.284 Updated baselines for 2011/12 - December 2013 3.1iii(L) Groin hernia Reduce Monthly 0.042 Updated baselines for 2011/12 - December 2013 3.1iv(L) Varicose veins Reduce Monthly 0.079 Updated baselines for 2011/12 - December 2013 3.1v(ID) Number of elective procedures weighted by effectiveness - psychological therapies Reduce Monthly Indicator in development New baseline for 12/13. IC baseline is DSR bur CSU 3.2(L) Emergency admissions for children with lower respiratory tract infections (LRTI) Rolling Annual Reduce Monthly 566.90 550.76 496.44 495.68 baseline is just rate per 100.000 pop.

3.3(ID) An indicator on recovery from injuries and trauma Increase ? Indicator in development An indicator on the proportion of stroke patients reporting an improvement in activity/lifestyle on the Modified 3.4(ID) ? Annual Indicator in development Rankin Scale at 6 months

The proportion of patients with fragility fractures recovering to their previous levels of mobility / walking ability at Annual Financial 3.5.i(ID) Increase Only baseline available is the England average. 30 days year

The proportion of patients with fragility fractures recovering to their previous levels of mobility / walking ability at Annual Financial 3.5.ii(ID) Increase Only baseline available is the England average. 120 days year

Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into Annual Financial 3.6i(L) Increase Baseline currently at LA level, needs discussion. rehabilitation/reablement services year

Numerator baseline is at LA level, denominator will Proportion of older people (65 and over) who were offered rehabilitation following discharge from acute or Annual Financial 3.6ii(L) Increase come from SUS which will need development, needs community hospital year discussion.

BASELIN BASELINE Plan Plan Plan Plan Plan Plan ENSURING THAT PEOPLE HAVE A POSITIVE EXPERIENCE OF CARE Threshold Frequency E JAN FEB MAR Q4 YTD Comments IC April JAN FEB MAR Q4 YTD CSU

Only baseline available is the England 2011/12 - 4a.i(l) Patient experience of Primary Care - GP services Increase Bi-Annual 78.25% 2012/13 average.

Updated with IC baselines December 2013 (July 4a.ii(L) Patient experience of Primary Care - Out of hours GP services Increase Bi-Annual 64.68% 64.64% 2012 to March 2013) data period

Only baseline available is the England 2011/12 - 4a.iii(L) Patient experience of Primary Care - NHS dental services Increase Bi-Annual 82.63% 2012/13 average.

Annual Calendar Complex methodology, needs further work within 4b(L) Patient experience of hospital care Increase year CAT team.

Although a placeholder, data for 13/14 is available and has been shown. Score is calculated: 15% 4c(Pl) ? Combined Friends and Family Test Response Rate (Sandwell & West Birmingham) LAT 19.48% 20.46% 20.40% 20.10% 15.44% respondents who would recommend minus respondents who would not recommend. No baseline.

Although a placeholder, data for 13/14 is available and has been shown. Score is calculated: 4c(Pl) respondents who would recommend minus respondents who would not recommend. No baseline.

4.1(L) Patient experience of outpatient services Increase ? Indicator currently under review by the IC

Annual Calendar 4.2(L) Increase Responsiveness to in-patients’ personal needs year Indicator currently under review by the IC

4.3(L) Patient experience of A&E services Increase Ad hoc Indicator currently under review by the IC Only baseline available is the England 2011/12 - 4.4i(L) Access to GP Services Increase Bi-Annual 67.89% 2012/13 average.

Only baseline available is the England 2011/12 - 4.4ii(L) Access to dental services Increase Bi-Annual 94.83% 2012/13 average.

4.5(L) Women’s experience of maternity services Increase Ad hoc 2010 & 2013 publication at England level

4.6(L) Survey of bereaved carers Increase Annual Only baseline available is the England average.

Only baseline available is the England 2010 - 2013 4.7(L) Patient experience of community mental health services Increase Annual average.

4.8(Pl) An indicator on children and young people’s experience of healthcare ? ? IC working on indicator development 4.9(Pl) An indicator on people’s experience of integrated care ? ? IC working on indicator development

14 BASELIN BASELINE Plan Plan Plan Plan Plan Plan SAFE ENVIRONMENT AND PROTECTING THEM FROM AVOIDABLE HARM Threshold Frequency E JAN FEB MAR Q4 YTD Comments IC April JAN FEB MAR Q4 YTD CSU

5a(L) Patient safety incident reported (Rate per 100 admissions) - Sandwell and West Birmingham Hospitals Increase Quarterly 9.81 Oct - March 13 published Feb 14

5a(L) Patient safety incident reported (Rate per 1000 bed days) - Black Country Partnership Increase Quarterly 24.06 Oct - March 13 published Feb 14

Safety incidents involving severe harm or death (Rate per 100 admissions) - Sandwell and West Birmingham 5b(L) Reduce Quarterly Oct - March 13 published Feb 14 Hospitals 0.02

5b(L) Safety incidents involving severe harm or death - Birmingham & Solihull Mental Health Trust Reduce Quarterly 0.08 Oct - March 13 published Feb 14

5c(Pl) An indicator on hospital deaths attributable to problems in care ? ? Placeholder - indicator under development

Added as % of VTE assessed patients, although 5.1(ID) Incidence of hospital-related venous thromboembolism (VTE) - SWBH In Development Reduce Monthly 87.00% 97.62% 98.62% definition states per resident population, needs discussion.

5.2.i(L) Incidence of healthcare associated MRSA infection YTD Reduce Monthly 0 0 3 0 3 0 3

5.2.ii(L) Incidence of healthcare associated C. difficile infection YTD Reduce Monthly 10 98 90 107 97 117 106

IC in final stages of reviewing this data - should be 5.3(ID) Incidence of newly-acquired category 2, 3 and 4 pressure ulcers In Development Reduce Monthly published Dec 2013

5.4(L) Incidence of medication errors causing serious harm Reduce Quarterly 2008 to 2011/12 publication at England level

5.5(L) Admission of full-term babies to neonatal care Reduce Annual Baseline currently at PCT level, needs discussion.

5.6(L) Incidence of harm to children due to ‘failure to monitor’ Reduce Annual 1,057 Only baseline available is the England average.

15 BASELINE BASELINE Plan Plan Plan Plan Plan PLANNING FOR PATIENTS - ANNEX A Threshold Frequency JAN FEB MAR Q4 YTD Comments IC CSU JAN FEB MAR Q4 YTD

CB_A1i Potential Years of Life Lost (PYLL) from causes considered amenable to health care - adults Reduce Annual - CY 2,599.40 IC Baselines updated @ September 2013

CB_A1ii Potential Years of Life Lost (PYLL) from causes considered amenable to health care - children and young people Reduce Annual - CY 563.70 IC Baselines updated @ March 2014

CB_A2 Under 75 mortality rate from cardiovascular disease Reduce Annual - CY 84.39 IC Baselines updated @ September 2013

CB_A3 Under 75 mortality rate from respiratory disease Reduce Annual - CY 35.02 IC Baselines updated @ September 2013

CB_A4 Under 75 mortality rate from liver disease Reduce Annual - CY 23.22 IC Baselines updated @ September 2013

CB_A5 Under 75 mortality from cancer Reduce Annual - CY 130.53 IC Baselines updated @ September 2013

CB_A6 Composite measure on emergency admissions Reduce Monthly Placeholder - indicator in development

New baseline for 12/13. IC baseline is DSR bur CSU CB_A6_01 Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) Rolling Annual Reduce Monthly 1143.90 776.08 890.84 879.58 baseline is just rate per 100.000 pop. Definition changed to 'all ages'.

New baseline for 12/13. IC baseline is DSR bur CSU CB_A6_02 Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Rolling Annual Reduce Monthly 583.00 599.05 529.64 516.81 baseline is just rate per 100.000 pop.

New baseline for 12/13. IC baseline is DSR bur CSU Emergency admissions for acute conditions that should not usually require hospital CB_A6_03 Rolling Annual Reduce Monthly baseline is just rate per 100.000 pop. Definition admission 1720.70 1106.28 1804.23 1806.48 changed to 'all ages'

New baseline for 12/13. IC baseline is DSR bur CSU CB_A6_04 Emergency admissions for children with Lower Respiratory Tract Infections (LRTI) Rolling Annual Reduce Monthly 566.90 550.76 496.44 495.68 baseline is just rate per 100.000 pop.

IC CCG latest Baseline is for July 11- March 12 CB_A7 Proportion of people feeling supported to manage their condition Increase Bi-annual 60.78% therefore excluded. CSU baseline taken from GPPS July 12- March 13.

CB_A8 Health related quality of life for people with long-term conditions Increase Bi-annual Baseline currently at LA/PCT level, needs discussion.

Baseline updated from 11/12 to 12/13 but only CB_A9 Estimated diagnosis rate of people with dementia Increase Annual 48.70% available at England average level.

No CSU baseline comparison at present as historical re-admissions data has not been mapped to CCG.IC CB_A10 Emergency readmissions within 30 days of discharge from hospital Rolling Annual Reduce Monthly 12.85 6.48% 7.48% 6.95% Baseline 2010/11 update released March 2013 added March 2014

CB_A11_i PROMS - Hip replacement Reduce Monthly 0.397 Updated baselines for 2011/12 - December 2013

CB_A11_ii PROMS - Knee replacement Reduce Monthly 0.284 Updated baselines for 2011/12 - December 2013

CB_A11_iii PROMS - Groin hernia Reduce Monthly 0.042 Updated baselines for 2011/12 - December 2013

CB_A11_iv PROMS - Varicose veins Reduce Monthly 0.079 Updated baselines for 2011/12 - December 2013

Only baseline available is the England 2011/12 - CB_A12_i Patient experience of Primary Care - GP services Increase Bi-Annual 78.25% 2012/13 average.

Updated with IC baselines December 2013 (July 2012 CB_A12_ii Patient experience of Primary Care - Out of hours GP services Increase Bi-Annual 64.68% 64.64% to March 2013) data period

Complex methodology, needs further work within CAT CB_A14 Patient experience of hospital care Increase Annual Calendar year team.

Although a placeholder, data for 13/14 is available 15% and has been shown. Score is calculated: CB_A13 Combined Friends and Family Test Response Rate (Sandwell & West Birmingham) ? LAT 19.48% 20.46% 20.40% 20.10% 15.44% respondents who would recommend minus respondents who would not recommend. No baseline.

Although a placeholder, data for 13/14 is available and has been shown. Score is calculated: CB_A13 respondents who would recommend minus respondents who would not recommend. No baseline.

CB_A15 Incidence of healthcare associated MRSA infection YTD Reduce Monthly 0 3 0 3 0 3

CB_A16 Incidence of healthcare associated C. difficile infection YTD Reduce Monthly 98 90 107 97 117 106

16 BASELINE BASELINE Plan Plan Plan Plan Plan PLANNING FOR PATIENTS - SUPPORTING MEASURES - ANNEX B Threshold Frequency JAN FEB MAR Q4 YTD Comments IC CSU JAN FEB MAR Q4 YTD

CB_B1 Referral to Treatment pathways - Perentage of admitted pathways within 18 weeks >=90% Monthly 89.66% 89.22% 89.42% 89.44% 91.03% CB_B2 Referral to Treatment pathways - Percentage of non-admitted pathways within 18 weeks >=95% Monthly 97.08% 96.93% 96.86% 96.96% 97.00% CB_B3 Referral to Treatment pathways - Percentage of incomplete pathways within 18 weeks >=92% Monthly 93.16% 93.30% 92.83% 93.09% CB_B4 Diagnostic test waiting times - Percentage of patients waiting 6 weeks or more for a diagnostic test <=1% Monthly 1.34% 0.89% 0.95% 1.06% 1.00% CB_B5 A&E waiting time - Percentage of patients who spend 4 hours or less in A & E >=95% Weekly 95.31% 92.26% 95.18% 94.32% 94.44% Trust Sandwell & West Birmingham Hospital Type 1 92.70% 87.96% 92.32% 91.10% 91.22% Trust Sandwell & West Birmingham Hospital Type 2 98.99% 98.94% 99.73% 99.21% 98.91% Trust Sandwell & West Birmingham Hospital Type 3 100.00% 100.00% 100.00% 100.00% 100.00% CB_B6 Cancer 2 week waits - All cancer two week wait >=93% Monthly 97.16% 94.65% CB_B7 Cancer 2 week waits - Two week wait for breast symptoms (where cancer was not initially suspected) >=93% Monthly 97.78% 96.80%

Cancer day 31 waits - Percentage of patients receiving first definitive treatment within one month of a cancer CB_B8 >=96% Monthly diagnosis (measured from date of decision to treat) 96.90% 98.55%

CB_B9 Cancer day 31 waits - 31-day standard for subsequent cancer treatments-surgery >=94% Monthly 97.37% 97.22% CB_B10 Cancer day 31 waits - 31-day standard for subsequent cancer treatments-anti cancer drug >=98% Monthly 100.00% 100.00% CB_B11 Cancer day 31 waits - 31-day standard for subsequent cancer treatments-radiotherapy >=94% Monthly 85.48% 100.00% CB_B12 Cancer 62 day waits - All cancer two month urgent referral to first treatment wait >=85% Monthly 83.05% 84.13%

CB_B13 Cancer 62 day waits - 62-day wait for first treatment following referral from an NHS cancer screening service >=90% Monthly 87.50% 100.00%

Cancer 62 day waits - 62-day wait for first treatment for cancer following a consultants decision to upgrade the No Operational CB_B14 Monthly patient's priority Standard 89.29% 96.30%

CB_B15_01 Ambulance clinical quality – Category A (Red 1) 8 minute response time >=75% Monthly 94.40% 89.40% 86.20% CB_B15_02 Ambulance clinical quality – Category A (Red 2) 8 minute response time >=75% Monthly 74.30% 73.90% 76.60% CB_B16 Ambulance clinical quality - Category A 19 minute transportation time >=95% Monthly 99.50% 99.10% 99.00% CB_B17 Mixed Sex Accommodation (MSA) Breaches Eliminate Monthly 4 7 17 91 CB_B18 Cancelled Operations - SWBH (number of cancelled ops ) Reduce Quarterly 174 CB_B18 Cancelled Operations - SWBH (number of breaches of 28 day standard ) Reduce Quarterly 1 CB_B19 Mental Health Measure – Care Programme Approach (CPA) >=95% Quarterly 95.69% CB_S1 Non-elective FFCEs (First Finished Consultant Episode) YTD <=plan Monthly 50152 50,881 55496 55,688 60938 60,886 CB_S2 All first outpatient attendances YTD <=plan Monthly 126787 112,484 139045 123,088 152278 134,474 CB_S3_01 Elective finished first consultant episodes (FFCEs) - Ordinary YTD <=plan Monthly 8,080 8,841 9,616 CB_S3_02 Elective finished first consultant episodes (FFCEs) - Daycase YTD <=plan Monthly 32,066 34,950 37,927 CB_S3_03 Elective finished first consultant episodes (FFCEs) - Total YTD <=plan Monthly 51119 40,146 56261 43,791 61955 47,543 CB_S4_01 A&E Attendances - Type 1 DH Proportion attributed Attendances Monthly Weekly 14,503

CB_S4_02 A&E Attendances - All DH Proportion attributed Attendances YTD 169,543 194,802 186,498 203,690 203,452 194,802 203,690 <=plan Weekly

IAPT data is no longer collected in IPMR therefore CB_S5_01 Mental Health Measure- Improved access to psychological services - Entering treatment >=plan Quarterly proxy measusres to be used from MHMDS - work in progress

IAPT data is no longer collected in IPMR therefore CB_S5_02 Mental Health Measure- Improved access to psychological services - Moving to recovery >=plan Quarterly proxy measusres to be used from MHMDS - work in progress

CB_S6 Number of 52 week Referral to Treatment Pathways 4 2 3 Admitted 1 0 1 2 27 Zero Monthly Non-Admitted 1 0 0 1 157 Incomplete 2 2 2 Local line Ambulance handover time - delays of >30 < 60 - Sandwell & West Birmingham Hospital Reduce Monthly 127 164 205 CB_S7_01 Ambulance handover time - delays of over 30 minutes - Sandwell & West Birmingham Hospital Reduce Monthly 128 178 214 CB_S7_02 Ambulance handover time- delays of over 1 hour - Sandwell & West Birmingham Hospital Reduce Monthly 1 14 9 Local line Crew Clear - delays of > 30 <60 minutes - Sandwell & West Birmingham Hospital Reduce Monthly 12 13 16 CB_S8_01 Crew Clear - delays of over 30 minutes - Sandwell & West Birmingham Hospital Reduce Monthly 12 13 16 CB_S8_02 Crew Clear - delays of over 1 hour - Sandwell & West Birmingham Hospital Reduce Monthly 0 0 0 CB_S9 Trolley waits in A&E over 12 hours 0 0 0 0 1 Trust Sandwell & West Birmingham Hospital Type 1 0 0 0 0 1 Zero Weekly Trust Sandwell & West Birmingham Hospital Type 2 0 0 0 0 0 Trust Sandwell & West Birmingham Hospital Type 3 0 0 0 0 0

CB_S10 Urgent operations cancelled for a second time Zero To be confirmed locally

17 Quality Premium indicators March

Quality Attainable Forecast PREVENTING PEOPLE FROM DYING PREMATURELY Threshold Baseline YTD Performance Premium Value (£) achievement

Potential Years of Life Lost (PYLL) from causes considered amenable to health care - adults Reduce by 3.2% 2599.4 12.50% 328,648 328,648 2013 - 2014 Potential Years of Life Lost (PYLL) from causes considered amenable to health care - children and young people

Comments : Annual publication- no data for 13/14 available yet

Success : Success based on a 10 year rolling average - reduction is success.

YTD Quality Attainable Forecast Improving quality of life for people with long-term conditions Threshold Baseline Performance Premium Value (£) achievement

Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) Rolling Annual 776.08 873.58

Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Rolling Annual 533.05 516.81 Annual reduction 13/14 to 25.00% 657,295 0 14/15 Emergency admissions for acute conditions that should not usually require hospital admission Rolling Annual 1106.28 1806.48

Emergency admissions for children with Lower Respiratory Tract Infections (LRTI) Rolling Annual 550.76 435.68

Comments : Using current CSU data comparisons, at the end of February, against the 12/13 baseline, two of the four indicators are below target. Expectations are that all four indicators will need to achieve a reduction.

Success : For each of the indicators - a reduction or zero percentage is success.

YTD Quality Attainable Forecast Ensuring that people have a positive experience of care Threshold Baseline Performance Premium Value (£) achievement

An indicator on the Friends and Family test - placeholder , Inpatient Score 36.60% >=15% 20.40% 12.50% 328,648 328,648 An indicator on the Friends and Family test - placeholder, A&E(Type 1&2) Score 15.10%

Comments : Current performance is that FFT is being rolled out in accordance with the national plan, and the combined inpatient and A&E score is above 15% at SWBH.

Success : CCG must oll out the annual plan. Including Maternity services by Oct 13, and the balance by end of year. KPI to improve from Q1 13/14 to Q1 14/15.

YTD Quality Attainable Forecast Treating and caring for people in a safe environment and protecting them from avoidable harm Threshold Baseline Performance Premium Value (£) achievement

Incidence of healthcare associated MRSA infection YTDZero 0 3 12.50% 328,648 0 Incidence of healthcare associated C. difficile infection YTDBelow baseline 107 98

Comments : Although C Diff cases are below throeshold. There have been 3 outbreaks of MRSA during the year. The two indicators are likely to be combined and therefore the CCG will fail this portion of the QP.

Success : MRSA cases to be zero. C Diff cases to be below threshold

18 YTD Quality Attainable Forecast Local Priority 1 Baseline Performance Premium Value (£) achievement Urgent Care 55,630 53,070 12.50% 328,648 328,648 Comments : This local priority has been achieved based on the non-elective Everyone Counts definition processed on SUS data. Success : To reduce the total number of admissions year on year.

YTD Quality Attainable Forecast Local Priority 2 Baseline Performance Premium Value (£) achievement

Child Health and Safeguarding 80.00% 12.50% 328,648 0 Comments : Awaiting final data but ulikely to achieve 80%. Success : GP engagement for Case conferences - Minimum 80%

YTD Quality Attainable Forecast Local Priority 3 Baseline Performance Premium Value (£) achievement Long Term Conditions 688.93 776.08 12.50% 328,648 0 Comments : Planned reduction has not been achieved. Success : Reduction from the current 11/12 CSU baseline to 970 per 100,000. (CSU baseline was amended in-year due to more accurate processing)

To be updated: Population £ per head QP total (£) Total achieved (£)

525836 5 2,629,180 985,943

The total payment for the CCG will be reduced (25% per each of the below) if the Providers do not meet the NHS Constitution rights or pledges for patients in relation to -

i) maximum 18 week waits from March 13/14 89.42% (-25%) -410,810 referral to treatment

ii) Maximum 4 hour waits in A&E YTD 13/14 94.46% (-25%) -410,810 departments

iii) Maximum 62- day waits from urgent GP referral Q4 13/14 83.90% (-25%) -410,810 to first definitive treatment for Cancer

iv) Maximum 8 minute responses March 13/14 86.20% (+25%) 410,810 for Category A red 1 ambulance calls.

