EAST STAFFORDSHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY A G E N D A
OPEN SECTION Thursday 27th June 2013 1pm – 3pm Hill Street Health & Well-being Centre, Burton upon Trent
Lead Time 1. Apologies Chair 13:00
2. Declarations of Interest Chair If an Executive member has any pecuniary/non-pecuniary interest in any contract, proposed contract or other matter under consideration at this meeting, he/she shall disclose the fact to the Chair and shall not take part in the consideration or discussion of the matter or vote on any question with respect to it.
3. Minutes of Meeting held on 23rd May 2013 Paper Chair 13:02
4. Actions from Meeting held 23rd May 2013 Paper Chair 13:05
5. Chair’s Report Paper Chair 13:10
6. Accountable Officer’s Report Paper Tony Bruce 13:20
Strategic Matters 7. Primary Care Development Plan Paper Sarah Laing 13:30
8. Staffordshire Health & Well-being Strategy Paper Charles Pidsley 13:35
Quality & Safety 9. Quality Report Paper H Johnstone 13:45
Performance 10. Finance Report Paper Wendy Kerr 14:00
11. Performance Report Paper Wendy Kerr 14:10
12. QIPP Monitoring Paper Sarah Laing 14:20
Governance 13. PCT Operational Hand-over Paper Wendy Kerr 14:30
14. Issues Arising from Governing Body requiring Verbal All 14:40 entry on CCG Risk Register
15. Minutes of Committees – Issues to be raised by exception by Chairs of Committees Quality Paper 14:45 QIPP Finance and Performance Committee Paper Steering Group – 9th May 2013 – deferred until September
16. Any Other Business Verbal 14:50
Questions/Comments from the Public Private Agenda The Chairman to move the following resolution: - "That representatives of the press and other members of the public be excluded from the remainder of this meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest" (Section 1(2) Public Bodies (Admissions to Meetings) Act 1960).
EAST STAFFORDSHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY Minutes of the East Staffordshire Clinical Commissioning Group Governing Body Held on Thursday 23rd May 2013, Barton under Needwood Village Hall, Crowberry Lane, Burton on Trent, DE13 8AF
Present: Dr Charles Pidsley Chair Tony Bruce Chief Accountable Officer Ann Tunley Patient and Public Involvement Lay Member Dr Wai Lim GP Executive Dr John Cleary GP Executive Dr Liz Gunn GP Executive Dr Catherine Faarup GP Executive Professor Mike Chester Secondary Care Consultant David Harding Governance Lay Member Sarah Laing Chief Operating Officer Lucy Heath Consultant in Public Health Heather Johnstone Chief Nurse(part only)
In Councillor David Leese East Staffordshire Borough Council Attendance: Councillor Beryl Behague East Staffordshire Borough Council Paul Winter Head of Performance and Governance Katie Kidd Staffordshire Commissioning Support Unit(agenda item only) Denise Pidd Personal Assistant (minutes)
MINUTES OF THE MEETING OF THE EAST STAFFORSHIRE CLINCIAL ACTION COMMISSIONING GROUP GOVERNING BODY
GB(05)01 WELCOME AND INTRODUCTION Dr Charles Pidsley welcomed all present to the first East Staffordshire Clinical Commissioning Group (CCG) Governing Body meeting held in public advising that there would be an opportunity at the end of the agenda for questions from members of the public. Dr Charles Pidsley extended thanks to Councillors Beryl Behague and David Leese for attending the meeting as observers.
The Governing Body introduced themselves for the benefit of members of public present.
APOLOGIES
Apologies were received from Michele Fildes, Dr John Tansey, Wendy Kerr and Dr David Dickson, Local Medical Council representative.
GB(05)02 DECLARATIONS OF INTEREST 1
Professor Mike Chester – designs QIPP Schemes for CCGs.
GB(05)03 MINUTES OF THE MEETING HELD 28TH MARCH 2013 GB (01)10 amend ‘soft launch’ to ‘full launch’. GB (03)22 Action to be amended for Sarah Laing only and points 4 and 5 merged.
GB(05)04 ACTIONS FROM MEETING HELD 28TH MARCH 2013 GB (01)06.3 Tony Bruce advised the Governing Body that he had undertaken the required action. Action Closed.
GB (02)06 Full discussion and report at Agenda Item 6. Action Closed.
GB (03)11 For discussion at Executive Directors Meeting. Action Closed.
GB(05)05 CHAIRMAN’S REPORT Dr Charles Pidsley stated that the report contained a summary of activity of meetings he had attended to date; no questions were raised. Dr Charles Pidsley drew attention to the heading in the report, ‘Strengthening Quality Assurance’, and sought Governing Body approval to appoint a former Non-Executive Director of South Staffordshire Primary Care Trust as a lay, non–voting member to the Governing Body and Quality Committee to further strengthen quality assurance in line with Authorisation requirements.
The Governing Body approved the proposal.
GB(05)06 ACCOUNTABLE OFFICER’S REPORT Tony Bruce stated that the report gave an overview of where the Clinical Commissioning Group was presently and gave assurance to the Governing Body that in key domains of work progress was being made. Governing Body members were invited to contact Tony Bruce with any suggestions regarding the format and future content of the report. Councillors Behague and Leese were invited to raise any questions during the meeting as they felt appropriate. As approval sought in the report had been proposed in the Chairman’s Report, the report was now for Governing Body assurance only.
The Governing Body was assured: • That the key strategic matters faced by the CCG are receiving appropriate early leadership attention • That services commissioned by the CCG are currently assessed as safe and that quality issues are being acted on • By the CCG’s performance against national and local expectations and that remedial action is being taken where appropriate • That key corporate governance issues have been identified and are being appropriately addressed
GB(05)07 AGREEMENT OF BUSINESS PLAN Tony Bruce stated that the Governing Body had previous knowledge/input into the report and invited any questions. There were no questions. The Governing Body • Approved the Interim Business Plan Priority Areas set out in Section 2 of the report 2
• Requested a progress update against these priorities, for assurance T Bruce at the September Governing Body Meeting • Requested a Business Plan for the period 1st November 2013 to 31st T Bruce March 2014 is approved at the September Governing Body Meeting.
GB(05)08 PLAN ON A PAGE Tony Bruce advised the Governing Body that the CCG is required to produce this document for public consumption, detailing the key intentions of the CCG for the local population. Tony Bruce stated that the content of the document formed the priorities of the CCG.
Dr Catherine Faarup raised concerns in respect of the wording and target outcomes, specifically chronic diseases; expressing the view that the targets may be too stretching for some Practices. Paul Winter confirmed that alternative wording submitted by Dr Catherine Faarup had been incorporated into a revised version of the document.
In response to a question from Lucy Heath, Tony Bruce invited Lucy Heath to work with the CCG to devise a form of words and aspiration that could be articulated that clearly stated the CCG commitment to reducing health inequalities. Tony Bruce stated that it had been his experience that it was difficult to demonstrate a change in health inequalities on a short term timescale with measurable indicators to support outcomes at a later date.
Councillor Leese stated that the concept of stretching targets was one that was regularly faced in the Council environment and that this was managed by reporting mechanisms that allowed explanation as to why changes had occurred. Councillor Leese further commented that targets consistently met would raise doubts and supported ‘stretching targets’.
Dr Catherine Faarup stated she also had concerns regarding meeting the target set for dementia diagnoses within the current service.
Tony Bruce proposed that the content of the Plan on a Page be finalised by Dr C delegated authority. The Governing Body agreed that delegated authority Pidsley; Tony Bruce; be with Dr Charles Pidsley, Tony Bruce and Sarah Laing in consultation Sarah with Dr Catherine Faarup for the approval of the finalised Plan on a Page Laing; Dr C document. Faarup The Governing Body approved the: • Plan on a Page, incorporating adjustments as subsequently agreed outside the meeting, to reflect the CCG’s priority deliverables for 2013/2014; specifically the “2013/2014 Outcomes” • Publication of the document • Agreed “2013/2014 Outcomes” for inclusion in the Interim Business Plan Priorities to 31st October and within the CCGs Performance Management Reporting.
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GB(05)09 TRADE UNION RECOGNITION AGREEMENT Katie Kidd presented the report to the Governing Body stating that effective from the 1st April 2013 the CCG became an NHS recognised employer and therefore has the option to recognise trade unions. Katie Kidd stated that the agreement was a standard document and recognises the British Medical Association, Royal College of Nurses, Managers in Partnership and Unison.
The Governing Body: • Approved the trade union recognition for East Staffordshire CCG Dr C and the Clinical Accountable Officer signs the trade union Pidsley recognition agreement • Agreed that the Accountable Officer for Stafford and Surround CCG chairs the quarterly partnership forum on the CCGs behalf.
Patient Centeredness Questionnaire Professor Mike Chester advised the Governing Body and members of the public in respect of the tabled questionnaire for completion and review at the end of the meeting in evaluating the Governing Body’s deliberations being patient centred
GB(05)10 QUALITY REPORT Heather Johnstone advised the Governing Body of further updates to the report since it had been originally produced which had been before the Clinical Quality Review Meeting (CQRM) had taken place. Heather Johnstone stated that the team were looking at the format of future reports in order that reports gave Governing Body members more comparative data within organisations in addition to the information highlighted as pertinent to the East Staffordshire CCG.
Heather Johnstone advised the Governing Body that visits by Sir Bruce Keogh had commenced and she had been part of the visiting team this morning to Burton Hospital Foundation Trust (BHFT) and was due to return this afternoon.
Tony Bruce highlighted the difference in the direction of movement between the decline in the Trusts own patient satisfaction scores and the rise in the Friends and Family test.scores; and questioned what conclusions should be drawn from this. Heather Johnstone responded that the anomaly with the Patient experience figures was noted but the data most valuable, from a quality aspect, was the Trust Metric and this is declining. Heather Johnstone stated that BHFT do well in the friends and family test. The response rate on friends and family is very low but compared to other Trusts the BHFT response rate is high, inclusive of both in and out patient experiences.
Professor Mike Chester stated that such a low response rate was very poor. Heather Johnstone advised of actions being taken to reduce collection of less significant data and greater focus on significant data collection. Professor Mike Chester offered his assistance in support of this.
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Heather Johnstone confirmed, in response to a question from Tony Bruce, that H BHFT had performed well in terms of both response and outcomes and the Johnstone response rate was in line with other Trusts. In order to gain a fuller picture of the situation comparative data would be included in the next report.
Heather Johnstone confirmed to Councillor Behague that the friends and family H questionnaire formed part of the discharge process. Heather Johnstone agreed Johnstone to raise at CQRM how the process could be improved.
Ann Tunley in response to a question from Dr Charles Pidsley, stated that work was continuing to obtain patient stories, with particular attention to collecting those missed on discharge. The associated leaflet is currently being redesigned. Heather Johnstone confirmed that patient stories are being shared with BHFT.
Ann Tunley advised that the Patient Board had recently been shown a system where the patient story can be tracked and it is the intention of the Patient Board to do this.
Dr John Cleary raised concerns around what appeared to be two x-ray reporting systems. Heather Johnstone stated that this is an action on CQRM and it is anticipated that BHFT will have a timescale for a solution to report.
The Governing Body are assured in respect of current quality assurance and improvement measures being used by the CCG to monitor the quality and safety of commissioned services. Members noted the planned revisions to the report.
GB(05)11 FINANCE REPORT Tony Bruce presented the report in the absence of the Chief Financial Officer, Wendy Kerr. He stated that the report referenced 2012/2013 when the CCG was a department of South Staffordshire Primary Care Trust (SSPCT). In order for the PCT to deliver its financial position of a surplus of £1.1m the CCG were expected to deliver an underspend of £1m which the CCG had come very close to meeting. The report also addressed the 2013/2014 budget adjustments as contracts had been agreed and signed off. In anticipation of this significant reserves had been put be in place to accommodate the move from one SSPCT to the CCG becoming a statutory body.
The Governing Body: • Was assured of the financial position being reported for East Staffordshire CCG for 2012/2013 subject to final audit approval • Understood the context of the Continuing Care update raised within the report • Understood the context and approved the changes made to the 2013/2014 financial budget plans in recognition of the outcomes of the 2013/2014 contracting round.
GB(05)12 PERFORMANCE REPORT Paul Winter presented the report on behalf of the Chief Financial Officer, Wendy Kerr. Paul Winter stated that the report reflected the position of SSPCT, of which the CCG had been a sub-committee. The data was representative of the 5
PCT and would in future be specific to East Staffordshire CCG. In order to give a local indication of data where possible BHFT data had been included in the report. The front cover highlights the nationally achieved indicators. A report to the June meeting of the Governing Body will inform of the East Staffordshire W Kerr CCG position, with data, indicating compliance with national targets.
In response to a question from Dr Wai Lim, Paul Winter confirmed that the figures on the front cover reflected data for the entire organisation including all sites within the area.
Paul Winter confirmed to Tony Bruce that one of the patients exceeding the 52 week target was an East Staffordshire patient. The contract management team have been instructed to liaise with the provider and to enact the associated fine for not meeting contract requirements.
The Governing Body acknowledged the performance issues reported in Table One and was assured that the Exception Reports for each under- performing area provided satisfactory assurance.
GB(05)13 QUALITY INNOVATION PRODUCTIVITY AND PREVENTION (QIPP) MONITORING 2013/2014 Sarah Laing advised the Governing Body that of the £6.6m QIPP savings required in 2013/14, almost half have been identified and programmed. Work continues through the “Opportunity Search” to identify further opportunities. Sarah Laing stated that commitment to various financial demands, contingency funds and strategic change reserves formed part of the unidentified QIPP.
Sarah Laing stated that £3.09m of schemes had been identified and in month 1 this had realised £0.5 million. Future reports to the Governing Body will see the data produced in another format as more detailed information is provided by the Commissioning Support Unit (CSU). Sarah Laing advised the Governing Body that David Harding had, prior to this meeting, identified that the month by month figures contained within the report did not show unidentified QIPP; this will be rectified in future reporting. A scoping meeting had taken place last month to identify where other opportunities could be found and further data is awaited to take possible opportunities forward. A report will be presented to the Governing S Laing Body at the Governing Body meeting 26th September 2013. Tony Bruce advised the Governing Body that Dr Liz Gunn had been involved in the scoping of QIPP opportunities at the meeting.
In response to a question from Lucy Heath, regarding opportunities to present the aspects around quality innovation and prevention as well as productivity in QIPP, Tony Bruce responded that the CCG commitment to QIPP was to improve outcomes for patients with a current focus on improvements that also released financial resources. When financial stability could be assured, work that will see improvements for patients that will not necessarily have a financial saving attached to it could be given greater attention. Tony Bruce confirmed that in circumstances where money has been saved quality had not been compromised.
Professor Mike Chester declared an interest stating that he worked with other CCGs on QIPP. Dr Charles Pidsley asked that any further discussion take place
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at the end of the meeting. The declaration was duly noted.
Lucy Heath questioned whether the activity and information behind quality impact assessment could be easily summarised. A further request was made, by Dr Catherine Faarup, for it to be presented in a simpler format. Dr Charles Pidsley requested that this could form a discussion at a future meeting. Dr John S Laing Cleary stated that an easily demonstrable savings would be medicines management to demonstrate savings on prescribing on unproven drugs.
The Governing Body was assured that East Staffordshire CCG has accomplished the majority of the QIPP proposals and recognises where it has not achieved and has a clear plan to scope for further opportunities.
GB(05)14 REVIEW OF CORPORATE RISK REGISTER Paul Winter stated that in accordance with the governance framework the CCG monitor all aspects of risk which are duly recorded on the Corporate Risk Register. In line with CCG Framework risks scoring above 12 come to the Governing Body for oversight and for assurance that all risks are being managed appropriately. Detailed discussions take place at the Quality and QIPP Finance and Performance Committees respectively in respect of clinical and non-clinical risk and management actions in place to reduce the level of risk. Governing Body is advised quarterly.
Tony Bruce stated that the report indicated the majority of the risk factors were associated with financial challenge and addressing them would be in line with the CCG financial strategy.
In response to a question from Dr Wai Lim the Governing Body agreed that P Winter the Mental Health Contract changes from payment by result (PBR) to contract constituted a financial risk and would be added to the register.
Professor Mike Chester questioned whether the Area Team (AT) had provided further information in respect of the proportion of monies returned to the AT for the Specialised Services Contract. Tony Bruce responded that he had no confirmed information, at this time, to share with the Governing Body.
Sarah Laing confirmed, in response to a question from Tony Bruce that changes to the Community Services Contract to PBR were not finalised at this stage but would need to be added to the Risk Register at a later date.
The Governing Body • approved the content of the risk update report • were assured of the management of risk • Added a new risk in respect of the Mental Health Contract moving from PBR to a contract.
GB(05)15- MINUTES OF COMMITTEES 17 Dr Charles Pidsley explained, for the benefit of the members of the public, that the minutes were representative of the three main reporting mechanisms into the Governing Body meeting and the representation from the groups on other provider led meetings and were provided for information only. 7
GB(05)18 ISSUES ARISING FROM GOVERNING BODY REQUIRING ENTRY ON CCG RISK REGISTER The Mental Health Contract to be added to the register. P Winter
GB(05)19 QUESTIONS/COMMENTS FROM THE PUBLIC Dr Charles Pidsley invited questions from members of the public.
John Bridges questioned how the meeting had been advertised. Paul Winter confirmed the process and that the dates and Governing Body papers had been posted on the CCG website in addition the CSU were instructed to produce a press briefing. John Bridges suggested that CSU inform patient boards and district group who could ensure this would be disseminated amongst practices.
John Bridges stated that the general public had very little awareness of the work of the CCG and that the website was not available to all members of the community. Sarah Laing responded that the CCG are in the process of producing a prospectus. Lucy Heath suggested that service providers could have an endorsement on their literature.
Tony Bruce stated that a meeting with the CSU should be arranged and expected outcomes commissioned that could include a requirement for a survey to be undertaken. Lucy Heath stated that a half yearly survey called “Feeling Different” was led by the Police and a question had been recently included regarding public awareness of their local CCG.
Ann Tunley agreed to take the issues raised back to the Patient Board and A Tunley District Group and report back to the Governing Body. Tony Bruce stated that Wendy Kerr was the CCG contact as she managed the CSU contract. Sara Minter suggested that enquiries be made with the CSU as to what services had been provided to other CCGs.
Councillor David Leese stated that recent changes to the NHS had left both members of the public and other organisations unclear as to how the new health economy operated. It was acknowledged that not all members of the public would wish to engage with the CCG but a process should be established should they wish to do so.
Governing Body and members of the public took part in the questionnaire tabled Dr Pidsley by Professor Mike Chester. Sarah Laing suggested as a result of the discussion around patient centeredness that agenda time be allowed for discussion.
Lucy Heath advised the Governing Body of a communication tool that profiles L Heath the population called Mosaic which she offered to access and provide further information to the Governing Body.
Sarah Laing advised the Governing Body of a future attendance at Health and S Laing Scrutiny Board scheduled and the intention to organise further stakeholder events.
An invitation was made to Members to attend a Patient Participation Awareness S Laing event being held at The Tutbury Village Hall. John Bridges stated that the group had had overwhelming support to attend on the day but unfortunately no commitment had been received to date from the CCG. John Bridges 8
acknowledged that Sarah Laing had recently committed CCG support.
Councillor Leese advised the Governing Body that the Community Volunteers Group held a number of bodies within their ‘umbrella’ that could provide contact details for other community groups.
Professor Mike Chester advised the Governing Body of the work he had been doing in London in respect of QIPP savings. He expressed the difficulties Governing Body members have in managing this without seeming to gain pecuniary advantage. Councillor Leese responded that recent changes in predetermination in issues of planning had now been lifted and that pragmatic management now appeared to be the way forward.
GB(05)20 ANY OTHER BUSINESS Dr Charles thanked members of the public and Councillors for the contributions to the meeting.
There was no further business. The meeting was declared closed.
DATE AND TIME OF NEXT MEETING 27th June 2013, 1.00pm Venue to be confirmed.
SIGNED: ...... DATE: ...... (Chairman)
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ACTION LIST
Governing Body Meeting –23rd May 2013
Meeting Agenda Date Item Subject and Action Status 24/1/2013 GB(01)06,1 Update as to Pilot regarding iPhone/iPads apps to provide access to discharge Dr Tansey Action bring forward for letters. 26/9/2013 24/1/2013 Use of liaison psychiatrist instead of RAID – to be taken back for discussion at T Bruce Action Closed GB(01)06.3 Local Health Economy Forum 28/2/2013 GB(02)06 Tony Bruce and Sarah Laing to meet early Easter to consider further QIPP T Bruce/S Action Closed schemes and agenda paper for April Governing Body Laing 28/3/2013 GB(03)06.1 Winterbourne Review. Further update in July H Johnstone Agenda - 25/7/2013 28/3/2013 GB(03)10 Governing Body to be provided with an Activity Report of research taking place H Johnstone 25/07/2013 across East Staffordshire. 28/3/2013 GB(03)11- Process for non-exception cases for IFR S Laing For discussion at para 8 Executive Directors Meeting Action Closed 23/5/2013 GB(05)07 The Governing Body requested T Bruce 26/9/2013 • A progress update against the three priorities in the Interim Business Plan to 31st October, for assurance at the September Governing Body Meeting. • A Business Plan for the period 1st November 2013 to 31st March 2014 for approval at the September Governing Body. 23/5/2013 GB(05)09 The Governing Body Dr C Pidsley • Approved the trade union recognition for East Staffordshire CCG and the Clinical Accountable Officer signs the trade union recognition agreement 23/5/2013 GB(05)10 Heather Johnstone confirmed… that BHFT had performed well in terms of both H Johnstone para 5 response and outcomes and the response rate was in line with other Trusts. In order to gain a fuller picture of the situation comparative data would be included in the next report GB(05)10 Heather Johnstone confirmed to Councillor Behague that the friends and family H Johnstone para 6 questionnaire formed part of the discharge process. Heather Johnstone agreed to raise at CQRM how the process could be improved.
23/5/2013 GB(05)12 The data was representative of the PCT and would in future be specific to East W Kerr Staffordshire CCG….A report to the June meeting of the Governing Body will inform of the East Staffordshire CCG position, with data, indicating compliance with national targets. 23/5/2013 GB(05)13 QIPP Monitoring: A report will be presented to the Governing Body at the S Laing para 2 Governing Body meeting 26th September 2013 GB(05)13 Lucy Heath questioned whether the activity and information behind quality S Laing para5 impact assessment could be easily summarised. Dr Catherine Faarup requested it be presented in a simpler format. 23/5/2013 GB(05)14 The Governing Body agreed that the Mental Health Contract changes from PBR P Winter to contract constituted a financial risk and would be added to the Risk Register 23/5/2013 GB(05)19 Questions/Comments from the public: Ann Tunley agreed to take the issues A Tunley raised back to the Patient Board and District group and report back to the Governing Body. 23/5/2013 GB(05)19 Sarah Laing suggested as a result of the discussion around patient Dr Pidsley centeredness that agenda time be allowed for discussion. 23/5/2013 GB(05)19 Lucy Heath advised the Governing Body of a communication tool that profiles L Heath the population called Mosaic which she offered to access and provide further information to the Governing Body. 23/5/2013 GB(05)19 Sarah Laing advised the Governing Body of…the intention to organise further S Laing stakeholder events. 23/5/2013 GB(05)19 Patient Participation Awareness, Wednesday 5th June 2013, Sarah Laing to S Laing confirm CCG support.
G:\East Locality 2\SHAREPOINT MIGRATION\East_Staffs_CCG\Meetings\CCG Governing Body\Meetings 2013\June\3. ACTION SHEET - Enc 2.docx
Title Chairman’s Report
Reporting to Governing Body
Date of Meeting 27th June 2013
Commissioning Lead(s) Author(s) Dr C Pidsley
Purpose of the Report (Please select) Approval Assurance x Discussion
Key Points/Executive Summary
This report contains a summary of key meetings that the Clinical Chairman has attended.
Recommendations (what is expected from the Board)
This report is provided for information and assurance.
Enclosures
Attached report.
1 Author: Date: East Staffs CCG
Chairman’s Report to the Governing Body (27th June 2013)
This report is shorter than usual as it covers a period during which I have taken 2 weeks annual leave. We have had our first Governing Body meeting in public which we felt was successful logistically but which was attended by 2 members of the public only. I am grateful to Councillors Behague and Leese, whose contributions to this meeting were most helpful and supportive. A meeting has been held with the CSU Communication and Engagement team to address how publicity for future meetings can be improved in the future.
The Keogh Rapid Response Review of Queens hospital Burton, has now completed its visit. A risk summit is pending after which the findings will be published. Having attended as an observer, I was struck by how committed the workforce were. There was a desire to emphasise a lot of the good work that is done by the hospital whilst at the same time being very open about the considerable demands placed upon them and those areas needing improvement.
The Health and Wellbeing Board has now had its first meeting in public on the 13th of June at which the Staffordshire Health and Wellbeing Strategy was released with questions for the public engagement process. The Strategy itself is tabled for today’s meeting. East Staffordshire CCG will participate in a county wide public engagement process coordinated by Engaging Communities Staffordshire. There will be events organised by each CCG as well as the other partners of the HWBB. The 12 week process will culminate in a major county event.