Annual Value 410,810 The NHS CB will reserve the right not to make any payment where there is a serious quality failure during 2013/14.

19 Enc 6

Report Topic: Partnerships and Collaboration Committee Report

Report From: Dr Basil Andreou

Date: 2nd July 2014

Aim of Report To update the Governing Body on the work of the Partnerships and Collaboration Committee

The Governing Body is asked to: RECOMMENDATIONS a) note the contents of this report

SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP

Report to the Governing Body

Subject: Partnerships and Collaboration Committee

Date: 2nd July 2014

Authors: Jack Wilkinson Business Support (Partnerships)

Remit of Committee The purpose of the Committee is to;

 Provide the Governing Body with assurance that appropriate arrangements and processes are in place to optimise the commissioning of health services through the involvement of partner organisations, patients and carers

 Establish and monitor the overall progress of strategic partnerships and associated plans to ensure completion within agreed timescales

Progress in the last Month

Push Site Update from Rachel Loveless (Senior Commissioning Manager)

All four push sites have been identified and have confirmed clinical leads. Several meetings have taken place with each push site to ensure that the clinical leads, practice managers and where appropriate GP partners and other practices linked to the community nurse team footprint is aware of the overall objective of the push site.

Practices have begun to identify patients in the at-risk cohort and those patients who would benefit from targeted management. The push site leads have been working with partners to think about how they can work differently and in some cases with other push sites. Oldbury Health Centre (team 10) and the Tividale Family Practice and Whiteheath (team 23) have expressed a desire to work collaboratively. The Black Country Family Practice (team 17) and the three practices that make up Your Health partnership (team 20 a,b,c) will continue as separate push sites.

Data collection mechanisms have been established with finance and the CSU and work has begun to analyse this data. The data will form the basis for the Commissioning Plan that each push site will need to complete. The Commissioning Plan template has been shared with the clinical leads and the push sites have begun to think about the content they will need to ensure a robust plan. Leads have also been developing ideas that could transform the way in which they work as well as ideas for new initiatives to be commissioned to ensure their objectives are met.

As part of the BCF work with Sandwell Council, Oldbury Health Centre (team 10) and the Tividale Family Practice and Whiteheath (team 23) are working towards integrating their MDTs with social care and community organisations. The proposal is to develop a community social work team pilot to be part of an integrated care/case management MDT approach to the delivery of health and social care support in a new way.

The community social work team pilot will be based around a defined population with clear links to primary care development, community nursing, community schemes and

2 neighbourhoods. The role of the local G.P will be a key member of the established integrated team. This pilot will begin on 23rd June.

Push Site Update from Kulbinder Thandi (Senior Commissioning Manager)

 Push Sites are agreeing and establishing how they will profile their patient population. This will be to identify how they can manage patients to prevent unplanned admissions.  Practices are utilising MICs and also local information  They are cross referencing individual patient data together with areas of high admissions to begin the process of next steps – which will be looking at how the condition/s can be managed within the practices, and within a multi-disciplinary team approach.  Following this, they will identify gaps and start on their business plan.  All 3 push site clinical leads and individual practices are actively engaging with their officer support - Senior Commissioning Manager and Commissioning Manager.  Regular push site meetings are taking place with one push site, and on a when required basis with the other two. This is due to the makeup of the push site practices.

Push Site Update from Saba Rai (Senior Commissioning Manager)

 Push site PID developed  Clinical leads appointed for all push sites.  Work is progressing with clinical leads.  2 clinical leads meetings have been held.

Update on Health and Wellbeing Boards (Sandwell and Birmingham) Sandwell HWBB

 The board met on 4th June with the main agenda discussion focussed on children and families. The board minutes will be ratified on 3rd July. It was agreed that there is a lot of activity and joint working at operational levels but that there is lack of a strategic vision and plan. The board agreed that further analysis is required to understand the current picture and gaps.  The CCG annual report was presented to the board.  Public Health updated the board on the challenges for Sandwell in relation to health protection – TB (screening for latent infections in new arrivals) and HIV (Sandwell high prevalence area). A health protection board has been established and the HWBB agreed to the establishment of a HIV steering group with regular reports to the HWBB on performance.  The next meeting in July will focus on Mental Health and Wellbeing.

Birmingham HWBB

The board meets on a 1/4ly basis – next meeting should be in July.

Update on Engagement activity

The Engagement Activity is detailed in Appendix 1 of this report

Issues for escalation to Board No issues were identified for escalation.

APPENDIX 1

Sandwell and West Birmingham CCG – Communication & Engagement - Quarterly Update (April – July 2014)

Headline Topics

 Stroke Review: Draft Communication and Consultation Plan produced. Pre-Engagement underway.

 MSK: Provider events 26th June and 24th July, patient, carer and wider stakeholder event 26th June

 Planning AGM & Road shows across the patch

Other Prominent Programmes of work

 Four Sandwell CAMHS Pre-consultation workshops delivered in June

 NHS111 – On-going lead co-ordinator for the programme. Regular attendance to meetings and cascaded updates. Communications out to GP practices and providers. Co-ordination of NHS 111 Open Days.

 Push Sites – GP lead event, 24th June as local push sites develop their commissioning plans

Sandwell and West Birmingham CCG – Communication & Engagement - Quarterly Update (April – July 2014)

Project Name Objectives / Overview Activity Update Status Timings

Service Redesign/Co-design & Re-configuration Stroke Review  Offer advice on proposals for formal  Stakeholder analysis, launch event aimed at  Green Plans for formal consultation provider, stakeholder event, consultation – October 14  Pre- Engagement Activity communication and engagement plan,  Feedback on pre-engagement phase focused engagement  Draft Communication and Consultation  Pre-deliberative Patient Event Plan  Established Stroke Advisory Group  Support Stroke Patient Advisory Group  Advert for consultation partner  Ensure consistent communications across  Procure partner CCGs for the Stroke Review  Draft consultation documentation  Keep stakeholders informed during stroke  Next edition of Stroke Bulletin review  Public Health Needs Analysis & EQiA  Manage reputation of CCGs during stroke review MSK  Gather patient insight in respect of MSK  Organise 2 provider focused events  Green June (Phase 1 – pre- services  Organise a patient, carer and wider deliberative phase) 14  Engagement on future service model stakeholder event  Ensure consistent communications across  Facilitate discussions at Patient Networks, CCGs for the MSK Review Agewell Forums, PPGs, focus groups etc.  Keep stakeholders informed during MSK  Advice and Support review  Develop Communications & Engagement  Manage reputation of CCGs during MSK Plan

Project Name Objectives / Overview Activity Update Status Timings

review  Develop communications materials Mental Health  Establish robust engagement model for  Re-format existing Open Mic  Amber June/July 14 mental health service users  Working with locally based MH  Mental health service users involved in organisations to identify service users to procurement of new model participate in procurement of new service  IAPT workshop for providers providers  Engage and support service users in the IAPT workshop Cardiology  Redesign of Cardiology  Stakeholder analysis  Amber June/July 14  Develop key messages – channels of communication  Determine engagement methodology  Pre-deliberative Event (s) End of Life care  Continue to support the project with  On-going  Green TBC patient representation and engagement PHB  To evaluate the patient journey through  Patient journal about to be rolled out  Amber October 14 the PHB process Respiratory  Redesign of Community Respiratory  Stakeholder analysis  Green services  Develop key messages – channels of communication  Determine engagement methodology  Pre-deliberative Event (s)  Study Day 7th July Experience Led  Desired outcome – 3 year commissioning  Update report to Sandwell HWBB  Green August 14 CommissioningTM LTC strategy and implementation plan,  Confirm and Challenge Event with outcomes framework and improvement Commissioners and Providers contract specification, developed using  360 Feedback Event aimed at participants the ELCTM Programme approach with a  Development of LTC Strategy and Management Action Plan (MAP) that Implementation Plan

Project Name Objectives / Overview Activity Update Status Timings

outlines how the change will be managed across SWB CCG. Urgent Care  Manage local communications and  Preparing and implementing a  Green On-going engagement activity around the Urgent communication and engagement plan Care Workstream  Identify and manage engagement &  Supporting the CCG to raise awareness of communication to and with local partners pressures of urgent care (Acute Trust, Voluntary Community Sector  Supporting patients to make the most and Local Authority) appropriate choices in healthcare  Plan and facilitate engagement events for patients, their carers and the wider public.  Localise national communications regarding the pressure on the Urgent Care system and manage channels of communication (e.g. Choose well )  Identify local reputational risks to feed into wider communications  Develop responses for local Q&As if required e.g. FAQ  Intermediate Care leaflets  GP Out of Hours Survey  Urgent care workstream support  DToC Communications Plan  Development of 14/15 choose well campaign Co-Commissioning of  Support the CCG EOI  Communicate and collate responses around  Green June 14 Primary Care the opportunity to Co-commissioning Primary Care to all member practices  Ensure the expressions of interest includes any initial views of local stakeholders including patients

Project Name Objectives / Overview Activity Update Status Timings

RCRH  Support the RCRH programme  RCRH Case Studies  Red June/ July 14  Continued liaison with SWBH on MMH  Cont’d engagement around Care Closer to Home NHS 111  To raise awareness of 111  National pilot campaign to promote 111  Green Until Summer 14  To encourage take up of service  Co-ordination of materials  To promote alternatives to A&E  Liaison with partners  Co-ordination of open days

Primary Care  Communicate the objectives of the  Stage local consultation events inc -  Green May/June 14 Mental Health consultation mental health consultation facilitated focus group discussions Birmingham  Ensure stakeholders are kept informed of  Share consultation with LCGs the consultation and are supported to  Share findings with lead commissioner - BXC take part CCG  Ensure members are engaged and take  On-going advice and support to evaluation part in the consultation  Manage the reputation of the CCG

CAMHS consultation –  Communicate the objectives of the  Stage local consultation events inc.  Green May/June/July 14 Birmingham and Sandwell CAMHS consultation facilitated focus group discussions  Ensure stakeholders are kept informed of  Share consultation with LCGs the consultation and are supported to  Share findings with lead commissioner - BXC take part CCG  Ensure members are engaged and take  On-going advice and support part in the consultation  Manage the reputation of the CCG Carers - Sandwell  Ensure S256 agreement with Local  Budget meeting  Amber July 14 Authority (Sandwell) reflects  Meet SMBC ASC Carers Commissioner  Agree way forward – comment on service

Project Name Objectives / Overview Activity Update Status Timings

specifications, share & agree plans etc Carers - Birmingham  Tbc  Tbc IMPOWER  Understanding people’s behaviour in  Designing targeted campaign  Green June/ July 14 respect of urgent care usage (A&E)  Development of UC brokerage scheme  Developing appropriate solutions for  Improving hospital signage targeted cohort  Budget proposal  Raising the profile of Primary Care  Marketing Strategy  Digital and marketing support to  Support at workshops IMPOWER work

LCG support – Below  Communications and Engagement  Overarching Communications and  Green June/July 14 support to LCGs to manage their work Engagement Plan programmes and wider LCG reputation  Inter LCG communication management  Organisational communication - feedback to LCGs Black Country  Mental Health; Enhanced Services;  To be agreed Outpatients Modernisation Healthworks  Stroke; Pathway Management  To be agreed ICOF  Long Term Conditions; System Usage  To be agreed Pioneers For Health  Urgent Care; Intermediate Care; Frail  To be agreed Elderly Sandwell Health Alliance  Children and Young People;  To be agreed Readmissions; Community Services; EoLC Better Care Fund/Integration Push Sites  Support the Push Sites Clinical Leads and  Establish confirm & challenge panels  Green July 14 Senior/Commissioning Managers in  Draft Push Sites Communication and ensuring robust clinical, patient, carer Engagement Plans

Project Name Objectives / Overview Activity Update Status Timings

engagement in the development of local  Clinical Leads Engagement commissioning plans Sandwell Community Offer  Establish and strengthen community  Participate in a series of information and  Green July 14 development as part of the integration networking events agenda  Represent CCG in awarding the grant to the successful applicants, through a competitive procurement process  Draft Community Development PID  6 x introduction sessions for successful applicants and push sites leads

Birmingham Healthy  Establish a number of Healthy Villages  Participate in the Healthy Villages Co-  Green  July 14 Villages pilot sites across West Birmingham ordination Board and Programme Board  Promote HV concept (community development approach) to GP Clinical Leads associated with Push Sites  Conduct Asset Based Community Development mapping around Handsworth Wood Medical Centre  Present HV proposal to clinical leads push site meetings

Voluntary & Community Sector

Route2Wellbeing Portal  Knowledge of VCS low level preventative  Development of an VCS information portal  Green services aimed at GP providers and other Healthcare professionals  IT role out of portal

Project Name Objectives / Overview Activity Update Status Timings

 Promote VCS portal to VCS organisation – aimed at sign up  Promote VCS portal to providers – aimed at take up & referral

Patient, Partnership and Stakeholder Engagement

PPE Model  Support all elements of the PPE model  Co-ordinate, support and manage the  Lead the development of the Patient and various Patient Summits; LCG Patient Partnership Advisory Group (PPAG) Networks, as well as developing new  Ensure that the CCG is compliant with its Patient Networks statutory duty under S.14Z2 – Duty to  Co-ordinate, support and manage the PPAG Consult meetings  Develop and support PPG’s

PED (Patient Engagement  Smarter techniques for engagement  Software development to broaden the use  Amber Database) of the database Communications and  Develop a comprehensive  Development of Communications and  Green August (1st draft) Engagement Strategy communications and engagement Engagement Strategy strategy for the CCG  Strategy aligned to Strategic and  Give strategic communications and Operational Plans engagement direction for the CCG

Central Care Records  Promote Central Care Records amongst  Advice and Support  Green May – July 14 patient population  Thread CCR into all known networks TBC - Mail-out postponed  Ensure patients are supported to make an  Support CSU to set up Patient and Expert informed choice Panel for CCR  Promote the benefits of CCR  Manage the reputation of the CCGs

Project Name Objectives / Overview Activity Update Status Timings

AGM & Roadshow  Providing support to the CCG in its duty to  Planning AGM & Roadshow  Green July 14 have an AGM  Selecting AGM & Roadshow dates  Promote the work of the CCG  Event logistics (presentations, catering etc)  Ensure the key CCG’s stakeholders are  Promoting AGM aware of the vision, priorities and projects of the CCG Neighbourhood based  Strengthen community and stakeholder  Community events attended Green October 2014 To be agreed Intensive engagement engagement in the Lozells area  Greet and meet community champions projects  Engagement with local VCS  Using innovative and creative channels of engagement

Social media Strategy  Develop a Social Media Strategy for the  Set up dates for training engagement team  Amber CCG  Set up dates for training wider team  Train CCG staff and Clinical Leads Develop forward  Ensure CCG makes the most of any  Need to set up a process for proactive  Amber June/July 14 media/marketing quarterly proactive stories/opportunities stories to be added to the planner action plan  Enable forward planning for positive and  CCG to inform communications of potential negative stories proactive work taking place  Issued email to all senior directors AGM & Roadshow  Providing support to the CCG in its duty to  Planning AGM & Roadshow  Green July 14 have an AGM  Selecting AGM & Roadshow dates  Promote the work of the CCG  Event logistics (presentations, catering etc)  Ensure the key CCG’s stakeholders are  Promoting AGM aware of the vision, priorities and projects of the CCG ‘Get Involved’ Membership  Develop a Membership Scheme for the  Design and develop membership  Green CCG information pack

Project Name Objectives / Overview Activity Update Status Timings

 Enhance the reputation of the CCG &LCG  Purchase ‘goodies’ as part of membership drive  Develop calendar of events to promote ‘Get Involved’ Membership Scheme Health and Wellbeing  Lead on stakeholder engagement event  Date being confirmed  Green July 14 Board Engagement on behalf of the Board Member practice staff  ICOF nurse forum  2nd meeting held. Attendance increased  Green significantly Communication Specific

Review of Membership  Provide an easy to read CCG directory for  New clinical leads to be contacted  Green June Directory GPs and Staff  Revised staff list to be sought  Design- Late June/ early July 14 Newsletter  To create and maintain a weekly  On-going  Green To be agreed with CSU newsletter for GP members  In addition to ad-hoc GP emails being issued  To ensure the newsletter is a primary tool for sharing information and updating members

Website  To create and maintain a patient/provider  CSU to support CCG in handover of website  Red – CSU August 14 friendly website management awaiting  To create and maintain a membership  Daily website updates handover friendly intranet site  Next web forum meeting details  To train CCG staff in uploading materials from CCG to certain areas of the site

 To promote usage of the site Quarterly Stakeholder  Ensure effective communication between  Co-ordinate content  Green May/June 14 Bulletin the CCG and its stakeholders  Agree format

Project Name Objectives / Overview Activity Update Status Timings

Members Events  Ensure members are kept informed of the  Events logistics  Green TBC work of the CCG  Reminders to practices  Ensure members are engaged in the work of the CCG  Support the CCG as a membership organisation 360 Stakeholder Review  Support the CCG in communicating with  Leading talk at Directors meeting  Green  June/July 14 stakeholders  Producing feedback packs for LCGs

 Support the CCG in responding to  Producing response action plan feedback of 360 review  Liaising with Ipsos Mori to breakdown  Evaluating review to improve responses in results by LCG 14/15 Time2Talk  Raising awareness of Time2Talk service  Development of Communications Plan  Green  June/July 14  Increasing the profile of the CCG  Internal and stakeholder promotion of

Time2Talk  Looking into You Tube videos HSJ Award submissions  Raising the profile of the CCG at a national  Development of award submissions  Green  4 July 14 level  Proofreading

Strategic support for Chair  Strategic communications support to  Daily strategic guidance  Green  June 14 and governing body Chair and Accountable Officer  Attendance at Board and Directors  Reputation management meeting

 Strategic planning  Chairs Report  Governing Body communications workshop  Support to Chair SWBH Leadership event, NHS Confederation Presentation

Project Name Objectives / Overview Activity Update Status Timings

and event support  NHS England Assurance Visit  GP Training presentation  Support, Training and presentation development for Conventus Event Childhood Minor Illness  Informing parents of young children of  Social Media plan  Amber  June 14 Guide the alternatives to A&E  Additional booklets to be ordered  Raising awareness of common illnesses  Stakeholder bulletin update and ailments and how to self-care

Annual Report  Supporting the CCG to develop a  Liaison with finance teams and auditors  Green  June 14 comprehensive and plain English Annual  Attendance at Governing Body

Report  Web banner  Word document design  Full design and Executive Summary for AGM Health Area Case Studies  Promoting the work of the Health  Co-ordination  Amber  Summer 2014 organisations across the Area Team  Editorial boundary  Design Primary Care Co-  Supporting the CCG in its strategic  Proofread  Green  20 June 2014 commissioning Bid responsibilities  Visual word document

Strategic Report  Supporting the CCG in its strategic  Proofread  Green  20 June 2014 responsibilities  Design template across 4 CCGs

 Supporting the CCG to communicate in  Word document plain English

Project Name Objectives / Overview Activity Update Status Timings

TV Screen  Promote internal communications  Meetings with CCG  Amber  May/June 14 opportunities  Loan of a temporary tv screen (sourcing

content) Internal Communications  Support Staff Council and Senior  Set up a staff council survey  Green  June 14 leadership team to manage effective internal communications

Core Health Messages  Develop core public communication  Co-ordination  Amber/R  June 14/July 14 messages for the CCG  Editorial ed

 Work with Public Health to identify  Design priorities Influenza/vaccines booklets  Support CCG objectives to increase  Liaise with NHS England to agree  Amber  Summer 14 vaccine updake vaccine booklets

Migrant Health  Promote CCG priorities and work around  Developing a profile pack on migrant  Amber  Summer 14 Equality and Diversity Strategy health populations in LCGs- connecting

with Public Health Stakeholder bulletin  Ensuring our stakeholders are kept up to  Quarterly bulletin  Amber  Developed June date with the work 14/ designed

 Monthly bulletin via mailchimp- based July 14 on Chair’s report- and adhoc for  June/early July important updates 14 Media  Protecting the reputation of the CCG  Media protocol WMAS  Green  June 14  Promoting the work of the CCG  HSJ online panel debate  Keeping stakeholders, media and local  IVF statement residents of what is happening in their NHS

Project Name Objectives / Overview Activity Update Status Timings

Francis Plan on a page  Promoting the quality work of the team  Development  Green  Summer 14  Ensuring stakeholders and members  Design understand how the CCG will address quality Twitter and media training  Building social media policy  Following Governing Body workshop- team  Green  Summer/  Supporting senior leaders in proactive and to arrange a series of sessions for GB Autumn 2014 reactive communications members and senior staff to be trained on social media and media handling MP briefings  To set up regular briefings with MPs  Meeting with Gisela Stuart  Completed  May 14 across the year  Briefing pack for MP meeting  Support at meeting

Clinical leaders  Provide an easy to read CCG directory for  Clinical leads promotion  Completed  May 14 GPs and Staff  Clinical leads photos

Design/Digital  Manage CCGs Brand  Annual Report  Completed  May 14  Produce high quality materials  Delivery of replacement board  TV screens (meeting, ordering)  Intermediate care leaflets co-ordination  Signage installation at Kingston House  Adhoc website updates around 30  Dementia banner  Twitter- 16 tweets and 1,380 followers Media  Protecting the reputation of the CCG  Portway Leisure Centre  Completed  May 14  Promoting the work of the CCG  PCMH press releases  Keeping stakeholders, media and local  Ministerial briefing WMAS residents of what is happening in their  Media enquiry circumcision NHS  Media enquiry CCG budget for CSU  Aston Medical School press release

Project Name Objectives / Overview Activity Update Status Timings

 Lyng Centre filming  HSJ – internal communications/website  Inquest comment  Wednesbury Health Centre statement Heartbeat Magazine  To communicate better with SWBH  Bi-monthly column in the Heartbeat  Completed  May 14 magazine

Adhoc requests for CSU   Lozells Press release  Green  June 14  Lozells marketing materials  June 14  Promotion of GP Migrant Health Training  June 14  Christmas Survey  June 14  IVF survey  June 14  Race for Life support  July 14  Patient Voice leaflets  June/ July 14  Staff structures  Summer 24  OD documents  Summer 2014  Equality workforce report  Summer 2014  Revising policies section of website  July 2014

Enc 7

Report Topic: Urgent Care Update

Report From: Sirjit Bath

Date: 2nd July 2014

Aim of Report To update Governing Body members on developments within urgent care

Members are asked to: RECOMMENDATIONS  Note the contents of the report  Support the work programme

IMPLICATIONS:

Financial

An ongoing programme of patient and public involvement will be rolled Patient & Public out as part of the strategy development. Key links are also being made Involvement with the voluntary and community sector in support of the prevention and well being agenda. The work programme for 14/15 is being reviewed in light of the Healthcare requirements of the 2014/15 Everyone Counts planning guidance and Commissioning Transforming Urgent and Emergency Care Services in England.

Equality Impact Equality impact assessments will be completed as required for each Assessment/Diversity project in the programme and as part of the strategy development Impact Engagement (Clinical or Ongoing clinical engagement via urgent care leads and with other key Non Clinical) clinicians at SWBCCG urgent care network board Development of procurement plans and timescales will need to be Legal compliant with national and EU legislation and guidelines.

Vision and Values Designing services to meet the needs of the local population

Workforce none

Other n/a

SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP

Report to the Board

Subject: Urgent Care Programme Update

Date: 26th June 2014

Author: Debra Howls

Introduction The urgent care agenda continues to be complex and demanding for the team.

Progress to date

Performance

Month to date performance against the 95% target is currently falling short of the required standard with just over 1000 patients waiting 4 hours of more (as at 26th June). There are performance issues across both City and Sandwell ED sites although City continues see more pronounced under performance. In early June SWBH completed and submitted an action plan for recovery against the 95% target to the NHS Trust Development Authority, which was supported by the CCG. SWBH are now required to complete weekly SITREPS, which must also be signed off by the CCG. These cover a broad range of indicators such as attendances, admissions, conveyances, breaches, incidents, cancelled operations and discharge rates. Clinical meetings have resumed between the CCG UC leads and the clinical A&E Director (with management support) to review performance and challenge improvement plans are necessary.

The number of DTOCs in the system remains a concern for all partner organizations, with daily numbers now consistently around 40 and even reaching 50 this week. Daily conference calls continue to be held between SWBH, SMBC, BCC, icares and SWBCCG to review the position and problem solve individual cases. The Urgent Care Working group has been overseeing a redesign of the patient pathway during the acute phase of care, ensuring the an Estimated Date of Discharge is agreed at an early stage and that assessments are completed in a timely fashion in the most appropriate setting. All organizations are working towards a go live date of September for the new protocols and policies.

NHS 111

The number of calls made to the services has grown steadily over recent moths however a decrease in call volume was observed in May. The activity assigned to SWBCCG GPs is detailed below:

Calls Triaged Jan-14 Feb-14 Mar-14 Apr-14 May-14

Sandwell and West Birmingham 6100 6231 6849 7706 7471

Call answering rates continue to be above target and in May there was a 0% abandonment rate. The majority of patients receive a disposition that directs them into primary care with only around 8% directed to attend A&E departments in May.

The impact of the decision to decommission out of hours emergency dental services is being felt across the system. A&E clinical staff are reporting an increase in the number of patients presenting with dental conditions and the DOS leads are having difficulties in obtaining up to date information on alternative out of hours arrangements to populate the directory. Both of these issues have been escalated to NHS England who hold the responsibility for commissioning dental services.

WMAS

New figures showed that last weekend (Friday 20th – Sunday 22nd June 2014) was the third busiest since the Trust was set up in 2006. The only weekends that have been busier were when the region was blanketed in a thick layer of snow. Over the three days, the Trust responded to 8,432 incidents. That is 14.6% more than the previous year which accounted for 7,358.

It is very concerning that the regional demand has been rising rapidly for over two months; at a rate that is far above what would have been expected. Whilst SWBCCG activity is underperforming against contracted levels (at month 2) the contract was based on 4.5% growth, meaning that activity levels are increasing locally too. All red targets (Red 1,2 and 19) were achieved local again in May as were the green targets.

Bed Audit

As part of the preparation for winter 2014/15 it was agreed at the Urgent Care Network Board that a review of acute beds would be undertaken, as it has done in the previous 2 years. A multidisciplinary team (colleagues from SWBH, SWBCCG, BCC and SMBC ) repeated the bed audit across both city and Sandwell sites to establish issues surrounding discharge from acute care. A number of significant findings have emerged and a more detailed paper will be going to the UCNB in June. Headline issues include:

Winter

The CCG has received notification of the winter funds allocation for 2014/15 and the Governing body are asked to note that the sum of £3.2 million is being made available to the local health and social care economy. Partners have already been asked to consider what measures can be taken to support the wider system during the winter months and now that the amount of investment available has been clarified the CCG can lead early planning for winter to ensure efficiency of investment and resilience of the urgent care system

The UCNB will oversee the commitment of these funds and the winter panel will be reconvened to examine each proposal and assess impact and value for money.

Urgent Care Network Board

The urgent care network board (UCNB) continues to meet on a monthly basis with good representation from key partner organisations.

Key discussions this month focussed on commitment to the 7 day services programme, the SWBH action plan for the NDTA, DTOCs and the recent bed audit. In July the network board will be reviewing the progress of the community operations hub, the options surrounding the initiatives worked up under the behavioural insights project and a DOS gap analysis for Mental Health Services.

Strategy

The team has been working to clarify our strategy and vision for urgent care services in the future. This is a complex process and the preferred clinical model needs to be aligned with the RCRH strategy, estates, funding flows, IT systems and patient preferences. A paper will be taken to the Directors group for detailed discussion and decision in the coming weeks.

Next steps

Recommendations Members are asked to:  Note the contents of the report  Support the work programme

Date: 25th June 2014 Item No.8

Report Topic: Falls Prevention

Report From: Claire Parker

Date: 2nd July 2014

Aim of Report To provide assurance of the work being completed by providers in the prevention inpatient falls.

RECOMMENDATIONS The Governing Body is asked to NOTE the contents of this report.

IMPLICATIONS:

Financial None

Patient & Public None Involvement

Healthcare None Commissioning Equality Impact Assessment/Diversity None Impact Engagement (Clinical None or Non Clinical)

Legal None

Vision and Values None

Workforce None

Other None

SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP

Report to the Governing Body

Subject: Fall Prevention – SWBH and BCP FT

Date: 2 July 2014

Author: Laura harper

Patient Falls and Preventative Actions

The purpose of this report is to provide assurance to the Governing Body Committee that preventative strategies are in place by providers to decrease the amount inpatient falls resulting in harm occurring within inpatient settings.

This report will look at falls that have occurred over the last 12 months (March 2013 – March 2014) within acute settings in Sandwell & West Birmingham Hospital and the Black Country Partnerships Foundation Trust.

Sandwell & West Birmingham Hospitals

The graph below shows the number of patient falls resulting in harm reported by SWBH per month. The graph shows a downward trend over the last 12 months.

All 33 incidents have been investigated by the Trust through a table top review process, which is chaired by the deputy chief nurse and the Adult Safeguarding lead nurse at SWBH. These meetings are used to determine the outcome of the fall to see whether it could have been prevented or not.

The Table Top Review Process involves ascertaining the avoidability of each fall that has occurred. The charts below show the actual number of avoidable/unavoidable patient falls per month; and the respective percentage of avoidable to unavoidable patient falls during the same period.

1. Actual Number of Avoidable/Unavoidable Falls Per Month 2. Percentage of Avoidable/Unavoidable Falls per Month

The trend line in chart 1 indicates that the number of avoidable falls in SWBH has fallen since the start of 2014. Chart 2 also indicates that the monthly percentage of avoidable falls has also decreased. This seems to indicate that the falls strategies employed by SWBH are having a positive effect on reducing the likelihood of a patient suffering harm from a fall that could have otherwise been prevented.

From March 2013 to September 2013 over 70% of all the avoidable falls were found to have been caused by preventative strategies not being in place e.g. risk assessments and care plans, while other root causes included communication between staff and patients and non-detailed handovers.

All lessons learned from these incidents have been shared within the trust at ward level and completion of outstanding actions is monitored by the corporate team. In addition to this, a falls themed review action plan was submitted to the clinical quality review meeting in April 2014 which gave an insight to the actions that had been put in place following falls TTRs and the progress of the action. The adult safeguarding lead had also identified some themes from the TTRs which highlighted issues in the following areas:

 Confusion /Mental capacity  Handover of patients (particularly high risk) when nurse leaves bay/ward temporarily  Toilet environment and conflict with maintaining privacy  Times of transfers (night) and information given for transfer

As documented in the minutes of the April 2014 clinical quality review meeting, SWBH explained that they were re- launching the falls prevention and management initiative. During the launch they would also utilise evidence-based care plans to explain and define reporting methods. These would be disseminated to the wider Trust via road show events.

Falls Themed Visit – Sandwell General Hospital & City Hospital

Alongside the work that has been done in-house at SWBH, SWB CCG conducted an announced visit which took place on 13th October 2013 at both Sandwell General Hospital and City Road Hospital sites. The visit provided opportunities to meet key staff and patients and to see the service in operation.

The main findings from the visit provided assurance to SWB CCG that the majority of ward staff were aware of the patient falls protocol and had received suitable training, which included sessions on management falls risk and falls care planning. All staff showed evidence that they were aware of the incident report requirements associated with Patient falls, and confirmed that lessons learned from falls were shared within the ward.

Some example of the good practice that was identified is shown below:

- A Senior Nurse Advisory Group (SNAG) is in place, which covers a wide range of audits and risk assessments chaired by Chief Nurse - ‘Falling leaf system’ was in use which identified the Falls Risk, using colour-coded cards. - Falls Policy/protocols available via the intranet - Falls folder was accessible to staff - Falls Graphs on display in some wards - Patient falls were discussed at ward level staff meetings - Patients who are at risk of falls were discussed during handovers via Safety Briefings and Daily Care Records - Falls information Age UK booklet were available on most wards and were issued to patients on some wards - It was noted on some of the wards white board monitors were used to identify ‘At Risk’ patients - On some wards patients were involved in falls prevention discussion - Patient falls information was communicated to staff using screensaver messages - A Falls Group continues to be held at Rowley Regis Hospital, co-ordinated by Lyn Jones

With these preventative strategies in place, a reduction in the total number of falls resulting in serious harm has been achieved, and the respective percentage of falls deemed avoidable fell to 45% in the final two quarters of 2013/14.

Black Country Partnership Foundation Trust

Between March 2013 and March 2014, only four patient falls that resulted in serious harm were reported by BCP FT, and all of these occurred within the Acute setting of Edward Street Hospital.

Incident Unit Ref date Reported Location (BCP) Edward BCP 2014/6124 21/02/2014 21/02/2014 Street (BCP) Edward BCP 2014/5386 11/02/2014 17/02/2014 Street (BCP) Edward BCP 2013/25902 03/09/2013 05/09/2013 Street (BCP) Edward BCP 2013/36573 06/12/2013 12/12/2013 Street

Table top reviews were conducted for all four incidents. In each case, the investigation concluded that the root cause in each incident was a patient accident, though lessons learned were still identified. These are shown in the table below.

ID Root Cause Lessons Learned In this type of ward environment demands on staff fluctuate No absolute root cause depending on the number of patients on the ward and their 2014/6124 could be found on this individual needs – this can vary greatly at a time throughout the day occasion and it is not always possible to get additional staff at short notice.

Elderly patient’s clinical In this type of ward environment demands on staff fluctuate condition, medication, depending on the number of patients on the ward and their staffing, as demands on individual needs – this can vary greatly at times throughout the day staff can fluctuate and it is not always possible to get additional staff at short notice. 2014/5386 depending on patients and their individual It should be noted that the patient had been adequately assessed in needs. All preventative relation to the fall safe bundle and all records & care plans reflected strategies were in place that patients were individually assessed and care plans supported for the patient. the delivery of care Comprehensive multi-disciplinary falls risk assessment is required to manage patient risk more effectively based upon: the ‘Inpatient FallSafe Care Bundle Checklist’, the ‘Physical Health and Wellbeing Assessment’ and refined physiotherapy assessment and treatment Patient non-compliance documentation. Actions should be evidenced within multi - 2013/25902 with staff advice. disciplinary care plans developed with patients and their carers. There was an increased risk of patient falling and of not being discovered for some time when mobilising to, within and from the back garden at Edward Street Hospital. This was due to the lack of systematic observations at times by nursing staff. Section 17 leave of absence for ground leave would have been good practice. No root causes identified but Caution and awareness of the gradient of the rubber mat on the recommendations 2013/36573 ramp. identified to ensure

future safety of patients.

Fallsafe Implementation

BCP FT reported to the CQRM in April 2013 that the Fallsafe Patient Falls management protocol was being implemented by the Trust. The Fallsafe system has been chiefly developed by the Royal College of Physicians to maximise the effectiveness of identifying the risk of falls and implementing evidence-based practices to minimise future risk. Since April 2014, BCP FT has introduced and revised falls risk assessment and flowchart, and FallSafe training has been provided to staff working with Older Adults. BCP FT have also implemented a new Falls Strategy which involves reviewing patient fall trends data, and working more closely with their governance assurance unit to improve the Trust’s internal reporting and learning systems.

During the August 2013 CQRM meeting, BCP FT reported that the implementation of Fallsafe was progressing well, and that the following achievements had so far been made:

 Identification of FallSafe Leads for the wards – In place.  Training of FallSafe Leads – Completed.  E-learning Programme for FallSafe commenced – On-going.  Ward based action plan for implementation of FallSafe on wards – Audits commenced May 2013  Governance Structure put in place: - Falls Implementation Group – May 2013 - Falls Steering Group – Sep 2013 - Falls Strategy Sign off – July 2013  Information for patient, carers and public including accessible information developed – Aug 2013

Falls Themed Visit – Edward Street Hospital

Following the identification of a trend in patient falls at Edward Street hospital, the CCG visited the site to conduct a themed falls review.

Examples of good practice observed during this visit are listed below:

- Evidence that FallSafe principles/recommendations was embedded on wards - Red leaf system in use to identify patients “at risk” of falling - Falls Safety Cross reporting tool - FallSafe Newsletter (ensures lessons are learnt across the organisation) - Physical Health Matron in place - FallSafe Leads assigned to both Wards - Falls protocol/processes in place - FallSafe leaflets available in various formats for patients and staff - Walking aids evident - Falls Policy/protocols available on the intranet - There is a Falls Strategic Steering Group – (bi-monthly meetings) - Staff - excellent awareness of falls policy and procedures - Established falls prevention/management training programme (FallSafe) - Band 3 upwards input falls data onto Datix - Walls colour coded in line with dementia therapy - Patient assessment takes place within 72 hours of admission for physical health

The visiting team concluded that the implementation of Fallsafe has been successfully embedded within wards. BCP FT also provided the CCG with good assurance that the Patient Falls policies and protocols were being reflected in practice, and that a robust incident and investigation process identifies any gaps in practice, in order to share any learning with the rest of the trust.

Co-commissioning primary care

Expression of interest

20 June 2014

Contents page

1. Introduction P3 2. Supporting our Strategic Plan P5 3. Scope of co-commissioning interest P7 4. Benefits and realisation P9 5. Timescales P11 6. Monitoring and evaluation P11 7. Risks P12 8. Governance P12 9. Engaging our stakeholders and members P13 10.Contacts P13

Introduction

We are a membership organisation with much to be proud of. During our first year we have driven forward clinically led service redesign not only for our registered population but also across Birmingham and the Black Country. We have demonstrated our system leadership, commitment to improving clinical quality and safety, vision to empower patients and create a sustainable health and social care economy. Our achievements were nationally recognised when we won the Health Service Journal CCG of the Year award in 2013.

We have demonstrated our leadership and effective partnership working, by acting as lead commissioner for the West Midlands Ambulance Service, leading a review of stroke services across Birmingham, the Black Country and Solihull and commissioning the Home Oxygen Service. We also agreed to lead and successfully turned around the commissioning of the NHS 111 service across the West Midlands.

About us We are a membership group of 111 GP practices across the Sandwell and West Birmingham area, caring for more than 535,000 patients. We recognise that there are five distinct districts within our area, so our practices are further split into five Local Commissioning Groups (LCGs):  Black Country  Healthworks  ICoF  Pioneers for Health  Sandwell Health Alliance. This enables us to deliver change at a local level.

Our vision

Our vision is simple to understand but more challenging to deliver: healthcare without boundaries. This vision is driving our expression of interest to co- commission primary care with NHS England.

We want to work across organisational and geographical boundaries to improve the health and the quality of health and social care services provided to our patients, by:

 Giving them the opportunity to benefit from healthier lifestyles  Bringing appropriate elements of care closer to home  Designing services to meet the needs of our local population  Improving clinical quality and patient experience.

We want to deliver stability for our members, support local innovation and ensure resources are located equitably to deliver improved health outcomes, whilst developing the capacity and capability of primary care. We believe that our aspirations are consistent with and will help deliver, NHS England’s Primary Care Strategy.

Co-commissioning in Sandwell and West Birmingham Co-commissioning primary care will be mutually beneficial but the associated risks will need to be managed carefully. Our members feel that the opportunities could outweigh the risks if; through co-commissioning, we can agree that the current GMS, PMS, APMS, enhanced services and the estates development budgets remain within the Sandwell and West Birmingham health economy.

We want to develop a commissioning framework, in partnership with the local Area Team and potentially Right Care Right Here neighbouring CCGs (if interested), that enables all partners to commission “placed based” provision that: Our geographical footprint spans two local authority  Builds upon the success of the Quality and boundaries, covering the Outcomes Framework whole borough of Sandwell and the western part of the  Delivers the Better Care Fund City of Birmingham.  Addresses local health inequalities through targeted

interventions For the past 10 years the  Improves the overall patient experience. Right Care Right Here (RCRH) Partnership has been the local We will also seek to collaboratively commission support for vehicle of delivery for meeting strategic estates development. Our local system our local health challenges. It transformation programme, Right Care Right Here, includes is a well established the delivery of a new hospital (Midland Metropolitan partnership between the CCG, Hospital) and a number of community developments to the two local authorities and support the transformation of out of hospital care. other health services, formed to achieve major transformational change. It is committed to improving people’s health and the quality of health and social care services provided to them

Supporting our Strategic Plan

We recognise and value the contribution primary care makes within the health economy. We plan to strengthen its role by investing more resources into improving the £4.2million primary care offer and the quality of care provided. To do this we have set aside £4.2m to invest in primary care during 2014/15, this additional investment will: to be

 Support the integration of health and social care invested in  Focus local networks of practices’ attention on developing “placed based” commissioning plans primary  Set out our aspirations for improving health outcomes  Deliver our Quality Innovation Productivity and care Prevention challenge in 2015/16.

The success of the Better Care Fund relies on the quality and performance of primary care in terms of the lead care co-ordinator role, steering the multidisciplinary team, prevention, patient education/self-care and proactive management of long term conditions. Our partnerships and strategic commissioning and redesign committees ensure the strategic objectives of the Better Care Fund, our local transformation programme (Right Care, Right Here) and collaborative commissioning arrangements are aligned and being delivered.

Over the next two years we want to maximise the potential of primary care to deliver quality care; that is safe, compassionate, proactive, responsive and effective. Our activity and capacity assumptions predict a 15% reduction in unplanned admissions (in line with local BCF plans) and a shift of planned activity into the community, in preparation for the new Midland Metropolitan Hospital.