On the 18th of June, I am due to meet a number of the consultants from Queens hospital who are taking part in a clinical leadership programme sponsored by the hospital. This will be an opportunity to present the CCG ‘Plan on a Page’, and to share views as to how Hospital Clinicians and General Practitioners can work together. It is still my intention to organise a major event for GPs and Consultants to get together to discuss recent Health Service changes and to get to know one another better. Unfortunately over the last 5-10 years the nature of the provider /purchaser interface and movement of education away from the Post Graduate Centre have led to relatively few opportunities for face to face contact. I shall give a verbal report of this meeting on the 27th June.
Title Chief Accountable Officers Report
Reporting to Governing Body
Date of Meeting 27th June 2013
Commissioning Lead(s) Author(s) Tony Bruce
Purpose of the Report (Please select) Approval Assurance X Discussion
Key Points/Executive Summary This paper gives an overview of the strategic and operational issues facing the CCG and how they are being addressed.
It is written to “frame” the meeting within an overall context and is structured in the same format as the Agenda.
Further details are contained within the Directors reports.
Recommendations (what is expected from the Board) The Governing Body is invited to: • Be assured that the key Strategic Matters faced by the CCG are receiving appropriate attention
• Be assured that the services commissioned by the CCG are currently assessed as safe and that quality issues are being acted on
• Be assured that performance against national and local expectations is satisfactory; that both A&E waiting and waiting for planned routine care is improving and that finances appear to be on track at this early stage of the year.
• Be assured that key corporate governance issues have been identified and are being addressed, particularly the strengthening of quality assurance.
Enclosures
Report Attached
1 Author: Date: East Staffs CCG Report to: ESCCG Governing Body
Report from: Tony Bruce – Accountable Officer
Subject: Chief Accountable Officers Report
Date 27 June 2013
1. Introduction
1.1 This paper gives an overview of the strategic and operational issues facing the CCG and how they are being addressed.
1.2 It is written to “frame” the meeting within an overall context and is structured in the same format as the Agenda.
1.3 Further details are contained within the Directors reports.
1.4 The Governing Body is invited to:
• Be assured that the key Strategic Matters faced by the CCG are receiving appropriate attention • Be assured that the services commissioned by the CCG are currently assessed as safe and that quality issues are being acted on • Be assured that performance against national and local expectations is satisfactory; that both A&E waiting and waiting for planned routine care is improving and that finances appear to be on track at this early stage of the year. • Be assured that key corporate governance issues have been identified and are being addressed, particularly the strengthening of quality assurance.
2. Strategic Matters
Long Terms Conditions Services
2.1 Improving the life outcomes and support provided to local people with a long term health condition is ESCCGs number one improvement priority.
2.2 A structured piece of work is being undertaken within the CCG, and with partners including Public Health and our collaborative commissioning partners, to understand better the numbers of people with LTCs, the best evidence of how outcomes can be specified; and the best evidence of the support that those people will most benefit from.
2.3 An informal meeting of governing body members will be held in July to shape this work further, prior to a paper being presented to the formal Governing Body in September for approval. This in turn will inform our discussions with our collaborative commissioning partners, providers; and our Commissioning Intentions for 2014/15.
NHS 111
2.4 ESCCG is working with its collaborative commissioning partners to both secure the interim service provision and an appropriate long term solution to provide an effective 111 Service for local people.
2.5 As this is a commercially awarded contract it is not appropriate to say more, publically, at this time.
CCG Finances
2.7 As reported to the Governing Body in May the CCG has inherited a challenged financial situation; with a need to generate savings of £6.6m in 2013/14; and a total of £12m over its first 3 years.
2.8 The CCG is in discussion with the NHS Commissioning Board with a view to agreeing a “smoothing” of the saving requirement. These discussions are continuing.
Mid Staffordshire Foundation Trust.
2.9 The Trust Special Administrator has been working to 19th June as the deadline for the initial publication of draft recommendations. In the most recent Stakeholder Bulletin (dated 14th June) the TSA has announced that they have requested an extension of 30 days for the publication of initial recommendations; and a further 10 working days for the public consultation, taking account of summer holidays.
3. Quality
3.1 The Quality Committee of the Governing Body undertakes the detailed assurance work across the CCGs commissioned services on behalf of the Governing Body, testing through lay member challenge and appreciative inquiry, the conclusions reached by the executive quality management function.
3.2 At its meeting on 29th May the Committee considered the services commissioned by the CCG to be safe. It recognised that some services did not meet the quality standards expected and that actions were being taken to address those issues.
3.3 The Committee meets on 26th June 2013 to consider the most up to date information available. Any changes to the reported position will be reported verbally to the Governing Body.
3.4 The Keogh Review visit to BHFT has been completed, including both the announced and unannounced visits. The CCG was involved in both visits as an “observer”. The Risk Summit stage of the review is being undertaken on 21st June and the CCG is again involved. An update will be given verbally at the meeting.
3.5 On 17th May the group of service leads for Emergency Medicine in the West Midlands wrote jointly to the CEOs of Acute Trusts and Commissioners to express their concerns about the pressures, safety and quality of care in the EDs across the region. A co-signatory to that letter was Dr James Crampton, Clinical Lead for Emergency Medicine at BHFT. 3.6 Following receipt of the letter Dr Gunn (GB Member) and I met with Dr Crampton and other senior doctors at BHFT to hear their concerns, consider any on-going quality issues and agree a joint way forward, building on the joint work already underway. Dr Crampton confirmed that he has no current concerns regarding safety within the department. Further he has agreed to play a personal leading role in the Urgent Care Board which will drive the design and implementation of urgent and emergency care locally, led by Dr Wai Lim from the CCG.
4. Performance and Finance
Performance
4.1 Performance against the range of NHS Mandate, NHS constitution and CCG aspirations continues to be generally positive, recognising that not all performance data is yet fully available.
4.2 The 2 major performance challenges of recent months have been the 4 hr A&E Standard and 18 week Waiting times for Routine Planned care (RTT). The A&E Standard is now being achieved and sustained. The actions to restore 18 week RTT by 30 June are on track. There is some concern about the level of performance on the Ambulance turnaround at A&E Standard and this is being investigated.
Finance
4.3 Based on the available information the CCGs overall corporate financial performance appears to be on track, although systems are still bedding down, and a degree of caution is required when interpreting the position.
4.4 Again, based on the information available, the delivery of the £3m programme of identified QIPP opportunities appears to be on track; although there are some anomalies in the data which are being further investigated. The Opportunity Search to identify the scale of the gap between our current performance levels and best quartile and best decile respectively is ongoing. The CSU has been requested to expedite this work and some comparative data on aspects of our commissioning portfolio has been received. This will progrewssively enable evidence based decision making to focus our efforts in addressing the remaining financial gap, in year, and over the 3 year period.
5. Governance
Authorisation
5.1 As a review is underway of the CCG Authorisation Conditions. It has been recommended by the NCB Area Team that the conditions relating to the appointment of the AO and Governing Body member development plans are now removed (having been met). It has further been recommended that the 2 conditions relating to the Clear and Credible Plan and Finance (related to QIPP plans) respectively are maintained. These two are linked and both relate to the extent of financial challenge faced by the CCG (£12m over 3 years) and the current absence of a clear QIPP plan to address this gap fully.
5.2 In my last report I referred to the proposals to further strengthen the CCGs quality assurance arrangements. These have been progressed as follows:
• A Co-Opted Lay Representative for Quality has been appointed and taken up post • The Head of Quality has been appointed and will take up post on 1 July • The transfer of contract management responsibility for the SSSFT contract to SES&S CCG will enable a greater focus on BHFT and overall corporate quality assurance • Changes to the working practices and operation of the Quality Committee are being introduced to bring a sharper focus to its assurance function.
Organisational Development
5.3 The ODSG met again in June to plan the next steps of implementation of the OD Plan. An outline plan has been agreed and is being programmed in through 2013.
5.4 A key element of the programme is the development of the clinical leadership arrangements within the CCG; both in setting direction and in leading implementation and delivery; through the Governing Body, Steering Group and Clinical Associates.
Lead Arrangements
5.5 At its meeting in May the Governing Body resolved to transfer the lead commissioning responsibility for mental health services, and the lead for the SSSFT contract to SES&S CCG, subject to ESCCG maintain strong and effective influence through it clinical and managerial participation in the collaborative arrangements.
5.6 A handover of these lead arrangements was effected on 17th June.
Risk Management
5.5 The risk register continues to be maintained. The principal risks continue to be:
• Finances related to the scale of the 13/14 and 3 year financial challenge, linked to the initial evidence of average or better than average performance across many of the CCGs commissioning areas. • Financial risks linked to specialised services transfers, continuing care backlog, the cluster PCT financial outturn and CCG risk sharing • Capacity and capability of the CCG , particularly quality assurance; although action has been taken which will now reduce this risk • Sustainability of local access to services going forward, reflecting national factors locally.
File - TB/AO report to GB June 2013
Title Primary Care Development
Reporting to Governing Body
Date of Meeting Thursday 27th June 13
Commissioning Lead(s) Author(s) Sarah Laing Michelle Escombe
Purpose of the Report (Please select) Approval Assurance Discussion
Key Points/Executive Summary The purpose of this report is to provide assurance to the Governing Body on progress towards agreeing a strategic approach to the development of primary care and on progress towards addressing primary care’s contribution to reducing non-elective activity at Burton Hospital (BHFT).
The Primary Care Development Plan (PCDP) will be available following production of the Area Team (AT) Primary Care Strategy and will outline ESCCG’s strategic approach to the following areas of responsibility relating to primary care: • Improving the quality of primary medical care services; • Member practices’ contribution to CCG priorities including the QIPP agenda; • Enhanced services (Medical and Optical); • Patient participation in primary care – patient participation groups (PPGs); • GP Information Management & Technology (IM&T).
Out of scope – the engagement of member practices will be addressed via the organisational development (OD) programme and is not included as part of the PCDP.
Strategy Development • NHS England (NHSE) retains responsibility for primary care contracts and is ultimately accountable for primary care performance and quality. • ATs no longer have sufficient resource to maintain the relationships and local intelligence required to secure improvements in quality. • Health & Social Care Act (2012) places a duty on CCGs to work in partnership with ATs.
Across Staffordshire & Shropshire, the following progress has been made: • ‘Securing Excellence’ group created – Accountable Officers and Clinical Chairs • ‘Primary Care Quality Group’ reformed – Primary Care leads (AT, CCG, LMC) • Initial data trawl of national indicator set • ESCCG practice visits • Local alignment to QOF Quality & Productivity (QP) indicators
Next steps: • AT Primary Care Strategy is due imminently. CCGs must be consulted and should reference the AT strategy in local PCDPs. • A Memorandum of Understanding (MOU) is in development and will outline the
1 Author: M Escombe Date: 17th June 13 East Staffs CCG respective responsibilities and relationship between the AT and CCGs. It is also likely that it will describe the role of Local Medical Committees (LMCs) in supporting the quality agenda.
Reducing Non-Elective Activity: Practice Visits • 11 practices in total have been visited since April o Formal practice visits have been undertaken in 6 practices, all with significantly higher than average non-elective activity at BHFT, and have agreed detailed action plans o In order to ensure alignment with the QP indicators, informal visits have also been undertaken with 7 practices (2 of which were follow up visits) • Remaining practices will have formal visits by the end of September • All practices will have action plans in place in advance of winter pressures • Action plans are aligned to QP indicators to ensure that practices receive sufficient funding to undertake any additional work • Formal follow up visits are confirmed for 6 months after the initial visit, therefore commencing October-13 • Informal visits will be made to all practices in between by the Practice Integration Manager.
A monthly report detailing the change in non-elective activity by practice will be presented to the Governing Body from July.
Recommendations (what is expected from the Board)
The Governing Body are asked to be assured that: • The Primary Care Development Plan is progressing in collaboration with the AT, neighbouring CCGs and the LMC; • ESCCG strategic approach to primary care is aligned to national policy and CCG priorities including QIPP; • Practice visits are being undertaken to secure primary care’s contribution to reducing non-elective activity at BHFT and overall improvements in the quality of primary medical services.
Enclosures
None
2 Author: M Escombe Date: 17th June 13 East Staffs CCG
Title Staffordshire Health and Wellbeing Strategy
Reporting to Governing Body
Date of Meeting 27th June 2013
Commissioning Lead(s) Author(s) Dr C Pidsley
Purpose of the Report (Please select) Approval x Assurance Discussion x
Key Points/Executive Summary
The Staffordshire Health and Wellbeing Strategy has been published and presented at the first Health and Wellbeing Board meeting in public on the 13th June. It is titled, ‘Living Well in Staffordshire’ It should be noted that Stoke City as a separate local government unitary authority has its own separate Strategy and HWBB.
The production of this document is a statutory duty of the Health and Wellbeing board.
It is noted that the Strategy underpins the shared and joint accountabilities of the constituent organisations.
The Strategy recognises the need to transfer from intensive resource draining reactive care to preventative care.
Two key principles of the strategy are: • To tackle the wider determinants of health and wellbeing • To invest in early help and prevention.
The population of Staffordshire are to be encouraged to take greater responsibility for their health care whilst ensuring the vulnerable are supported.
The County of Staffordshire has one of the fastest growth rates in elderly population, a significant rural population, ethnic diversity and significant variation in life expectancy between areas of deprivation and affluence.
The Strategy has 12 priorities.
The focus for the year 2013/14 will be 3 of those priorities. Parenting, Reduction of harm due to alcohol, and supporting the frail elderly.
The enablers, which will release resources for prevention and reduce those needed for intervention, will be better governance, integrated commissioning, public engagement, and integrated provision.
1 Author: Date: East Staffs CCG The members of the HWBB recognise that the Strategy contains radical proposals, which will arouse vigorous debate. A 12 week engagement plan in envisaged from mid June. East Staffs CCG is requested to set up local events to publicise the Strategy and encourage response to a number of questions that have been drawn up around the content of the Strategy.
Recommendations (what is expected from the Board)
1. The Governing Body is asked to support the Health and Wellbeing Strategy 2. The Governing Body is asked for its opinion as to whether the East Staffordshire CCG Strategy (ESDOC) and specifically its ‘Plan on a Page’ is aligned to the Health and Wellbeing Strategy. 3. In those areas where there may be lack of alignment, are the Governing Body in agreement that the Executive team develop proposals that will bring the CCG strategy in to alignment with the Health and Wellbeing Strategy?
Enclosures
1. Staffordshire Health and Wellbeing Strategy
2 Author: Date: East Staffs CCG Living well in Staffordshire
Keeping you well Making life better
Our Five Year Plan 2013–2018 Staffordshire Health and Wellbeing Board
1 ‘Prevention is better than cure’ Foreword by the joint chairs of the Health and Wellbeing Board
taffordshire is a good place to live. People will need to take on much greater Our communities compare favourably on personal responsibility for their own wellbeing, Smany measures of wellbeing with the rest making the right choices when these are open to of the West Midlands and with England, but the them. At the same time, we need to recognise global economic crisis has affected our county, and understand those people who are vulnerable increasing the level of need and reducing the or at risk, so that we can focus on prevention and resources available for public services. In addition, early help for them. our very success over recent decades means that This will only be possible if we can shift resources many more of our most vulnerable people live to currently used in intensive reactive services to a ripe old age, often needing considerable help, invest in services that identify needs at the earliest especially in later life. possible stage and stop them getting worse. As the leaders of the main public services across This strategy sets out our priorities for action. the county, members of Staffordshire’s new Health It is intended to strike up informed debate across and Wellbeing Board are clear that the way public Staffordshire, engaging local people, carers and services currently operate is not sustainable and advocates, service providers, and public bodies. must change. We must move away from a situation These conversations will refine our approach and where too many of our services are reactive, guide its implementation over the coming years. helping people only when things have gone wrong, often at great expense. We believe that the publication of this strategy will be heralded as the moment Staffordshire became Instead, we must support local people to live and united in its effort to make best use of the social work in safe, pleasant and resilient communities, and financial resources available to improve the to control their own lives and shape their own health and wellbeing of people who live here. wellbeing. In this way, people will enjoy longer lives with a better quality of life. Our ambition requires radical transformation of services for the public across Staffordshire.
Councillor Robert Marshall Dr Johnny McMahon Joint Chair, Health and Wellbeing Board and Joint Chair, Health and Wellbeing Board and Chair, Cabinet Member for Health and Wellbeing, Cannock NHS Clinical Commissioning Group Staffordshire County Council
2 3 Section 1: Based on figures from 2012, 22% of households in services, and behavioural change in the number of the West Midlands are in fuel poverty, higher than people making healthy lifestyle choices. any other English region. This rate is higher in rural Staffordshire’ history of innovation, self-reliance The Context of Staffordshire households (24%) and higher still in households and adaptability suggests that, with the leadership where adults are unemployed. of the Health and Wellbeing Board, its residents will taffordshire is a county characterised by a The economic structure in Staffordshire has also A key driver of housing need within any given area rise to the challenges that these changes present. diversity of people and place. changed considerably in recent years, along with is population change. Greater levels of population More detailed information on Staffordshire SAs a large county, covering a range of rural ways of working and patterns of employment. increase the need for housing and jobs to support may be found in the Enhanced Joint Strategic and urban settings, Staffordshire’s communities Manufacturing remains a key sector for the county, it, alongside the full range of community and Needs Assessment at www.staffordshire. compare well with the rest of the West Midlands but the public sector now provides around a fifth commercial services. District and borough council gov.uk/YourHealthInStaffordshire and in the and England. of all jobs. There has also been growth in rural spatial strategies are being developed to take ‘Staffordshire and Stoke on Trent Story’ at account of changing to our population. Residents tell us they feel proud of their heritage employment, with an increase in the range of www.staffordshireobservatory.org.uk/research/ and are happy to live in an environment rich in industries represented, as well as the number of Addressing health inequality in Staffordshire thestaffordshirestory natural beauty and full of economic potential. roles. requires two things: organisational change in the way the public sector designs and commissions Health and wellbeing is important to them. When These changes have seen an increase in part-time asked to describe their main measure of quality working and also a rise in youth unemployment, of life, top priorities include being fit and healthy, which continues to be the focus of national and having access to strong social networks, and local economic development strategies. having the ability to be a productive member of Crime and anti-social behaviour continue to fall in their local community. Staffordshire, but there is still more to be done. Staffordshire’s population has changed ‘Troubled families’ cost taxpayers well over £100m considerably over the last decade. We now have a year in Staffordshire, and pressure on limited an older population, with a 25% increase in the budgets is worsening, with an increase in the number of people aged 65 and over in the ten number of children living in poverty and the number years between 2001 and 2011. This is greater than of looked after children. the national rate of change. Inadequate housing causes, or contributes to, The county is also more ethnically diverse, with many preventable diseases and injuries, including an increase in the black and minority ethnic respiratory, nervous system, and cardiovascular population, which now includes around 86,500 disorders, and cancer, as well as reducing mental people, roughly 10% of the total. health and wellbeing. At a national level, it is These demographic changes have contributed estimated that poor housing costs the NHS at least to a changing health and wellbeing profile for the £600m per year. county. Although the rate of house building has Although the overall health of the population has fallen over the past six years, the provision improved in recent years, with people living longer of affordable housing in Staffordshire has and fewer people dying from major illnesses, increased annually since 2007 (other than significant inequalities exist across the county. Life between 2011 and 2012). House prices in expectancy rates vary by up to 12 years between Staffordshire fell by 1.2% between 2012 and different areas and communities. 2013, suggesting that more accommodation is available for families and individuals. This The nature of community needs has also changed, is supported by increasing sales volumes. with increased demand for support with long-term Nonetheless, national data suggests that conditions, vulnerability to becoming a victim of homelessness rates are continuing to rise and crime, mental illness, substance misuse and affordability remains an issue, particularly in rural increased rates of obesity. areas. In particular, an aging population has required a shift to support people to maintain an independent life, with great scope for modern technology to help them remain in their own homes.
4 5 Section 2: Section 3: Our Vision Principles
Working together to lead transformational change Staffordshire will be a place where improved health and wellbeing is experienced by all. It will be a “Through leadership, influence, pooling of our good place to live. People will be healthy, safe and collective resources and joint working where it prosperous and will have the opportunity to grow up, matters most, we will make a real difference to raise a family and grow old, as part of strong, safe and the lives of Staffordshire’s people.” supportive communities.
taffordshire’s Health and Wellbeing Board Our shared vision reflects the many elements that brings together the main public service lead to a long and healthy life and the contribution Sorganisations that have responsibility for that each of our organisations makes to them. improving the health and wellbeing of people who We cannot fully achieve our aims for local people live here. without working together, towards a shared goal. It includes representatives from: In taking forward this vision, the key partnerships • Staffordshire County Council, with its across the county, including: responsibilities for social care, public health, • Staffordshire Strategic Partnership education, and economic development, • Staffordshire Local Enterprise Partnership • District and Borough Councils, with their • Staffordshire Education Trust responsibilities for housing, the environment, licensing, leisure and culture, will work together, to ensure that there is real impact for the people of Staffordshire. • NHS Clinical Commissioning Groups, responsible for health services, We will also develop solid links with the voluntary and community sector, with district and borough • Staffordshire Police and Crime Commissioner level partnerships and with the Health and and Staffordshire Police, with responsibilities Wellbeing Board for Stoke-on-Trent. for improving community safety, • NHS England, responsible for primary and specialist healthcare, and • Healthwatch, the community champion for users of health and social care services, in the form of Engaging Communities Staffordshire. While each of us has a unique perspective, we are united in our vision for the future.
6 7 taffordshire’s Health and Wellbeing Board is cannot achieve enough. Figure 2: The Scale of the Financial Challenge for Staffordshire (£m) committed to transforming public services We are committed to re-look at the work of our Sthat contribute to local health and wellbeing. organisations and those we commission to deliver We will show the courage and determination to do services on our behalf the right thing and Staffordshire’s people will hold In so doing, we have adopted the following key £2,250 us to account. principles. Although we have all made great efforts to improve £2,000 our services over recent years, we recognise that, in the face of unprecedented budgetary pressures, a step-by-step approach to change has not and £1,750
£1,500
Tackling the wider determinants of health and wellbeing £1,250 Health and wellbeing is influenced by a wide range For example, people with a better education tend of social, economic and environmental factors, to live longer and be less likely to suffer from £1,000 some of which are influenced by large-scale depression. The majority of Staffordshire’s children universal trends and others by individual behaviour. and young people achieve the expected national £750 For Staffordshire’s 850,000 residents, this means standards of education attainment, but there are dealing with a range of challenges, from the more differences in how well a young person is likely to £500 traditional issues in public health, such as keeping do, dependent on where in the county they live. fit and eating healthily to wider impacts on health This is particularly the case at Key Stage 4 and in £250 such as finding rewarding employment, getting a relation to post-16 learning and skills. good education and securing comfortable housing. £0 2010/11 2011/12 2012/13 2013/14 2014/152015/16 2016/172017/18 2018/19
Investing in early help and prevention Social Care (actual) NHS Prevention and Primary Care (Actual) With growing pressure on limited public resources, than on preventing crises through early help and NHS Secondary / Urgent / Care (Actual)Social Care (predicted) we need to fundamentally change the way we advice that enables people to stay independent NHS Prevention and Primary Care (Predicted) NHS Secondary / Urgent / Care (predicted) support people to be healthy and well. and well. Experience shows that we have been too focused Figure 2 shows how, if current trends were to prevention. That figure is more than three quarters on supporting people when things go wrong, rather continue, the cost of providing social care and of the approximated £400m currently spent on NHS services would inexorably rise year on year. prevention and primary care services. This would Based on the existing way of providing services, have a severe impact on the county’s ability to fund Figure 1: Distribution of 600,000 £1,200 by 2018/19 an extra £62m a year would be preventative services that can reduce demand Health Need and Health required to meet the predicted £365m social care for expensive acute services in the future, which Spend in Staffordshire 500,000 £1,000 bill. An extra £230m would be needed to meet in turn would raise costs even higher, creating (2010/11) the predicted £1.25bn acute hospital care cost. a ‘vicious circle’ of ever-increasing demand and Figure 1, for example, shows 400,000 £800 This would mean a total predicted funding gap of costs. that we use a large part of £292m. This increase, against the backdrop of the NHS budget to support 300,000 £600 financial recession and diminishing resources is people with severe disease. Number unsustainable. Given that there will be no additional Yet these people represent 200,000 £400 funding available, this extra £292m across social only a small proportion of the care (£ millions) spendHealth care and acute services would have to come total population, with perhaps 100,000 £200 from funds that could otherwise be spent on ten times as many people in Staffordshire already on the 0 £0 road to serious ill health. Health y individualsPeople with a lifestyle risk People with long term Number of people dying factor conditions
8 9 Reactive care is expensive. On average: Section 4: • One non-elective patient admission to hospital costs £1,674 • One day spent in a mental health acute hospital bed costs £312 • One week in a residential care home for an older person costs about £585 Values • One month with a foster family costs about £2,760 taffordshire’s Health and Wellbeing Board is committed to the transformation of a whole system • One case of criminal ‘violence against the person’ has a total social and economic cost of almost of services and processes that affect the health and wellbeing of local people. This is a huge and £14,000 Sdifficult task. • A year in prison costs an average of over £37,000 per prisoner As such, it is essential that the work of the Board is guided by strong, meaningful and shared values that • A one-year order involving probation supervision and drug treatment costs about £1,400 are founded in what Staffordshire’s people say is important to them.