Our primary care development work steam aims to empower networks of practices to develop local commissioning plans, based on population health management. These plans will support practices to address the diverse needs of their patient populations. We are actively working with the Area Team to improve the quality of care provided by our members, this work is supported by an infrastructure of protected learning events and targeted support.

Measurable

Identify Defined Analysed Spot and population manage crisis Stratified and better segmented Population Delivered Planned Evidence based Management Interventions interventions with across stratified clear outcomes groups

Supported Efficient Effective Long Empowered Partnership- using Term Conditions Enabling self care right skills in the /End of Life for patients right place management

Locally driven change We have a dedicated primary care development project involving 35 volunteer practices with a registered population of 230,000, who are working together in 12 defined “placed based” networks across our five local commissioning groups. Each network is supported by a dedicated team consisting of a clinical lead, senior commissioning manager, commissioning manager, quality officer, medicines management officer and finance officer. The team’s role is to support the network to understand their population diversity, their patient risk profile and to identify interventions, which are evidence based, value for money and will support improved health outcomes and patient experience.

This primary care development programme will support our members to:  Test the concept of community health networks  Support and in some instances start the dialogue about federated partnership working  Think and act locally to address health inequalities  Empower general practice to engage in a proactive rather than reactive way to improve the health and wellbeing of their local population  Connect partners at a community level to maximise the opportunities for health and social care (as part of the Better Care Fund work streams)  Connect directly with communities, co-producing solutions to address their health issues  Embed health and social care integration  Support the development of primary care  Identify and constructively address variations in practice  Deliver increased community capacity in preparation for the new Midland Metropolitan Hospital in 2019/20  Work with their patients and patient participation groups to define high quality primary care.

The networks are expected to produce “placed based” commissioning plans by the end of September. The plans will be robustly analysed and impact assessed to ensure they deliver our strategic objectives, are realistic, deliverable and provide value for money. The outputs from this project will inform the proposed new co- commissioning framework and the future commissioning of primary care as part of a whole system.

Decisions to approve service provision changes and investments will be subject to our governance process, with additional scrutiny (confirm and challenge) from the Patient Advisory Group and our lay directors.

Scope of co-commissioning interest

Our proposed co-commissioning model:

Develop and commission against a new commissioning framework to support the delivery of our collective objectives (CCG and NHS England)

Align human resources to  NHS England - procurement, contracting and form a joint team – with performance management resource (all transactional dedicated resources to components), performers list, revalidation and deliver the joint appraisals commissioning of primary  CCG – clinical leadership, management resource to care develop/design a new framework (in partnership with NHS England), quality team to support practices to improve and provide a positive patient experience, financial support to determine and manage a pooled budget, engagement with members, the public and support the discussions with Local Medical Committee Pooled or aligned joint  The current level of investment in primary care budget - core, enhanced (general practice) will be retained within the health and local investment to economy commission provision  The CCG will contribute additional financial that delivers improved resources to support the delivery of strategic outcomes and contains objectives (transformation of out of hospital care, transactional costs. shift capacity from secondary to primary care)

Co-commission primary care premises development A key delivery mechanism for our transformation agenda

Collaboratively establish  Scenario 1: Low level interest from partners: CCG appropriate joint would work collaboratively through the established protocols for an end to Capital Review Group, to prioritise local schemes end process for estates for action by the Area Team. development – the level of collaborative working will  Scenario 2: High level buy in from partners: depend upon the appetite collectively resource a joint team, hosted by the of the Area Team and our CCG, which manages the primary care estates neighbouring CCGs. development budget on behalf of all partners. This would support the whole process from development of plans and strategies through to sign off of business cases and the implementation of capital project plans.

Primary care We would seek to pool core, enhanced and local enhanced primary care funding, within an agreed commissioning framework, as an opportunity to deliver a whole system approach and the local Right Care Right Here transformation project. The development of our “place based” commissioning plans is a significant first step and will inform the framework outcomes.

The proposed primary care co-commissioning framework would connect our commissioning strategies to deliver:

 Improved quality  Patient experience  Partnership working  Measurable health outcomes.

Premises We are keen to explore the co-commissioning of primary care premises development, as this represents a key delivery mechanism for our transformation agenda. It is clear that there is very little resource available from the local Area Team, so all partners would need to assess what financial commitment they could make in order to establish a joint team. Without this collaborative approach there is a real challenge in delivering the premises agenda, under the current arrangements.

We are reviewing our Right Care Right Here activity plans, to ensure that the spread of community activity best meets our future needs and they are realistic in light of financial constraints. The success of this proposal will very much depend upon the appetite of the Area Team and our neighbouring CCGs to work collaboratively, as it is likely to require the delegation of primary care budgets and the establishment of a joint team to deliver the required agenda.

Our future plans for developing primary care and community capacity will see the use of a network of developments, including some new and the expansion of some existing buildings.

Track record We have an excellent track record of effective partnership working, through collaborative arrangements and more formal section 75 agreements, to commission a range of services. Jointly commissioning primary care will ensure that the primary care service offer is connected to our wider strategies, including the Better Care Fund and Right Care Right Here.

Benefits and realisation

Patient benefit Realisation

1 High quality care 1. Clinically evidenced services 2. Best practice i.e. NICE 3. Safe and effective services at the point of delivery 4. Appropriate prescribing and review 2 Improved patient 1. Feeling empowered and valued experience 2. Improved access 3. Improved quality and safety of provision 4. Reduced complaints and incidence 3 Patient and public 1. Implementation of the community health network model, involvement in developing including clear connections to the development and use of services – assets based community assets approach 4 Clear point of access for 1. Our Time to Talk Team provides a clear point of access concerns and queries General practice benefit Realisation 1 Shift in resources from 1. Our future activity and capacity assumptions forecast a secondary care to primary reduction in hospital usage and a minimum 20% shift to the care community 2. The development of a new commissioning framework will expand the provision offered by primary care 3. Additional funding will be made available to support the expansion of primary care capacity and capability 2 General practice 1. Coordinated/targeted workforce development (skills and development capabilities), sustainable workforce planning and growth 2. Supported learning 3. Developmental approach to reduce variations in practice 3 Increased primary care 1. Structured primary care support capacity and capability 2. Themed protected learning events

4 Effective integration at a 1. Effective health and social care integration(Better Care Fund) grass roots level 2. Effective integrated working between primary and specialist services 3. Effective use of community services 4. Reduced usage of secondary care (delivery of the Right Care Right Here trajectories) 5. Increased primary care activity

5 Improved General Practice 1. Effective relationship between commissioners and experience contractors 2. Improved communication 3. Timely resolution of issues 4. Timely payments 5. Reduced bureaucracy 6. Collaborative working between networks of practices 7. Supported development

CCG and NHS England Realisation Benefit

1 Reduction in 1. The combination of all core, enhanced and locally enhanced commissioning provision into one framework, would reduce transactional transactional costs costs and lead to greater efficiencies in staffing

2 Improved health 1. Locally based approach to meeting the needs of our diverse outcomes and quality population 2. Targeted intervention to improve health and wellbeing 3. Targeted quality improvements, improved performance against quality outcomes, patient management, prescribing, vaccinations 4. Proactive management of complex patients 5. Timely and efficient mobilisation of resources to support people in crisis 6. Shift in focus to proactive prevention, patient empowerment and community mobilisation

3 Tackling inequalities 1. Community health network commissioning plans clearly identify the diversity of the population and how their needs will be addressed 2. The joint commissioning framework will outline the performance required 3. Performance monitoring will assess compliance 4. Evaluation of impact will be measured via public health intelligence and service usage

4 Development and delivery 1. A joint team responsible for the end to end process of the unit of planning 2. Accessible expert advice and guidance strategic estates strategy 3. Project management of development process 5 The CCG Time to Talk 1. The flow of communication would improve leading to Team would support improved relations between member practices and the Area effective flows of Team communication between 2. The CCG and the Area Team would understand the issues of Practices, the CCG and members and jointly develop solutions Area Team 3. Formal complaints will reduce

Timescales The proposed timescale for the co-commissioning pilot is:

Timescale Action On approval  Form the team 2–3 months  Address information governance issues e.g. sharing intelligence  Scope current funding, performance, stakeholder engagement  Engage with members and patients

4 months  Develop and design the new joint commissioning framework and engage with members/partners 12 weeks  Consultation/engagement April 2015/16  Pilot new framework and joint commissioning arrangements September – March 2015/16  Evaluate

Monitoring and evaluation The evaluation framework would focus on the delivery of the benefits mentioned previously. This would include the following success factors:

 Reduced commissioning transactional costs and efficient use of the current resources  Improved service delivery  Improved health outcomes  Improved quality measures  Measurable primary care growth - workforce, skills, capabilities and service offer  Effective integration between health and social care (Better Care Fund)  Effective integrated working between primary and specialist services  Effective use of community services and reduced use of secondary care (delivery of the Right Care Right Here trajectories)  Patient experience and feedback through GP survey and the Friends and Family test  General Practice experience and feedback.

Risks We know that in expressing an interest in co-commissioning there are a number of associated risks:  Our management costs will increase because NHS England does not currently have sufficient resources to commission primary care. Therefore we will need to recruit to or redeploy our existing workforce  Our members have polarised views regarding the benefit of co-commissioning and additional engagement will be required to ensure members are fully informed and supportive  We may receive increased external scrutiny from freedom of information requests, patients, the public, Healthwatch and overview and scrutiny committees due to the perceived conflicts of interest  NHS England’s resources may be overstretched and could be destabilised by the implementation of co-commissioning, particularly if local CCGs recruit externally  A change in legislation may be required to enable new methods of commissioning primary care to be developed and implemented.

In partnership with NHS England, we will take proactive steps to mitigate all perceived risks.

Governance Our Governing Body is aware of the potential governance challenges in co- commissioning primary care and has agreed that the four independent lay directors will lead the development and implementation of the governance arrangements.

We already have a robust internal governance structure, which has been reviewed by CW Audit, however as a clinically (primary care) led organisation we recognise that co-commissioning primary care presents significant challenges in managing conflicts of interests. We plan to introduce additional confirm and challenge processes, involving our independent lay directors, our chief officers and the Patient Advisory Group.

We propose that a co-commissioning Board is developed with involvement from all the local participating CCGs. This board would oversee the developments and assure the Area Team that the local joint teams are managing conflicts of interest and delivering the objectives. Formal partnership agreements would be developed outlining the roles and responsibility of co-commissioning partners and the associated governance.

We also recommend that an external scrutiny process, similar in nature to a peer review, is developed. This would involve lay directors with the support of local participating CCGs and NHS England. We would be willing to support the development of this peer review process.

Engaging our stakeholders and members We value the voice of our members, patients and stakeholders and will proceed with our expression of interest in accordance with their wishes. Through the development phase we will continue to listen to the views of our members, patients and stakeholders and support them to understand the advantages and disadvantages of the proposed arrangement.

We will carry out extensive engagement around the design of a new commissioning framework and the implementation phase. Concerns and issues will be resolved in partnership with the Area Team, thereby assuring members and patients that any challenges have been satisfactory addressed.

Contact details

For further information contact:

Sharon Liggins, Chief Officer (Partnerships) Email: [email protected] Phone: 0121 612 2833

Sandwell and West Birmingham CCG Kingston House 438-450 High Street West Bromwich B70 9LD

Tel: 0845 155 0500 Web: www.sandwellandwestbhamccg.nhs.uk

Enc 11

Analysis of Continuing Healthcare activity and commissioning data for Report Topic: the period 2010-2014

Richard Thompson, CHC & Care Home Quality Lead Pharmacist Report From: Kay McEvilly, Continuing Healthcare Business and Contracts Manager

Date: 2nd July 2014

Aims of Report  To review current activity trends for Continuing Healthcare (CHC) within Sandwell and West Birmingham CCG and historical trends for Sandwell PCT;  To benchmark activity against local peer organisations;  To explore and understand any anomalies identified;  To identify areas of good practice and potential areas for improvement.

Discussion Points  Relevant parties are requested to read and note the contents of the report and the recommendations below.  Awards of eligibility for Continuing Healthcare funding are lower in Sandwell and West Birmingham than in some neighbouring areas but this appears to relate to referrals received rather than the assessment and decision making process following referral.  Where cases have been referred to appeal, the PCT/CCG’s decisions have been consistently upheld, with only a single case overturned in the available data.

RECOMMENDATIONS  Strategies to address the CCG’s apparent outlier status in the reported data should focus on the identification of appropriate individuals with primary needs for healthcare via the checklist process detailed in the National Framework.  To promote quality and consistency of referral, consideration should be given to training relevant primary care and social care practitioners to support the appropriate identification of individuals who may be eligible for CHC funded care.  Monitoring of activity changes will be required and this should be supported by effective feedback mechanisms for all partner agencies to promote best practice.  Systems and resources in the CCG’s CHC team will need to be reviewed to ensure services are sustainable should demand increase.

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Background

Concerns have been expressed by partner agencies within the local health economy about apparent low levels of NHS-funded Continuing Healthcare (CHC) in Sandwell and West Birmingham. This represents a potential source of health inequality and a potential reputational risk to the organisation. Available activity data collated by the Department of Health indicates that Sandwell PCT and latterly Sandwell and West Birmingham CCG have had lower levels of CHC activity compared to neighbouring organisations when this is considered in relation to local population size.

As this anomaly leaves the CCG vulnerable to challenge from local partners and providers, a data analysis exercise has been completed to determine if local perceptions are accurate and to explore the reasons for any anomalies that exist. In conjunction with this, data has also been collated from the local and regional appeals process to provide assurance in relation to the decision making process and to determine if there are any trends or common themes that may identify areas where improvements are required.

Method

Activity data was collated from Department of Health submissions for cases awarded per 10,000 weighted population and percentage rates of award based on Fast Track and standard CHC referrals.

Data was also reviewed initially for costs of commissioned care but as this may be confounded by a number of factors including quality of commissioning, model used for commissioning in each locality (banded versus case-specific approaches), and cost trends within local health economies, this approach was considered to be of less value for comparison in this exercise and this information has not been included in this report.

Information on outcomes of cases subject to local or regional appeal was compiled from departmental records.

Findings

Initial data analysis confirmed that cases awarded in Sandwell per 10,000 weighted population were consistently among the lowest in the region, both for West Midlands PCTs for data up to 2012-13 and then subsequently for CCGs across the wider Midlands and East region. The original PCT caseload was focussed primarily on individuals with physical health needs but the later addition of individuals with needs relating to mental health and learning difficulties had a limited impact to the overall position and this was not thought to account for the preceding observed anomalies.

To determine the reasons for the discrepancies seen with neighbouring organisations, the figures were analysed further to look at the volume of referral and assessment and the subsequent conversion rates for CHC eligibility.

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The following graph illustrates the percentage of cases approved for CHC eligibility, comparing Sandwell health bodies with those in neighbouring localities, on a quarterly basis during the review period.

100 90 Sandwell 80 Birmingham 70 Dudley 60 Wolverhampton Walsall 50 40 30 20 10 0 Q1, Q3, Q1, Q3, Q1, Q3, Q1, Q3, 10/11 10/11 11/12 11/12 12/13 12/13 13/14 13/14

This data illustrates that for significant periods during the years reviewed, the percentage of individuals confirmed as eligible for CHC following a new referral for assessment in Sandwell was comparable to, or in some cases higher than, awards in peer organisations (data for Sandwell and West Birmingham CCG in quarter 2 of 2013-14 is estimated and may not accurately reflect activity).

The data was also reviewed to determine the number of new referrals recorded by each organisation during the review period and these are illustrated below.

900 800 700 600 Sandwell 500 Birmingham 400 Dudley 300 Wolverhampton 200 Walsall 100 0 2010-11 2011-12 2012-13 2013-14

From the above data it is clear that new referrals for CHC assessment as collated within Department of Health figures are lower for Sandwell for the period 2010-13

Enc 11 when compared to local peers (the figures for 2013-14 will be influenced by changing organisational boundaries).

Data published by the Health and Social Care Information Centre provides further evidence of recent comparative activity with peer organisations. The data below illustrates the snapshot position for the final quarter of 2013-14 – the figure indicating the current eligible patients per 50,000 weighted population at quarter end.

Birmingham and the Black Country 54.3 Birmingham South and Central 33.6 Dudley 48.6 Sandwell and West Birmingham 48.6 Solihull 67.7 Walsall 75.0 Wolverhampton 86.0 Birmingham Crosscity 44.4

The weighted capitation formula determines an area’s target share of the available resources based on their share of the England population, with the share adjusted, or weighted, to account for the local population’s needs for health services relative to those of other areas. The figure for England for the same period was 53.8.

Conversion rates for individuals assessed via the Fast Track pathway (where urgent assessment is required due to poor prognosis) were also reviewed, but there was less regional variation in these results. The average quarterly acceptance rate for fast track referrals within Sandwell was 92%, compared with 98% for the four comparator bodies. It is worth noting that the validity of some of the declared data for Fast Track activity is open to question, as there were multiple quarters where conversion rates greater than 100% were reported.

Cases referred for local or regional appeal from 2011/12 onwards were also reviewed and a breakdown of the outcomes of these 21 appeals is shown below.

Local appeal - CCG 10% 5% decision upheld 5% Regional appeal - CCG 42% decision upheld Regional appeal - CCG decision overturned Regional appeal - award modified 38% Outcome not yet confirmed

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Where an outcome has been reached, PCT and CCG decisions were upheld in 89% of cases that were referred for appeal, and in one further instance the award period was increased by 3 months. The decision not to award was overturned in a single case.

Discussion

The comparisons in this report are based on data declared to the Department of Health by the respective commissioning organisations for the purposes of monitoring CHC activity. It is acknowledged that there may be variations in this data resulting from differing collation and reporting practices within each organisation, but for the purposes of this comparison the data is used as published.

From the available data, it is clear that overall numbers of positive CHC eligibility decisions in Sandwell have been consistently lower (when measured by heads of population) than those of local and regional comparators, but the snapshot data for the final quarter of 2013-14 shows a position closer to the regional average. The data indicates that this reduced activity is not generally due to low acceptance rates when individuals have been assessed, but appears to be related to historically lower initial rates of referral for assessment. Based on the evidence seen, this appears to a more compelling explanation for the observed discrepancies than any changes in case mix during the review period.

There has been an observed reduction in conversion rates from assessment to eligibility for some periods during 2013/14 and this will require further review. Discussions between senior managers and clinicians in the team have already begun to examine whether this reflects a change in practice, and to enable any potential underlying factors to be identified.

The validity of the clinical decisions reached following assessment is supported by evidence from the local and regional appeals process. Where cases have been referred for appeal, decisions have been consistently upheld in the PCT/CCG’s favour, with only one decision overturned in its entirety. These outcomes provide an indication that local decisions are generally in accordance with the principles of the National Framework.

It is apparent from the data collated that further work is needed to address the apparent discrepancy between awards within Sandwell and West Birmingham and some bordering areas. The focus of this work should be to ensure those who may be eligible for NHS-funded CHC are not disadvantaged by variations in local practice.

There may be a number of historical reasons for low referral rates, including changing attitudes toward, and engagement with, CHC within partner agencies. Local authority and primary care colleagues will have an important role to play in identifying individuals who require multidisciplinary assessment for CHC eligibility, but consideration will need to be given to training to ensure checklists are completed to a reliable and consistent standard. It will also be important to establish effective feedback mechanisms to promote engagement and ensure best practice is shared with all applicable practitioners

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Additionally, existing systems and resources within the CCG’s CHC team will need to be reviewed to ensure any increased demand can be met in a timely and effective manner. It is anticipated that imminent changes to the IT systems used to manage activity will help in the streamlining and monitoring of this process. Further work will be required to consider the likely financial impact of any increased activity.

The findings of this exercise should be useful to dispel some of the preconceptions that may exist relating to access to NHS Continuing Healthcare within Sandwell and West Birmingham, but, by highlighting the differences that exist between the CCG and neighbouring commissioners, they also indicate that there are complexities and challenges that will need to be addressed to ensure that the commissioning of care for this patient group adequately addresses local need in future.

Publications Gateway reference: 01828

CAMPAIGN LAUNCH

 

Chief Executives of NHS Trusts and NHS Foundation Trusts

CCG Clinical Leads (cc the Accountable Officers)

Other providers of NHS-funded healthcare

25 June 2014

Dear Colleague,

Yesterday, the Secretary of State for Health launched a new campaign to make the NHS the safest healthcare system in the world, building on the recommendations of the Berwick Advisory Group. The campaign has set out a 3-year shared objective to save 6,000 lives and halve avoidable harm as part of our journey towards ensuring patients get harm free care every time, everywhere.

The Sign up to Safety campaign is for everyone in the NHS. We want the campaign to generate a movement which places the safety of patients as a top priority in everything that we do. We have all agreed to sign up to safety and have made a commitment to align our organisations’ work with the campaign.

We hope that you will wholeheartedly support the campaign and sign up to become part of creating the movement for safety. We ask you to harness the talent and enthusiasm within your organisation and connect with others across the NHS.

Publications Gateway reference: 01828

The power to make enduring changes, which can have huge impact on the patients we serve, will come from your willingness to commit to this campaign, your support for ideas that arise from your people, and from excellent implementation.