By contrast, it has been estimated that preventative We want to invest more in spotting problems early, Living safe and well in my own In light of the findings of the recent inquiry into health services delivered in the community save so that we can stop these getting worse. By doing Mid-Staffordshire Hospitals NHS Foundation £4 for every £1 spent, while every £1 spent on this, not only will the people we support have a home Trust by Robert Francis QC, a key element of drug prevention saves £10 on treatment and may better quality of life, we will also make better use this will be to build systems based on quality of People enjoy a much better quality of life if they prevent a drug user committing crime to the value of the limited money we have. This will require bold experience, which properly safeguard vulnerable are able to live in their own home and remain part of £36,000 a year. action to change the way we decide which services people and allow us to act quickly and decisively if of their local community. We will support solutions are needed and how these services are delivered. things go wrong. Staffordshire’s Health and Wellbeing Board is that are built around people’s ongoing home life committed to supportingFigure families 3: Virtuous to avoidCycle ofcrisis, Early Intervention and independence, taking account of their housing The role of Engaging Communities Staffordshire with all the poor life experience this involves. needs. As part of this, we need to ensure that on the Health and Wellbeing Board is to ensure local communities are safe and are supportive that the views and experiences of patients, service Figure 3: Virtuous Cycle of Early Intervention of all of their members, especially those who are users, and communities are at the heart of our vulnerable. approach We support solutions that are built around the Living my life my way, with help person, that provide services of the highest quality Increase and demonstrate respect, dignity and fairness. resilience in when I need it CYP, families and household People experience greater wellbeing if they have Making best use of taxpayers’ control over their own lives and are able to make choices about what happens to them. Information, money advice and guidance enables most people to The organisations represented on the Health do this by allowing them to draw on the support and Wellbeing Board spend around £3.5bn a and services available to everyone. However, the year – more than £4,000 for every person living in Improving most vulnerable people in our communities may Staffordshire. all need extra support. We will place great value on As public service organisations, we will ensure aspects of solutions that offersuch targetedas support at an early that every tax payer gets quality, value for money place stage, reducing inequalities by helping vulnerable Increase the Reduce services. capacity in dependence on people to achieve the wellbeing others take for community based acute care and granted. This means that we will always look for the best interventions and reduce anti-social person or organisation for the job. In some cases, support behaviours this will mean delivering services ourselves and in Treating me as an individual with others, it may mean other organisations delivering fairness and respect services on our behalf – particularly those in the voluntary sector. Key: Staffordshire’s public services should be based on preventive impact of resilience the principle that people deserve to be treated as shift of resources individuals, receiving support of a standard that we can all be proud of. specific programmes and asset- based approaches effective care pathways
10 11 Section 5: Figure 5: Life expectancy at birth, Staffordshire residents, 2009-2011 (provisional)
Priorities England Staffordshire Reducing health inequality There are significant differences in life experience and health outcomes between people living in the best East Staffordshire parts of Staffordshire and those in the most deprived areas. This is shown in Figure 4. Connock Chase Female Newcastle-under-Lyme Male Figure 4: Inequalities in Staffordshire Staffordshire Moorlands
Least deprived areas Most deprived areas Tamworth Lichfield Claim incapacity benefit 3% 12% South Staffordshire Health Have a limiting long term illness 14% 23% Smoke 16% 34% Stafford Get a least five GCSEs A*-C 70% 37% 72 74 76 78 80 82 84 86 Education 16-18s not in education, training or employment 4% 15% Claim free school meals 4% 33% Yet too many people do not live to Become a professional or manager 36% 12% theses ages, and too many experience Are employment deprived 5% 19% avoidable ill-health and disability for Work many years before they die. Live on benefits 6% 26% Have no access to a car or van 8% 42% Around 8,000 people die every year in Staffordshire. About a third of Live in poverty as a child 5% 39% them are aged under 75 and can be Live in income deprived households 4% 28% considered to have died prematurely. Home and Live in poverty when they are aged 60 and over 8% 32% family We know why people die early in Are part of a lone parent family 3% 11% Staffordshire: almost three quarters of Live alone as a pensioners 10% 16% deaths are due to long term conditions such as cardiovascular disease, All crime 3% 15% cancer and respiratory diseases. Experience of Anti-social behaviour 2% 10% Suicide and accidents are the biggest crime Burglary 0.3% 0.6% killers of young people, especially Deliberate fire 0.1% 0.6% young men. See Figure 6. Life expectancy for men (years) 81 74 There are 148,000 adults and 8,300 Life expectancy children living with at least one long Life expectancy for women (years) 85 79 term condition in Staffordshire.
The ultimate measure of wellbeing is healthy life to live 69 years without disability, and women 72 expectancy. A healthy life is likely to be both longer years. In other words, both men and women can and happier. currently expect to spend the last ten years of their Overall, life expectancy in Staffordshire is 79.1 lives in poor health. Figure 5 shows how this varies years for men and 82.9 years for women. Looking across the county. at the duration of good health, men can expect
12 13 Figure 6: Common causes of Other causes Circulatory diseases A ‘life-course approach’ focuses on a person’s Twelve areas for action deaths in Staffordshire, 24% 13% experience of health, from the moment of 2009-2011 Over the five years covered by this strategy, we conception through childhood and adolescence to will work together to address the 12 priority areas adulthood and old age. for action shown in Figure 7. By focusing on a By looking at the circumstances in which people small number of priorities, we will have the biggest in Staffordshire are born, grow up and live, we can possible impact on health and wellbeing across the Suicides 1% identify key factors generating poor health and county. early death and then put the services in place to Our priorities draw on the evidence presented in Accidents address these problems at the earliest possible the Enhanced Joint Strategic Needs Assessment 2% stage. (eJSNA) for Staffordshire, which is supported by By acting now, in 2022 we could see 78,000 more detailed assessments done for each of the eight people leading healthy lives, 10,000 fewer people districts and boroughs across the county. Respiratory diseases with early onset disease and 3,000 fewer people 13% with severe disease. The difference between acting and failing to act Cancers could be up to 700 deaths a year – every year. 13%
Figure 7: The twelve areas for action Our traditional approach has been to react to the and mental illness will increase, especially in the causes of early death – so if someone is found to over-65s. Starting well Growing well Living well Aging well Ending well have cancer, we care for them and treat them but In numerical terms, this would mean that, by 2022, very little is done about preventing the cancer in there might be 14,000 more people with unhealthy Giving children Maximising Making good Sustaining Ensuring care and the first place. This is shown by where we currently lifestyles, 29,000 more people with early onset the best start potential and lifestyle choices independence, support at the end spend our money. disease, 9,000 more people with severe disease, ability choice and control of life In 2012/13, the NHS in Staffordshire spent £1bn and 600 additional deaths a year. As noted earlier, on secondary, emergency and ongoing care, which care and support for these people could cost 1. Parenting 3. Education 6. Alcohol 9. Dementia 12. End of life is well over half the total amount spent by the NHS an additional £292m a year and would need to 2. School 4. NEET (Not in 7. Drugs 10. Falls across the county. be found from public services such as schools, readiness Education, 8. Lifestyle prevention leisure, or highways, impacting on our communities Similarly, of the £545m spent each year in total by Employment and mental 11. Frail and the health and wellbeing of future generations. Staffordshire County Council (excluding schools), or Training) wellbeing elderly £303m is spent on social care for people whose We want to change this. We want to tackle the 5. In care needs are assessed as being substantial or critical causes of health inequality and early death by and on children who have been taken into care. focussing on early help and prevention, not by reacting to crisis. This equates to just over half of the total spent. For Starting Well Priority 2 - School readiness: The foundations of a number of complex reasons, the trend for health, We will support people to take active control of human development are laid in early childhood, so educational and social outcomes for looked after The highest priority in the Marmot Review was their own health and wellbeing. the aim to give every child the best start possible good indicators of future health and wellbeing are children remains poor nationally. There is a high the early skills they learn in readiness for school. rate of teenage pregnancies, substance abuse, This kind of long term behaviour change will need as this is crucial to reducing health inequalities us to work with communities to challenge long held across the course of someone’s life. This includes the development of language, mental health problems and a lower life expectancy motor and social skills. The early years are a very amongst looked after children and as such these cultural values, raise aspirations and provide the Priority 1 – Parenting: The quality of parenting a tools they need to shape their own futures. sensitive period when it is much easier to help the young people often require extra support from the child receives has a big impact on their chances developing social and emotional structure of the To do this, we need to consider people’s lives in local authority. in life. Good parenting enables children to have infant brain, and after which the basic architecture their full complexity. If we continue as we are, Staffordshire’s ageing a good start and to achieve their maximum is formed for life. If children have the social and population will lead to an unmanageable surge Starting Well potential. Giving children a good start breaks the emotional capability to be ‘school ready’ at the cycle of deprivation that can otherwise continue in demand for health and social care services. The highest priority in the Marmot Review was the age of five, this will have a significantly positive for generations. Although people will live longer, these will not be aim to give every child the best start possible as impact on the rest of their lives. healthy years. Instead, long-term chronic ill health this is crucial to reducing health inequalities across
14 15 Figure 7: continued The focus for 2013/14: parenting, alcohol use and supporting the frail elderly
Growing Well education, employment or training (NEET): The Parenting Drug Executive Board (ADEB) to oversee the development and delivery of a strategy to reduce Children, young people and adults who are number of 16-18 year olds not in education, Getting the best start in life is an important factor in alcohol-related problems in Staffordshire. The supported to reach their potential can have employment or training varies from under 4% a person’s future health and wellbeing. in Stafford to 9% in Cannock Chase. We need strategy will involve initiatives to educate and greater control over their lives and their health Good parenting is not only essential for a safe, to reduce these differences and ensure that prevent problems, provide early help when issues and wellbeing. happy and healthy childhood, it sets children up young people can participate in a productive and arise, treat the most entrenched problems, to reach their potential and lead a successful adult Priority 3 - Improving educational attainment: fulfilling life. regulate the availability of alcohol and enforce legal Areas of low educational attainment and life. Priority 5 - Children in Care: The safety of restrictions. skills are often associated with high levels of In Staffordshire, we know that a child’s wellbeing worklessness, deprivation and poor health. In children and young people in care is a priority for Supporting the frail elderly every organisation that works to protect children. varies with age. Over 5,000 children are identified Staffordshire there are variations in the number of as being in need, with nearly a third of these being The way in which we support people to age well pupils achieving five or more A*-C GCSE grades We need to do more to ensure that the chances and to keep their health and independence is of in life for young people in care are the same as under the age of 5 years. that we will need to address. considerable importance to our communities. for those who are not. We want young people in Our eJSNA highlights a number of important areas, Priority 4 – Reducing those who are not in care to reach their full potential. ranging from obesity to educational attainment Staffordshire has an increasing population of older and unintentional injuries, where we need to work people, and the number of residents aged over 75 together to support good parenting and improve years is expected to double by 2033. Living Well Priority 8 - Promoting healthy lifestyles and health and wellbeing for children. We will develop Too many elderly people are experiencing mental wellbeing: Nearly 500,000 adults in Enabling good lifestyle choices means that people new ways of supporting parents that start during vulnerabilities that can be avoided or better Staffordshire have at least one lifestyle risk factor, in Staffordshire can lead long and healthy lives. pregnancy and continue into a child’s early years. managed. Over half of adult protection referrals either being a smoker, consuming too much We will build stronger universal services that are relate to people aged 75 and over, while Priorities 6 and 7 - Reducing harm from alcohol alcohol, having a diet low in fruit and vegetables available to all families and will work together to malnutrition amongst older people in nursing and and drugs: An existing priority is to reduce or not taking enough physical exercise. Many harmful levels of alcohol consumption and people have more than one lifestyle risk factor. In build resilient families and communities who are residential care settings is estimated at 40-45%. alcohol-related harm in Staffordshire. The effects some areas existing targets are not being hit, or supported with early help to stop problems getting Dementia is expected to increase in an ageing of alcohol and drug misuse impact on all areas trends are moving in the wrong direction. worse. population and there are significant numbers of of health and community safety, and have far Alcohol use people with undiagnosed long-term conditions. reaching effects across society. Around one in four adults in Staffordshire drinks We also need to do more to support carers. more than the recommended amount of alcohol. A new model of ‘anticipatory care’ will be Ageing Well of deaths from accidental causes, including This leads to a wide variety of health, crime developed to support people who are elderly and By helping people to live independently and be falls, is higher amongst the over 65 age group and social problems, many of which affect our frail. The new approach will help to identify and in Staffordshire, partially in Cannock Chase, in control of their lives, we can support older communities and particularly the elderly and manage long term conditions. It will ensure that we Lichfield, Stafford and Tamworth. people to be healthy and well. vulnerable. provide seamless care and support that focuses Priority 11 – Frail elderly: Many older people Priority 9 - Dementia: Amongst people aged 65 Across the course of someone’s life, many harmful on the needs and wishes of the elderly person so are living with one or more long-term medical and over, over 10,000 people in Staffordshire effects can be experienced due to alcohol: foetal that they can keep their independence and quality condition and for a significant number, getting were estimated to have dementia in 2010. This is alcohol syndrome (FAS) in unborn babies, chronic of life for as long as possible. This work will be expected to rise to over 14,000 by 2020. Many older brings frailty, instability, immobility, driven by a number of new local Accountable Care incontinence or dementia. As we age we tend health conditions (such as hypertension), mental cases go undiagnosed. Of the 10,300 expected health deterioration and death from liver disease. Partnerships. cases of dementia in Staffordshire, only 4,200 to use health and social services more. The are recorded on GP registers. challenge faced by member organisations of the Alcohol consumption also contributes directly to Health and Wellbeing Board is to work together the number of crimes committed, makes victims Priority 10 – Falls prevention: The numbers to provide good quality personalised care. more vulnerable, and is often a significant factor in road traffic accidents and accidental dwelling fires that lead to death or life threatening injuries. Ending Well Priority 12 – End of Life: When someone reaches Alongside partners such as the Probation Ensuring good quality care and support at the the end of their life, we will ensure that they are Service, we will work through the Alcohol and end of someone’s life. well cared for and, as far as possible, are in a place of their own choice.
16 17 Section 6: spend was brought in line with our peers, this Key priority areas for releasing resources would free up a significant amount of funding that The diseases that have the greatest impact on could be spent on early intervention programmes demand for intensive support are cancer, heart Shifting Resources to give people with learning disabilities more disease, and dementia. In 2010/2011, of the freedom and choice in how they receive their 68,700 emergency (unplanned) hospital admissions t has been known for many years that there on early intervention. However, if Nottingham were support. across Staffordshire, almost half were patients with are significant benefits to be gained from a able to invest another £1.6m per year to roll out Such radical shifts in resources would have to be one or more long term condition (47%). The most Igreater focus on early help – the old adage that Family Nurse Partnerships to all teenage parents accompanied by radical changes in the emergency common causes of admission to hospital are for ‘prevention is better than cure’ has long applied. eligible for the programme, it has been predicted care system. hypertension (8%), coronary heart disease (6%), Although we have started to make some shifts that this would save £4m-£8m by the time these For example, reducing demand on the acute and cancer (5%). in resources, notably in the area of services for children were 15 as well as improving the health hospital system, so that expenditure could be As a Board, we are committed to investing in the people with learning disabilities, examination of and well being of a considerable number of families reduced while maintaining the quality of care, prevention of these diseases wherever possible, data for the system as a whole suggests that we in their community. This money could then be would require a significant reshaping of that and early help for those who have been diagnosed. further reinvested in other prevention programmes. have in fact been moving in the wrong direction. system. It might, for example, require a large Through the development of a Community Care While the absolute amount of resource available Significant improvements to outcomes and financial reduction in the number of hospital beds occupied Strategy, we will work in new ways to support in 2013 is significantly greater than was the case savings have also been seen in other aspects of by emergency patients – recognising that we older people and those with long term conditions, a decade ago, the proportion devoted to intensive health and wellbeing. Identification and advice for already have many more beds than our population including physical and sensory disabilities. harmful / hazardous drinkers can save £4.30 for might suggest are required. This would make it and specialist services has grown at a faster rate The strategy will outline how local organisations every £1 spent in the average GP cluster. Brief necessary to reconsider the existing system of than that allocated to early help and prevention. will work together to meet the needs and interventions delivered in GP surgeries result in an three acute hospitals within the county, leading As noted earlier, we now spend more than £1.3bn expectations of local people. It will ensure that the estimated 40% reduction in alcohol consumption to a different model of care. Similarly, reducing across health and social care reacting to the services developed and delivered in partnership and a cost-saving of £123 per person. For every expenditure on residential care, through helping symptoms of ill health and current trends would are modern, innovative, creative and make a real 100 alcohol-dependent people treated with early many people to remain independent and living mean this would increase to almost £1.6bn by improvement to the lives of people with long term intervention support, 18 A&E visits and 22 hospital in their own homes, might mean that some 2018/19. conditions. admissions may be prevented. This costs £40,000 existing care homes were no longer required, with If we are to focus on early help and prevention and saves £60,000. Similarly, one alcohol liaison consequent impact on providers in that sector. The healthcare needs of individuals with more than rather than reaction at a point of crisis, we must nurse at a cost of £60,000 may prevent 97 A&E one chronic condition are likely to be complex. In change how we use the resources available to us. In reshaping the hospital system, it will be visits and 57 hospital admissions, saving £90,000. important for us to recognise the challenges the past, people with multiple conditions have had To spend more on prevention and early help An even more striking example of both the cost involved. The NHS Payment by Results system several different health workers to address each means spending less on reactive intensive and patient benefits of early intervention can means that Trusts are paid for the work they of their conditions. This has led to a duplication support. This should quickly become a virtuous be seen in primary care screening. It has been do, and so reductions in demand are matched and inefficiency, and in some cases contradictory circle, where increased focus on prevention and suggested that, for every 5,000 patients screened by reductions in income. However, this does interventions. Therefore the approach to supporting early help reduces the need for later intensive for potential health problems in primary care not in itself release funds for investment by people with multiple chronic conditions must intervention, releasing further resources for settings, 67 A&E visits and 61 hospital admissions commissioners in preventative services. In order take the person involved and all of their health prevention and early help. may be avoided. These screenings have an initial to reduce their costs, hospitals need to be able conditions into consideration as a whole with as By reducing spending on emergency intervention cost of £25,000, but can save up to £90,000. to withdraw capacity in parallel to falling demand. few separate points of contact as possible. This will allow a more holistic, effective and efficient we would release millions of pounds to significantly Reducing our spending on emergency intervention Due to the nature of healthcare, capacity often approach to addressing need. increase spending on prevention. A large increase to the level achieved by the top performing areas in needs to be withdrawn as whole units (such as in the resources available for prevention would England would release significant funds and allow an entire ward, an entire consultant team), rather Cancer allow us to conduct prevention programmes that us to increase spending on prevention by more than piecemeal. Care will therefore be required to We will develop the support available to cancer will improve outcomes for residents and make than half. ensure that the proposed reductions in the need for patients and carers. We will ensure that diagnosis considerable savings in the future. A specific example of an opportunity of this nature acute care are managed in such a way as to allow is provided as early as possible and that patients An example of this strategy can be found in can be found in nursing and residential care hospitals to match them with a phased programme are made fully aware of the options available to Nottingham, where the local authority has invested services for adults with learning disabilities. In of capacity reduction, which avoids the risk of the support them with their decision making around heavily in a comprehensive early intervention 2011/12, 51% of the budget available for adults system becoming destabilised. their health and social care needs. package of support for 0-5 year olds and their with learning disabilities was spent on residential parents / carers. This has boosted Nottingham’s and nursing care. This was almost a quarter more Foundation Stage results to above the national than the average spend by the surrounding shire average. Unfortunately, budget pressures have counties, where only 42% of the budget was spent restricted how much local authorities can spend on this form of intensive care. If the Staffordshire
18 19 Heart Disease Our main focus is to ensure that people living with Section 7: We will contact people who regularly need dementia get care that is tailored specifically for unplanned secondary care and offer them a them and helps them to live the best life possible. planned package of support that will anticipate, To make best use of the money we have available Enablers co-ordinate and join up the health and social care to us, we need to be more innovative in the way support they need. we meet the needs of people with dementia. We’ll o improve the wellbeing of Staffordshire’s How we work out what needs to be done support people to remain within the community for We know that patients with a diagnosis of heart people through early help and prevention, we (integrated commissioning) longer by investing in memory clinics, carer support disease are high users of hospital emergency must ensure that the way we work supports and mental health liaison in hospitals in order to T The achievement of our vision requires that we departments, but by offering early help we hope change rather than hinders it. manage dementia, delirium and depression. undertake our commissioning functions in a to reduce the likelihood that they will need to be We believe these system changes need to be different way than previously, taking account of the admitted to hospital. Work is also in hand to develop ‘Dementia Centres made in four vital areas: wider determinants of health as well as the clinical of Excellence’, which will meet the needs of Dementia • How we make decisions (governance) evidence. dementia sufferers as their health deteriorates and Across Staffordshire there are estimated to be will reduce the need for people to be transferred • How we work out what needs to be done It is no longer enough for us to simply work over 10,000 people living with Dementia (both from residential care to specialist units. (integrated commissioning) alongside each other. Instead, our commissioning diagnosed and undiagnosed) and this number is • How we ensure there is a powerful voice for needs to become truly integrated across a range of set to increase significantly over the coming years. service users (public engagement) the most important topics, minimising duplication and avoiding situations where our organisations • How we design how services are delivered pull in different directions. (integrated provision) • How we make decisions (governance) With support from the King’s Fund, which has an international reputation for its expertise in this field, The Health and Wellbeing Board will play a central we have identified a number of areas where there is role in ensuring that all parts of the system across benefit in taking forward a deeper integration of our Staffordshire work together to deliver the agenda commissioning responsibilities, bringing together set out in this strategy. both staff and budgets. The Board is the only forum where the main In doing so, we will be able to draw upon the commissioning bodies – county council, clinical experience of the Joint Commissioning Unit, commissioning groups, district and borough which has for the past several years undertaken a councils, and police – come together. It is also range of commissioning functions on behalf of the held accountable by the community champion County Council and the two Primary Care Trusts. HealthWatch, to ensure its debates and decisions This work will need to have particular regard to the take account of public interest. relationship with Stoke-on-Trent. We have a statutory duty to produce this strategy, and all of us have a statutory duty to have regard More locally, we will build upon the solid to it in developing our own organisational plans, foundations already developed by the district and but Staffordshire’s Board will be more proactive borough councils to develop integrated models of than this. commissioning that are suited to and responsive to the specific needs and contexts of each part of the The Board will: county. • lead the big, strategic issues, setting the How we ensure there is a powerful voice direction for the whole system for service users (public engagement) • will identify and resolve those issues that block progress in key areas, so that people on the As the recent report of the Francis Inquiry makes ground are able to deliver the radical changes clear, the voice of the local population must be at needed the heart of our debates, just as our communities must be the centre of everything we do. • develop clear arrangements for working with the Staffordshire Strategic Partnership, The experience at Stafford Hospital is especially Staffordshire Local Enterprise Partnership, powerful for us and we are united in our Stoke-on-Trent Health and Wellbeing Board, commitment to ensure that we avoid such dreadful district and borough health and wellbeing failures in care affecting Staffordshire’s people ever boards and local health and social care forums again.