We ask you to join us and to give your personal support to this important initiative.

Yours sincerely,

David Behan, Chief Executive David Bennett, Chief Executive Care Quality Commission Monitor

David Dalton, Chief Executive Catherine Dixon, Chief Executive Salford Royal NHS Foundation Trust NHS Litigation Authority

David Flory, Chief Executive Simon Stevens, Chief Executive NHS Trust Development Authority NHS England

Publications Gateway reference: 01828

What does Sign up to Safety mean?

Our vision is for the whole NHS to become the safest healthcare system in the world, aiming to deliver harm free care for every patient every time. This means aligning all the activities and programmes of our organisations to achieve this single common purpose.

As Chief Executive or leader of your organisation, we invite you to set out what your organisation will do to strengthen patient safety by

 Setting out the actions your organisation will undertake in response to the five key pledges (Annex 2) and agree to publish this on your organisation’s website for staff, patients and the public to see. You may like to share and compare your ideas before you publish and support will be available to you.  Committing to turn your proposed actions into a safety improvement plan which will show how your organisation intends to save lives and reduce harm for patients over the next 3 years. Again, support will be available, if you wish to access it, to assist in the description of these plans.  Within your safety improvement plan you will be asked to identify the patient safety improvement areas you will focus on. You will be supported to identify 2 or more areas from a national menu of high priority issues and 2 or more from your own local priorities.

Additionally:  As described in the ‘Berwick Review’ it is essential that boards and other leaders of organisations understand all of the ways to really know how safe their organisation is. We anticipate that boards and leaders will wish to review their practices against the ‘gold standard’ approaches cited in the document ‘The Measurement and Monitoring of Safety’ by Charles Vincent et al. (http://www.health.org.uk/publications/the-measurement-and- monitoring-of-safety/). We will ask for your support to do this.  We know you understand the importance and power of measurement to support improvement. It is vital that our measures are standardised, simple and in widespread use already. We know new and improved measurement tools are under construction but until these are available our measures should include existing methodologies, such as the mortality measures and the NHS Safety Thermometers. We will ask for your agreement to use nationally agreed methods to measure relevant harms and improvement.  We would like you to commit to enhancing capacity and capability in the NHS for safety improvement. For example, we would expect you to support a number of your staff, perhaps 3 each year for an average trust, to be safety leaders or champions who can lead your improvement work and who will be able to share their knowledge with the next generation of safety leaders. We anticipate that this will, for example, support the development of the 5,000 strong ‘Fellows’ Programme that NHS England is developing.  We would also like you to adopt or adapt a ‘safety briefing’ for all patients so that they may understand how to be active in support of their own safe care in the NHS. We will provide more details on this as part of the campaign.

Publications Gateway reference: 01828

What support is available? The campaign team for Sign up to Safety will comprise a small central team who will use social movement principles to create a bottom up approach to change and bring together local safety leads to ensure the campaign is for all care providers in all care settings. The campaign team will be led by Dr Suzette Woodward, Campaign Director.

A National Co-ordination and Support Group, chaired by Sir David Dalton will provide cross system support and ensure overall co-ordination, brand and leadership support for all the national patient safety initiatives including the patient safety collaborative programme, the Safety Action for England team (see below) and the safety fellows.

Improvement support and advice will be initially provided by the Improvement Alliance - a combination of improvement and measurement experts from across the NHS. This will be enhanced by the collaborative programme and safety fellows as they are developed and recruited.

Other Information NHS Litigation Authority Contribution The NHS Litigation Authority (NHS LA) will support those organisations who have patient safety improvement plans which demonstrate a reduction in their higher volume, higher value claims. The NHS LA is committed to support these organisations financially.

Intensive support A new Safety Action for England (SAFE) team will be developed to provide short-term support to individual trusts in the area of patient safety. Modelled on the existing emergency and elective care intensive support teams, the SAFE team will provide trusts with a clinical and managerial resource to assist and develop organisational and staff capabilities to help improve the delivery of safe treatment and care. The team will be piloted later this year.

Transparency A new suite of hospital patient safety data on NHS Choices has also been launched today. The website provides hospital level patient safety data in a tabular form and trusts can be compared against each indicator. There are seven indicators, three of which are composites made up of subsidiary indicators and each indicator is or will be RAG rated. The seven indicators cover the following:

 Care Quality Commission (CQC) National Standards  Open and honest reporting  Infection control and cleanliness  Patients assessed for risk of blood clots  Responding to patient safety alerts  Recommended by staff to their relatives and friends  Nursing and midwifery staffing levels

The safety website can be found at: www.nhs.uk

Publications Gateway reference: 01828

Role of other national bodies Monitor and the NHS Trust Development Authority are supporting this campaign and will coordinate their efforts to offer advice on sources of support, expertise and information to participating NHS Trusts and NHS Foundation Trusts developing their improvement plans for patient safety. The work of NHS Improvement Quality through the Patient Safety Collaborative Programme and more widely will be aligned to this campaign.

CQC has agreed to review trusts improvement plans for safety as part of its inspection programme. CQC will not offer a judgment on the plans themselves but consider them as a key source of evidence for trusts to demonstrate how they are meeting the expectations of the five domains of safety and quality.

What to do next? Visit the Sign up to Safety website (www.SignuptoSafety.nhs.uk) where you will find more information about the campaign and what you need to do to sign up your organisation. There are also resources to download to help kick off your local communications work, information about what the first 12 Sign up to Safety trusts are doing locally with their campaign, and links to useful patient safety improvement tools and resources. You can join the patient safety conversation on Twitter at #SignuptoSafety @SignuptoSafety. Publications Gateway reference: 01828

Annex 2

The five ‘Sign up to Safety’ pledges

By signing up, the trusts have pledged a commitment to:

 Put safety first. Commit to reduce avoidable harm in the NHS by half and make public the goals and plans developed locally.

 Continually learn. Make their organisations more resilient to risks, by acting on the feedback from patients and by constantly measuring and monitoring how safe their services are.

 Honesty. Be transparent with people about our progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong.

 Collaborate. Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use.

 Support. Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate the progress.

Enclosure No: 13

GOVERNING BODY

Report Topic: Declarations of Interest Register 2014/15

Report From: Claire Parker, Chief Officer, Quality

Date: 2nd July 2014 Aim of Report The Governing Body members are asked to approve the updated Declarations of Interests Register for all Sandwell and West Birmingham Clinical Commissioning Group Members. This is a requirement for Sandwell and West Birmingham Clinical Commissioning Group members under Standing Orders set out in the Constitution.

Discussion Points For Information RECOMMENDATIONS Members of Sandwell and West Birmingham Clinical Commissioning Group are asked to:

1. Approve the Sandwell and West Birmingham Clinical Commissioning Group updated Declarations of Interest Register for 2014/15.

IMPLICATIONS Financial None Patient & Public None Involvement Equality Impact Assessment/Diversity Not Applicable Impact Healthcare

Commissioning Engagement (Clinical or

Non Clinical) Legal Vision and Values All Workforce Director Checked [Initials] Date Received by Committee Secretary

SWBCCG Governing Body Register of Interests – February 2013

NAME ORGANISATION INTEREST MEMBERS Nick Harding  Handsworth Wood medical centre. Partner and  Partner and property share owner. property share owner.  Vitality Partnership  partner and director of subsidiary companies  Vineyard Churches UK & I.  Trustee  Royal college of GP  GP trainer, GP examiner  Home Office – Birmingham Crematorium  Appointed doctor  Health & Safety Executive for Asbestos, Ionising  Appointed doctor Radiation, and Lead medicals  Maritime Coastguard Agency  Appointed doctor  Faculty of Medical Leadership & Management  Member  Aston University  Honorary Senior Lecturer in Community Cardiology and Primary Care Leadership

Basil Andreou  QOF  Lead Minor Surgery Provider  Sandwell local medical committee  Secretary  Sponsored by drug companies  Teacher at Educational Events  Sandwell LMC  LMC Secretary  Sandwell and West Birmingham NHS Trust  GPwSI in Dermatology

Priyand Hallan  GP Solutions UK  Spouse holds directorship

Sam Mukherjee  Principal-Newtown and Aston Pride Health  Wife Nurse Practitioner Centres  Director ICOF LLP and GGP.Com Ltd  Founder member of both companies  SWBH  Wife is Clinical Nurse Specialist

SWBCCG BOARD REGISTER OF INTERESTS: UPDATED September 2013

NAME ORGANISATION INTEREST Inderjit Marok  Rotton Park MC  GP principal  Summerfield Group practice  Partner  GPP.com  Director  ICOG LLP  Director

Vijay Bathla  PMS practice  Principal GP senior Partner  Birmingham LMC  Member and Executive member  Birmingham British International Doctors  Chairman Association  Pioneers for Health LCG  Chairman  RCGP  Fellow  BMA  Member

Sirjit Bath  Walsall Road Medical LTD  Director  Tower Hill Medical LTD  Director  RCGP  Member  BMA  Member  Minor Surgery  GPwSI  Family Planning  Instructing Doctor  GP trainer  GP Appraiser George Solomon  Black Country Family Practice Ltd  Director  Black Country Family Practice  Partner  Tipton Care Organisation  Co-Chair  Capa 1st  Partner is owner of company who provide training to Healthcare Professionals

SWBCCG BOARD REGISTER OF INTERESTS: UPDATED September 2013

NAME ORGANISATION INTEREST Ian Walton  Ryland View Nursing Home  Retained GP  Spires Health Care  Director  Tipton Care Organisation  Chair  Primhe  Chair  British Society of Clinical and Academic  Course Organiser Hypnosis  Lilly pharmaceuticals  Paid speaker  ASD Metals  Medical Adviser  Horseley Heath Surgery and Tandon Medical  Partner and Owner of Share in the Property Centre  Birmingham City University  Visiting Lecturer  Royal College of GPs  Lead for Mental Health  Pfizer  Sponsored to attend a master class in anxiety and Depression at Madingley Hall, Cambridge University  Walton Hill Associates  Director  Mental health in Family Medicine  Editorial Board  Journal of Psychological Therapies in Primary  Editorial Board care Sabbatical from May 2014

SWBCCG BOARD REGISTER OF INTERESTS: UPDATED September 2013

NAME ORGANISATION INTEREST Ranjit Sondhi  CCG Board. Not associated with any member  Vice Chairman practice. Lead lay member on patient and public engagement at Board level  Trustee – PMA Trust  Trustee  Trustee – Nishkam Health Care Trust  Trustee  Chairman of Advice Birmingham – a partnership  Chairman of voluntary organisations  Women’s Hospital Birmingham  Wife (Anita Bhalla) is Non-Executive Director  QC Selection Panel  Panel Member  Criminal Cases Review Commission  Commissioner  Cole Trust  Trustee  Sampad – South Asians Arts Organisation  Chairman

Felix Burden  Burdens of Disease Ltd  Director  Fellow Royal College of Physicians  Fellow  Diabetes UK  Member  Burdens of Diabetes Ltd  Commissioned to undertake educational meetings on blood glucose monitoring by Birmingham Cross City, Birmingham South, and Solihull CCGs; the funding for this will come from 4 pharmaceutical companies: Spirit health care, Abbot Diabetes care, GlucoRX, and Glucomen.  In addition the company has been commissioned by Spirit Health Care to lead a meeting for employees of that company.

SWBCCG BOARD REGISTER OF INTERESTS: UPDATED September 2013

NAME ORGANISATION INTEREST Julie Jasper  Westlands Associate  Managing Director  Thorns Community College  Chair  Birmingham Metropolitan College  Governor  Dudley CCG  Member

Margot Warner  Nursing and Midwifery Council  Member  Warner Healthcare  Director and Owner  Birmingham and Solihull NHS Cluster  Senior Nurse  Royal College of Nurses  Member  GMB Union  Member Resigned May 2014 Richard Nugent  HECS Architects  Principal  Sandwell college  Governor  Warley Woods Community Trust  Director/Trustee  Architects for Health  Executive Member Janette Rawlinson  Just Real Solutions – independent consultancy  Owner/Principal Consultant  Cerebral Palsy Midlands  Clients of Just Real Solutions  SCVO  Clients of Just Real Solutions  Institute of Directors  Member  NIHR Clinical Research Network: Cancer  Patient Representative (appointed October 2013 for 3 Years) to one of their Clinical Studies Groups and Consumer Liaison Group

Andy Williams  CSU  My partner works as a senior manager in the Commissioning Support Unit that the CCG contracts with.  James Green  None Registered  None Registered

SWBCCG BOARD REGISTER OF INTERESTS: UPDATED September 2013

NAME ORGANISATION INTEREST Claire Parker  Birmingham Crisis Centre- Women’s refuge for  Trustee and Vice Chair Domestic Violence with direct links to Safeguarding

Sharon Liggins  None Registered  None Registered

Alison Hodgson  None Registered  None Registered

Jyoti Atri  Sandwell MBC  Director of Public Health  Faculty of Public Health  Member  UKPHR  Registrant  Action for Blind People charity  Husband is Operations Manager Jon Dicken  Non Registered Ram Sugavanan  Vitality Partnership  Partner  Smethwick Medical Center  Property share owner  Gpwsi in Orthopaedics  Minor surgery provider  RCGP  Member  BMA  Member  Sandwell LMC  Member Lynda Scott  Non registered Mike Smith  Wincross Hacker Young consulting Ltd T/As  Director foursight  UHY Hacker Young (Birmingham), LLP  Partner  Trinity High School & sixth form Centre (Redditch  Governor and Chair of Finance Committee  Redditch Borough Council  Wife is Housing Services Team Leader Stepped Down June 2014 David Hughes  None Registered  None Registered Started June 2014

SWBCCG BOARD REGISTER OF INTERESTS: UPDATED September 2013

SWBCCG BOARD REGISTER OF INTERESTS: UPDATED September 2013 Enc 14

Date: 2nd July 2014

Title: Safeguarding Children Update

Prepared by: Gene Kelly and Eileen Welch – Designated Nurses

PURPOSE & BACKGROUND

Purpose The purpose of this report is to provide an update on issues and key activities in relation to Safeguarding Children.  Looked After Children Update Key Points  Training  Initial Child Protection Conference  Multi-agency Safeguarding Hub (MASH)  Child Death  SCR/ Smaller Scale Audits  Domestic Abuse  SWB CCG Section 11 compliance  Birmingham Ofsted

Prior Committee None Approval

IMPLICATIONS

Resources

Quality & Patient Working in progress improve and monitor the effectiveness Experience of early help offered to children

Consultation & Engagement

Equality Improved access and support to children and their families. Most vulnerable receive targeted support

Legal None

1 Eileen Welch and Gene Kelly

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1. Introduction

1.1 The purpose of this report is to update Sandwell and West Birmingham CCG Governing Body on issues and key activities in relation to safeguarding children.

2. Looked After Children Update

2.1 A newly appointed Designated Nurse for Looked After Children commenced in post on 1st April 2014.

2.2 In response to the OFSTED inspection of Looked After Children Services, August 2013 OFSTED and recommendations for immediate action:

 Ensure that plans are firmly in place to eliminate the backlog of initial health assessments for children and young people coming into care.

 Ensure plans are in place to improve the quality of initial and review health assessments to ensure that these include the fullest information obtainable to inform the comprehensive health needs of looked after young people

 LAC Health Services were aware that the 20 working day schedule to submit health care plans to the Local Authority following the child’s initial health assessment in accordance with the statutory guidance 2009 were not being met. As a consequence, care plans from statutory reviews for Looked After Children were being drawn up without access to health information. There were difficulties identifying where delays were occurring, in response to this data has been collated over the past 6 months for children entering care who have been appointed for an initial health assessment.

2.3 The reasons for delays in the initial health assessment include:

 The absence of a single point of notification within the local authority to inform the CCG when a child enters care  Late requests from social workers to book an initial health assessment  The operation of a system whereby social workers can choose to book a clinic date which may be outside of timescales  The desire for large sibling groups to be seen together.  Clinic availability – lack of capacity to accommodate numbers of children being looked after  Administrative processes causing delays and extending timeframes  In June there were 32 children and young people who were brought into care and

2 Eileen Welch and Gene Kelly

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this was unprecedented but followed a recent OFSTED inspection of Safeguarding. This coincided with cover arrangements that had been made for the Designated Doctor’s booked sick leave but which had been based on a standard month influx of children.

2.4 In response to these findings a systems approach was adopted to review health processes and minimise delays in process.

 The CCG Safeguarding Looked After Team to take on the responsibility of booking the Initial health assessment clinic, when in Information Sharing Agreement has been agreed with Sandwell and West Birmingham Hospital Trust.  Social Workers will be given an appointment at the time of request.  Clinic availability has been increased.  The reduction in the need for Designated Doctor to attend adoption panel has created more capacity for assessments to be undertaken.  Administrative processes have been reviewed and improved by auditing the appointment and booking process and the timeline for initial assessments and electronic checking of report and signature by the Designated Doctor has expedited the turnaround of the health report.

2.5 Timeliness and Quality of Assessments

 Following a review of the paperwork used for Initial Health Assessments (IHA) and Review Health Assessments (RHA) The British Adoption and Fostering (BAAF) forms have been introduced. They are available electronically thus aiding the transfer of information to children’s services.

 Best practice standards have been developed and this will require that staff undertaking assessments should be competent to undertake them in accordance with Intercollegiate Roles Framework(May2012)

 A ‘hot desk’ for the designated Nurse for Looked after Children in the LAC social workers main office. To discuss any health concerns regarding looked after children, and respond to outstanding health assessments.

 From June 2014 there will be a new process whereby local authority will notify health daily of all children that have become looked after. An initial health assessment appointment will be booked following notification, reducing the risk of exceeding time scales. This process will continue to be audited.

3 Eileen Welch and Gene Kelly

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2.6 Out of borough’ Review Health Assessments:

 All review health assessments completed both in borough and out of borough are quality assured by the Designated Nurse for LAC.

2.7 Request for Health summary from GP’s for IHA:

 Recommendation from Small Scale Audit – That GP’s should provide a summary of health information for looked after children when they attend for IHA. An audit of this has been undertaken for the past 6 months and there were 13 responses from GP’s. This was included in the GP briefing pack to be given out at the GP Safeguarding Leads away day in October 2013.

 It is also proposed that discussion takes place with GP Safeguarding Leads and Commissioning Support Unit to facilitate the sharing of information for Look After Children, prior to IHA taking place.

2.8 The voice of the child:

 The BAAF form gives the assessor the opportunity to capture the child’s voice and views and the REDY System was introduced in May 2014 which captures the experience of children and young people who attend for initial health assessment.

Regular LAC reports on progress are submitted to the performance accountability Board.

3. Training

3.1 Safeguarding Children training to GP Practices is the responsibility of NHS England. Level 3 Safeguarding Children training from 1st April 2014 is provided via Elearning.

3.2 The Safeguarding Children Unit will provide additional safeguarding children training to the GP Practice Safeguarding Leads during 2014/15 and the Birmingham Named GPs will provide top up safeguarding children training to the West Birmingham GPs.

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4. Representation from Primary Care at Child Protection Conferences

4.1 In Sandwell, in response to concerns raised over agency attendance at initial child protection conferences a new process has been introduced from the 1st June 2014. The Safeguarding Children Unit are the single point of contact for a report and invitation to initial child protection conferences for GP’s, Health Visitors, School Health Nurses, Midwives and Paediatricians. There is a dataset to monitor compliance with the process, which will be reported quarterly to the Sandwell Safeguarding Children Board and Performance Accountability Board.

4.2 In Birmingham new developments in format for Child Protection Case Conference have identified the requirement for a safe portal for GPs and other organisations to receive and send items such as invitations, minutes and reports in relation to conferences in a timely manner. There will be training for users of the new portal upon commencement for all organisations once the system is in place.

5. Sandwell Multi-agency Safeguarding Hub (MASH)

5.1 The Sandwell MASH has been operational since November

5.2 There is an ongoing evaluation of the MASH and to date it has evaluated extremely positively with particular reference to the invaluable health contribution.

5.3 Sandwell MASH has recently won an award for recognising innovation and excellence in public service risk with mitigation.

5.4 SWB CCG have resourced the deficit in Domestic Abuse Lead Health role within MASH, which had been identified as a significant risk factor. 5.5 Birmingham MASH is due to go live on 28th July 2014. There will be a launch event for all partners across all agencies.

6. Child Death Review Process

6.1 Work continues between Birmingham and Sandwell Safeguarding Teams to ensure a robust notification process of all child deaths within the CCG is in place and the SWB CCG Lead Nurse for Child Death reviews is monitoring compliance with this.

7. Serious Case Reviews / Smaller Scale Audits

7.1 Sandwell Safeguarding Children Board are in the process of undertaking a Serious

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Case Review and Management Review for two children who have not died but there are probable lessons to be learnt.

7.2 In Birmingham between April 2013 and March 2014 there were 169 child deaths, two less when compared with the same period for the previous year.

7.3 Two Management Reviews have been undertaken in the same period of both years

7.4 One Serious Case Review was commissioned in 2012/2013 and 2 have been commissioned in 2013/2014

8. Domestic Abuse

8.1 SWB CCG have appointed a Strategic Lead for Domestic abuse who commences in post on 1st July 2014 to drive the domestic violence agenda which continues to be a significant issue for Birmingham and Sandwell areas who regularly undertaking Domestic Homicide Reviews and domestic abuse being a common feature in child protection cases.

9. Section 11 Compliance

9. 1 SWB CCG and its providers are monitored for Section 11 compliance by both the BSCB and SSCB.

9.2 SWB CCG were assessed on their section 11 compliance by a Scrutiny Panel of the SSCB on 09/01/2014. The panel identified that there were no significant gaps in assurance but the following points were noted:

 There are challenges working across two local authorities areas because the CCG is not coterminous with the local authority. Closer collaboration is required with the Designated Safeguarding Children Team at Birmingham South Central CCG in order to achieve greater consistency of approach and joined up working. The Memorandum of Understanding with the Birmingham South Central Hosted Team has been signed by all relevant parties. The Designated Nurse function has been removed from the MOU and is provided by SWB CCG Safeguarding Children Unit to provide better cohesion between Sandwell and West Birmingham. The monthly Joint CCG Meetings are

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regularly attended by the Designated Nurse.

 SWB CCG needs to improve how it engages with children and young people; it needs to more effectively seek the views of children and young people and use these to inform the development and commissioning of health services for its population. The Voice of the Child Standards led by SWB CCG Chief Officer for Quality have been developed and are awaiting further progression by the SSCB.

 Joint work is required with the local authority to improve the timeliness of Initial Health Assessments for Looked After Children to ensure that statutory timescales are met and health information is made available for the Initial Statutory Review when a care plan is developed for each Looked After Child. Refer to LAC report detailed above.

9.3 The Safeguarding Health Forum Minutes are submitted to the Quality and Safety Committee and clearly articulate the safeguarding children agenda within SWB CCG.

9.4 The Safeguarding Children and Adult CQUINs are in the provider contracts and will be monitored by the Safeguarding Children Unit in collaboration with the hosted team.

9.5 The CCGs Vulnerable People and Families Assurance Visits of the providers in Birmingham and Sandwell during 2014/15 have commenced. A detailed report of the findings from Sandwell and City Hospitals and Black Country Hospitals will be submitted to the Quality and Safety Group.

9.6 The Safeguarding Children Dashboard for the providers will be monitored by the Safeguarding Children Unit in collaboration with the Birmingham South Central Hosted Team.

9.7 There has been an internal audit review for SWB CCG Safeguarding Arrangements as part of the 2013/14 internal audit plan agreed by the audit committee and chief finance officer. The preliminary findings of the audit did not highlight any weaknesses that would materially impact on the achievement of the systems key objectives. Full details of the findings will be submitted in the final audit report.

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10. Sandwell Safeguarding Children Board.

10.1 The Chair of the Sandwell Safeguarding Children Board left post June 2014. Interviews for a new Chair took place on Monday, 23rd June and the post has been appointed to.

11. Birmingham Ofsted Inspection 2013/14

11.1 Following the DfE commissioned review by Professor Le Grand and the recent Ofsted Inspection, Birmingham have developed a three year improvement plan with oversight from Lord Norman Warner, Chair of Birmingham Performance Accountability Board.

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SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP

QUALITY AND SAFETY MEETING

Minutes of the meeting held on Monday 19th May 2014 Kingston House, Ground Floor Meeting Room 1:00 – 3:00pm

Present: Sam Mukherjee (SM) – Chair Claire Parker (CP) – Chief Officer, Quality SWBCCG Dr Ayaz Ahmed (AA) – Quality Lead, Sandwell Health Alliance Dr Earl O’Brien (EOB) – GP Lead, Pioneers for Health Liz Walker (LW) – Head of Medicines Management SWBCCG Dr Liz England (LE) – GP Lead, Healthworks Richard Nugent (RN) – Independent Committee Member Dr Inderjit Marok (IM) – Vice Chair, ICOF Anna Pronyszyn (AP) – Infection Prevention Nurse Consultant Tom Richards (TR) – Quality and Risk Lead SWBCCG Gene Kelly (GK) – Designated Nurse for Sandwell Dr Imran Zaman (IZ) – ICOF Lesley Jones (LAJ) – Customer Care Officer SWBCCG – Minutes

In attendance: Pam Kaur (PM) – Senior Commissioning Manager Kay McEvilly (KM) – CHC Business and Contract Manager

Apologies: Alison Hodgson (AH) – Quality, Safety and Risk Manager SWBCCG Jonathan Beasley (JB) – Quality manager SWBCCG Jayne Salter-Scott – (JSS) – Commissioning Manager Engagement SWBCCG Graham Price (GP) – Healthwatch Communications and Engagement

Item Subject Action 1. Apologies As noted above. 2. Declarations of Interest None 3. Minutes of Last Meeting: (Enc 1) Amendment to page 4. Action note should read AY (Angela Young) and not AP (Anna Pronyszyn). The Committee agreed the remainder of the minutes as an accurate record of the last meeting.

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Item Subject Action 4. Action List and Matters Arising Action List:

080713 – Imaging concerns. The Committee agreed to keep this issue on the agenda. Feedback awaited from CQR meeting. Action: Ongoing CP

080713 – Safeguarding.

Develop a specification for the CCG requirements for safeguarding children’s

services from South Central CCG.

GK explained that a service specification around the designated Doctors in draft

is being amended together with a Memorandum of Understanding. A meeting

will take place today where these documents will be discussed. CP explained

that this will produce a much more integrated and streamlined process.

SM queried where information on contacts will be disseminated.

GK stated that contact lists will be on the website once produced.

CP asked if the Safeguarding Unit could run the next PLT and hold workshops

around safeguarding for children and adults. Will also pick this up in Primary

Care. The GP’s present agreed. GK Action: Ongoing

091213 – Infection Prevention.

AH to raise the possibility of a similar dashboard to Birmingham model with

Sandwell Local Authority (risk rating/ranking system for care homes). AP to

lead on this action. AP reported that Birmingham does not have a dashboard at

present. The Committee agreed to close this action.

Action: Closed.

Actions and Matters Arising – March Meeting (Enc 3)

The Committee agreed to look at a sub group for the analysis of complaints. AH

to take forward and request reports from providers. Members to include

members of the Committee and safeguarding representative. Terms of

Reference to be bought back to the next Committee.

Draft Learning from Experience Policy on today’s agenda.

Awareness of the risk registers of Providers to be bought to this Committee.

Ongoing

220414 – NHS England Report.

CP agreed to circulate to members after the meeting. CP Action: Closed

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Item Subject Action Matters Arising: The Committee discussed the problems encountered trying to gain access to the member’s area of the SWBCCG website through the registration process with the CSU. Members stated long delays in receiving their passwords. SM stressed the importance of quick and easy access if information and applications are to be added to the website. Agreed to take forward to IT.

Action: Members area access to be discussed with IT department.

5. Quality Report – March 2014.

CP explained that April and May data will be presented at the next meeting, and that the Quality Report format is under review and will be trimmed down. CP explained that this report has been discussed previously at Governing Body.

TR presented an executive summary of the report on following points:-

 Never Events. All 6 serious reviews have now been closed.

 Second wave of GP training on Datix reporting to take place.  Ongoing trial on the use of the audit tool.  Steis reports show a decline over the year. Overall number of serious incidents also declined over the year.

TR explained that the next report will be in a new format which will clarify

where each incident stands in the Steis process.

RN queried the number of late reported Steis incidents. CP agreed that late reporting is a recognised issue and is under challenge.

LE commented that the Datix form was too complicated and took too long to complete. TR to meet with LE to discuss improvements. SM queried whether Datix could be accessed via the SWBCCG website and whether the report could illustrate reporting from individual LCG’s by number to feedback. TR explained that this was possible and that only NHS staff would be able to access the form (as it requires an N3 connection). TR stated that a transfer to the SWBCCG website could possibly assist in calculating the number of hits, though this would have to be confirmed by the Communications Team. TR agreed to show reporting of each LCG by number as requested.

Action: TR to meet with LE to discuss possible improvements to the Datix TR/LE forms.

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Item Subject Action 6. Exception Reports:

Annual Complaints Report:

TR presented the report which included was summarised as follows:-

 297 complaints, concerns and compliments received combined.  Complaints average 8 per month.  Reduced amounts of complaints in favour of concerns.  60% of complaints and concerns related to our commissioned services. Trends of complaints include, appointments, attitude of staff and clinical care and treatment.  CCG complaints trends are within patient experience in relation to commissioned services i.e. continuing healthcare funding.  GP concerns included issues around patient experience of the appointment booking systems, attitude of staff and clinical care or treatment.

The report includes a lessons learnt section and makes use of graphs to illustrate breakdowns of the information.

SM explained that the GP concerns would be picked up in the Primary Care Development sessions.

The Committee accepted the report.

Customer Care Team Evaluation Report:

TR presented the report for information.

CP informed members that the CCG Customer Care Team (Time2Talk) were to be featured in an article in the HSJ at the end of May, and that nationally the CCG’s customer care model is being viewed as the way forward for the management of complaints and concerns.

SM passed on the Committee’s congratulations to the Team.

The Committee agreed to accept the report.

Emerging Concerns:

The Committee agreed to follow up on the following concerns:-

 Delayed cancer diagnosis challenges through CQRM.  Review of the WMAS Steis incidents.

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Item Subject Action 7. Safeguarding:

DHR Media Strategy. (Enc 6) Multi Agency DHR Media Protocol. Enc 7)

GK presented the reports.

GK explained that the Information enclosed is from Birmingham. GK asked for

any comments of the members to take back.

SM queried if there was any points that should be highlighted to the Committee. GK stated that the strategy and protocols are very clear with regards to the agreed response to media interest of domestic homicide reviews.

BSC Safeguarding Report (Enc 8)

The Committee agreed that the CCG require relevant and more local

information. GK agreed to discuss this issue at the meeting later today and

request a report which reflects the West Birmingham elements as the report

currently does not break the information down to individual CCG’s. GK Action: GK to feedback at next meeting.

8. Infection Prevention – End of Year (tabled report)

AP presented the report for end of year. The main points discussed were:-  MRSA screening rates have improved.

 Blood contamination rates have exceeded targets. The issue has been

identified as problems following policy which reflects poor practice.

Nurse training is taking place in Accident and Emergency Departments.

 C diff incidents have shown an improvement.

 C Diff Pre-48 hours targets have improved. AP requesting information

on our patients who may access the Queen Elizabeth or Russells Hall

Hospitals.

 MSSA increase since February which could be attributed to an increase

in the incidents of cellulitis.

 E-Coli bacetermia numbers are quite high. AP stated that these were

not care related. This issue was raised in the Governing Body meeting.

 Increase of CPE. AP explained a safety alert was sent out in March. A

toolkit for identification, management and control was produced by

Public Health England. All acute trusts action plans due by 30th June.

Assurance is required from Ambulance and Mental Health Trusts on

their planning for cases. CP stated that this issue would be picked up at

their CQRM’s.

 MRSA cases on NMU. An outbreak meeting will be held and AP expects

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Item Subject Action that the Ward will implement changes required before the meeting.

CP explained that during visit to two Wards at Sandwell General Hospital some infection control issues were picked up. The visit highlighted that only basic

prevention needed to be in place.  Flu vaccine status. SM requested information on flu vaccinations in Care Homes.

 Norovirus at high levels, however quick identification has meant that

high numbers of Ward closures have been avoided this year.

 Scarlet Fever. There has been an increase of cases reported and

outbreaks in schools. Interim guidance is available for outbreaks in

schools. AP to send CP figures for Birmingham.

RN queried follow ups for patients contracting urinary infections. AA commented that urinary infections can be contracted due to poor toilet hygiene. However it was recognised that there will be difficulties in fully controlling these incidents due to the issues of a patient’s privacy and dignity.

Action: AP AP to provide information on flu vaccinations in Care Homes

AP to send CP figures for scarlet fever outbreaks in Birmingham.

9. Equality and Diversity: No report

10. Medicines Management:

Prescribing Development Scheme (Enc 9). LW explained that this document was approved at Directors Meeting last week.

Locality PDS rationales 2014-15 (Encs 11,12,13 and 14)

SM queried the ICOF PDS as not yet submitted. IZ explained that this would be

complete for the next meeting of Quality and Safety Committee in June.

LW explained the adopted development projects submitted to the Committee by each of the localities.

The Committee agreed the projects chosen.

SHA Locality PDS – SOP’s (Enc 15)

Presented for information.

NSAIDS Audit Template (Enc 16)

Presented for information.

Enc 15

Item Subject Action Blood Glucose Test Strips Audit Template (Enc 17)

Presented for information.

Management of Infections in Primary Care – Antibiotics Guidelines (Enc 10).

The Committee agreed the document.

11. Policies and Procedures:

Domestic Abuse Policy (Enc 18) GK presented the Policy and explained that there were amendments in yellow to incorporate person centred principles. Requested the Committee agree the Policy.

The Committee accepted the Policy.

Draft Visit Policy (Enc 19)

TR presented this Policy and explained that it had been produced to formalise procedures for announced and unannounced visits.

RN queried whether the CCG was cross checking with other CCG’s and the CQC.

CP explained that collaborative visits take place and the CQC are informed and

they would also contact the CCG before their visits. Invitations would also be

made to attend visits to Birmingham teams. Reports are fed back through the

CQR processes.

RN queried whether the inspections would also take note of the structural environment/premises. CP explained that this element of inspection would take place and was also incorporated following learning from previous visits.

SM asked that the word ‘visit’ be attached to the title. TR confirmed that this would be rectified.

The Committee accepted the Policy.

Action: TR to amend title TR

(Draft) Learning from Experience Policy (Enc 20)

TR presented the Policy for information only and asked that the item be

deferred until the next meeting for consideration. CP asked that the Committee

forward any comments on the draft document to TR.

Action: Policy to be discussed again at next meeting. TR

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Item Subject Action Continuing Healthcare Process (Enc 21)

PK presented the report and gave a summary on the following points:-  Increase in expenditure due to picking up Mental Health and Learning Disability clients and West Birmingham patients.

 TUPE’d across assessors from the Acute Trust.

 Continuing with data cleansing.

 Serious incidents in Nursing Homes for Intermediate Care patients.

These beds have now been closed so now looking at a different type of

service for I.C. beds for next winter.

 A Pharmacist recruited to the Team is reviewing medication processes

taking place in Nursing Homes and Residential Homes that are non

nursing.

Any incidents identified would be addressed and would also link into safeguarding work.

PK explained that information on awards of CHC will be presented at a future meeting of the Quality and Safety Committee. This which will show benchmarking against other CCG’s both regionally and nationally.

CP explained that KM is working on assessments coming through are that these

are being converted to continuing healthcare.

SM queried how the CCG compare on the backlog of assessments. PK agreed that there are number of retrospective reviews to be completed. A recruitment plan is going forward to assist with the workload although this will take some time to put in place.

SM queried the progress of the Winterborne clients and their transfer into Community Services. CP gave assurance that all clients have been reviewed and staff have been appointed to oversee all transfers.

CHC audit completed in draft at present. The full report will be presented to PK the Quality and Safety Committee in the future.

Action:

PK to submit information on benchmarking to Quality and Safety Committee

PK to submit Audit report to the Quality and Safety Committee.

12. Additional Items:

None discussed.

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Item Subject Action COPY MINUTES FOR INFORMATION 13. CQRM – BCPFT:

None submitted.

14. C QRM –SWBHT - February minutes (Enc 22)

The Committee accepted the report for information.

15. CQRM – DGFT – February minutes (Enc 23)

The Committee accepted the report for information.

16. West Midlands Ambulance Service – Quality Meeting.

None submitted

17. Health Forum Minutes. – March 2014 - (Enc 24)

The Committee accepted the report for information. ANY OTHER BUSINESS: 18. GK informed the Committee that Claire Parker would be standing in as Chair for the Safeguarding Board until new chair appointed.

The Committee congratulated Claire on her appointment.

19. Date of the next meeting : Monday 21st July, 1:00-3:00pm

Kingston House, 2 Rear, Meeting Room 1

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SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP

SANDWELL HEALTH ALLIANCE L.C.C. BOARD MEETING

Minutes of the Meeting held on Tuesday 27nd May 2014, 1.00-4.00pm at Oakwood Surgery, Izons Road, West Bromwich

Attendees: Dr B Andreou (BA) Chair Dr P Hallan (PH) Vice Chair Dr A Ahmed (AA) Quality & Safety GP Lead Dr D Manivasagam (DM) Partnership GP Lead Paul Russell (PR) Commissioning Manager, SWB CCG Angela Poulton (AP) Senior Commissioning Manager, SWB CCG Hannah Peach (HP) Prescribing Lead

In Attendance: Theresa Kavanagh (TK) Business Support

Apologies: Dr P Klair (PK) Finance & performance Lead Deska Howe (DH) Patient Representative

Item Subject 1.0 Welcome and Apologies 1.1 BA welcomed everyone.

Apologies: Dr Klair, Dr Ahmed joining at 2pm as attending a meeting, Laura Mainwaring 1.2 joining the meeting later; Deska Howe

2.0 Declarations of Interest 2.1 BA suggested that GPs’ Declarations of Interest be brought up throughout the meeting.

3.0 Minutes of the Previous Meeting 3.1 The minutes from the previous meeting were confirmed as accurate by the board members with no amendments required. 6.3 Medicines Management, written reply to be added.

ACTION: DH sent email TK to check contents and inform BA

3.2 Actions From Previous Meeting

3.2.1 3.2.3 Primary Care Flex Schemes: PR mailed Debra Howl’s evaluation report to all Board members. Narrative brief overview also sent to everyone. PR also resent request for Full Evaluation report to be sent but understands this may not be done due to too many variables to define properly. It was accepted that SHA probably made better use of the Scheme but the outcome did not show any evidence that it reduced attendances

Enclosure 16

in casualty nor reduced the four hour wait target. It is therefore difficult to say whether the scheme worked or not without detailed evaluation can only conclude that it has not been proven.

ACTION: PR to request detailed evaluation again to check whether one will become available or not.

3.3.2 3.2.4 BA raised issue of distribution lists with Linda Scott.

3.3.3 4.10 PR raised with Jenny Fullard regarding CCG Yearly Report and ask if she can pick out LCG Headlines / templates for us to use for an LCG report. No response as yet.

ACTION: PR to raise this again with Jenny Fullard.

3.3.4 7.2.1 Action for DH who has sent apologies.

ACTION: TK to check email sent by DH

3.3.5 11.2.1 Completed 3.3.6 11.2.2 Completed

3.3.7 13.1 DM – IT problems. issued password 3 times and still can’t access – sense that staff on Helpdesk not know what they are doing. Problem for 4/5 weeks – PR to get Kam’s mobile (agreed at PMs meeting) – ring directly if logged problem not resolved. BA raised at Directors. Issue of prioritisation where practices can’t operate. AP advised add to Datix system.

ACTION: PR will mention back to Martin and get Kam’s number for escalation.

3.3.8 ACTION: TK to put next meeting date in Action Column of minutes

4.0 Chair and Vice Chair’s Report

4.1 BA : Reported a debate about a request from the Area Team as to whether the CCG would be interested in piloting Co-commissioning Primary Care Services. There were concerns and issues raised mainly around difficulties that may arise with regards to Performance Management and possible sanctions against member practices. An expression of interest was raised and a decision to be made once more guidance was available and engagement made with members to see if it was something they wanted to take forward.

4.2 The main concern is around conflict of interest and the fact that the CCG is a membership organisation. There are Pros and Cons. Birmingham Cross City has decided against it.

16th June is deadline for interest. 4.3

4.4 The view of the Board at this meeting was to wait as members may want to know what was in this remit. This subject has been discussed at Directors. BA sees risk to CCG and

Enclosure 16

finance and showed concern that this would increase workloads on the LCGs. SHA may not be able to monitor its current remit of contract within its capacity effectively so how could taking on more work with clinicians also be a positive thing to do.

4.5 NHS England realise they cannot expect the CCG to commission to improve quality unless they also have responsibility for commissioning it and having the people who provide care, Primary Care on board.

4.6 BA: Board to board with providers have happened. But provider clinicians must meet with commissioning. It is worth refocusing that we as a board need to lead. PH said we have good communication with providers and trusts for many years.

4.7 It was pointed out that most discharge letters don’t have discharge date – only an admission date. Sometimes the letter may say admitted date and then ‘discharged five days later’. This basic concern put to providers not been addressed.

4.8 BA: responded that we have an opportunity now to get all these issues for the clinical lead to negotiate on our behalf for the whole CCG (not just our LCG).