20 21 In order to strengthen the voice of people who use How we design how services are delivered Section 8: services (adults, children and young people alike) (integrated provision) we have established a new organisation called Over the past few years, health and social care Engaging Communities Staffordshire (ECS). commissioners have changed their focus from Measuring Success Building on the experience and expertise of the direct delivery of services to improving outcomes Local Involvement Network (LINk), ECS will go for people in Staffordshire by securing delivery of far beyond the remit for Healthwatch to become services through other organisations. Joint Health and Wellbeing Strategy Outcomes a centre of expertise and knowledge about the In putting Staffordshire’s people at the centre of It is important for the Health and Wellbeing Board (HWB) to adopt outcomes that provide assurance that people of Staffordshire. every service we commission, and by ensuring that progress is being made towards the overarching Joint Health and Wellbeing Strategy (JHWS) vision. It will have a key role as an independent we always seek the best organisation for the job, organisation to collate and challenge all the we have the opportunity to take dramatic steps to available information about how people experience stop hand-offs that make no sense to service users Staffordshire will be a place where improved health and wellbeing health and social care services, undertaking new and absorb energy and resource. is experienced by all. It will be a good place to live. People will research where necessary, and drawing on this to At the same, we can seek to establish the right mix be healthy, safe and prosperous and will have the opportunity to present a clear and persuasive contribution to the of providers with different strengths and areas of debate. expertise. grow up, raise a family and grow old, as part of strong, safe and Through its full membership of the Health and The integration of community health care and adult supportive communities. Wellbeing Board as the provider of Staffordshire’s social care in the Staffordshire and Stoke-on-Trent HealthWatch, ECS will provide a powerful NHS Partnership Trust is delivering a service with And principle: connection with the people of Staffordshire, much less fragmentation and duplication, with ensuring that their voice is heard at every stage. original savings estimates of £31.5m per annum. “Through leadership, influence, pooling of our collective In addition, there is a raft of communication Its work delivers more preventative and early- mechanisms in place locally that will complement response work than under the previous system to resources and joint working where it matters most, we will make the countywide work of Healthwatch, in particular 1.2m people. The benefit of this integrated system a real difference to the lives of Staffordshire’s people.” scrutiny through District and Borough councils. underpins the intention to develop the thinking, through the establishment of Independent Futures To this end a number of overarching indicators are proposed: (services for people with lifelong disabilities) and Families First (services for children and families) into a provider model. This works across traditional sector boundaries to deliver real, holistic benefit. Priority Area Indicator Baseline Baseline Date Proportion of people reporting feeling happy yesterday 71.9% 2011/12
Proportion of people feeling very satisfied or satisfied with 95% 2012 Vision their local area as a place to live
Proportion of people who live in a strong, safe and Aspirational indicator for supportive community development Proportion of people who report a positive experience of Aspirational indicator for using services development Proportion of people who report strongly agreeing or Baseline to be agreeing that local services are successfully dealing with 2013 Principle collected a range of issues Proportion of Staffordshire Plc budget spent on early TBC TBC intervention and prevention
22 23 Role of the Joint Strategic Needs Assessment (JSNA) Section 9: The JSNA is a process that identifies the current proposed by stakeholders will be considered for and projected health and wellbeing needs and inclusion. One of the products of the Staffordshire assets of the local population. JSNA process will be a needs profile focussing on Making the Transformation The Staffordshire JSNA adopts an ‘outcome based the indicators listed in the HWB OF. approach’ and considers indicators that illustrate The JSNA needs profile will be used to inform he argument for shifting resources to focus Pace of change outcome that are within the Health and Wellbeing the Joint Health and Wellbeing Strategy (JHWS). on prevention and early help is strong, but in That a change of focus to prevention and early help Boards (HWB) responsibility. To this end a Health It supports the identification of priority areas for Treality, it has barely begun. can be achieved has been demonstrated by the and Wellbeing Board Outcome Framework (HWB action. The JHWS is a five year strategy but will The reasons for this are complex and are affected Staffordshire Fire and Rescue Service. OF) has been developed (appendix A). This is be reviewed on an annual basis in the light of new by organisational, funding, social, political, and informed by indicators included in the national data to check the priorities are still appropriate. Recognising that avoiding a fire starting is even systemic factors that can lead to organisations better than putting it out quickly, the Service has outcome frameworks for the NHS, Adult Social The HWB OF indicators that are relevant to and professional groups pulling against each other, Care and Public Health with a specific focus placed great emphasis on active fire prevention the priority areas will receive specific attention rather than together. efforts, drawing on available data to identify those on indicators that are shared by more than one from the HWB as these provide an indication of framework. Over the next year the HWB OF will Embedding change into existing people most at risk of a fire. progress in the priority areas. For the first year organisations be reviewed and additional outcome indicators these are listed below: Not only has this led to a significant reduction in A key test of whether we have genuinely changed the number of fires over the past several years, the way we work across Staffordshire will be but the trusted position of fire officers within the Priority Area HWB OF Indicator Baseline Baseline Date the extent to which the ambitions set out in this community has allowed them to provide early School readiness - Proportion of children achieving a good 2012 strategy are reflected in the delivery plans of our warning to other public services about people 68% level of development within Early Years Foundation Stage member organisations. becoming vulnerable. Baseline to be Child development at 2-2.5 years 2013 A standalone implementation plan for this strategy However, we need to be realistic about the pace of collected would be an expression of failure, as it would change that is possible. Parenting Healthy weight in 4-5 year olds 77.3% 2011/12 indicate that we have failed to influence the We cannot just focus on future generations, we Healthy weight in 10-11 year olds 65.5% mainstream work of our organisations. also need to maintain appropriate support for Baseline to be The key route for delivery for this strategy will people already experiencing ill health, or heading Vision indicators for parents (27% n=~460) 2013 collected therefore be through the Staffordshire County towards it, so that we can minimise its impact and Proportion of people receiving social care who receive self- Council Strategic Plan, the Police and Crime Plan maximise their quality and length of life. TBC 2011/12 directed support and those receiving direct payment of the Police and Crime Commissioner, the plans of Our priorities must therefore be a balanced mix the NHS Clinical Commissioning Groups and of the Baseline to be of short-term investment to meet current needs Quality of life for people with a long term condition 2013 collected district and borough councils. and medium-term support for people at risk of Baseline to be The contribution of these various plans will be becoming vulnerable or in the early stages ill health, Effectiveness of reablement services 2013 Frail elderly collected reviewed by the Health and Wellbeing Board, but alongside a longer-term focus on prevention and we are clear that it is neither our role to monitor early help that will improve wellbeing and tackle Vaccination uptake in 65+ - PPV 66.8% 2011/12 Vaccination uptake in 65+ - Flu 71.4% them or to hold individuals to account for delivery avoidable ill health in the first place. of the details within them. Rather, we will seek Baseline to be Vision indicators for 65+ (24% - n = ~400) 2013 to hold each other to account for our respective collected contribution to the achievement of our shared Alcohol related admission to hospital 448 per 100,000 2012/13 Q2 vision. Alcohol Under 75 mortality from liver disease 12.9 per 100,00 2009-11
The role of performance management
The HWB OF and the JSNA needs profile are thread between the outputs of these activities and not performance management tools. The Health the desired outcomes will be identified. These will and Wellbeing Board will identify activities to be provide the basis for performance management commissioned to achieve the priority outcomes. Performance measures that provide a golden
24 25 • Under 75 mortality from respiratory disease • Incidence of harm to children due to failure to Appendix A (1,3,5) monitor (3,4) • Alcohol related admissions to hospital (1, Specific aim: Enhancing quality of life for people Health and Wellbeing Outcome Framework 5) with long term health, care and support needs • Under 75 mortality from liver disease (1,3,5) • Social care/health related quality of life for Key: • Under 75 mortality from cancer (1,3,5) people with long term conditions (2,3,5) 1. Public Health Outcomes Framework Coloured Text: Health and Wellbeing Strategy • Excess mortality rate in adults with mental • People feel supported to manage their condition Priority Outcomes 2. Adult Social Care Outcomes Framework illness (1,3) (1,2,3,5) 3. National Health Service Outcomes Bold Text: Health and Wellbeing Strategy Year • Potential years of life lost (PYLL) from causes • Carer reported quality of life (2,3) Framework One Priority Outcomes considered amenable to healthcare (3,4,5) • Improving people’s experience of integrated 4. Childrens Outcomes Framework Italicised Text: Data not yet available • Successful completion of drug treatment (1) care (2,3) 5. Clinical Commissioning Group Outcomes • Proportion of older people (aged 65 and over) Framework • People entering prison with substance misuse issues who are not previously known to who were still at home 91 days after discharge 6. Feeling the Difference Survey community treatment (1) from hospital into reablement/ rehabilitation services (2,3) Specific aim: Improving children’s health and Specific aim: Improving the wellbeing of the • Domestic Abuse (1) wellbeing from neonatal to 19 years • Proportion of people receiving social care population, satisfaction with lives, the social • Violent crime (including sexual violence) (1) who receive self-directed support and capital of communities and their satisfaction with • Babies born at a healthy weight (1,4) those receiving direct payment (2) • Re-offending levels (1) their local services • Babies breastfed (1,4,5) • Emergency readmissions within 30 days of • People feel satisfied with their lives (1,6) • The percentage of the population affected by • Mothers who smoke at time of delivery (1,4,5) discharge from hospital (1,3,5) noise (1) • People feel happy (1,6) • Under 18 conceptions (1,4) • Effectiveness of reablement services (2) • Statutory homelessness (1) • People don’t feel anxious (1,6) • Children in poverty (1,4) • Estimated diagnosis rate for people with • Utilisation of outdoor space for health reasons dementia (1,3,5) • People feel the things they do in their life are (1) • Child development at 2-2.5 years (1,4) worthwhile (1,6) • Dementia – a measure of the effectiveness of • Fuel poverty (1) • School readiness (1,4) • People feel satisfied with their local area as post-diagnosis care in sustaining independence • Social isolation (1,2) • Healthy weight in 4-5 year olds and 10-11 and improving quality of life (2,3) a place to live (6) year olds (1,4) • Older people’s perception of community safety • Adults with LD/ in contact with secondary MH • People agree that local public services are • Pupil absence (1,4) successfully dealing with a range of issues (1,2) services who live in stable and appropriate in their area (6) • Smoking prevalence – adult (over 19s) (1) • 16-18 year olds not in education, employment accommodation (1,2) or training (1,4) • People live in a strong, safe and supportive • Diet (1) • Employment of those with a LTC including community • GCSE (5 A-c incl English and Maths) adults with LD or who are in contact with • Excess weight in adults (1) secondary MH services (1,2,3) • People have a positive experience of using • Hospital admissions caused by unintentional • Proportion of physically active and inactive and deliberate injuries in under 18s (1,4) • PPV vaccination uptake in 65+ (1) services adults (1) • Emotional wellbeing of looked after children (1,4) • Flu vaccination uptake in 65+ (1) • People feel satisfied with the overall level of • Recorded diabetes (1) service provided by the police, the criminal • Smoking prevalence – 15 year olds • Hip fractures in 65+ (1) • Take up of NHS Health Check by those eligible (1) justice system, the county/city council, the • Tooth decay in children aged five (1,4) • Falls and injuries (1) district/borough council, the fire and rescue • Self-reported wellbeing (1) • Chlamydia diagnosis (15-24 year olds) (1,4) service, their GP, their local pharmacy, their local • Hospital admissions as a result of self-harm (1) hospital (6) • Population vaccination coverage (1,4) • Suicide (1) Specific aim: Improving the wider determinants of • Unplanned hospitalisation for asthma, diabetes health which affect health and wellbeing and health Specific aim: Preventing people from dying and epilepsy and lower respiratory tract inequalities prematurely infections in under 19s (3,4) • People in prison who have a mental illness (1) • Life expectancy (M/F) (1,3) • Children and young people’s experience of • Sickness absence rate (1) • Infant Mortality (1,3,4) healthcare (3,4) • Killed and seriously injured on England’s roads • Under 75 mortality from CVD (1,3,5) • Admission of full term babies to neonatal care (1) (3,4)
26 27 Tel: 0800 051 8371 Email: [email protected] www.engagingcommunitiesstaffordshire.co.uk Living Well in Staffordshire, Health and Wellbeing Board, Unit 30, Staffordshire University Business Village, Dyson Way, Staffordshire Technology Park, Beaconside, Stafford, ST18 0TW
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Title Quality Report for Governing Body
Reporting to East Staffs CCG Governing Body
Date of Meeting Thursday 27th June 2013
Commissioning Lead(s) Author(s) Heather Johnstone Heather Johnstone Sue Wilson
Purpose of the Report (Please select) Approval Assurance Discussion
Key Points/Executive Summary
The report includes an update on general quality activity including recruitment
Burton Hospital Foundation Trust (BHFT)
• Sir Bruce Keogh’s review of mortality • Patient experience • Eliminating Mixed Sex Accommodation
Staffordshire and Stoke On Trent Partnership Trust (SSOTP) • Pressure Ulcers
South Staffordshire and Shropshire Healthcare Foundation Trust (SSSFT) • Provision of therapy services to inpatients
Recommendations (what is expected from the Governing Body)
Members of the Governing Body are asked to be assured in respect of current quality assurance and improvement measures being used by the CCG to monitor the quality and safety of commissioned services.
In addition, the Governing Body are asked to advise of any further action to be taken to further enhance assurances provided within this report.
Enclosures
(1) ESCCG Quality Report
1 Authors: Heather Johnstone/Sue Wilson Date: 17th June 2013 East Staffs CCG
Quality Report June 2013
Summary ESCCG quality committee continues to meet on a monthly basis and is now becoming well established. The committee receives update reports in respect of all Staffordshire based key providers i.e. Burton Hospital, Staffordshire and Stoke on Trent Partnership Trust (SSOTP) and South Staffordshire and Shropshire Mental Health Foundation Trust (SSSFT).
Work is underway to ensure that the committee also receives information in respect of out of area providers currently commissioned by the CCG. This is particularly relevant for the Royal Derby Hospital with many patients from Burton travelling to Derby for treatment.
In addition, quality committee reviews reports in respect of key quality agenda items such as safeguarding adults and children as well as medicines management. The clinical risk register is now a standing item on the quality committee agenda and all quality related risks rated 12 and above are monitored.
This month the quality committee received, for the first time, a summary of key quality indicators and each of the main provider’s performance in relation to this. Work is underway to obtain similar data for the Royal Derby Hospitals from their lead commissioners and it is expected that this will be included in future reports to Governing Body.
Changes There are shortly to be a number of changes which we anticipate will have a positive effect on the way the CCG monitor and report quality. These are listed below:
1. Clinical Quality Improvement Manager – the CCG have now recruited a part-time, very experienced senior nurse and experienced quality manager to undertake this role (Sue Wilson). She will commence in post on 1st July for one year and will support the Chief Nurse and members of the Quality Committee in all key quality assurance and improvement work. She will also work closely with the local Commissioning Support Unit (CSU) to continue to develop the joint work in this area.
2. Associate Lay Representative – the Governing Body were previously advised that we were looking to retain a former PCT Non-Executive Director, Lynne Smith, to support the CCG to deliver key quality requirements and to share her learning from working in the PCT during and after the Mid Staffordshire Inquiry. Lynne will support the on- going development of the Quality Committee, bringing her knowledge and experience to add to the wealth of experience already working on this agenda. Arrangements for this have now been finalised and Lynne commenced in this role on 1st June. This is a temporary appointment and will run for one year.
3. Quality Committee – in recognition of the importance of quality and safety and coupled with the appointment of additional members described above, work is underway to ensure that the Quality Committee delivers all key requirements within the limited time and resource available. In order to achieve this members have been advised of a number of proposals to ensure that the meeting runs to time, is
Authors Heather Johnstone & Sue Wilson June 2013 Page 1
focussed and that sufficient time is available to discuss and debate individual provider issues and to drawer clear conclusions on the level of assurance being given. An extra meeting is scheduled to take place before the next Committee on 26th June to discuss the practicalities of this further. In addition, the terms of reference will be subject to review and will be presented for approval once amended.
Regulators involvement and issues Sir Bruce Keogh’s team have undertaken their review of Burton Hospitals. This review took place 22nd – 24th June and was followed by an unannounced visit on the evening of 3rd June. The final stage in the review process is a Risk Summit which is due to take place in Cambridge on 21st June and which will be attended by representatives from all involved in the review process including the CCG. The final report is expected shortly and Governing Body will be updated further once this is received.
The CCG have not been advised of any further regulatory involvement in reviews of local providers.
Visits, Inspections, Regulators and Audits SSOTP A routine internal quality visit was undertaken to the Speech and Language Service at Tamworth Health Centre in April. One red rated area of non-compliance was identified relating to signage, maintenance and cleaning. This will be discussed in detail with the Trust at the next CQRM in June.
SSSFT The Trust has an internal programme which CCG representatives attend. SSSFT reported the key findings from 6 Essential standards visits (3 in South Staffs) carried out or reported in Q4. One area requiring urgent attention relating to recording allergies was dealt with immediately. Areas of good practice were identified along with areas with scope for improving quality.
Infection Control BHFT One case of cDifficile was reported in April. The trust has undertaken a full root cause analysis and the results of this are awaited. Once known any learning will be implemented.
SSOTP No cases of MRSA bacteraemia or cDifficile were reported and MRSA screening is at 100%.
SSSFT No issues have been reported.
Patient Experience &Patient Surveys BHFT During April 321 patients were surveyed by volunteers using handheld electronic devices. The data was collected and analysed using the recently implemented Meridian Patient Feedback system. There was a target of 20 patients per ward however the capacity of patients on some wards and the availability of volunteers meant that in some cases this wasn’t achieved. However it is worth noting that the overall number of responses received across the trust was almost double the amount in previous months using the Trust’s old system. The new system brings a suite of patient experience questions and these are being piloted for 3 months to monitor the robustness of the questions.
Authors Heather Johnstone & Sue Wilson June 2013 Page 2
Scores for questions are analysed using the standard Meridian scoring system which attributes a percentage score to different responses. The new scoring system will still allow for benchmarking and comparisons across wards and divisions. A composite Patient Experience Score is created for each Ward based on the response to all questions asked including “Overall, how would you rate your care?”
The lowest scoring area in April was “Have you been involved in decisions about your discharge?” with 125 out of 321 patients saying that they hadn’t been involved in decisions about their discharge. However it was suggested that the question may have been asked too early in the patients hospital stay. Progress in relation to this will be monitored via CQRM.
The National Friends and Family Test was rolled out in April, extending to all patients over 16 discharged from A&E without being admitted.
The combined results for A&E and Adult Acute for April are a score of 75 and the response rate was 12.9%. This is a reduction on previous month’s score and response rate and this reduction is linked with difficulties in undertaking this audit in A & E. Progress is being monitored via CQRM.
SSOTP The Trust does undertake the Friends and Family Test on their community hospitals in the North of the county. Although not related to ESCCG patients the most recent score was 74.14, an increase from 67.30 from March.
Task and finish groups are scheduled in June to work in collaboration with Prison Healthcare managers to devise user questionnaires and feedback for all the prison healthcare services. The trust is one out of 10 NHS organisations working on a research project with DH and Picker institute to develop and test mechanisms for measuring new models of patient experience along with pathways which will be shared as national best practice.
SSSFT SSSFT have, through the CQUIN process, made a clear case that the Friends and Family Test is not an effective tool for monitoring patient experience in the mental health setting. It is currently not mandatory for mental health trusts in 2013/14. SSSFT intend to continue using the question but do not intend to present the result in the same format in future. SSSFT will still be in a position to go back to the raw data and present the score in the old format should it become mandatory in year.
Complaints
BHFT 41 complaints were received in April. The top categories were medical care & treatment, communication, attitude of staff, nursing care & treatment and admission/discharge/transfer. Action and learning from complaints is being monitored.
During April the trust achieved 100% acknowledgement time of a complaint within 3 working days which was an increase from last month where they achieved 94%.
SSSFT These are reported quarterly due to low numbers of complaints. 24 formal complaints were made in Q4 as compared with 32 in Q3. The key themes relate to clinical treatment and
Authors Heather Johnstone & Sue Wilson June 2013 Page 3
attitude of staff. Although two of the clinical treatment complaints relate to one specific ward, the circumstances were distinct.
SSOTP The trust has recorded 27 complaints in April and has acknowledged all of them within the 3 day requirement. Six of the complaints relate to community teams in the south division although no specific trends have been identified. A detailed breakdown of complaints is scheduled to be reviewed by the next CQRM.
A number of PALS concerns were raised related to issues around appointments, aids and equipment, quality of care, waiting time, communication, access to service, staff attitude, records, medication, transport. Further information in respect of action taken to address these issues has been requested.
81 compliments were received, 25 of which were via the Ele-lite system which is used by the Trust.
Eliminating Mixed Sex Accommodation
BHFT The trust has reported 10 mixed sex breaches, some of which were in relation to patients who were delayed transfers out of ITU when the patient was fit for transfer. Work by the Trust and the CCGs to address flow should help to avoid this issue in future.
The remaining were non-invasive ventilation (NIV) patients and although they received the best level of care it has not been agreed that NIV patients are a “clinically justified breach” and hence this impacted upon the numbers. This leaves an issue with estates in order to avoid future breaches. It should be acknowledged that the Trust are good reporters of mixed sex breaches and area working hard with the CCG to reduce the numbers of breaches which occur.
No breaches reported by any other local providers.
Pressure Ulcer Reduction
BHFT Six grade 3 pressure ulcers were reported in April. The trust has undertaken a detailed piece of work and has identified areas where improvements are needed in availability of equipment. This is being rectified but the trust recognises that more work is needed to further reduce the numbers of pressure ulcers. The trust’s stated ambition is to eliminate all avoidable grade 2, 3 and 4 pressure ulcers.
SSOTP There has been an increase in the number of pressure ulcers reported in April following the decrease seen in March 2013. CCGs are maintaining their focus on this area and a pressure ulcer themed CQRM is planned for the joint July meeting. A pressure ulcer reduction target is being negotiated as a CQUIN and the trust continue to undertake root cause analysis investigations on all grade 2, 3 and 4 pressure ulcers. The trust’s internal scrutiny panel has identified four main themes which are clinical record keeping, patient or carer non-concordance, posture and seating and end of life skin changes. Work is on-going in each of these areas.
Authors Heather Johnstone & Sue Wilson June 2013 Page 4
Serious Incidents
BHFT During April 2013, 9 new Serious Incidents were reported. Two of these were retained cannulas and five were pressure ulcers. The trust also provided detail of all SIs that have been agreed for closure and presented a summary of lessons learned as a result of the investigation and changes in practice to prevent recurrence.
SSOTP 29 serious incidents were reported for April, of which 17 were grade 3 or 4 pressure ulcers. One serious incident report has exceeded the 45 day requirement for closure and an extension has been agreed with the CCGs as the patient’s notes were not available. There are no other themes emerging.
SSSFT 9 serious incidents were reported in April. The numbers of serious incidents has not shown any marked or sustained upward or downward trends. SSSFT has continued to be able to submit root cause analysis investigations for closure within 45 working days during April.
The trust has shared executive summaries of 7 SI investigations for review at CQRM. The lessons learned are shared with the CCG. In previous months, this report has discussed issues around how to distinguish unexpected deaths related to natural causes from those that might subsequently be found be suicides. SSSFT have produced data from April 2011, showing variation in unexpected deaths excluding those found be related to natural causes, there is no evidence of unusual trends in unexpected deaths not related to natural causes.
Based on the guidelines in the addendum to the contract, SSSFT identified 3 incidents that were not classified as SIs but which did meet the criteria of the duty of candour guidelines. In all 3 cases patients received and apology and were offered a written explanation.
Authors Heather Johnstone & Sue Wilson June 2013 Page 5
Finance Report Month 2 2013/14 (1 April 2013 –31 May Title 2013)
Reporting to Governing Body
Date of Meeting 27th June 2013
Commissioning Lead(s) Author(s) W Kerr
Purpose of the Report (Please select) Approval Assurance X Discussion
Key Points/Executive Summary
East Staffordshire CCG is currently showing a Year to Date surplus of £236k, compared to a planned surplus of £83k. The CCG is forecasting an outturn position of £500k surplus as per the budget plan approved in March. As at month two no reserves or contingencies have been released. Key issue arising from the month two report is the Specialised Services negative budget of £1.9m, representing the value remaining outstanding against the original £10m initially top sliced by NHS England. The shortfall in funding has not been phased in to the month two position (£317k) because CCG’s, Area Team and Specialised Services are still working to resolve the issue. As part of the 2013/14 plan submitted to the Area Team and NHS England the CCG has made it explicit that of the £6.6m QIPP it is the intent to deliver £4m recurrently in 2013/14, and the balance of £2.6m to be financially supported in year non recurrently by the 2% non recurrent reserve held. In recognition of this the CCG Governing Body needs to be assured regarding the delivery of the £3.1m identified (separate report within the QF&P agenda) and the requirement for additional schemes in excess of £0.9m to be identified. An opportunity search has commenced to identify potential areas for the delivery of £0.9m additional QIPP schemes; this information is due to be provided by SCSU by the end of June. As part of the South Staffordshire PCT Annual Accounts approval the level of continuing care provisions was increased by an additional £6m resource. However the PCT no longer has a surplus balance in which to transfer a legacy surplus share over to the CCG. The impact of this to ESCCG is £115k, currently not reflected within the position.
1 Author: W Kerr Date: 17/6/2013 East Staffs CCG
Recommendations (what is expected from the Board)
The Governing Body are asked to: • Be assured of the financial position being reported for ESCCG • Understand the context of the risks raised within the report.
Enclosures
Attached report.
2 Author: W Kerr Date: 17/6/2013 East Staffs CCG Finance Report Month 2 2013/14 (1 April 2013 – 31 May 2013)
1. Integrated Single Financial Environment. As part of CCG’s authorisation process it was made mandatory that all CCG’s would utilise the National financial systems offering provided by Shared Business Services. The impact of this has been that a totally new ledger system has had to be implemented with effect from the 1st April 2013, this has resulted in new Coding Structures. Processes for Payments, Sales Invoicing and Cash management. Reporting formats.
A Project team has been in operation during 2012/13 as part of the Staffordshire Customer Support unit (SCSU) to support implementation. A number of system processes remain to be resolved and these are being highlighted locally and nationally where appropriate.
The key benefit of the National system is that there is no longer a requirement to submit independent Financial Monitoring Returns since the CCG’s financial information is automatically extracted from the system. Hence it is important that the system produced accounts are robust and accurate and are aligned to the Governing Body’s financial reports. The Timetable for closure of the accounts each month is governed by a National Timetable which requires hard closure by the 7th working day of the month.
As at month two the Income and Expenditure Accounts have been produced, it is the intention from month three onwards to incorporate cash management, balance sheet and better payment policy reports. Interim resource has been allocated by SCSU to support East Staffordshire CCG and South East Staffordshire and Seisdon CCG in recognition of the support provided by the CCG’s SCSU finance team in the closure of PCT accounts, ensuring that as at the end of month three the monthly routine processes associated with a reporting cycle are all in place,
2. East Staffordshire CCG Financial Position for 2013/14 as at Month Two.
2.1. East Staffordshire CCG is currently showing a Year to Date surplus of £236k, compared to a planned surplus of £83k giving an overall favourable variance of £153k. The CCG is forecasting an outturn position of £500k surplus as per the budget plan approved in March. Forecasting will be incorporated within the reports but as at month two it is too early to identify any significant trends emerging.
2.2. Table one below highlights the CCG’s Anticipated Revenue Resource Allocation, against which the CCG’s Financial Plans for 2013/14 have been based upon.
3 Author: W Kerr Date: 17/6/2013 East Staffs CCG
Table One – ESCCG Revenue Resource Limit.
The return of the £115k surplus may be at risk due to the impact of the late adjustment to 2012/13 Financial Accounts relating to the continuing care retrospective provision. This is on the agenda for discussion at the next Cluster Chief Finance Officers meeting.
2.3. Table two below shows the CCG’s Summary position as at the end of Month two (1st April to 31 May 2013).
Table Two – Financial Overview Month Two (Period 2).
4 Author: W Kerr Date: 17/6/2013 East Staffs CCG As at month two no reserves or contingencies have been released. The value for the QIPP represents the value remaining outside of contracts of the CCG’s £6.6m QIPP requirement.
3. Acute Commissioning Table three below showing the Acute Commissioning Analysis.
Table Three –Acute Commissioning Month Two (Period 2).
3.1. Key issue arising from the month two report is the Specialised Services negative budget of £1.9m, representing the value remaining outstanding against the original £10m initially top sliced by NHS England. The £1.9m represents the value which has not been reconciled with an equal and opposite adjustment to provider’s contract values arising from the transfer of key functions to Specialised Services. The shortfall in funding has not been phased in to the month two position (being £317k) because CCG’s, Area Team and Specialised Services are still working to resolve the issue.
It has been agreed via Area Teams within the West Midlands that external resources be brought in to review the Specialised Services reduction and to provide clarity as to why a number of CCG’s across the West Midlands remain with a negative budget relating to the Specialised Services transfer. The Specialised Services -£1.9m is being flagged as a financial risk to NHS England and Staffordshire and Shropshire Area Team as part of the monthly narrative reporting being submitted. The CCG does not have a contingency to cover this risk element and have communicated this to the Area Team. An update will be provided as part of month three report.
3.2. It should be noted that only one month’s contract monitoring has been received to date which is currently in the process of being fully validated by SCSU, no significant areas of concern have been highlighted.
5 Author: W Kerr Date: 17/6/2013 East Staffs CCG 3.3. The main under spend being reported based on April’s Activity data relates to under performance at Burton which is due to the phasing of the monies allocated for the back log elective waiting list and therefore it is anticipated this will be corrected at month three when the majority of the 18 week activity will be delivered.
3.4. West Midlands Ambulance Trust is showing over performance of £10k at month one, this is ESCCG risk share of the overall ambulance contract with the other CCG’s being South East Staffordshire and Seisdon, Cannock, Stafford and Surround. However it should be noted that ESCCG was reporting under performance of £9k, where as the other CCG’s are reporting over performance prior to the application of the risk sharing agreement.
3.5. University Hospital Birmingham and University Hospital North Staffs (UNHS) both showing £16k overspend as based on activity data at month one, expenditure across a number of specialties in particular critical care for UNHS.
3.6. An update is to be provided by Stafford and Surround CCG regarding the continuing care position, this is due at the end of quarter one.
3.7. A separate report has been written regarding an update relating to the continuing care retrospectives provision carried forward from the legacy South Staffordshire PCT.
4. Primary Care
Table four below shows Primary Care Expenditure as at the end of Month Two (Period 2).
Prescribing information will not be available until July and actuals have been aligned with budget plans until monitoring information is available.
5. CCG Running Costs.
The CCG has a running cost envelope of £25.00 per head of population. Table five below shows the CCG to have a small under spend as at month two, which in the main relates to non pay under spends on general administrative expenditure.
6 Author: W Kerr Date: 17/6/2013 East Staffs CCG
Table 5 Running Costs as at Month Two (Period 2).
6. QIPP The CCG as part of its Financial Plan for 2013/14 requires £6.6m of QIPP savings. To date the CCG has identified plans amounting to £3.1m of which the majority have been incorporated within 2013/14 contracts, therefore leaving £3.5m to be identified. Table one within the report shows £3.7m which consists of £3.5m to be identified and £200k relating to a variation order to be actioned for Cardiology against University Hospital Leicester as a result of the opening of the catheter laboratory at Burton Hospital Foundation Trust.
6.1. As part of the 2013/14 plan submitted to the Area Team and NHS England the CCG has made it explicit that of the £6.6m it is the intent to deliver £4m recurrently in 2013/14, representing 3% of the CCG’s Recurrent Revenue Resource, and the balance of £2.6m to be financially supported in year non recurrently by the 2% non recurrent reserve required to be held, which amounts to £2.7m, therefore offsetting each other in 2013/14. The plans recognise that QIPP programmes above 3% would be challenging and therefore unlikely to be delivered in year.
6.2. The financial plan for 2014/15 recognises the requirement for £2.6m of the 2013/14 QIPP to be recurrently carried forward. All financial plans submitted relating to 2013/14 have made this implicit along with discussions with the Area Teams Director of Finance. The Area Teams Director of Finance has confirmed that this has been acknowledged and to proceed on this basis, no feedback has been received by the Area Team to the contrary at this stage of the process.
6.3. In recognition of this the CCG Governing Body needs to be assured regarding the delivery of the £3.1m identified (separate report within the QF&P agenda) and the requirement for additional schemes in excess of £0.9m to be identified and delivered in year, thereby allowing for any in year slippage.
7 Author: W Kerr Date: 17/6/2013 East Staffs CCG 6.4. An opportunity search has commenced to identify potential areas for the delivery of £0.9m additional QIPP schemes; this information is due to be provided by SCSU by the end of June.
7. Continuing Care Retrospectives Claims
In March 2012 the DH gave notification of the intention to introduce a close down for any new cases to the system which require assessment of eligibility for NHS Continuing Healthcare (NHS CHC) funding. This close down applies to episodes of care which occurred during the period 1st April 2004 to 31st March 2012. The Staffordshire and Stoke on Trent PCTs (Staffordshire Cluster) received a significant number of retrospective claims and these are currently being processed and reviewed by the Continuing Care teams in the Staffordshire Commissioning Support unit.
In order to be fully compliant with the Accounting Standard that deals with Provisions and Contingent Liabilities, the Staffordshire Cluster PCT’s took into consideration a number of key factors, in particular history of success of probability of different types of claims, average of number of weeks and average costs of successful claims, to determine the correct level of provision required for 2012/13 accounts. Based on the original assessment a total provision within 2012/13 draft accounts for South Staffordshire PCT was £596k.
As part of the external audit review the auditors challenged the length of period being used by each PCT and requested an amendment to the calculation to reflect the historical length of claim being experienced by each PCT. This resulted in a changed from 12 weeks to 168 weeks increasing the provision requirement from £596k to £7.3m a movement of £6.7m.
Funding to support this movement was generated by an additional resource limit allocation of £6m and a reduction to the PCT’s control total surplus to zero.
The implications to the CCG’s resulting from the late adjustment are:
• A significant provision now exists to cover the retrospective claims., whether this is sufficient or not only will be identified as the assessments are completed, but it should be recognised that this provision does provide a significant risk cover margin to that previously provided within the draft accounts.
• These provisions will transfer as per the assets and liabilities guidelines to CCG’s. ESCCG should therefore receive as part of the legacy Balance Sheet transfers its capitated share of the overall SSPCT provision.
• No payback on the additional Revenue Resource support is required.
• The CCG cannot benefit from the provision in the future if the additional provision is too high.
• The PCT no longer has a surplus balance in which to transfer a legacy surplus share over to the CCG. The impact of this to ESCCG is £115k which was previously anticipated within the 2013/14 Budget Plans. Consideration will need to be given as to whether this addressed with additional QIPP schemes or supported via the contingency funds.
8 Author: W Kerr Date: 17/6/2013 East Staffs CCG • CFO’s are to receive an update at the next CFO’s meeting with the Area Team Director of Finance at the end of June, updates will be provided if any further changes have an impact on ESCCG.
8. Memorandum of Understanding
ESCCG are party to a Memorandum of Understanding (MOU) jointly with South East Staffordshire and Seisdon, Cannock and Stafford and Surround CCG’s. Aim of the MOU is to ensure that no one organisation suffers a financial detriment at the benefit of another due to budgets not being allocated correctly when the resource baseline was undertaken in July 2012. As a result to date £1.5m of expenditure has been identified requiring transfer to ESCCG, this is matched by equivalent expenditure but will impact on the Revenue Resource per head of population available for ESCCG residents. It is proposed that the transfer of budgets takes place in June; subject to the process being in place to undertake this, if not then the transfer will be undertaken at the earliest opportunity.
9. Risk/Mitigation actions
Risk Mitigating Actions Level Specialised Regular agenda item at Area Team/CFO meetings. High Services Agreement for external review to be undertaken West Midland’s wide, awaiting outcome of findings.
OOH Legacy pensions issues awaiting outcome of review to Medium be known September 2013. Engaged actuary to undertake assessment. Informed Area Team of Legacy issue. 111 Additional funding incorporated in 2013/14 financial Medium plan for 111above known requirements. Regular review of financial position undertaken based on new information received. Delivery of £6.6M 2% non recurrent fund representing £2.7m available QIPP financial to offset minimum £2.7m recurrent QIPP savings requirements in 2013/14. Contract negotiations incorporate majority of the £3.1m of QIPP schemes identified, and CQUINS have been aligned to the QIPP schemes for Burton Medium and SSOTP. Discretionary investments funds to be held to support any shortfall in potential delivery of in year QIPP requirements. Local and national contingencies funds available Governance arrangements for the monitoring of QIPP schemes via QIPP Programme Board and QIPP, Finance and Performance Committee. Opportunity search taking place by SCSU to support further identification of QIPP Schemes.
Managing acute Contracts Activity for 2013/14 included growth uplift trust activity and recognised 2012/13 over performance levels. within agreed Continuing care 12% uplift above 2012/13 outturn contract performance (based on month 10).
9 Author: W Kerr Date: 17/6/2013 East Staffs CCG values/Continuing Local and national contigency fund available Care CCG regular monitoring of contract performance. Apply contract terms in full (18 wks, fines,penalties, CQUINS) Medium Sharing with CCG practices information /benchmarking. Follow up where appropriate using Practice Integration role. Click view being rolled out for practices to deep dive into data where required
Prescribing Practice visits for top eight practices with the highest Budgets savings required to be delivered to ensure engaged in Overspend the process. Medicines Management Team supporting practices in achievement of QIPP and management of practice Medium budgets. Benchmarking data/reports shared. Budgets monitoring at practice level and information reviewed at QIPP Programme Board and QIPP, Finance and Performance Committee. Budgets uplifted by 5% prior to savings plans identified and communicated to practices.
Recommendation:-
The Governing Body are asked to: • Be assured of the financial position being reported for ESCCG. • Understand the context of the risks raised within the report.
10 Author: W Kerr Date: 17/6/2013 East Staffs CCG
Title ESCCG Performance Report Month 1 2013/14
Reporting to Governing Body
Date of Meeting 27th June 2013
Management Lead(s) Author / Co-Author Wendy Kerr / Sarah Laing Paul Winter
Purpose of the Report (please select) Approval Information Discussion
Key Points / Executive Summary
This is the first ESCCG-specific report, outlining current performance against a range of national outcome measures (performance targets). This new style report was agreed by the QIPP, Finance and Performance Committee in April. It has been updated where data is currently available. There is a time-lag in several areas owing to current constraints with national data availability (e.g. Cancer Waiting Times) and CSU Business Intelligence data provision owing to national ‘Section 251’ difficulties.
Exception Reports provide an overview of the actions being taken in areas of under-performance in the “Quality & Safety” and “NHS Constitution” Dashboards. A summary of current performance against these principal, nationally or locally-defined (contractual) outcome measures in 2013/14 indicates the following non-achieving areas:
18 Week Waits (RTT): ESCCG “Admitted” patients at all Providers, but predominantly BHFT 52 Week Wait: one specialised services patient at Robert Jones & Agnes Hunt Orthopaedic A&E 4-hour Waiting Times at BHFT Mixed-Sex Accommodation & Cancelled Operation breaches at BHFT Pressure Ulcers Reduction at BHFT
All other targets are by definition currently on track.
Purpose of the Paper and Recommendations (what is expected from the Committee)
The Governing Body is provided with these reports for assurance regarding Performance Management. This will help retain an active grip on performance issues, whether those affect the CCG or Providers, in the areas that the CCG is held to account for delivery by the Area Team.
The Committee is asked to:
- Acknowledge and discuss the performance issues reported in the Performance Report;
- Be assured that the Exception Reports for each under-performing area provide satisfactory assurance.
Enclosures
11.1 - Month One Performance Report 2013/14
ESCCG Performance Report 2013-14 "Balanced Scorecard" Summary (Areas 1 to 5 are from the CCG Assurance Document)
Are local people getting good AG Are patient rights under the NHS 1 2 quality care? Constitution being promoted? AR CCG Report Are health outcomes improving for To be assessed at end Q1 Are CCGs commissioning services AG 3 4 work- local people? (July) within their financial allocations? sheets Are CCG authorisation conditions 3.11 - B 3.1.1 - C Delivery of CCG Strategy: clinical Systems QIPP 5 6 being addressed / removed? 6.3 - A 6.4 - E priorities & QIPP
"Quality Premium"Analysis NB: NHS England reserves the right not to pay regardless of performance if there's been a serious quality failure in 13/14 ESCCG Population = 133,065; QP payment = £5 per head of population: maximum possible QP payment = £665,325
CCG manages within its Total Resources for 2013/14? Step One YES NO [this is a de minima pre-qualifying criterion] CCG reduces Potential Years of Life Lost (COF Domain 1) Step Two £83,166 £0 QP payment [this qualifies for 12.5% of the total QP] CCG reduces Avoidable Emergency Admissions (COF Domains 2&3) Step Three £166,331 £0 QP payment [this qualifies for 25% of the total QP] CCG rolls out F&FT; improves patient experience (COF Domain 4) Step Four £83,166 £0 QP payment [this qualifies for 12.5% of the total QP] CCG has 0 MRSA cases; achieves C.Diff target (COF Domain 5) Step Five £83,166 £0 QP payment [this qualifies for 12.5% of the total QP] CCG achieves it's Local Priority #1 target (LTCs prevalence reporting) Step Six £83,166 £0 QP payment [this qualifies for 12.5% of the total QP] CCG achieves it's Local Priority #2 target (DTOCs reduction) Step Seven £83,166 £0 QP payment [this qualifies for 12.5% of the total QP] CCG achieves it's Local Priority #3 target (Dementia prescribing: anti-psych) Step Seven £83,166 £0 QP payment [this qualifies for 12.5% of the total QP] CCG achieves all Constitution targets (RTT incompletes, A&E 95%, Step Seven £665,325 - X% £0 QP payment 62-d cancer waits, Cat As < 75 mins) - lose 25% of earned QP for each failure Summary East Staffs CCG - Clinical Quality & Patient Safety NHS England - CCG Assurance Framework [judgement based on numbers of standards not met by the CCG] Are local people getting good quality care? GREEN: all = "No" response; G A R AMBER/GREEN: One or more "Yes" responses but action plan in place mitigates risks; Between standard / Below 95% variance or At or above standard / AMBER/RED: One or more "Yes" responses & no plan in place / plan not mitigating risk; threshold & 95% A for 2 consecutive threshold RED: CQC, Monitor or TDA enforcement action, CCG not engaged in action planning to address risk; variance months
INDICATOR OUTCOME Commissioned Providers (CCG as Lead or Principal Associate Commissioner) BHFT SSSHFT SSOTP Has the local Provider been subject to enforcement action by CQC? N N N Is Provider a Monitor "quality compliance risk" &/or requirements re. licence conditions breaches? N N N Is Provider subject to NHS Trust Development Authority enforcement action based on "quality" risk? N N N Does feedback from the Friends & Family Test (or other patient feedback) indicate any causes for concern? Y 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: MRSA cases are above zero? N N N Do Provider level indicators from the NQD show: C.Diff cases above Provider plan? N N N Do Provider level indicators from the NQD show that: MSA cases are above zero? Y N N Does the Provider currently have any unclosed Serious Untoward Incidents (SUIs)? Y Y Y Has the Provider experienced any "Never Events" during the last quarter? N N N Overall Rating: are local people getting good quality care? Amber-Green Amber-Green Amber-Green ESCCG Clinical Governance Does the CCG have any outstanding conditions of authorisation in place on clinical governance? N CCG self-assessed & identified any risks re. concerns over quality issues discussed by GB regularly? Y CCG self-assessed & any risks re. proactive identification of early warnings of service failure? N CCG self-assessed & any risks re. arrangements for dealing with/learning from SUIs & Never Events? N CCG self-assessed & any risks re. concerns re. active participation in Quality Surveillance Group? N EPRR - where an emergency event occurred in last quarter did the CCG self-assess / identify any concerns re. N arrangements for dealing with it? Winterbourne View - has the CCG self-assessed & identified any risk to progress against its action plan? N
Overall Rating: are local people getting good quality care? Amber-Green
Quality & Safety 2 ESCCG Quality Dashboard (data presented for Burton Hospitals FT unless otherwise stated) Latest Monthly or Quarterly Performance Quality Requirement Threshold Trend Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total 'Never Events' (No.) Zero - VTEs prophylaxis (%) 100% 99.3% VTE RCAs (No.) 100% - Total MRSA cases (No.) 0 = 0 Total C.Diff cases (No.) 32 = 1 Total Complaints (No.) Reduction 41 Total PALs contacts (No.) - 341 PSED compliance 100% complete - Total Incidents (No.) Reduction 411 Total Serious Incidents (No.) Reduction 21 Total 'EMSA' breaches (No.) Zero 10 Quality Visits (Ann / Unann No.) Min 4 / 2 = 1 Mortality: Dr Foster (ratio) 100 - no data Mortality: HSMR (ratio) 100 - 109 Mortality: SHMI (ratio) 100 - no data Mortality: CHKS (ratio) 100 - no data Mortality: post surgery (ratio) 100 - no data Mortality: weekend (ratio) 100 - no data Quality assurance (ward metrics) Improvement - Safeguarding incidents Reduction - Pressure Ulcers (No. Level 2) Reduction 24 Pressure Ulcers (No. Level 3-4) Reduction 6 "Duty of Candour" audits 100% complete - no data "Friends & Family Test" (adult+acute) Improvement 75 Realtime Experience (overall) Improvement - 85 52 week waits Zero 52wk+ = 0 Trolley Waits in A&E Zero 12hr+ = 0 Urgent ops cancelled (2nd time) Zero = 0 Breastfeeding on discharge 68.5 - 70% - 68.5% 69% 69.5% 70% Time on stroke unit 80% 77.4% TIAs scanned / treated 60% <24 hrs 72.7%
Quality & Safety 3 Latest Monthly or Quarterly Performance Quality Requirement Threshold Trend Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar A&E unplanned reattendances < = 5% 6.1% A&E left w/out being seen rate < = 5% 2.4% Time to A&E assessment 95% <15mins = 25 mins Time to A&E treatment Ave < 60 mins 65 mins Minimise Delayed Discharge < = 3.5% 2.9% MRSA screening: electives 100% 92.8% MRSA screening: non-electives 100% 88.5% Clinic Letters sent < 5 days 100% - 88% Time to surgery #FNOF 100% < 48hrs 92.9% Catheter care improvement plan > = 95% - no data Patient falls reduction < 27 0
Quality & Safety 4 East Staffs CCG Delivery of the NHS Constitution
NHS England - CCG Assurance Framework [judgement based on numbers of standards not met by the CCG] Is the NHS Constitution being delivered? G A R Below lower GREEN: No indicators rated Red ; AMBER/GREEN: No indicator rated Red but future concerns; Between standard & At or above standard threshold or A x2 lower threshold AMBER/RED: One indicator rated Red ; RED: Two or more indicators rated red; consecutive months
Lower Latest Monthly Performance Standard Indicator Standard Trend Threshold Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar met? Referral to Treatment (RTT) waiting times for non-urgent, Consultant-led treatment Admitted patients starting treatment within 90% 85% 79.1% N max 18 weeks from referral Non-admitted patients starting treatment 95% 90% 98.6% Y within max 18 wks from referral Incomplete pathway patients (yet to start 92% 87% 95.2% Y treatment) do not wait > 18 wks Number of patients waiting more than 52 0 10 1 N = weeks Diagnostic test waiting times Patients waiting for a diagnostic test should 99% 94% 99.78% Y not wait > 6 weeks from referral A&E waiting times Patients admitted, transferred or discharged 95% 90% 91.31% N < 4 hours of arrival at A&E (BHFT) Cancer waiting times - maximum 2 week (14 days) waits for first outpatient appointment, for all patients referred urgently Patients referred by a GP with suspected Due end 93% 88% Y - cancer June Patients with breast symptoms (where Due end 93% 88% Y - cancer wasn't initially suspected) June Cancer waiting times - maximum 1 month (31 days) waits from diagnosis to first or subsequent treatment From diagnosis to first definitive treatment, Due end 96% 91% Y - all cancers June For subsequent treatments where that Due end 94% 89% Y - treatment is surgery June For subsequent treatments where that Due end 98% 93% Y - treatment is an anti-cancer regimen June For subsequent treatments where that n/a for n/a for n/a for n/a for n/a for n/a for n/a for n/a for n/a for n/a for n/a for n/a for 94% 89% - - treatment is a course of radiotherapy BHFT BHFT BHFT BHFT BHFT BHFT BHFT BHFT BHFT BHFT BHFT BHFT
NHS Constitution 5 East Staffs CCG Delivery of the NHS Constitution
NHS England - CCG Assurance Framework [judgement based on numbers of standards not met by the CCG] Is the NHS Constitution being delivered? G A R Below lower GREEN: No indicators rated Red ; AMBER/GREEN: No indicator rated Red but future concerns; Between standard & At or above standard threshold or A x2 lower threshold AMBER/RED: One indicator rated Red ; RED: Two or more indicators rated red; consecutive months
Lower Latest Monthly Performance Standard Indicator Standard Trend Threshold Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar met?
Cancer waiting times - maximum 2 month (62 days) waits from referral to first definitive treatment (* denotes locally-agreed standard in CCG contracts) Due end For urgent GP referrals for cancer 85% 80% Y - June
For referrals from an NHS screening service Due end 90% 85% Y - for all cancers June Following Consultant decision to upgrade Due end 95% * 90% * Y - patient priority, all cancers June Category A ambulance calls - targets are reported at ESCCG / Staffordshire patch / Area Team levels, but only performance managed at the latter Cat A calls resulting in an emergency 69.2% 75% 70% 81.9% Y response arriving < 8 minutes (Red 1) 78.6% Cat A calls resulting in an emergency 76.1% 75% 70% 76.1% Y response arriving < 8 minutes (Red 2) 76.6% Cat A calls resulting in an ambulance arriving 95% 90% 96.4% Y at scene within 19 minutes Mixed Sex Accommodation breaches: ESCCG-wide position reported as 1st number, Burton Hospital as 2nd owing to CCG Lead Commissioner arrangement Minimise breaches 0 > 10 6 / 10 N Cancelled Operations (* denotes locally-agreed standard with Burton Hospital, not assessed by NHS England in CCG Assurance Framework) Patients who have operations cancelled on or after the day of admission (inc. day of surgery) for non-clinical reasons, offered another binding 100% * 100% * 99% N date < 28 days or treatment to be funded at the time & hospital of the patient's choice Mental Health Care Programme Approach (CPA): the % of people in adult mental illness specialties on CPA 95% 90% 100% Y followed up < 7 days of discharge from (SSSHFT) psychiatric inpatient care during the period
Overall CCG Assurance Framework Rating: is the NHS Constitution being delivered? Amber - Red NHS Constitution 6 East Staffs CCG Delivery of the Financial Framework
Area Team - CCG Assurance Framework Tool [judgement to be confirmed] Are CCGs commissioning services within their financial allocations? G A R GREEN: ; To be defined. However an overall Green rating can only be AMBER/GREEN: ; achieved if all primary indicators are individually Green. 2 or more See individual See individual See individual AMBER/RED: ; would lead to an overall Red rating. Qualified Audit opinion would indicators below indicators below indicators below RED: ; lead to an overall Red rating.