4.9 BA: Partnership Sub Committee Meeting 4.9.1 A meeting was held with partnership sub-committee, with all the clinical leads for the Push Sites two weeks ago to express how to take things forward and what ideas clinicians had with regard to initiatives as a well as ways of working together and bringing the teams together. A lot of Push Site clinical leads did not understand what their role was initially but by the end of the day they were more clear. In terms of how to tackle our QIPP problems and integration problems ideas were limited. BA said we have to be thinking about big things if we want to keep people out of hospital and manage them in the community settings with all the services wrapped around them in the communities but it is early days. We need to think bigger. Dr Hallan stated that little things like taxis for house bound were suggested but we are probably already doing this. More clinical case managers, small scale but wide ranging integration thinking is needed.

4.9.2 PH did not report further on infant mortality as this had been updated in the Steering Group.

4.9.3 Assisted Conception. NICE guidelines suggests 3 cycles for infertility management should be offered. That’s why at least two should be offered. The case in favour of one cycle was considered as appropriate because it would give the chance to offer infertility treatment to more couples with the new extended policy criteria i.e. same sex couples etc.

4.9.4 The CCG is procuring a new service collaboratively with other CCGs. Sandwell is the only one offering 2 cycles. So the IVF Policy has to be harmonised. We have to decide whether we want to go to one. If we choose to go to 1 cycle instead of the 2 currently offered we would have to be prepared for a challenge in the courts id we do not have sound reasoning behind the policy change. Decision still not made. Governing body has to decide that.

Enclosure 16

4.9.5 Various attendees voiced their opinions mainly in favour of at least 2 cycles. However it was pointed out that if went for 2 or 3 cycles the money would have to come from somewhere else. Reasons for not doing 3 cycles can’t be on grounds of finance however, with other CCGs only offering 1 cycle it may be difficult to harmonise favourably.

5.0 Governing Body Report

5.1 BA: Minutes attached 6.0 Locality Work Plan

6.1 Locality Governance Arrangements

6.1.1 Discussions were held about time spent at Steering Group meetings and Board meeting commitments. Various options were put forward. It was agreed to move the Steering Group meetings to every two months if Steering Group agree. Could send newsletter update on non-meeting month to update all members.

6.1.2 It was also suggested that the Board meeting have two meetings one for the Board meeting and one to focus on Work Plans, the second meeting to take place in place of the cancelled Steering Group meetings.

ACTION: BA : To put meeting every two months to vote at Steering Group meeting.

6.1.3 A further change was suggested to change the Board Meeting dates to third Tuesday of the month instead of the fourth to accommodate having to submit updates to Directors by the last Wednesday of the month where BA has to take key messages from this Board Meeting about SHA’s work programme. AP suggested that members may wish to keep a record of time capacity issues which can also be used to let directors know how much time is being spent on the workplan requirements with these meeting sessions, with preparation, reading papers, attending. In case this becomes unworkable and members need to evidence to show how this cannot be sustained with the current sessions members are paid.

BA: Members with a responsibility for contract monitoring are to link in with contract manager. In addition to board meetings, steering group meetings there may be a requirement to attend contract meetings with the providers on occasions.

ACTION: ALL to track sessions spent with evidence if required. For our own purposes.

6.1.4 The requirement in future will be to have slicker meetings Finance reporting top headlines and then quarterly report which board members must read.

In missing Steering Group meetings will have local news letter sent out with Deska Howe receiving the same. Ask for immediate feedback to BA.

ACTION : BA to announce at next steering group.

6.1.5 AP: Raised question as to whether the board had the right people attending the board meetings. Various people were mentioned including :Laura Cooper, Contract Leads,

Enclosure 16

Therese McMahon for EOL.

BA said Laura Cooper should be present when a report to the Directors was required.

ACTION: TK to send Programme Team and Board Members new dates of meetings for SHA Board.

6.1.6 AP had some notes on readmissions which will be distributed Just showing attendees that the approach to the readmissions work has started, where we have got to and what information we have got. Food for thought about things you are leading on what areas are being targeted to make savings.

ACTION: AP to distribute information

6.1.7 Brief discussion took place around the governance as well as the readmission work being undertaken. AP advised that all members read all papers attached to the agenda this month to get a better understanding of the governance process and work undertaken so far.

ACTION: ALL read the pre papers that were attached.

6.2 Locality Action Plan

6.2.1 PR developed the workplan objectives from the Terms of Reference from SHA Pack which everyone was given and has been populating this over the last few weeks. This is just a review as to what is under our remit. This will keep manifesting as we go on and discuss. PR discussed the workplan as it currently stands.

6.2.2 Children’s and maternity come under the Children’s Team and belief that Birmingham Cross City will cover maternity for us in Manjinder’s absence. Termination of pregnancy (ToPs) may come under the same commissioner.

6.2.3 What has come out of this work is, by picking up SWB Community we will be requested to review the 20 or so service specifications that are in the contract over the next 12 months.

6.2.4 In terms of Community Services at least 100 (101) contracts are currently in the SHA portfolio. What is in our remit still needs to be defined for some of these in terms of contracting. Some don’t fit under us logically. Work is on-going to define this.

We will suggest which we think fits under us and which ones don’t and report back to the board with an update once this work has been done. For example Stroke Association Community Contract sits with us however Stroke Leads are Healthworks not SHA.

A few years ago PH had to score 180 contracts. This is number of contracts we had at that time.

6.2.5 PH: Raised the concern around not being able to monitor effectively with his example

Enclosure 16

of a non-speaking child having to wait a year for speech and language support not 18 weeks. If we have issues like that they should go back to the contract lead and this would go to the Contract Performance meeting. Via exception reporting.

6.2.6 It was suggested that Laura Cooper attends quarterly or as required to these meetings.

7.0 Quality and Safety Report

7.1 A point was raised as to whether we really need detailed medicines management updates at this meeting and an option was suggested that maybe we could have papers for members to go through at their leisure or a bullet point report only.

BA responded that if we can commit to reading and preparing then that would be fine otherwise we have to compensate for the lack of time to review in this meeting.

7.2 Budget 2013-14  £216, 160 underspend (March 2014 data)

7.3 PDS 2013-14  Points awarded on Q4 2013-14 data  March data has just become available

7.4 PDS 2014-15  Approved by Quality & Safety Committee and Governing Body

7.5 Locality target – NSAIDs  Audit & action plan = 2 points  Reducing prescribing (achieving target) = 3 points

8.0 Partnership Report

8.1 This item was not reported upon in the absence of DH.

ACTION: TK to check any emails 9.0 Ophthalmology

9.1 Service specification approved at SCR and is going to procurement. In response to lack of feedback from CBPG and SCR.

10.0 Finance and Performance Report

10.1 LM is working on budgets – last year £19m QIPP target, total surplus £6.4m and target £6.3m. Finance monthly reporting and finance lead for the contracts meetings being scheduled to go through the contracts.

10.2 Finance and performance reports to work a little bit differently in future and a Newsletter is something that could be demonstrated as Local news. This was agreed in this meeting. Report at next Steering Group Meeting.

Enclosure 16

ACTION: PK/LM to produce headliners going forward.

11.0 Annual Report from Nick Harding

11.1 Excerpt from the Full Annual Reports Guidance and Frequently Asked Questions Enclosure 7

PR annual report needs to be a forwarded from a clinical member not attached to CCG but needs to be disseminated to each Board member for comments. This board needs to feedback any comments. There is an audit committee tomorrow and GB on Thursday for sign off.

12. June 24th PLT

12.1 Requirement for board to rearrange meeting on this date. This was completed in the meeting

12.2 AP requested Suggestions about LCG PLT event. Ophthalmology updates, HIV diagnosis, diagnosing cancer in primary care how long from patient being diagnosed. – Diana, what do we need to do to become a provider. Considering federation – are practices interested and get someone external to speak.

12.3 BA stated he would do update on BMA Primary care contract AP to do slides,

ACTION: AP to do slides for BA

13. Any Other Business

13.1 AP: There was a meeting about what the work plan meant. Think about change and how we operate. We as a Board have responsibility for remit none of our other members do.

13.2 BA will report through the PMO how we are getting on. Need to be clear on what people are responsible for but that piece of work is yet to be done. Both AP/PR are to support BA. It was suggested that members keep a record of what they are doing for evidencing.

 Readmissions regarding QUIPP targets  Maternity

This may take Board members beyond one session per week and obligations cannot be met we must report it.

13.3 It was picked up about becoming a provider and it was agreed to take this outside the meeting

13.4 LM congratulated on promotion and thanked for contribution.

Enclosure 16

13.5 SC said there was no feedback from SCR.

14. Date and Time of next meeting: Tuesday 17th June 1-4pm

ACTIONS WHO BY WHEN

Actions from Tuesday 27th May

3.2: DH sent email TK to check contents and inform BA TK 17/06/14

3.2.1 PR to request detailed evaluation about Primary Care Flex Schemes, again to check whether one will become available or PR 17/06/14 not.

3.2.2 PR – to raise the issue of CCG Yearly Report and if Jenny Fullard can pick out headlines again as no response as yet. PR 17/06/14

3.2.2: TK to check email sent by DH (see Action 3.2 above) TK 17/06/14

3.2.2: PR regarding IT issues - will mention back to Martin and get PR 17/06/14 Kam’s number for escalation.

3.2.2: TK to put next meeting date in Action Column of minutes TK 17/06/14

6.1.1 BA : put once every two mponth meetings to vote in Steering BA 17/06/14 Group meeting.

6.1.2: ALL to track sessions spent with evidence if required. For ALL On going our own purposes.

6.1.3: BA to announce at next steering group. BA 17/06/14

6.1.4 TK to send Programme Team and Board Members new dates TK 17/06/14 of meetings for SHA Board.

6.1.5 AP to distribute information on readmissions AP 17/06/14

6.1.7 ALL read the pre papers that were put together for agenda. ALL 17/06/14

8.0 TK to check any emails TK 17/06/14

10. PK/LM to produce headliners going forward. PK/LM 17/06/14

12. AP to do slides for BA AP 17/06/14

Enc 17 HealthWorks Locality Commissioning Group Committee (Board) Meeting Tuesday 13th May 2014

Meeting Minutes

Attendees: Dr Ram Sugavanam (RS) Vice Chair Dr Harminderjeet Surdhar (HS) Finance and Performance Lead Diane Charles (DC) Patient Representative John Cash (JC) Patient Representative Dr Gwyn Harris (GH) Prescribing Lead Dr Liz England (LE) Quality and Safety Lead Dr Simon Butler (SB) Strategic Commissioning and Redesign Lead Dr Mark Foulerton (MF) Partnerships Lead Laura Mainwaring (LM) SW CCG, Finance Lead

In Attendance: Hayley Haworth (HH) SWB CCG, Business Support Officer Alvina Nisbett (AN) SWB CCG, Commissioning Manager Mohammed Khalil (MK) SWB CCG, Senior Commissioning Manager Nighat Hussain (NHu) SWB CCG, Director of Stroke Services

Apologies: Dr Nick Harding (NH) Chair Sonia Simkins (SS) Practice Manager’s Forum Chair Jayne Salter Scott (JSS) SWB CCG, Engagement Lead

Agenda Discussion Action Item 1. Introduction 1.1 Welcome and Introductions SB opened the meeting and took the Chair in the absence of NH and RS.

1.2 Absence and Apologies Apologies were noted as above. The Board was quorate.

1.3 Declarations of Interest There were no declarations of interest made.

1.4 Minutes of the Previous Meeting It was agreed that the minutes were a true and accurate record of the meeting.

1 Enclosure 1

Agenda Discussion Action Item 1.4.1 Matters Arising from the Previous Meeting 1.4.1 – JC asked if there is any further information regarding the MOM Pathway. SB responded that this is now a standing agenda item and will be covered later in the meeting.

2.8.1 – In regards to the Patient Summit, there was a pre-meeting where this was discussed; JC will provide feedback later in the meeting.

1.4.2 Actions from the Previous Meeting 1.4.1 – NH gave an update on LES’s/DES’s at the recent Members Event, and Carla Evans attended and gave a talk on LES’s. In regards to the letter NH sent to patients around this issue, HH to ask JF for the letter so it HH can be circulated.

2.2.3 – MK advised that there has been some initial scoping around how practices will engage with the ‘Everyone Counts’ scheme and discussions have taken place at the Directors Meetings. NH to keep the Board updated NH with the progress of this scheme.

4.3.4 – There is a HealthWorks Planning Meeting scheduled for 27th May.

4.3.7 – A spreadsheet has been created and circulated to Board Members, which details the meetings that Committee Members attend. If there are any meetings that HealthWorks send a representative to that are not All Committee recorded, they should be bought to HH’s attention to ensure that all Members meetings are captured and recorded.

12:45pm – RS arrived at the meeting, SB continued to Chair.

2. Feedback From CCG Board/Communities 2.1 CCG Chairs Report/Feedback 2.1.1 The report was reviewed by Board Members; however there were no further discussions.

2.2 CCG Governing Body Minutes 2.2.1 The minutes were reviewed by the Board. SB highlighted a point made by NH at the recent Member’s Event around new performance related target areas in relation to issues such as never events.

2.3 Commissioning and Redesign Committee 2.3.1 RS attended both SCR and CBPG.

2.3.2 At CBPG discussions took place around assisted conception. Sandwell are currently offering two cycles, whereas West Birmingham and the rest of the Country are offering one. NICE guidance however states 3 cycles. It 2 Enclosure 1

Agenda Discussion Action Item was decided that SWB CCG should go ahead with 1 cycle.

2.3.3 Same sex couples are now given the opportunity to have IVF treatment

2.4 Finance and Performance Committee 2.4.1 HS reported that the achievement of £19m for the QIP target was met, although £11.9m was non recurrent.

2.4.2 The running cost expenditure of the CCG was £10.5mfor the year which was within the running cost of £12.7m.

2.4.3 The year-end surplus was £6.4m against a forecasted surplus of £6.3m which was delivered by the CCG.

2.4.4 The overall prescribing budget is £83.4m, and a budget surplus of £1.3m was realised for the year.

2.4.5 In regards to A&E and Urgent Care, 94.4% was achieved for February remaining below the target of 95%.

2.4.6 In regards to the 18 week referral to treatment target, the admitted pathway performance was below 90% for the second time this year.

2.4.7 In summary SWB CCG delivered a financial surplus of £6.4 for the financial year on an overall budget of £622m. The overall financial climate remains challenging. Since the CCG has utilised the non-recurrent funds to deliver some of the QIP requirements during 2013/14 the underlying surplus remains below the 2% target, although the 2014/15 finance plan does address this.

2.4.8 It was asked whether other CCGs met their savings and QIP targets as SB would like to know how we compare to our peers. GH confirmed that SWB CCG is in a better position.

2.4.9 JC asked what happens to the surplus funds, and HS responded that it gets added onto the budget for the next year. LM added that technically we get the surplus back in the allocation next year; however the allocation for the next year will have to create another surplus which LM clarified is still £6.3m. Therefore this is protecting the baseline which will remain the same.

2.4.10 The budget for next year is £623m which has increased from £622m.

2.5 Partnerships Committee 2.5.1 MF updated that there will be a clinical lead at each push site; however the

3 Enclosure 1

Agenda Discussion Action Item leads are yet to be identified.

2.5.2 The Better Care Fund has been agreed for Sandwell, but not for Birmingham as further details are required.

2.5.3 At the Partnerships Meeting there were discussions around the offer for commissioning Primary Care from NHS England and it was advised that an expression of interest will be required by 20th June.

2.5.4 The voluntary sector discussed some good projects that are up and running from lottery funding with a view to getting 18-21 year olds into work. (Thought to be known as the ‘fulfilling lives project’.)

2.5.5 SB asked whether HealthWorks has any other push site practices, and it was confirmed that the first wave of practices have now been identified.

2.6 Health & Wellbeing Boards 2.6.1 RS reported that he has yet to attend a Sandwell Meeting; however Dr Basil Andreou is going to send further information to RS.

2.7 Feedback from Patient Representatives 2.7.1 DC advised that she was invited to the Pioneers for Health LCG Patient Summit and reported that she found this to be very interesting.

2.7.2 JC and DC both reiterated the need for HealthWorks to hold a patient summit, and DC added that the difficulty is finding a suitable area that is appropriate for both the Birmingham and Sandwell side of the LCG.

2.7.3 Prior to the Committee Meeting JC and DC met with JSS and MK and discussions started about formulating an engagement plan to go forward towards a patient summit. MK added that the engagement plan will be formulated and communicated back to the Board.

2.7.4 In regards to the seven day working for GPs across SWB, JC asked whether there is any information about who will be offering the service, where, and how long it will last for. SB responded that Vitality Practices are currently putting together a pilot to increase access for Vitality patients. This should be up and running by winter, however sites have yet to be identified.

2.7.5 JC requested further information regarding a pot of money that he believes is known as the ‘community offer’. The Committee had not heard of this pot of money and LM agreed that from a finance perspective she was not aware of this.

4 Enclosure 1

Agenda Discussion Action Item

2.8 Quality and Safety LE advised that there was no update.

2.9 Quality in General Practice Forum 2.9.1 SS was not present to provide an update.

3.0 Items For Agreement/Decision

3.1 None on agenda.

4.0 Items For Discussion/Information

4.1 Prescribing Update 4.1.1 GH has a meeting scheduled with finance following on from discussions at the previous meeting regarding incentives for GPs. This meeting is to discuss an innovative scheme to push forward larger savings next year.

4.2 Finance Update 4.2.1 LM advised that it is recognised that the reporting requirements for LCGs may need to change. There will be a meeting set up between MK, RS, LM, and HS to look at reporting requirements going forward.

4.2.2 LM advised that meetings have been set up with the contracting team as some people may not have the in depth knowledge to manage the SWB hospitals contract therefore the finance team will gain the knowledge to ensure that they are able to report accurately on the contract.

4.2.3 SB mentioned that it would be useful to have sight of practice level information that can be compared to other LCGs. LM responded that the CSU have been asked to identify whether it is possible for practice level reports to be provided, however CSU have yet to respond.

4.3 Stroke Update 4.3.1 NHu advised that the Stroke Reconfiguration Project is based across Birmingham, Solihull and the Black Country with a vision to improve the quality of stroke care.

4.3.2 The stroke review will cover the prevention, acute care and community and rehabilitation. The reconfiguration will focus on the hyper acute part of the pathway. The programme will look at the number of hyper acute specialist centres that we require. Reviews have informed that there is variability in clinical outcomes that need to be addressed to improve the quality of care.

4.3.3 The aim of the project is to look at the number of specialist centres that we need and ascertain whether 6 centres are sufficient, or do we need to centralise further to reduce the numbers. 5 Enclosure 1

Agenda Discussion Action Item

4.3.4 In regards to the available options, the clinical minimum threshold of volume for strokes is 600 therefore the first thing to test is whether the 6 centres have the minimum value. NICE guidelines state that there should be a maximum travel time of 45minutes which could be compromised if centres are closed. When looking at the review, whether there is a benefit to the patient if the centres are reduced will be taken into account.

4.3.5 For decisions to be made the current demand will be looked at, and health needs assessments have been carried out with criteria being looked at to assess the options. NHu clarified that it is hoped that any changes will take effect from July, however if there are any significant changes there will be a formal consultation prior to this. The options will be assessed using a decision tree which was viewed by the Committee in the available hand- outs.

4.3.6 MK advised that Liz Green is working on an early support discharge group; therefore locally we may have to amend some of the pathways to ensure they are in line with best practice. MK clarified that the work of the stroke project board is done across a larger geographical area for the CCG, however the LCG will need to work to implement best practice for SWB CCG. MK to compile plans that will presented to the Board at the planning MK meeting scheduled for 27th May.

4.3.7 DC expressed concerns around the closure of some units; NHu provided assurance that complete teams will be available at all units 24/7, and continued to explain that there are patient representatives on the stroke reconfiguration board who were consulted throughout the process. It was suggested that DC and JC could meet with Alan Hacket (the patient representative from the stroke project board) to discuss any concerns that they may have. DC and JC agreed that this would be useful and asked for HH/NHu it to be arranged.

4.4 Pathway and Demand Management 4.4.1 In regards to demand management there were initially 34 practices involved with the pilot shrinking to 6 as a consequence of IT issues that arose.

4.4.2 In regards to a query SB clarified that demand management has two parts; the first involves assessing and agreeing local pathways for the CCG and the second involves finding a solution to support a change in management of care. Map Of medicine is currently under trial to meet part of this objective. 4.4.3 RS is the lead for demand management, and Dr B Sidhu is the lead for

6 Enclosure 1

Agenda Discussion Action Item pathway management. MK added that a meeting is required with each lead before the next meeting. 4.4.4 MK stated that in terms of pathway management we have 61 localised and published pathways, with 140 further pathways to be reviewed and published. 4.4.5 Discussions took place around the importance of communicating the approved pathways to members. MK suggested that pathways should be reviewed and approved by November to communicate to members at the PLT Event later in the year. 4.4.6 AN mentioned that 140 pathways is a large number to review in the next year, therefore we need to be realistic about what we can achieve. RS added that we should focus on the areas that are easy to tackle, or areas where quality is lacking.