Financial Performance Individual indicator RAG rating threshold No. Indicator (P = Primary / S = Supporting) Green Amber / Green Amber / Red Red 1 Underlying recurrent surplus P >= 2% 1% - 1.99% 0% - 0.99% < 0% 2 Surplus - year to date performance P >= 1% >= 0.8% >= 0.5% < 0.1% 3 Surplus - full year forecast P >= 1% >= 0.8% >= 0.5% < 0.1% 4 Management of 2% non-recurrent funds within agreed processes S Yes No 5 QIPP - year to date delivery P >= 95% of plan >= 80% of plan >= 50% of plan < 50% of plan 6 QIPP - full year forecast P >= 95% of plan >= 80% of plan >= 50% of plan < 50% of plan 7 Activity trends - year to date S < 101% of plan < 102% of plan < 103% of plan < 104% of plan 8 Activity trends - full year forecast S < 101% of plan < 102% of plan < 103% of plan < 104% of plan 9 Running costs P <= RCA > RCA 10 Clear identification of risks against financial delivery & mitigations P Fully met Partial / Ltd Risk Partial / Material Risk Not met Financial Management Individual indicator RAG rating threshold 11 Internal / External Audit opinion + assessment of returns timeliness S tbc tbc tbc tbc 12 Balance Sheet indicators inc. cash management & BPCC S tbc tbc tbc tbc (3) Current YTD forecast surplus is in the "Amber - Red" range (0.5%), yet our performance is on track / target for the agreed position with the Area Team, which is why this is traffic-lighted as "Green"
£s, QIPP & Activity 7 QIPP [Summary Dashboard Performance against CCG Plan]
Scheme Lead Elements to be actioned, some risk, Not achieved (> 5% (Q = QIPP / T = Achieved RAG 2013/14 Target (£s) within 5% variance from target) Transactional) Mgr
GP/Exec X from target
System Efficiencies Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Mental Health: £ Target 77000 ------Full-Year Effect QT - - 77,000 13/14 Actual 77000 ------
Mental Health £ Target 81000 ------QT - - 81,000 Project Fiarrs Actual 81000 ------
£ Target 50000 ------HUB T - - 50,000 Actual 50000 ------
£ Target - - - - - 20286 20286 20286 20286 20286 20286 20286 POLCV QT 142,000
T Jones T Actual Dr Wai Lim Wai Dr - - - - -
0 Length of Stay: £ Target 34000 ------QT - - 34,000 children Actual 34000 ------
Nursing Home £ Target 126000 ------T - - 126,000 Project Actual 126000 ------
Wolverhampton £ Target - - 420000 ------T - - 420,000 transfer Actual ------
Loan Equipment £ Target 35000 ------T - - 35,000 Tender Actual 35000 ------
£ Target - - 12500 - - 12500 - - 12500 - - 12500 Fines & Penalties T 50,000 W Kerr T Jones T Actual 13000 7500 ------
£s, QIPP & Activity 8 Scheme Lead Elements to be actioned, some risk, Not achieved (> 5% (Q = QIPP / T = Achieved RAG 2013/14 Target (£s) within 5% variance from target) Transactional) Mgr
GP/Exec X from target
Unbundling £ Target - - 50000 - - 50000 - - 50000 - - 50000 T 200,000 W Kerr
Cardiology transfer Jones T Actual - -
£ Target - - 15000 - - 15000 - - 15000 - - 15000 T-Codes T 60,000 W Kerr T Jones T Actual 5000 5000
£ Target 403000 0 497500 0 0 97786 20286 20286 97786 20286 20286 97786 Programme Sub-Total 1,275,002 Actual 421000 12500
Staying Well in Later Life / LTCs Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
End of Life (no £ Target 2500 2500 2500 2500 2500 2500 2500 2500 2500 2500 2500 2500 procedure / Q no data yet no data yet trauma) Actual from CSU from CSU Activity 30,000 KPI = reduction of 1 hospital -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 Dr J Tansey Target death per month compared no data yet no data yet to (vs.) 12/13 Actual from CSU from CSU
Urgent Care: inc. £ Target 25963 25963 25963 51925 51925 51925 77888 77888 77888 104017 104017 104638 Q LTCs no data yet Actual 22906 from CSU KPI = monthly position on Activity -81 -81 -81 -163 -163 -163 -244 -244 -244 -326 -326 -326 total non-elective Target admissions, inc. comparison no data yet Actual 53 to plan from CSU % Target KPI = 95% A&E target at 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 780,000 Burton Hospital FT T Jones T Actual
Dr Wai Lim Wai Dr 91.3% 96.7%
Target KPI = Zero 12-hour trolley 0 0 0 0 0 0 0 0 0 0 0 0 waits at Burton Hospital FT Actual 0 0 Activity KPI = A&E attendances per Target 1000 population no data yet Actual 21.0 from CSU
£s, QIPP & Activity 9 Scheme Lead Elements to be actioned, some risk, Not achieved (> 5% (Q = QIPP / T = Achieved RAG 2013/14 Target (£s) within 5% variance from target) Transactional) Mgr
GP/Exec X from target
Staying Well in Later Life / LTCs Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Activity KPI = A&E admissions per Target 1000 population no data yet no data yet Actual from CSU from CSU Activity KPI = reduction in ACS Target Chronic admissions to no data yet no data yet hospital (CCG-wide) Actual from CSU from CSU £ Target - - - - 6081 6081 6081 6081 6081 6081 6081 6081 Frail Elderly Q 49,000
Dr E Gunn Dr Actual - - - - N Harkness
£ Target - - - - 10273 10273 10273 10273 10273 10273 10273 10273 Falls Q 82,000
Dr E Gunn Dr Actual - - - - N Harkness KPI = reduce by 4 non- Activity elective admissions per - - - -4 -4 -4 -4 -4 -4 -4 -4 Target 82,000 month vs. 12/13: Falls & Hip
Dr E Gunn Dr Actual - - - - Fracture, ages 65+ N Harkness Target 28463 28463 28463 54425 70800 70800 96763 96763 96763 122892 122892 123513 Programme Sub-Total 941,000 Actual 22906
Outpatient Redesign Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Ophthalmology: £ Target 47000 ------12/13 Full-Year Q Impact Actual 47000 ------106,000
T Jones T £ Target Ophthalmology: Lim Wai Dr - - - 4444 4444 4444 4444 4444 9194 9194 9194 9194 Q 13/14 Actual - - -
£s, QIPP & Activity 10 Scheme Lead Elements to be actioned, some risk, Not achieved (> 5% (Q = QIPP / T = Achieved RAG 2013/14 Target (£s) within 5% variance from target) Transactional) Mgr
GP/Exec X from target Activity - - - -11 -11 -14 -14 -11 -29 -29 -29 -29 OP Target KPI = reduction of FA Actual - - - Ophthalmology OP Firsts & Activity 106,000 Follow-ups vs. 12/13 Jones T
Dr Wai Lim Wai Dr - - - -80 -80 -91 -91 -80 -128 -128 -128 -128 OP Target FU Actual - - -
Target 47000 - - 4000 4000 5000 5000 4000 9000 9000 9000 9000 Programme Sub-Total 106,000 Actual 47000
Primary Care / Medicines Management Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Target 94463 48096 70096 67846 74846 74646 53584 59584 53584 53584 59584 56584 Programme Sub-Total 773,000
SB / ME SB Actual 90253.2 46451.6 Dr J Tansey
2% Non-Recurrent (reserve) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Target 0 0 0 0 0 0 0 0 0 0 0 2700000 Programme Sub-Total 2,700,000
W Kerr W Kerr Actual
Yet to be Identified QiPP Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Target 0 0 0 0 0 0 150000 150000 150000 150000 150000 150000 Fines & 900,000 10000 Penalties Target 0 0 0 0 0 0 150000 150000 150000 150000 150000 150000 Programme Sub-Total 900,000 Actual 10000
13/14 YTD M1 YTD M1 YTD M1 £000s Target Actual Variance Subtotal of QIPP schemes: identified 3,095 £570,426 £581,159 £10,733 Subtotal of QIPP schemes: yet to be identified 900 £0 £10,000 £10,000 2% Non-Recurrent 2,700 £0 £0 £0 Total QIPP Performance as at M1 6,695 £570,426 £591,159 £20,733
£s, QIPP & Activity 11 Contract Activity [Performance against Plan - East Staffs Acute Activity Trend Analysis]
ESCCG Patient Activity: A&E - at Burton & Derby Hospitals FTs
£s, QIPP & Activity 12 ESCCG Patient Activity: Elective and Non-Elective Inpatients - at Burton & Derby Hospitals FTs
£s, QIPP & Activity 13 ESCCG Patient Activity: Outpatients - at Burton & Derby Hospitals FTs
£s, QIPP & Activity 14 East Staffs CCG Authorisation Conditions & Assurance of Organisational Health / Capability
NHS England / Area Team (AT) - CCG Authorisation Conditions
Quarterly NHSE Checkpoint Update Criteria Proposed Condition ESCCG Action Required (c/o Rectification Plan) Q1 Q2 Q3 Q4
• Integrated Plan meets authorisation requirements Recovery Plan CCG must have a clear and credible integrated plan that submitted to AT: 3.1.1 - B • Work with key stakeholders on strategic vision meets authorisation requirements condition to • Planning assurance in line with ‘Everyone Counts’ remain until Q2
CCG must have detailed financial plan that delivers • Detailed Financial Plan that: Recovery Plan financial balance, sets out how it will manage within its - delivers financial balance submitted to AT: 3.1.1 - C management allowance, and is integrated with the - sets out how CCG will manage within management allowance condition to commissioning plan - is integrated with the commissioning plan remain until Q2
Provide evidence that the proposed Accountable Officer • Provide a copy of the AO’s appointment letter upon Letter provided 6.3 – A (AO) has been selected in line with national role outline, receipt from the CSU HR Function to AT attributes and competencies
• Gov Body Skills Audits (anonymised) All bar PDPs CCG must demonstrate that it has assessed the skills • Other outcomes from Gov Body OD Away Day supplied: 6.4 - E possessed by Governing Body members and has a plan to expected to be • Revised, Gov Body-approved OD Plan build Governing Body competencies / skills where required cleared at Q1 • Individual PDPs (anonymised) review
CCG Conditions 20 Area Team - CCG Assurance Framework Tool [judgement to be confirmed - under development]
Domain 1: A clinical and multi-professional focus, with quality central to the organisation NHSE Assurance Required = Quality is at the heart of governance, decision-making & planning arrangements; with examples of the CCG delivering local quality improvements. Member Practices are involved in making and implementing decisions. Views / input are sought, heard and valued from a range of professionals across all providers, not just GPs.
ESCCG Evidence = to be supplied when assessment aspects are confirmed by national CCG Development Working Group
Domain 2: Good engagement with patients / the public, listening to what they say & truly reflecting their wishes NHSE Assurance Required = The CCG is an active member of its Health + Wellbeing Board & sees engagement with patients / carers / members of the public & developing an open / transparent culture, as intrinsic to what it does. Examples of how CCG systematically monitors and acts on patient feedback, particularly in identifying quality issues.
ESCCG Evidence = to be supplied when assessment aspects are confirmed by national CCG Development Working Group
Domain 3: A clear + credible plan over the medium-term to deliver great outcomes within budget, which has been determined in partnership locally & reflects the priorities of the health + wellbeing strategy NHSE Assurance Required = The CCG has detailed financial plan that delivers against the finanical business rules, sets out how it will manage within its management allowance & is integrated with its commissioning plan. The CCG can demonstrate progress / delivery against its plan. There are ongoing discussions between the CCG, its neighbouring CCGs and provider organisations about long-term strategy + plans. Member Practices understand the local plans / priorities & are engaged in their delivery.
ESCCG Evidence = to be supplied when assessment aspects are confirmed by national CCG Development Working Group
Domain 4: Proper constitutional / governance arrangements & the capacity / capability to deliver all CCG duties + responsibilities including:
NHSE Assurance Required = (a) ability to manage all aspects of quality; (b) ability to commission the full range of services; (c) use of information to deliver an open & transparent culture; (d) financial control & capacity; (e) environmental & social sustainability.
ESCCG Evidence = to be supplied when assessment aspects are confirmed by national CCG Development Working Group
Domain 5: Collaborative arrangements with other CCGs, local authorities + NHS England, appropriate commissioning support & good partnership relationships with the CCG's providers
NHSE Assurance Required = The CCG has deep collaborative ties to their local authority, clinical senates + area teams; with shared governance of joint commissioning with area teams & where relevant, strong integrated commissioning with their local authority partner. The CCG has developed a strong / insightful working partnership with the local Health + Wellbeing Board. CCG has contract in place with an assured commissioning support services provider & can articulate clear plans for its commissioning support services between 2013 - 2016.
ESCCG Evidence = to be supplied when assessment aspects are confirmed by national CCG Development Working Group
Domain 6: Great leaders who individually & collectively can make a real difference NHSE Assurance Required = The CCG has individual / collective leadership who demonstrate commitment to partnership working & have the necessary skillset to lead commissioning + drive transformational change. Distributed leadership throughout the culture of the CCG / governing body means that there is extensive engagement & communication across Practices, with effective processes for two-way accountability in use. ESCCG Evidence = to be supplied when assessment aspects are confirmed by national CCG Development Working Group
CCG Conditions 20 East Staffs CCG - Performance Exception Reports Expected Outcome & Measure Issue Proposed Intervention (Method) Achievement Date As of the end of April, there continues to be some slippage reported against certain agreed actions within the agreed Remedial Action Plan: - Dedicated area for Rapid Assessment & Treatment (RAT), due Feb-13, rescheduled for June subject to capital works. BHFT is using alternate trolley spaces as a work-around The CCG continues to work with the Trust in - Review of current clinical pathways (acute medicine), due Feb-13, ongoing; achieving a common understanding as to increases in the numbers of admissions and a smaller Achievement of % rates as A&E - - Capacity for short-stay emergency patients (50 beds): even with 8 Acute Frailty Unit beds in increase in A&E attendances. The evidence suggests situ and early successes demonstrated, the Emergency Care Intensive Support Team (ECIST) per BHFT-originated patients a step change in admissions behaviour, not a surge recommended number of beds is not in place and there remain some issues around patient trajectory: seen within in attendances. However it is reported in the flows in this area. Further external assistance has been secured by the Trust to re-run the Quality Dashboard that unplanned reattendances 4 hours at Bed Modelling work previously undertaken; are increasing slightly, so this will be factored into - By 29.04.13 = 90% Burton ongoing discussions around the Action Plan. - By 20.05.13 = 92% Hospital - Ensuring each patient has a clear Case Management plan: due January and work is yet to be concluded by the Trust; - By 10.06.13 = 92% (BHFT) We will continue to jointly explore with the Trust - By 01.07.13 = 95% - Discharge and Social Care-related delays persist within the Local Health Economy (LHE), the thresholds for admission, the clinical decision- which are not helping with the flow of patients, especially those “pulled” out of the Trust by making process, and the pathways that patients Staffordshire & Stoke on Trent Partnership Trust (SSOTP) Discharge Teams; end up on through the hospital.
- CQUIN discussions being finalised for 2013/14 to aid delayed discharge flows across the LHE (sign-up at lead officer level has been achieved and the CQUIN proposal appears to be acceptable to both BHFT and SSOTP);
April 2013 performance data for all ESCCG patients is below 80% (79.1%); with the following Progression of the Elective and A&E Action Plans by Providers not achieving the target: BHFT (75.8%), Mid Staffs (75%), UHNS (85.7%), Derby BHFT is expected to ease the non-elective pressures 18 Weeks (84.2%), Uni Hospitals Leicester (88.2%), HEFT (50%) & Birmingham Children's (85.7%) that have a knock-on impact on elective care (bed Admitted & capacity, occupancy rates, surgery cancellations). Achievement of 90% rate by BHFT achieved 77.8% overall for all CCGs, which is a slight deterioration on the previous all BHFT specialties & overall Cancelled month (78.6% was achieved). However it is known that this is a "trade-off" from clearing the BHFT is working to try to reduce a backlog of as a Provider (for all Operations patient backlog, as already-breached patients will have been included in the activity, patients, currently waiting over 18 weeks, in order (at ESCCG / dragging overall performance down. Commissioners) by July 2013 to clear this as much as possible and to support BHFT) BHFT is working to an agreed Remedial Action Plan (which also includes cancelled routine delivery of the target. Numerous additional & operations as notified by a CCG Contract Query in March 2013: there were 3 operations theatre slots are being run to remove the backlog. 52-wk + cancelled in April not rescheduled within 28 days). waits There was one ESCCG patient waiting over 52 weeks - at the Robert Jones & Agnes Hunt The 13/14 Standard Contract has a £5k fine (ESCCG) Orthopaedic Hospital. CSU contract management team have advised this is a specialised mandated for any breaches: these will be pursued Zero 52-week plus waits as at services patient: Area Team are responsible for contractual intervention. A total of 110 by Area Team at the Provider to recoup this the end of April 2013 patients were waiting over 26 weeks (82 of whom are at BHFT). amount.
Exception Reports 17 East Staffs CCG - Performance Exception Reports Expected Outcome & Measure Issue Proposed Intervention (Method) Achievement Date
BHFT reported a total of 22 breaches of the national eliminating mixed-sex accommodation requirement in 2012/13. Many though related to patients being treated in Intensive Care or Mixed Sex High Dependency Units, which are not included in the standard national fine for breaches. CQRM meeting to discuss individual breaches - if in Accom- areas covered by the standard £250 per patient per Zero breaches in non- modation day fine, these will be enacted by the Contract April 2013 performance data for BHFT split by CCG is not yet available: however a total of 10 exemption areas by end Q1 Breaches (at Management Team. CQRM to check the increase in breaches were reported by BHFT in April and ESCCG had a total of 6 breaches reported by 2013/14 ESCCG / the DoH (a rate of 1.7 per 1000 finished consultant episodes). Receipt of the required numbers for Non-Intensive Ventilation to improve BHFT) analytical data and exception reports for those breaches occurring in non-exemptible areas working practices at the Trust. has not yet been received from BHFT either. This is being chased up through the Clinical Quality Review Meeting (CQRM) as a matter of urgency.
While not recorded as actual failures to deliver the requisite standards, the following is an update in order to brief on the data availability issue (which is an "exception" itself, applying the full definition).
Month 1 (April) data was not available at the time of writing the report - neither at CCG level CCG - BHFT Contract Review Board to discuss the Cancer nor from Burton Hospital. It should by now have been received for the latter. position with Cancer data availability at the June Data supply issues rectified Waiting meeting - improvements in the timeliness of data by BHFT in time for Month 2 Times (at Performance for the March, Quarter 4 and end of year 2012/13 for BHFT was generally very supply will be expected to help Commissioners (May) report - due in July. BHFT) good, with the targets being met in most cases. Only in the 62-waits category did monitor this particular area more closely and in a performance slip below standard levels. more "real time" way. BHFT achieved all the targets on a whole-year basis, which is why the traffic light is "green" for these standards for now, and no contractual intervention is required. However Month 1 data was needed to ascertain whether one would be for continuing the performance issue in 62-day waits.
CQRM meeting to discuss individual breaches Month 1 has seen a significant rise in the number of BHFT reported Grade 2 and Exception report & of supporting information provision by BHFT. Grade 3 & 4 Pressure Ulcers. Pressure Ulcers have been present in the "Top 5" improvement actions Pressure At the time of writing report, not all Trust- patient safety incidents routinely reported by BHFT for the last 3 months. information supply issues Ulcers (at originated exception reports were available. Furthermore, the Trust failed to achieve the necessary reduction targets in 2012/13 rectified by BHFT in time for BHFT) The CQRM is to be held on the 7th June. A when this area was a CQUIN scheme (and an SHA "ambition" to reduce the Month 2 (May) report - due in verbal update will be provided at the CCG's incidence of Pressure Ulcers). July. Quality Committee in late June.
Exception Reports 18 East Staffs CCG - Performance Exception Reports Expected Outcome & Measure Issue Proposed Intervention (Method) Achievement Date
Elective + Month 1 has seen a significant decrease in the number of patients admitted on an Non-Elective elective and non-elective basis to BHFT. However the only intelligence fed back to MRSA the CCG in relation to this deterioration has been about Data Warehouse issues CQRM meeting to discuss individual breaches Screening preventing accurate reporting. It may be that the rates as reported are not as low as Exception report & of supporting information provision by BHFT. (at BHFT) they are (they represent a steep fall compared with rates reported in 2012/13). improvement actions At the time of writing report, not all Trust- Nonetheless, the failure to provide supporting commentary to the Lead information supply issues originated exception reports were available. Clinic Commissioner is not acceptable and will be taken up with BHFT at the June CQRM rectified by BHFT in time for The CQRM is to be held on the 7th June. A Letters & meeting. Month 2 (May) report - due in verbal update will be provided at the CCG's Time to July. Quality Committee in late June. Surgery The non-reporting of intelligence regarding the deterioration in time to surgery for (#FNOF) at patients with a fractured neck of femur; and also regaridng the lower-than- BHFT expected rate of issuing Clinic Letters also applies to this latter point.
Exception Reports 19
Title QIPP Update Report for June 2013
Reporting to Governing Body
Date of Meeting 27th June 2013
Commissioning Lead(s) Author(s) Sarah Laing Sarah Laing
Purpose of the Report (Please select) Approval Assurance X Discussion
Key Points/Executive Summary
This report is to update the Governing Body on the current status of the QIPP programmes for ESCCG. It also includes a briefing on details of the Right Care document which suggests that improvements could be made in the area of Trauma in East Staffordshire.
Recommendations (what is expected from the Board)
1. For the Governing Body to be assured that the CCG is currently achieving its predicted QIPP targets. 2. For the Committee to be aware that there is still significant risk in the system and that the management team continues the opportunity search for further QIPP programmes.
Enclosures
12.1 – QIPP report; 12.2 – QIPP data set (Excel document); 12.3 – Right Care summary document.
Sarah Laing June 2013
1 Author: Date: East Staffs CCG Enc. 9a
East Staffordshire Clinical Commissioning Group Quality Innovation Productivity &Prevention Implementation June Report for April activity 2013 Author: Sarah Laing Chief Operating Officer
1.0 Summary of plans and achievement April 2013
As stated previously validated data will run two months in arrears thus we are now in a position to articulate the actual Quality Innovation Productivity and Prevention (QIPP) position of East Staffordshire Clinical Commissioning Group (ESCCG) for April 2013 .
The attached table (Appendix 1) gives a monthly position and also now includes a column on our financial position to include the yet to be identified QIPP.
Although the first month of verified data is demonstrating that we have achieved and slightly exceeded the target QIPP figure, it must be highlighted that significant risks remain within the QIPP system and that ESCCG cannot be complacent.
Identified QIPP savings for April 2013 £572,926 Actual QIPP delivered in April 2013 £591,159
Positive Variance +£20.733
Whilst the April data surrounding Urgent Care is demonstrating that the CCG has almost reached its predicted levels of savings around Non Elective Activity, the actual activity has increased against plan. Thus further analysis of this activity has been sought via the CSU to ascertain the nature of these admissions.
Early data for May is predicting that we are on track to deliver against the May QIPP trajectory; however this is only against the already identified QIPP programmes and the management team wish to assure the Governing Body that the opportunity search is continuing and highlight that may data has not yet been validated.
£000s Sub -Total of Schemes Identified for 13/14 £3,094m Schemes yet to be identified £900,000 Total QIPP achieved to date in 13/14 £591.159 Total QIPP required for the full financial year 2013/14 as at 25.02.13 £4m Total efficiencies required at 2% £2.7m
1.1 Summary report for QIPP not achieved in April 2013
All QIPP programmes have either delivered to or exceeded target with the exception of those outlined in the table below:
Programme Speciality Target Risk of Mitigation £Position at achievement month end Unbundle £16667 Awaiting -£16667 Cardiology feedback from BHFT Staying Well End of Life £2,500 AMBER Awaiting CSU data Urgent Care £25,963 £22906
The full QIPP dashboard is attached and clearly outlines all QIPP projects and details the financial realization or otherwise (Appendix 1).
2.0 Further Opportunity Scoping of unidentified QIPP
The data sets and analysis needed have been requested from the Commissioning Support Unit and the CCG is currently awaiting a response. The key areas included in the opportunity search are: Primary Care, Mental Health, Non Elective and Elective Acute Care, Prescribing, Continuing Health Care and Community Care.
It is planned that this piece of work will be complete by the end of July at the latest and a paper will be presented at the August QIPP, Finance and Performance Committee. The CCG has also recently received the “Spend and outcomes tool (SPOT) for CCGs, 2011/12, from the Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England” (Appendix 2) and is scoping this evidence further. This data indicates that ESCCG has a higher spend with worse outcomes regarding mortality from trauma and certain areas of cancer.
Staffordshire Public Health are working on this with us and have identified that out of 79 accidental deaths in East Staffs (district) between 2008-2010 18 were due to Road Traffic Accidents and 32 due to falls. We are currently trying to get more up to date data.
The management team wish to assure the Governing Body that Falls is already highlighted as a priority piece of work and that the CSU are also scoping more recent hospital data sets with regard to trauma spend. In addition Health Scrutiny at County level are aware of these initial publications and have advised that they wish to work with us on this issue. Lead Scheme Some Risk to achievement but Not Achieved or > 5% variance RAG Achieved ESCCG Lead Commentary within 5% variance from target (Q = QIPP / T = Transactional) GP / Exec Mgr 2013/14 Target (£s) from Target X
System Efficiencies Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Mental Health: £ Target 77,000 QT - - £77,000 Transactional item agreed to be delivered in Month 1 – delivered within the contract negotiations undertaken in 13/14 Full-Year Effect 13/14 Actual 77,000
Mental Health Project £ Target 81,000 QT - - £81,000 Transactional item agreed to be delivered in Month 1 – delivered within the contract negotiations undertaken in 13/14 Fiarrs Actual 81,000
£ Target 50,000 HUB T - - £50,000 Transactional item agreed to be delivered in Month 1 – delivered within the contract negotiations undertaken in 13/14 Actual 50,000
£ Target 20,286 20,286 20,286 20,286 20,286 20,286 20,286 POLCV QT Dr Wai Lim T Jones £142,000 Benefits not being realised until September 2013 Actual
£ Target 34,000 0 Length of Stay: children QT - - £34,000 Transactional item agreed to be delivered in Month 1 – delivered within the contract negotiations undertaken in 13/14 Actual 34,000
£ Target 126,000 Nursing Home Project T - - £126,000 Transactional item agreed to be delivered in Month 1 – delivered within the contract negotiations undertaken in 13/14 Actual 126,000
£ Target 420,000 Wolverhampton transfer T - - £420,000 Transactional item agreed to be delivered in Month 1 – delivered within the contract negotiations undertaken in 13/14 Actual 0
£ Target 35,000 Loan Equipment Tender T - - £35,000 Transactional item agreed to be delivered in Month 1 – delivered within the contract negotiations undertaken in 13/14 Actual 35,000
£ Target 12,500 12,500 12,500 12,500 Whilst fines relate to individual months they are enacted on a quarterly basis and will relate to A&E performance, 18 weeks, T W Kerr T Jones £50,000 Fines & Penalties Ambulance turnaround, Mixed Sex Accom Breaches and Cancer Breaches are the headline areas. Actual 13,000 7,500
Unbundling Cardiology £ Target 0 0 50,000 50,000 50,000 50,000 T W Kerr T Jones £200,000 Contract Variation Order in process of being finalised - expected benefits to be realised from June 2013 transfer Actual N/A N/A
£ Target 0 0 15,000 15,000 15,000 15,000 During the 13/14 Contract Negotiations the Unit Tariffs were revised at lower values than 12/13, realising a saving of £60,000 (this T W Kerr T Jones £60,000 T-Codes has been apportioned across the full year). Data to confirm this position is due mid June. Actual 5,000 5,000
£ Target 403,000 0 497,500 0 0 97,786 20,286 20,286 97,786 20,286 20,286 97,786 Programme Sub-Total £1,275,000 Actual 421,000 12,500
Staying Well in Later Life / LTCs Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
End of Life (no procedure / £ Target 7,500 7,500 7,500 7,500 Q trauma) Actual 0 0 0 0 Impact of increasing the ISW team activity will be monitored throughout the year starting from April 2013. SSOTP have agreed to Dr J Tansey TC £30,000 record from April and Report from May, with data received by CCG by mid-June. KPI = reduction of 1 hospital death per month Target Activity -3 -3 -3 -3 compared to (vs.) 12/13 Actual
£ Target 25,963 25,963 25,963 51,925 51,925 51,925 77,888 77,888 77,888 104,017 104,017 104,638 Urgent Care: inc. LTCs Q Actual 22,906 This is based upon the draft month 1 SLAM report from Burton and is subject to validation. At month 1 the indicative position is £23k below plan, however, the activity levels are 53 spells above plan. KPI = monthly position on total non-elective Target Activity -81 -81 -81 -163 -163 -163 -244 -244 -244 -326 -326 -326 admissions, inc. monthly comparison to plan Actual 53
% Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% KPI = 95% A&E target at Burton Hospital FT Actual 91.7% 96.7%
KPI = Zero 12-hour trolley waits at Burton Target 0 0 0 0 0 0 0 0 0 0 0 0 Dr Wai Lim T Jones £780,000 Hospital FT Actual 0 0
Target Activity KPI = A&E attendances per 1000 population The population figure used is 132,687 and month 1 A&E attendances for ESCCG at Queens. Actual 21
Target Activity KPI = A&E admissions per 1000 population This data is not available until mid June and arrives via SUS Actual N/A
KPI = reduction in ACS Chronic admissions to Target Activity This data is not available until mid June and arrives via SUS hospital (CCG-wide) Actual N/A
£ Target 6,125 6,125 6,125 6,125 6,125 6,125 6,125 6,125 Frail Elderly Q Dr E Gunn N Harkness £49,000 Actual 0 0 0 0 0 0 0 0
£ Target 10,250 10,250 10,250 10,250 10,250 10,250 10,250 10,250 Further analysis is required to determine if there are cash releasing savings relating to this clinical service. Early scoping has Q Falls identified that potential savings are linked to after care and medicines management. Actual 0 0 0 0 0 0 0 0 Dr E Gunn N Harkness £82,000 KPI = reduce by 4 non-elective admissions per Target Activity -4 -4 -4 -4 -4 -4 -4 -4 month vs. 12/13: Falls & Hip Fracture, ages 65+ Actual 0 0 0 0 0 0 0 0
Target 25,963 25,963 33,463 51,925 68,300 75,800 94,263 94,263 101,763 120,392 120,392 128,513 Programme Sub-Total £941,000 Actual 22,906
Outpatient Redesign Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Ophthalmology: £ Target 47,000 Q 12/13 Full-Year Impact Actual 47,000
Ophthalmology: £ Target 0 0 0 4,444 4,444 4,444 4,444 4,444 9,194 9,194 9,194 9,194 Q 13/14 Actual 0 0 0 0 0 0 0 0 0 Dr E Gunn T Jones £106,000 Target Activity -11 -11 -14 -14 -11 -29 -29 -29 -29 OPFA KPI = reduction of Ophthalmology OP Firsts & Actual 0 0 0 0 0 0 0 0 0
Follow-ups vs. 12/13 Target Activity -80 -80 -91 -91 -80 -128 -128 -128 -128 OPFU Actual 0 0 0 0 0 0 0 0 0
Target 47,000 0 0 4,444 4,444 4,444 4,444 4,444 9,194 9,194 9,194 9,194 Programme Sub-Total £106,000 Actual 47,000
Primary Care / Medicines Management Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Target S Bamford / M 94,463 48,096 70,096 67,846 74,846 74,646 53,584 59,584 53,584 53,584 59,584 56,584 Dr J Tansey £773,000 The phasing of this saving requires amendment and will be amended for the July Report Primary Care / Medicines Management Escombe Actual 90,253 46,452 46,475 37,230 37,230 37,229 12,951 12,951 12,951 12,951 12,951 12,951
2% Non Recurrent (reserve) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2% Non Recurrent W Kerr W Kerr Target 0 0 0 0 0 0 0 0 0 0 0 2,700,000 2% Non-recurrent funds being used to offset the position £2,700,000 Actual
Yet to be Identified QiPP Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Yet to be Identified QiPP Target 0 0 0 0 0 0 150,000 150,000 150,000 150,000 150,000 150,000 The exact phasing of this saving is to be confirmed and will be subject to the specific schemes £900,000 Fines & Penalties 10,000 (over plan)
Monthly Plan 570,426
Monthly Actual 591,159
Monthly Variance 20,733
YTD M1 YTD M1 YTD M1 Annual Target Target Actual Variance Subtotal of QIPP schemes identified £3,095,000 £570,426 £581,159 £10,733 Subtotal of QIPP schemes yet to be identified £900,000 £0 £10,000 £10,000 2% Non Recurrent £2,700,000 £0 £0 £0 Total QiPP £6,695,000 £570,426 £591,159 £20,733 Enc. 9c
Spend and outcomes in East Staffordshire, 2011/12 - trauma
Outcomes for programme areas
Public Health Staffordshire Page 1 There are no outliers for East Staffordshire CCG (outside z-score = 2). However East Staffordshire CCG is an outlier in terms of cancer spend. Trauma is also very close to being an outlier in terms of high spend, worse outcome.
Source: Spend and outcomes tool (SPOT) for CCGs, 2011/12, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England
Public Health Staffordshire Page 2
Trauma and injuries spend compared to mortality from accidents in East Staffordshire CCG
The two CCGs in the low spend, better outcome quadrant are: Kingston CCG and Richmond CCG.
Spend and Outcome relative to other CCGs Lower Spend Higher Spend Better Outcome Better Outcome
Lower Spend Higher Spend Worse Outcome Worse Outcome All ONS SHA CCG Z=1 Z=2
Source: Spend and outcomes tool (SPOT) for CCGs, 2011/12, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England
Public Health Staffordshire Page 3
Trauma and injuries spend compared to mortality from accidental falls in East Staffordshire CCG
The CCG in the low spend, better outcome quadrant, falling within the same ONS cluster group, is North East Lincolnshire CCG.
Source: Spend and outcomes tool (SPOT) for CCGs, 2011/12, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England
Public Health Staffordshire Page 4
Trauma and injuries spend compared to mortality from fractured femur in East Staffordshire CCG
The two CCGs in the low spend, better outcome quadrant are Richmond CCG and North East Lincolnshire CCG.
Source: Spend and outcomes tool (SPOT) for CCGs, 2011/12, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England
Public Health Staffordshire Page 5
Trauma and injuries spend compared to mortality from skull fracture and intercranial injury in East Staffordshire CCG
There are three CCGs in the low spend, better outcome quadrant: Richmond CCG, North East Lincolnshire CCG and Medway CCG.
Source: Spend and outcomes tool (SPOT) for CCGs, 2011/12, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England
Public Health Staffordshire Page 6
Trauma and injuries spend compared to mortality from land transport accidents in East Staffordshire CCG
The CCG in the low spend, better outcome quadrant is Richmond CCG.
Source: Spend and outcomes tool (SPOT) for CCGs, 2011/12, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England
Public Health Staffordshire Page 7
Title Staffordshire Cluster Operational Handover Documentation
Reporting to Governing Body
Date of Meeting 27th June 2013
Commissioning Lead(s) Author(s) W Kerr
Purpose of the Report (Please select) Approval Assurance X Discussion x
Key Points/Executive Summary
The PCT legacy document aims to capture the knowledge that has been accumulated through managerial and clinical interactions over a number of years.
The purpose of the overarching documentation is to: • Retain a ‘log’ of organisational memory as the NHS undergoes major structural changes to how it is organised and managed. • Enhance the robustness of handover arrangements. • Capture and transfer organisational memory and information. • Ensure quality and safety is not put at risk during structural change.
The document presented to the Governing Body for review is the 3rd and final revision. The CCG as a shadow body has been sighted on version 1 of the document and provided feedback at a point in time.
The CCG is not required to approve the operational handover documentation which went to Staffordshire Cluster’s PCT Board in March. The Legacy Document is part of a range of documents that were developed to assist the handover process between organisations, including the Cluster Quality Handover Document which was presented at March’s Governing Body.
Members of the Governing Body should be aware that the report should not highlight any issues which the CCG are not currently aware of.
1 Author: W Kerr Date: 17/6/2013 East Staffs CCG
Recommendations (what is expected from the Board)
The Governing Body are asked to: • Understand the context of the issues raised within the operational handover documentation. • Formally accept this handover report. • Review the documentation and consider if any new risks have been identified that are not already on the CCG’s risk register.
Enclosures
Attached report.
2 Author: W Kerr Date: 17/6/2013 East Staffs CCG
Staffordshire Cluster
Operational Handover
Document
March
2013
Page 1
Staffordshire Cluster Operational Handover Document
March 2013
Last Updated March 2013 Version Control Number 19.0
Page 2 Table of Contents ContentsTable of Contents ...... 3 Section 1: Introduction ...... 4 Section 2: Description of the Patch ...... 7 Section 3: Services Provided to the Local Population ...... 18 Section 4: Quality ...... 27 Section 5: Performance...... 38 Section 6: Financial History ...... 41 Section 7: Provider Capacity ...... 47 Section 8: Workforce ...... 53 Section 9: Summary of Key Changes Planned ...... 55 Section 10: Organisational Assets and Liabilities ...... 60 Section 11: Key Cluster Stakeholder Map ...... 62 Section 12: Governance...... 64 Section 13: Corporate Responsibility ...... 81 Section 14: Views of CQC & Monitor...... 82 Section 15: Transition, Close Down Plans and Handover Arrangements ...... 84 Section 16: Development and Approval of Legacy Document ...... 85 Library of Knowledge ...... 86 Appendices ...... 93 Appendix A - Primary Care Contracts and Services ...... 93 Appendix B – Acute Contracts and Services ...... 117 Appendix C – Tertiary Contracts and Services ...... 121 Appendix D – MH and LD Contracts and Services ...... 123 Appendix E – Community Healthcare Contracts and Services ...... 125 Appendix F – Other Contracts and Services ...... 128 Appendix G - Quality Handover Document
Note: • This document is an update of the previous Staffordshire Cluster Legacy Document which was last updated published in September 2012.
• This document supports the commissioning function of the three Staffordshire PCTs.
• Staffordshire and Stoke-on-Trent Public Health Directorates are developing separate Transition/Legacy documents to support their transition to the Local Authority.
Page 3 Section 1: Introduction
Purpose of the Document The National Quality Board publication: ‘Maintaining Quality through the transition’, (March 2011) sets out the importance of preparing Legacy Documents as we move to a future of clinically-led commissioning.
In October 2011, a Legacy Document was prepared for each PCT, and a single overarching document prepared for the Staffordshire Cluster of PCTs, the purpose of which is to:
• Retain a ‘log’ of organisational memory as the NHS undergoes major structural changes to how it is organised and managed. • Enhance the robustness of handover arrangements. • Capture and transfer organisational memory and information. • Ensure quality and safety is not put at risk during structural change.
The Legacy document and associated Library of Knowledge aims to capture the knowledge that has been accumulated through managerial and clinical interactions over the years. This transfer of underpinning systems and local knowledge is seen as vital for maintaining safety at several key stages of the transition and so all related documents will need to be maintained as living documents over a sustained period.
The Legacy documents are therefore intended to be organic and updated at regular intervals until March 2013 when PCTs are legally abolished. This is the final update, in line with the following schedule:
• 1st review March 2012 • 2nd review September 2012 • 3rd review March 2013
Updating of the document is the responsibility of the Director of Partnerships and Planning for the Staffordshire Cluster of PCTs.
Development and Future of the Document The Legacy Document is now referred to as the Operational Handover Document, which is part of a greater suite of information sources that will be used for the purpose of transition between outgoing organisations such as the PCT’s and emerging ‘receiver’ organisations such as Clinical Commissioning Groups.
A range of documents are being developed to assist the handover process between organisations. Currently these include:
• Cluster Quality Handover Document • Cluster Governance Close Down & Transition Plan • Public Health Legacy and Transition documents
Page 4 Summary of Key Risks/Issues and Achievements The Staffordshire Cluster of PCTs has three main acute providers within its local health economy that have all come under scrutiny with various issues.
Mid Staffordshire NHS FT is now in the process of an independent review by the regulator Monitor. Monitor, the sector regulator appointed Ernst & Young, supported by McKinseys, to set up a contingency planning team who concluded, Mid Staffordshire NHS FT is not clinically or financially sustainable. This has led to the consultation on a Trust Special Administrator (TSA) being appointed to take over the running of the Trust. The outcome of this consultation will be known by the end of March 2013. Should a TSA be appointed by Monitor then the Board of Directors and Governors will have their board role suspended and the TSA will take on the accountable officer role.
The CPT has given a recommended option, however the TSA does not need to follow this, they do however have to retain the Location Specific Services as per Monitor’s guidance. The CQC will be asked if a TSA is appointed to give an up to date opinion on the quality of services.
The Robert Francis QC Public Inquiry into the system oversight of MSFT has reported on the 6th February 2013. There had previously been an independent Inquiry by Robert Francis (2009) following the Health Care Commission inspection of 2009, into the hospital plus a case notes review into individual care. These reports have been publically available. The latest, the Public Inquiry had 290 recommendations, which the Government are currently developing a response to. These fall into the headline categories as follows: • Standards • Openness, transparency and candour • Leadership • Compassionate care • Information
MSFT has struggled during 2012/13 to address ongoing Referral to Treatment and A&E performance issues and meet national targets. A great deal of work has been undertaken and the Trust is now meeting the majority of its targets although diagnostic waits remain an issue. In December 2011 A&E at MSFT closed overnight between 10pm and 8am and remains closed.
Burton Hospitals Foundation Trust is also facing financial difficulty and is currently in breach of its Authorisation by Monitor. Burton is also facing severe pressure upon its A&E department and delivery of the A&E wait times targets. Currently there are discussions about how sustainable the Trust is long term, both financially and clinically. Burton is an outlier and has been for two years for its HSMR statistics. The SHMI statistics are not outliers, however following the Robert Francis Public Inquiry, Sire Bruce Keogh is investigating all hospitals which are an outlier and have been for two years, and therefore Burton will be one of the 14 his team will review.
University Hospital North Staffordshire NHS Trust has also struggled to meet wait time targets for A&E during 12/13 and in the previous year. Due to the severity and longevity of this problem, during 2012/13 significant financial penalties have been levied. Sustainability of the A&E target continues to be a concern.
In 2012 the NDTi were jointly commissioned to review the specialist health learning disability service across Staffordshire and Stoke-on-Trent. The report was published in April 2012. It recommended that senior managers in Staffordshire PCT, Stoke CCG, Staffordshire County Council and Stoke City Council make a shared and public commitment to take action to ensure that specialist learning disability health services across the area are (a) modernised and (b) developed in an integrated way with local authority commissioning and provision.
In August 2012 a project structure was established to take this work forward. This is being monitored from a quality perspective with an understanding to the recommendations following Winterbourne View. This work must link with what is happening with monitoring independent placements.
Page 5 Other areas of concern include: • Risks to QIPP delivery - that identified schemes do not deliver to the level or in the timescale required across the Cluster. • Risks to the quality assurance programme - during transition to emerging commissioning organisations. • Risks to the transfer of corporate records - in identifying and preparing for transfer to the correct receiver organisations.
However there are key achievements to note across the health economy as a whole:
• The Fit For the Future programme has delivered the £370 million new hospital at the City General site • More patients seen in primary care and community settings for patients with diabetes, respiratory and heart conditions reducing admissions and outpatient demand • Reconfiguration of mental health services has increased emphasis on community provision and reduced acute mental health bed based activity, • Innovative use of technology, including a number of telehealth systems currently being trialled by CCG’s • Development of new Community Health Centres across Stoke-on-Trent and North Staffordshire including sites at Meir, Cobridge and Tunstall • A decrease in reported Health Care Associated Infections • An increase in assessment and treatment in 24 hours for Transient Ischemic Attacks (TIAs) and Venous Thromboembolic Events (VTEs) • Improvements in CQUIN achievements • Improved Delayed Transfers of Care rates • Improved Cancer waits and urgent treatment including bowel, breast and cervical screening
Page 6 Section 2: Description of the Patch
The Staffordshire Cluster is a grouping of three PCTs – North Staffordshire, South Staffordshire and Stoke-on-Trent - serving over one million people and covering a wide urban and rural geographical area.
Progress has been made in achieving service reconfigurations and securing greater quality outcomes across patient safety, patient experience and clinical effectiveness through more emphasis on commissioning for quality, however there are still significant quality improvements needed across the System.
The Cluster operates with a total commissioning financial envelope of £1.9bn 2012/13. It has a has a Quality, Innovation, Productivity and Prevention (QIPP) funding ‘gap’ of £226m by 2014/15 but has created headroom by setting a local target of £355m. The Cluster began 2012/13 with a financial QIPP challenge of £106m, £69m attributable to Providers and £37m to Commissioners.
The Area and its Population The Staffordshire Cluster serves 1.1 million people covering a wide geographical area of approximately 1,012 square miles stretching from the Staffordshire Moorlands, which borders the Peak District in the North, to the conurbation of the Black Country in the South.
The Staffordshire Cluster area is very diverse. It ranges from densely populated urban areas to isolated rural areas, contains a rich mix of diverse racial and cultural backgrounds and has starkly differing socio-economic status across and within communities.
The Staffordshire Cluster is responsible for the healthcare of everyone registered with a GP in the area, which as of the 1st January 2013 was 1,118,273 people. This figure represents a near equal split of males and females.
Page 7
The population size has increased in recent years, with approximately 50,000 extra people residing in the Staffordshire cluster area, an increase of just less than 5% between 2001 and 2011 (ONS Data). This is below the percentage population increase seen in both England and the West Midlands where population size increased by 7.5% and 6.5% respectively. Most of the growth in the Staffordshire Cluster area was seen in the East Staffordshire, Lichfield and Stafford areas.
As with the rest of the country, Staffordshire has experienced a significant ageing of the resident population, with over 50,000 people in the PCT cluster area aged over 80 years old. This number has increased by over 10,000 people between 2001 and 2011, with the proportion of people aged over 80 increasing from 3.8% of the total population in 2001 to 4.6% in 2011. This ageing is most noticeable in the Cannock Chase and South Staffordshire areas which have seen the number of residents over 80 increase by 43% between 2001 and 2011. In contrast, Stoke-on-Trent has seen only a marginal increase in the number of over 80’s (7%).
The age profile in Stoke-on-Trent is different from the profile of that of Staffordshire County. There is a greater proportion of the population at lower age bands, with 40% of the population below 40 years old in Stoke-on-Trent compared to 34% in Staffordshire County. The graph below shows the profile of the population by 15 year age bands, demonstrating Staffordshire County’s higher proportion of elderly residents when compared to Stoke-on-Trent and the averages for both the West Midlands and England.
Page 8 Population Percentage by Age Band (2011 ONS Data)
England and Wales 17.6 19.9 20.6 19.4 14.7 7.9
West Midlands 18.2 19.9 19.8 19.2 15.0 7.8
Staffordshire County 16.5 17.7 19.4 20.8 17.3 8.2
Stoke-on-Trent 18.3 21.4 19.9 18.8 14.4 7.1
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
0-14 15-29 30-44 45-59 60-74 75+
Over the next 25 years, the ageing of the population in Staffordshire is projected to continue, with the number of people over the age of 65 increasing by 105,000 people, which equates to a 76% increase. The population aged 85 and over is projected to increase by 191% over the same period.
Over the next ten years, the forecast for ageing varies by local authority, with the graph below giving an indication of the comparative rate of change in each area:
Staffordshire Age Profile Change 2012-2022
Page 9 Ethnicity
Staffordshire has a lower proportion of non-white population (5.7%) than the West Midlands Region (13.5%) and England (11.3%).
Staffordshire Cluster % West Midlands % England %
White 94.3 86.5 88.7
Mixed 1.2 1.7 1.6
Black or Black British 0.8 2.4 2.8
Asian or Asian British 3.2 8.3 5.5
Other 0.5 1.1 1.4
Data Source: West Midlands Public Health Observatory 2006
Page 10 Deprivation
There are considerable differences in deprivation levels across the area. Stoke-on-Trent stands out as being much more deprived than the county of Staffordshire, although there are also pockets of deprivation in Newcastle-under-Lyme and Burton in particular.
These differences are illustrated in the figure below (the darker the map the greater the level of deprivation
Page 11 Health Profiles The health of people in Staffordshire is mixed compared with the England average. On the whole, Deprivation is lower than average in Staffordshire, as shown above however deprivation is noticeably worse than the national average in Stoke-on-Trent and in some pockets of Staffordshire County. Within the PCT cluster area 38,300 children live in poverty.
Over the last 10 years, all-cause mortality rates have fallen along with early death rates from cancer, heart disease and stroke. Rates of sexually transmitted infections, road injuries and deaths, smoking related deaths and hospital stays for alcohol related harm are better than the England average, however within the PCT cluster area there are clearly pockets where this is not the case.
However, there are significant challenges within the PCT cluster area, with the following indicators all worse than the England average: • Childhood Obesity • Levels of GCSE attainment • Alcohol-specific hospital stays among those under 18 • Breast feeding initiation • Smoking in pregnancy • Estimated levels of adult 'healthy eating' • Adult Obesity
The below health profiles show a summary of health for both Staffordshire County and Stoke-on- Trent.
Page 12
Page 13
Page 14 Health Inequalities
Staffordshire has common health challenges to other areas including:
• Reducing premature death from cancer. • Reducing premature death from Cardio Vascular Disease. • Improving end of life care. • Reducing alcohol related admissions to hospital, improve addiction services and prevention/management. • Reducing the number of avoidable elective and non-elective admissions. • Early facilitated discharge and enhanced recovery. • Reducing levels of delayed discharges, transfers of care and excess bed days. • Improving patient satisfaction and experience. • Reducing the incidence of Health Care Associated Infections and resultant ward closures due to outbreaks.
Reducing health inequalities is a key goal for all three Primary Care Trusts within the Cluster. Whilst people are healthier and living longer than ever before, stark inequalities in health experience remain and these are illustrated most starkly by variations in life expectancy across the Cluster.
Life Expectancy
Across the Staffordshire Cluster life expectancy is lower for men and women in certain areas:
• South Staffordshire - the areas of Cannock Chase, East Staffordshire and Tamworth demonstrate lower levels of life expectancy. • For North Staffordshire life expectancy is lower in the areas of Chesterton, Cross Heath and Knutton, Leek North and Biddulph East. • Within Stoke-on-Trent the health of the people is generally worse than the England average. This reflects the level of deprivation in Stoke-on-Trent; with over half of the population living in the most deprived areas of England.
Further information on health inequalities can be found in the Public Health Transition Plan documents, Public Health Annual Reports Joint Strategic Needs Analysis and from the Public Health Observatory.