4.5 Risk Stratification 4.5.1 MK advised that there is a need for the CCG to commission this. The CSU have already procured a Johns Hopkins ACG system tool which can be bespoked. MK clarified that part of the tool is paid for; however we will need to pay for the further development and additional project support.

4.5.2 It was asked whether there was any clinical input as to how effective the tool was before it was purchased, and MK responded that Dr Niti Pal was part of the early discussions. RS asked if there is any feedback on the effectiveness of the tool. MK responded that the first step is to have a demonstration of the tool to understand what it offers/does. This is taking place on 22nd May. Following this there should be a detailed project plan developed with the CSU.

4.5.3 RS stated that he does not feel there would be sufficient time to develop an alternate tool and it may be best to use the one already procured. GH mentioned that GPs are mandated to have 2% of patients named by the end of June. Practices are welcome to start the work if they do not feel that the tool will be available in time.

4.6 HealthWorks Members Event 4.6.1 Discussions took place around how to increase engagement for the events. SB mentioned that last year the quality and engagement scheme dictated that there had to be a representative from each practice present at each meeting, however this finished at the end of April therefore there is no current incentive for practices to attend meetings. MF reiterated a concern around the fact that this disadvantaged smaller practices that are left with little/no staff if a representative from each practice is to attend

7 Enclosure 1

Agenda Discussion Action Item each meeting.

It was suggested that part of the £5 per patient over 75 could be linked to engagement to incentivise attending meetings. RS will speak to Kulbinder RS Thandi regarding this suggestion, and will take it forward to Directors as an LCG suggestion.

4.6.2 Conversation took place around whether the format of the meetings could be changed to be more productive, for example increased group discussions. MF suggested that members could learn from each other by asking a practice with good data/good practice to take a slot on the agenda to share best practice with their peers. It was felt that this would give members a sense of ownership in the LCG.

4.7 HealthWorks Protected Learning Time 4.7.1 A list of potential topics was circulated and briefly discussed. The following topics were suggested; neurology, cardiology, MDU, understanding finance for GPs, gastroenterology, atrial fibrillation, prescribing, and CAMHS.

4.7.2 It was agreed that there should be shorter workshops with approximately 20 minutes per presentation and a generic update at the beginning of the event.

5. Any Other Business

5.1 On behalf of NH, RS thanked the committee for their effort and hard work this year and stressed the importance of attending all meetings.

6. Date and Time of Next Meeting

Planning Meeting – Tuesday 27th May 2014, Kingston House, 2R 1

Committee Meeting - Tuesday 10th June 2014, Kingston House Ground Floor Meeting Room

8 Enclosure 1 Enc 18

Minutes of the Black Country LCG Board

Thursday 15 May 2014, 12.30 – 15:00PM Black Country Practice, Neptune Health Centre, Sedgley Road West, Tipton, DY4 8PX Present:

Dr G Solomon (GS) Black Country Family Practice Carla Evans (CE) Senior Commissioning Manager Pam Jones (PJ) Patient Lay Representative Dr I Sykes (IS) Oakham Surgery Kat Meredith (KM) Commissioning Engagement Manager Sobia Bi (SB) SWB CCG, Finance Manager Jenny Fullard (JF) Communications Manager (CSU) Dr A Saini (AS) Tividale Family Practice Sandeep Pahal (SP) Medicines Quality Pharmacist Linda Baldwin Business Support Officer

Apologies

Dr S Muthuveloe (SM) Haden Vale Medical Practice

1.0 Welcome and Apologies GS welcomed everyone to the meeting

2.0 Declarations of any Interest

2.1 Other than those disclosed in the register of interests, no further declarations were recorded.

2.1.1 GS advised that all GP’s would have an interest in the Prescribing Incentive Scheme

3.0 Minutes of the last meeting and matters arising

3.1.1. The minutes of the last meeting held on 3 April 2014 were declared an accurate record of discussions.

4.0 ITEMS FOR INFORMATION / DISCUSSION

4.1 New LCG Responsibilities

4.1.1 CE advised that the Clinical Programme for 2014-15 which was distributed with the Board papers gives a high level summary of clinical programmes of work and giving a brief overview of how the programmes will operate in order to achieve QUIPP targets for Outpatient Modernisation and Mental Health. In the ‘Terms of Reference’ CE advised that the first 6 bullets are common to all LCG’s with the remainder being more specific to

Enc 18

Black Country. GS enquired about budgets and targets, CE informed him that the target for Out Patients Modernisation is to save £3m, providing a breakdown saying that £2m has already been given to SWBH. As details were sketchy at this point, CE and SB agreed to look into this further. CE advised that the next step is for GS and herself to meet with Olivia Amartey, Deputy Chief Officer, Operations to discuss how they intend to take forward the programme of work, which will require input from the Black Country Board. Once ideas have been formulated the next steps will be to take to Governing Body before being cascaded to members. In terms of time commitment, CE explained that board members would need to establish level of involvement and then agree what would be

expected of them. To achieve the savings the whole of the LCG would need to be

involved and come up with innovative ways in which to do this. One responsibility will be

for the board to manage the ‘by exception’ report from a clinical point of view, i.e. to

understand why a problem was raised and what they need to do to resolve; this will develop over time. CE advised that whilst the locality is responsible for overseeing a number of contracts they will not be involved in contract meetings as others in CCG already provide this level of support.

ACTION: CE and SB to discuss how the £3m QIPP target will be broken down

4.1.2 GS informed members that Black Country has responsibility for the Dudley group of Hospitals contract and the biggest contract is for the provision of Mental Health services, which is held with Black Country Partnership MHFT. Birmingham and Solihull MHT contract will service patients from Birmingham side of the CCG. GS said will need to keep

tight eye on these contracts, saying that the £3m target is for whole of CCG. CE talked

about national figures and how West Midlands compared to others, saying that important

decisions to be made with regards to taking activity out of the hospital or whether to

leave as stand and work in a different way. GS said instead of just rolling over contracts the CCG will have to review and monitor what’s required year on year. Need to think about payment for activity as well as patients. IS said he is aware of lipids clinic where patients never get discharged? IS said need to see patients for an agreed length of time then discharge? PJ asked how we deal with complexities. i.e. if straight forward cardiology, which then but turns out to be complicated. GS said no way around having to pay specialist to see someone a second time, but need to limit follow-on visits where ever possible.

4.1.3 CE advised that will be taking a Lipids review to Governing Body on 4 June 2014 seeking their approval to changes.

GS reminded members that this group will function as a project group rather than a 4.1.4 board. GS asked for suggestions. IS said need to design package of care and understand

the impact not getting it right will have on costs in the long run. Going on to say the worst case scenario is where patients are seen in various settings for different elements of their treatment; where happening it needs to be simplified - care should be seamless and easier for patients. In relation to this, IS asked how obliged are the CCG to offer patients choice. CE said should be able to identify at point of referral if specialism exists in

Enc 18

the community or need to go to acute.

4.2 Primary Care Foundation Support to Practices

CE advised that the deadline regarding the ‘access survey’ has now been extended. So far, only 4 practices have responded from the locality. IS asked if mandatory or optional. CE advised not mandatory but helpful as will inform CCG work. Members were asked to remind practice to complete if not already done so.

4.3 CCG Annual Report members Introduction

Ahead of today’s meeting CE e-mailed members a ‘Foreward’ to this year’s Annual Report, from this she advised that Dr Nick Harding has asked all LCG to approve this noting any changes. Members read and approved this. JF informed members that a copy will go to Audit Committee on 28th May for publication on the 13 June 2014. Members asked about biographies and related pictures. KM asked about patient representatives. JF said only the Directors and Clinical Leads details would appear in the published report; all others could appear on website e-document.

4.4 Strategic Commissioning and Re-design Update

AS named the new Mental Health leads as Dr Arun Saini, Dr Pauline Naughton and Dr Liz England. In relation to Mental Health contracts, GS said some contracts will have to be procured next year as rolled over some to take the place of the Enhanced services. Still finalising the harmonised IVF policy and cardiology specification, ECG and One Stop provision.

4.5 Finance and Performance Update

4.5.1 SB presented the Finance report drawing out the most salient points, which were:

 At Month 12 the CCG recorded a surplus of £6.4m  The QIPP breakeven position was at breakeven for the year, £141k above target  Contracts o SWBH – is showing an over performance of £2.2m which is a £0.2m improvement from M11. Direct Access, High cost drugs and unbundled rehab have been identified as areas of over performance o Dudley Group of Hospitals – the contract is £1.3m above plan, which is mostly due to T & O activity and maternity o Birmingham Women’s Hospital – again as with other acute trusts, this contract is showing over performance of £0.9m owing to Maternity and IVF activity

 Prescribing – Of the year to date under spend for of £2.4m SWBCCG – Black

Country locality have recorded an underspend of £134k

4.5.2 Dr Saini asked if still intention for practices to have a plan to help them meet targets. SB

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and CE talked about the Q & E scheme saying the scheme will not be taken forward into 2014/15. IS also discussed Malling Health patients as following the closure of their Wednesbury practice around 1000 of their patients have not yet reregistered with another CCG practice, although some have gone to other practices. PJ said patients don’t need to register if don’t wish too. With regards to some high cost prescribing SP said that anecdotal evidence is that, when parents ask, some GP’s will prescribe for whole family rather than just poorly child. New locums need guidance as what to prescribe. IS said there currently no incentive for pharmacist to raise either perceived or known ‘over use’ as an issue. CE asked if need to report on over / under activity for main providers. SP said the CCG plans to introduce electronic prescribing which will create an audit trail with approver details.

ACTION: SB, IS, GS and CE agreed to meet to discuss trust contracts, settling on 21 May as a possible date. SB to speak with Kate Oakley to co-ordinate diaries

4.6 Partnerships Update

4.6.1 On behalf of Dr Muthuveloe, CE gave out the following message. At the last partnership meeting on 8 May 2014, members discussed the Better Care Fund, Push sites and Clinical leads. He advised that the Partnership Committee will oversee the Better care Fund and progress of the 12 push sites. Going on to say the clinical leads for each push site will be meeting on the 16th May.

4.6.2 A representative from partnerships will attend the meeting. We would like 2 clinical leads to feedback on behalf of all push sites to partnership committee. We would like Clinical Leads to think of some terms of operation and a process of replacing clinical leads if needed.

4.6.3 He went on to advise that the My Time Contract is coming to a close: Services provided by Mytime are partly commissioned by Public Health and part CCG (previously PCT). CCG are currently commissioning

 Mental Health exercise programme  Exercise Referral Scheme  Expert patient programme  Walk from home  Cardiac Rehab  Pulmonary Rehab

4.6.4 As data shows attendance poor attendance for the ‘walk from home’ initiative the committee did not feel the service was worthwhile. It was also questioned if a primary care cardiac and pulmonary rehab was needed after a patient has already accessed the

secondary care cardiac / pulmonary rehab. The committee decided not to automatically

renew this contract, but use the opportunity to commission an alternative service.

NHS England have contacted the CCG for ‘Expression of Interest’ in Primary Care

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Commissioning - where we can commission for primary care with a 5 year plan. More details to follow.

4.6.5 Dr Saini asked if this is something members should be consulted on. CE said at this point the committee is only asking for ‘Expressions of Interest to find out the level of interest. IS said from a CCG perspective it is already difficult, therefore don’t need anything that makes more confusing. GS said need to be more joined up between NHS England and the CCG.

4.6.6 PJ asked what the reasons were for low referrals, feeling sure that patients do need the service, but that Mytime may be not engaging correctly. CE advised that a representative from Mytime visited the BC Practice Managers meeting to market the service, but recognise that their efforts may have come too late. PJ also enquired about ‘push sites’, the ones in BC asking if they will take on the responsibilities of other LCG’s. GS explained the process saying they represent all parts of the CCG. Dr Saini explained how would work in practice. Multi-Disciplinary Teams, made up of district nurses, social workers are to try to formulate new Care Plans, KM said this links with the community regarding community offer, will meet with community leaders on 16th to see what they want. CE gave out the names of BC push sites. PJ said could provide a patient perspective.

4.7 Quality and safety Update

GS advised that he had taken part in carrying out an unannounced visit to hospital – saying that patients remarkably open and honest about their experiences. PJ asked what wards he had visited. GS said as he didn’t have the detail it would be best to for PJ to liaise with Quality team. SP agree to try and find out. On PJ’s behalf.

ACTION: On behalf of PJ, SP agreed to find out the name of the wards GS visited as part of a recent unannounced visit

4.8 Prescribing Incentive Scheme 2014/15

4.8.1 SP informed members that the 105 patients from the locality are on sip feeds advising that a LCG paper is to go to Quality and Safety Committee next week. Other points of note from SP were around training, as follows:

1. Gita Lad, Pharmacy technician and SP will visits practices engaging with Practice Nurses to educate them on switches switch 2. Work is also underway to work with care homes, GP first make switches and then visit care homes. (To be piloted in Dr Saini surgery).

4.8.2 In terms of overspends the same 7 practices as previously recorded are still experiencing problems in this area. One of them, Glebefields have increased practice size although over spend is not proportionate. CE said need assurance that practices are engaging and trying to make suggested changes. CE asked, if as a board the LCG could formally write to ask who will be represent them them. SP agreed. Members seconded this. PJ asked if prescribing is in the contract. Members said ‘yes’. Again members discussed Malling

Enc 18

Health’s over spends, PJ asked if the LCG would write to them to address the problem. GS explained the difficulties in holding meetings as the head office is in Kent. CE said they have a contractual agreement then it is the responsibility of CCG to liaise with NHS England if there are any concerns. SP said cocerns are not just from a cost perspective, but also from a safety perspective. CE thought best that the letter should come from either Liz Walker or Claire Parker; SP agreed to progress this further.

ACTION: SP to contact either Liz Walker or Claire Parker from Quality to highlight the prescribing issues with the Malling Health group of practices

5.0 AOB

5.1. PLT planning – Tuesday 24th June 2014

CE advised that a the last ‘All members’ meeting it was agreed that would cover the following:

 Infection control  Risk assessments  Electronic prescribing  Mental Health  Wound Care

6.0 Date and Time of Next Meeting

Date: Thursday 5th June Time: 15:00 – 16:00Hrs Venue: Quality Hotel, Birmingham Road, Dudley, West Midlands, DY1 4RN

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Action Register

Item Action By Complete/Resolved No Whom

1 CE and SB to discuss how the £3m QIPP target will be CE & broken down SB

2 SB, IS, GS and CE agreed to meet to discuss trust SB, IS,

contracts, settling on 21 May as a possible date. SB to GS & speak with Kate Oakley to co-ordinate diaries CE

3 On behalf of PJ, SP agreed to find out the name of the SP wards GS visited as part of a recent unannounced visit

4 SP agreed to contact either Liz Walker or Claire Parker SP from Quality to highlight the prescribing issues with the Malling Health group of practices

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ICOF Board Meeting Minutes

Minutes of the Meeting held on Tuesday 20th May 2014 At Newtown Medical Centre, 1.00 – 3.00pm

Present: Organisation/Practice

Dr S. Mukherjee (SM) (Chair) Newtown Health Centre Dr I. Marok (IM) (Vice-chair) Rotton Park Medical Centre Dr S. Sarwar (SS) Rotton Park Medical Centre Dr I. Zaman (IZ) Broadway Noorin Akhtar (NA) Practice Manager, RPMC Rita Gupta (RG) Senior commissioning Manager, SWB CCG Gursharan Kaur (GK) Commissioning Manager, SWB CCG Mary Mungovan (MM) Practice Nurse, Newtown Health Centre Dr R. Muralidhar (RM) Newtown Health Centre Chris Vaughan (CV) Patient representative Mango Hoto (MH) Patient Representative Dr M. Sinha (MS) Church Road Surgery Sajj Raja (SR) SWB CCG Medicines Management Laura Mainwaring (LM) Finance, SWB CCG Philip Lydon (PL) SWB CCG

Item Details Action 1. Welcome and Introductions

SM welcomed those present to the meeting. 2. Apologies for Absence

Apologies were received from Dr Muralidhar 3. Declarations of Interest

All GPs present expressed an interest in the Over75s Scheme. 4. Minutes of the last Meeting

The minutes of the previous meeting were accepted as a true record with the following exception:

Dr I. Zaman is from Broadway not RPMC.

5. Chair’s Report

SM reported there had been a proposal that the Area Team co- commission Primary Care, which was suggested by the new Chair of

NHS England. It is currently in the early stages with a number of development sessions and guidance to follow in the future. Sharon Liggins has been invited to the next Steering Group meeting to discuss this further.

SM reported there is to be a new medical school at the University of Aston and Practices may be asked to accept student palcements.

SM reported the ICoF LCG did well regarding providing information in the recent Access survey, with only two practices outstanding. SM suggested practices look at the reports and use the July Steering Group meeting as an opportunity to discuss the results.

Front-of-house staff should have appropriate training as often as possible and this is going to be incorporated into the forthcoming PLT event in June.

6. Updates from various Committees

6.1 Partnerships

MS reported the focus is towards Primary Care quality, including how Long Term Conditions are co-ordinated. MS also advised the group he would like to be involved with Long Term Conditions meetings, i.e. Diabetes, Respiratory, MSK etc.

6.2 Quality and Safety

IZ reported there are two events based around infection control, one of which related to an outbreak of ‘flu in a nursing home which had caused concern regarding the lack of vaccinations which had been carried out.

There is to be a second wave of Datix training available in order to increase the level of incident reporting.

The three PDS targets for prescribing in 2014/15 are Sip Feeds, Antibiotics and Laxatives. Liz Walker, Head of Medicines Management, asked LCGs to establish why there are high levels of prescribing within these categories. IZ is working with SR on a project which will be presented at Steering Group.

6.3 Finance and Performance

As Dr Muralidhar was not present, LM gave a financial update, highlighting key areas of a report which had been circulated prior to the meeting. The QuIPP target for 2013/14 had been achieved and that we are working with CSU on how reporting can be improved.

At the time of the meeting, no information regarding A & E activity was available.

RG/GK are to clarify how the budget figures for 2014/15 savings are RG/GK to be interpreted.

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SCR

SS reported he had been unable to attend due to it coinciding with another meeting.

7. Items for Decision

7.1 Sandwell Joint Strategic Needs Assessment – LTCs

A report had been circulated prior to the meeting and members were invited to submit comments by 31st May to RG.

8. Items for Discussion

8.1 Finance Update

See above

8.2 Workplans 2014/15

A report had been circulated prior to the meeting regarding workstreams for 2014/15.

There are currently two proposals for Respiratory Services (Community Spirometry and Education and Training) from the secondary care team (Sandwell). It is planned that both business proposals will be presented at CBPG in the next month or two.

For the Birmingham side, there is a group focusing on Respiratory service redesign and BCHC have been served 12 months’ notice of termination of contract.

A Respiratory event is currently being planned for early July (Monday 7th, venue to be confirmed.).

IZ agreed to contact Michael Messington to obtain date relating to Respiratory.

SWB CCG are the commissioners leading on provision of the Home Oxygen service in which 22 CCGs are involved. A number of issues have been identified regarding contracts and there is a lack of clarity regarding individual CCHs remit. RG and GK are to meet with Andy Williams to raise awareness of these concerns.

Practices are to be contacted with details of patients on HOS and practices are to confirm whether or not the details are correct and current.

MSK services are undergoing redesign and specifications are to be agreed. There will be a new service available from October 2015 if the planned timescale is achieved.

A new Diabetes LIS has been in operation since April 2014.

OSCAR Sandwell and Birmingham (Sickle Cell Anaemia group)

have merged and there are no QuiPP savings attached to this service.

The contract with My Time Active which covers weight management is currently under review and will be presented at CBPG.

A demonstration from BT Health was not pursued as it would not be cost effective. The AIMS scheme is to be investigated.

The workplan is to be discussed with Olivia Amartey and outcomes fed back to the Board. 8.3 LTC Events Outcomes

PL reported the Engagement team had used a co-design approach with patients and providers in a round-the-table style. Further information and data analysis is available from PLK if required. 8.4 Primary Care Mental Health Redesign

Dr Liz England has been appointed as the new Clinical Lead for Mental Health. PL circulated a short document relating to the service redesign which is under consultation until 5th June. Birmingham and Solihull Mental Health trusts are looking to design the service based around the Sandwell model and are looking at a Single Point of Access for all three areas by 2015. 8.5 Everyone Counts (Over 75s)

RG advised the Board that there is a proposal for all over-75s with SS LTCs to have individual care plans. SS agreed to circulate a care plan which had been devised within the last few years for information. 9. Any Other Business

It was agreed the next Steering Group meeting will take place on Thursday 26th June as a number of key members will be absent for the next scheduled one. Date of Next Meeting

The next meeting will be held on Tuesday 17th June 2014, 12.30 – 3.00pm, Newtown Health Centre.

Action Summary

Item Description of Action By Whom

6 Clarify how budget saving figures are to be interpreted. RG/GK

7 Obtain information relating to Respiratory services/activity. IZ

7 E-mail comments re JSNA to RG by 31st May. All

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8 Circulate copy of care plan devised within last few years. SS