Page 15 Delivery The Cluster has two distinct health economies, in the North and the South:
• Northern Staffordshire – which covers the areas of Staffordshire Moorlands, Newcastle- under-Lyme and Stoke-on-Trent, operates within a clearly definable local care ‘system’ with around 88% of acute business going to a single local provider, University Hospital of North Staffordshire NHS Trust. North Staffordshire Combined Healthcare NHS Trust provides almost all the mental health care and Stoke-on-Trent City Council and Staffordshire County Council provide social care.
• South Staffordshire – which covers the areas of Stafford, Cannock, Burton, Lichfield, Seisdon and Tamworth, operates within a clear ‘market’ economy with only 59% of acute care provided by local NHS Trusts (Mid Staffordshire Foundation Trust and Burton Hospitals Foundation Trust) and the remainder being provided by more than seven other providers outside of the county. The majority of mental health services are provided by South Staffordshire and Shropshire Healthcare Foundation Trust and Staffordshire County Council provides social care.
The Fit for the Future (FFtF) programme is the main system redesign plan for the northern health economy and the Clinical Services Improvement Plan (CSIP) is the redesign programme for the South West Staffordshire. Similar plans are being developed for the South East (Burton) local health economy.
Working in Partnership The Staffordshire Integrated System Plan sets out how healthcare commissioners and providers in Staffordshire are working with partners and stakeholders to ensure a joined up approach for the health of the people in Staffordshire and Stoke-on-Trent.
Joint action on health inequalities, previously developed through Local Strategic Partnerships in Staffordshire and Stoke-on-Trent, are being carried through and developed as part of the new Health and Wellbeing Boards, working in partnership with Local Authorities, Staffordshire Police, Fire and local voluntary and third sector agencies.
The PCTs have worked closely with their local LINks and in Staffordshire a new Community Interest Company (Engaging Communities) is being set up to address issues identified in terms of engaging local populations in health and social care issues
Partnerships will be developed further as the proposals under the Health and Social Care Bill roll out. CCGs and the Cluster (on behalf of PCTs) are actively engaged in the development of the shadow Health and Well Being Boards (HWBBs) within Local Authorities. Both Staffordshire County and Stoke-on-Trent City Councils are Early Implementers for shadow HWBBs.
The Staffordshire Cluster has two upper tier Local Authorities Staffordshire County Council and Stoke-on-Trent City Council. Staffordshire County Council has eight District/Borough councils and CCGs and public health in Staffordshire are working closely with these on local issues.
Local Authority Transition There are two Joint Commissioning Units (JCU) in place, hosted by the City and County Councils. NHS North Staffordshire and South Staffordshire PCT commissions services collaboratively with Staffordshire County Council for adult services. NHS Stoke on Trent has the same arrangement with Stoke-on-Trent City Council. In Stoke-on-Trent joint commissioning includes both adult and children’s services. In the Adult JCU the main work areas are around Older People, Mental Health and Learning Disability whilst the Children’s JCU also focuses on CAMHS and disability services. Drug and Alcohol services are also jointly commissioned as part of the Safer City Partnership. In
Page 16 the Staffordshire JCU, all adult and substance misuse services are jointly commissioned and work is underway to assign JCU commissioning clearly to CCG leadership.
Adult social care services from Stoke and Staffordshire are heavily involved in the FFtF programme in the North, and Staffordshire is engaged in CSIP in the South. There is a single Safeguarding Board in place for adults across Staffordshire and two separate LA based Children’s Safeguarding Boards.
Health & Well Being Board Transition Shadow Health and Well Being Boards (H&WBB) are in place with both Local Authorities and have been meeting for some time.
A shadow Health and Wellbeing Board was established in October 2011.for Staffordshire County.. In Stoke-on-Trent an independent Chair for the H&WBB has been appointed and a shadow Board was established in December 2011.
Membership of both Boards is reflective of the required core membership with the addition of the Police Chief Constable for Staffordshire. Both Staffordshire County and Stoke City Councils are Early Implementers for shadow H&WBBs.
Page 17 Section 3: Services Provided to the Local Population
Contract Transition As part of the national requirement for NHS commissioners, the Cluster has been tasked with consolidating and documenting all of their contracts for services and undertaking an assessment of transition risk for each one, to secure ‘corporate memory’. The stocktake of service contracts took place between November 2011 and March 2012. The work allowed prioritised or urgent remedial actions to be addressed within the 2012/13 contracting round and alignment with NHS Commissioning Board (NHS CB) transition timelines the work for Contract Transition by April 2013 has been completed leaving a legacy of robust contracting to be handed to the new commissioning organisations.
Primary Care GPs, dentists, optometrists and pharmacists will play a greater role in delivery of healthcare services in the future. Some of this care will be delivered in a different way by GPs, specialist nurses and community optometrists. GP and nurse skills in areas such as Chronic Obstructive Pulmonary Disease (COPD), diabetes and heart failure services are being enhanced to deliver these services in the community. The drive and ambition to improve the quality of primary medical care through the emergent Clinical Commissioning Groups will bring an increased premium for improving access, quality and experience for patients.
The table below sets details of primary care contractors providing healthcare across the Staffordshire Cluster. As would be expected, there are a larger proportion of primary care contractors located in South Staffordshire as it covers a greater geographical area and larger population when compared to North Staffordshire and Stoke-on-Trent.
Primary Care Practices/Locations
NHS North NHS Stoke on South Staffordshire Total for the Staffordshire Trent PCT Cluster GP Practices 33 54 93 180 Dental 27 33 79 139 Practices Optometrists 31 46 88 165 Pharmacists 44 71 133 248
Details of specific primary care contractors are shown in Appendix A.
Overall, the review of medical and dental independent contractors is focusing on reducing variation and improving the quality of the services provided.
Across Staffordshire, work has concluded on a review of 70 PMS (GP) contracts. The purpose of the review was to reduce the variation in primary care and ensure PMS contracts offer the potential for improvement in the quality of care and patient outcomes, ensure effective use of NHS resources and be transparent about what services are being offered through this contract. This information will support the handover of primary care functions to the NHS Commissioning Board. The review findings have been shared with GP practices and an appeal process is complete with all alterations to contract signed. Changes to the PMS contracts were completed by August 2012
The Cluster is required to divest any remaining PCTMS and PCTDS contracts. The Cluster had only the High St Practice in North Staffordshire which currently held a PCTMS contract. List dispersal has taken place between local practices in the Newcastle under Lyme area and this practice closed on March 31st 2012. Neither South Staffordshire nor Stoke-on-Trent has any remaining PCTMS or PCTDS contracts.
Page 18 In South Staffordshire a dental performance framework has been implemented for the last three years. The framework includes clinical and non-clinical indicators with a combination of local and national benchmarks. The framework has significantly improved the quality of the services provided by dental practices .The framework is being implemented in North Staffordshire and Stoke and is being considered to form part of the NHSCB national performance framework.
Primary Care Risks Below is list of risks that have been identified in Primary care during this time of transition. Work is being carried out to mitigate these risks and provide assurance that these issues can be resolved or risk reduced.
• Staffing capacity to manage the current level of input and make the transition to the new system. • Financial position – savings being made through review of PMS contracts will support this year’s position, however increasing premises costs, pharmacy costs (without the link to drug cost savings which sit with CCGs • Uncertainty remains regarding the area team primary care budget for 2013/14 for primary care. • On-going disputes with practices – longstanding difficulties that require a great deal of management time and legal support. • Identifying and managing individual performance issues – where these are identified the difficulty in being able to manage performers within the regulatory framework while protecting the public. Decision Making Group (DMC) considers these issues where they are identified. • Poor performance – 2012/13 there were 17 practices identified as outliers through the analysis of the annual patient survey and further analysis has being undertaken and actions agreed. This work will form part of the medical contract assurance framework • Relationships – during the transition there needs to be a dialogue with CCGs and representative bodies to understand the role and nature of the relationships moving forwards. Also need to develop a relationship with HWBB for strategy delivery. • Complexity of the handover between parts of the system – has required a critical path so all partners are aware of who is doing what, when e.g. commissioning Enhanced Services • Ensuring the contractors deliver the required quality of services with many parts of the health system needing to co-ordinate to deliver this e.g. CQC registration of GP practices. • Blurring of boundaries between GPs as commissioners and providers – need to support them to deliver both roles with sufficient governance around decision making. • Lack of skills to deliver some new areas of work within existing teams.
Acute Hospital Services Acute healthcare across Staffordshire is commissioned from a total of 37 acute care providers. The main providers are University Hospital of North Staffordshire NHS Trust (Stoke-on-Trent and North Staffordshire areas), Burton Hospital NHS Foundation Trust (East Staffordshire area) and Mid Staffs Hospital Foundation Trust (South West Staffordshire area). The table below illustrates the bed numbers, workforce and financial turnover for each of the main NHS Hospital Provider Trusts across Staffordshire.
University Hospital of North Staffordshire NHS Trust is the largest NHS Trust within Staffordshire and is almost three times greater, in terms of bed capacity, than both Mid Staffordshire NHS Foundation Trust and Burton Hospital NHS Foundation Trust.
Page 19 Turnover Turnover 2011/12 2012/13 Bed 2010/11 2011/12 Forecast Planned Capacity Provider Geography Estate £m £m Surplus/ Surplus/ (January (deficit) (deficit) 2013) £m £m University Single Hospital of hospital site Northern North (from 2012) 1144 £1.6m £2.0m Staffordshire Staffordshire at Stoke- £410 £415 NHS Trust on-Trent Main Mid hospital site 398 Staffordshire South West at Stafford Of which 90 (£20.7m) (£18.5m) Foundation Staffordshire Community are at £158m £172m Trust Hospital at Cannock Cannock Main acute 388 site at 39 at Burton Burton Tamworth Hospital South East Community (SRP) £146m £176m (£7.7m) (£3.3m Foundation Staffordshire Hospitals at 44 at Trust Tamworth Lichfield & Lichfield (SJH)
Details of acute contracts are shown at Appendix B.
University Hospital North Staffordshire NHS Trust NHS North Staffordshire, NHS Stoke on Trent and the emerging CCGs are working closely with the University Hospital of North Staffordshire NHS Trust (UHNS), on service redesign and support their development towards Foundation Trust status.
UHNS and Stoke on Trent Primary Care Trust entered into a Private Finance Initiative contract with Health Care Support (North Staffordshire) Ltd on 19 June 2007 to build a new, modern hospital for Stoke-on-Trent. The construction of a new £370 million hospital on the City General site is now complete. The PFI contract term is for 37 years and 2 months and has a revenue stream of 52million pounds per annum.
The delivery of a single site acute hospital for the delivery of modern healthcare was a key strand to the Fit for the Future programme. The FFtF has redesigned services over a number of years to facilitate a shift away from acute care and into primary care and community care settings. As a result, the acute hospital has seen a reduction in beds, focussing more on the delivery of complex acute care with more care delivered in the community. Completion of the FFtF programme has resulted in a smaller, more modern acute hospital with fewer beds and significantly less capacity to provide outpatients, diagnostics and specific services on the acute hospital site. Re-design and transfer of these services to community settings has been ongoing within North Staffordshire for some years providing more care outside the hospital setting so that UHNS can increasingly focus on delivery of complex care.
The West Midlands Specialised Commissioning Team (now the Midlands & East Specialised Commissioning Group) completed informal engagement on proposals for the reconfiguration of trauma care services across the West Midlands, leading to UHNS being designated a Major Trauma Centre in February 2012.
UHNS Activity 2010/11 and 2011/12
Number of inpatients and day cases treated 2011/12 2010/11 Elective inpatients 12,938 13,352 Elective day cases 51,157 53,041
Page 20 Emergency inpatients 68,859 63,727 Number of outpatients seen New appointments 140,504 137,414 Follow up appointments 338,681 307,009 Number of emergency attendances Emergency Centre 106,556 104,580
Mid Staffordshire Foundation Trust During 2008 the Healthcare Commission carried out an investigation into Mid Staffordshire NHS Foundation Trust with a subsequent report being issued in March 2009. An Independent Inquiry into Mid Staffordshire NHS Foundation Trust chaired by Robert Francis QC was held in 2009 with a report containing recommendations published in early 2010.
A full Public Inquiry into the role of the commissioning, supervisory and regulatory bodies in the monitoring of Mid Staffordshire NHS Foundation Trust was announced in 2010 with South Staffordshire PCT named as a core participant. From July 2010 onwards the PCT was actively engaged in identifying relevant and appropriate evidence for submission to the Inquiry Team and the preparation of corporate and individual statements. Oral evidence to the Inquiry started in November 2010 and PCT witnesses appeared in March/April 2011. Transcripts of the PCT evidence can be found on the Inquiry website (http://www.midstaffspublicinquiry.com/). The recommendations, where published with the full report on February 6th 2013. The Government are now preparing a response to the report, which is expected by the end of March 2013.
Mid Staffordshire FT has been working closely with University Hospital North Staffordshire on clinical service development. Initiatives such as the Surgical Strategic Alliance (an initiative to bring about a fully integrated surgical service across both Trusts with a single governance structure and clear pathways and protocols) demonstrates the desire to collaborate across the health system to secure improvements to safety, quality and patient outcomes. A blue print for clinical services has been developed following seven months of collaborative work through five Clinical Working Groups. This work has reviewed the current service provision, identified what best practice would look like and set out the implications for Mid Staffs Foundation Trust, community, primary and social care. Five surgical clinical work streams were established (vascular surgery, emergency surgery, colorectal surgery, upper GI Surgery and breast surgery) to shape the future service model/configuration. The immediate priority was for vascular pathway to be reviewed and this has resulted in vascular surgery moving to UHNS from April 2012. Three joint consultant appointments have been made between the two Trusts to support this.
Stafford Hospital closed its A&E overnight on 1st December 2011 due to an inability to provide assurance on the delivery of safe services due to staffing issues. The Trust set itself criteria to meet for re-opening, which in September 2012 they believed that they could meet but only with mitigation. This was reviewed by commissioners and both Trust and commissioners felt that the A&E should not reopen overnight. During the time the A&E has been closed overnight, alternative service provision has been proven to be both safe and sustainable, with an average of 12 /15 patients each night, who could have been treated at Stafford, going to other hospitals.
On 11th September 2012 the Mid Staffordshire Commissioning Board, which is chaired by Stafford and Surrounds Clinical Commissioning Groups, recognised that the Trust had met most of the criteria set out, however remained concerned about the sustainability of a 24/7 service and the dilution of senior staff presence should the department reopen 24/7. As a result of this consideration, the Commissioning Board decided that the A&E department at Stafford Hospital should not fully re-open between the hours of 10pm and 8am.
Previous to this decision, Monitor announced an independent review into the sustainability of Mid Staffordshire NHS FT. A contingency planning team led by Ernst & Young and supported by McKinseys has concluded Mid Staffordshire NHS FT is not clinically or financially sustainable. This has led to the consultation on a Trust Special Administrator (TSA) being appointed to take over the running of the Trust. The outcome of this consultation will be known by the end of March 2013.
Page 21 Should a TSA be appointed by Monitor then the Board of Directors and Governors will have their board role suspended and the TSA will take on the accountable officer role.
The CPT has given a recommended option, however the TSA does not need to follow this, they do however have to retain the Location Specific Services as per Monitor’s guidance. The CQC will be asked if a TSA is appointed to give an up to date opinion on the quality of services.
Mid Staffs Activity 2010/11 and 2011/12
Patients treated 2010/11 2011/12 Non Elective (Emergency) patients 27,701 27,516 Elective patients 4,439 3,981 Day case procedures 31,067 30,729 New outpatients 77,002 79,900 Follow up patients 181,921 206,899 A&E attendances 52,185 50,451
Burton Hospitals Foundation Trust Following the award of preferred provider status for the running of South Staffordshire Community Hospitals to Burton Hospitals Foundation Trust, the transfer of the community hospitals to Burton Hospitals Foundation Trust took place in July 2011.
Burton Hospital Foundation Trust also took ownership of the Independent Midlands Treatment Centre in July 2011. This had been previously operated by Circle
As a result, BHFT now provides services out of four main hospital sites: • The Queen’s Hospital in Burton-Upon-Trent, Acute hospital with A&E • The Treatment Centre on the Burton site, a dedicated centre for day case surgery and treatment • Samuel Johnson Community Hospital, Lichfield - local services, including a midwife-led maternity unit and 24/7 minor injuries. • Sir Robert Peel Community Hospital, Tamworth - local services, including an endoscopy unit and a 24/7 minor injuries
The significant changes in activity provided by the Trust are shown below:
BHFT Activity 2010/11 and 2011/12
Patients treated 2010/11 2011/12 Non Elective patients 41,084 41,194 Elective inpatients 6,208 6,125 Daycase procedures 12,891 26,720 New outpatients 57,190 70,806 Follow-up outpatients 105,383 138,271 A&E attendances (including MIU’s) 71,936 114,654 All patients 294,692 397,770
In November 2011, Monitor, the independent regulator of NHS foundation trusts, found that Burton Hospitals NHS Foundation Trust was in significant breach of the terms of its Authorisation (see section 14). The regulator’s decision was a result of the serious financial challenges the Trust continues to face.
The Trust are in an informal ‘turnaround’ with Monitor as a result of a detailed in-year analysis and external due diligence, the Trust has assessed its year-end forecast outturn deficit at circa £7.7million. There is now discussion on the long term sustainability of the Trust both financially and clinically.
Page 22
Burton Hospital’s mortality statistics in terms of HSMR’s have led them to be identified as one of the 14 Trusts the Medial Director for England Sir Bruce Keogh will investigate following the Robert Francis Public Inquiry.
Tertiary Services Specialist services tend to be high in cost and low volume. Due to this they are often only provided in specialist centres to a population of more than one million people. The three PCTs commissions West Midlands Specialised Services (now the Midlands & East Specialised Commissioning Group) to commission services on its behalf. Information is available at http://www.wmsc.nhs.uk/.
Details of contracts are shown in Appendix C.
Mental Health and Learning Disability Services The Staffordshire Cluster commissions services from two main mental health services providers; North Staffordshire Combined Healthcare NHS Trust and South Staffordshire and Shropshire Healthcare NHS Foundation Trust. Details of contracts and services are shown in Appendix D.
North Staffordshire Combined Healthcare NHS Trust North Staffordshire Combined Healthcare NHS Trust provides mental health and learning disability services for patients in NHS North Staffordshire and NHS Stoke on Trent. There is a strong track record of multi-agency working including Section 75 partnership agreements with both local authorities for mental services, provision of psychological therapy services in North Staffordshire and other strong links with the voluntary / independent sector.
The Trust are progressing a series of service and pathway redesigns to ensure productivity improvements and an associated skill-mix review. The organisation is also working with the PCTs on a range of initiatives to deliver QIPP and CIP. These initiatives include the introduction of Yorkshire Care Pathway Cluster models, reduced reliance on inpatient beds and enhanced community provision, and will significantly reduce the number of interfaces between discrete services and provide a much more streamlined patient journey. During 2012 the Trust completed a formal consultation on changes to older people’s mental health services which relocated services from Bucknall to Harplands and enabled the Trust to close the Bucknall Hospital site. A second formal consultation on further changes to both adult and older people’s services has also been completed, which has seen the beds removed from the Resource Centres and the closing of the Bennett Centre, with an enhanced home treatment and crisis response service.
North Staffordshire Combined Healthcare NHS Trust has formally agreed not to pursue Foundation Trust status and an alternate future for services are being considered with the Trust Development Agency.
South Staffs and Shropshire Healthcare NHS Foundation Trust South Staffordshire and Shropshire Healthcare NHS Foundation Trust (SSSFT) provide mental health and learning disability services for patients across South Staffordshire PCT. They also provide some community paediatric services. The Trust is working in partnership with the CCGs on significant service change and to provide greater services in the community. A major formal consultation on changes to adult mental health services has been completed on proposals to reduce inpatient beds, following increased investment in community services. This was approved by South Staffordshire PCT board on March 28th 2012, and the Margaret Stanhope Centre in Burton closed in September 2012.
Page 23 Staffordshire & Stoke-on-Trent Partnership NHS Trust (Community Healthcare Services) Community healthcare in Staffordshire had been mainly commissioned from the three PCT community services provider arms, which were brought together into a single new organisation, named the Staffordshire & Stoke-on-Trent Partnership NHS Trust established in September 2011. The new Trust consulted upon and was approved to proceed with Section 75 partnership integration with the adult social care services of Staffordshire County Council. This took place from April 2012. (Note this does not include the social care services of Stoke-on-Trent City Council).
The rationale for aligning the existing three PCT provider services alongside adult social care services will further strengthen the successful delivery of transformational change, provision of community based care and delivery of high quality and integrated services. The community services in Northern Staffordshire are already providing enhanced services to people with long term conditions such as diabetes and COPD, a range of intermediate and reablement services and a single point of care, as part of the FFtF programme.
Details of Community Services contracts are shown in Appendix E.
Prison Services South Staffordshire PCT commissions health services for seven prisons, NHS North Staffordshire commissions’ health services for one prison and NHS Stoke on Trent do not commission health services in prisons.
Prisons Prison Type Prison Operator Popn Size Young male adults (18-21 yrs old.). Sentenced and Brinsford Public Sector 577 remand, 11 inpatient healthcare beds Adult male sentenced and remand prisoners. 11 Dovegate Contracted (Serco) 1060 inpatient healthcare beds Drake Hall Women sentenced prisoners 18 years + Public Sector 315 Featherstone Adult male sentenced prisoners. Public Sector 655 Oakwood Adult male sentenced prisoners. Contracted (G4S) 1605 Stafford Adult male sentenced prisoners. Public Sector 741 Young adult male (18-25) longer sentenced Swinfen Hall Public Sector 654 prisoners.
Popn Prison Type Prison Operator Size Juvenile centre (15-18 years olds), male, remand Werrington Public Sector 160 and sentenced
Prison Commissioning Arrangements 2012/13 The Cluster received funding of £11.7 million in 2012/13 to commission healthcare services in Prisons. This figure excludes funding the PCT receives as part of its main allocation for community and secondary care services for prisoners, and substance misuse funding for prisons which is transferred to the Local Authority under a section 75 agreement. In 2012/13 substance misuse funding totalled £6.5 million.
Both NHS North Staffordshire and South Staffordshire PCT utilise this funding to commission a range of primary care (e.g. GP, OOH, pharmacy, dental, optometry and nursing services) to be delivered within prisons, along with primary and secondary mental health services. These services mirror those provided within the community and are commissioned through standard contracting routes. Please note: these contracts have been adapted, following primary care or formal legal
Page 24 advice, to suit a custodial environment as a number of the mandatory terms cannot be applied within these settings.
Prison health is currently included as a schedule in the local Community Trust (SSOTPT), mental health (SSSFT) and Out of Hours (Badger) contracts. All other prison health services are separate contracts which are managed by the PCTs Prison Health Commissioner or primary care team (prison dental contracts). Substance misuse services in prisons are contracted by the Local Authority Substance Misuse Commissioning Team.
In line with advice received from the SHA, where prison based health services are included as a schedule in a wider contract these will be separated out from April 2013, enabling contacts to exist directly between the NCB LAT and the provider. The exception is likely to be planned secondary care and community services (see below).
The prison pharmacy contract is due to expire in October 2013 and the procurement process commenced during the latter half of 2012. As a standard pharmaceutical contract will be used to underpin this service the SHA have confirmed that formal Operational Contracting Assurance Framework (OCAF) approval was not required. Out of Hours services will be transferring to the commissioning management of Clinical Commissioning Groups in line with new “who pays” responsible commissioner guidance.
Prisoner acute care is currently commissioned by CCGS as part of the acute hospital contracts. Funding or non-emergency secondary care and community services for prisoners will transfer to the NCB from April 2013 and will be delivered through. an associate commissioner model with CCGs.
The County Council’s Substance Misuse Commissioning Team has recently completed the re- procurement of prison services, which the PCT participated in. It is anticipated (subject to any contrary instruction from the NCB) that the Substance Misuse Commissioning Team will continue to commission these services from April 2013 on behalf of the .Area Team , underpinned by a formal agreement between the .A.T and the Local Authority stating clear lines of accountability (these will ultimately rest with the NCB) and clarifying roles and responsibilities.
Current Risks • Current performance (staffing levels and dental service activity) by SSOTPT. Total contract value £4mn/annum. • Spend on escort, bed watch and constant watches – potential overspend of £250k/annum on a £900k budget, based on past years performance. • Ensuring contracts for services remain ‘fit for purpose’ and viable when extracted from wider contracts with providers. • Ensuring that offender health needs and commissioning responsibilities are integrated into the emerging wider structures (CCGs, Public Health, Health and Wellbeing Boards).
Regional Responsibilities The Cluster is running a single operating model for Offender Health. The West Midlands Offender Health Commissioning Team was established on the 1st April 2012 and is hosted by the Staffordshire Cluster of PCTs. The majority of the team are on a 12 month secondment until the 31st March 2013.
The team cover Prison Health Commissioning, Police Early Adopter, and liaison and diversion programmes. In relation to the Police Early Adopter programme the team are supporting both Early Adopter waves (Wave 1 – Staffordshire and West Midlands and Wave 2 - Warwickshire and West Mercia).
Page 25 Other Providers
Voluntary Sector The CCGs commission services from the voluntary and third sector organisations which range from small schemes of less than £10,000 to substantial services approaching £1m. The services commissioned are predominantly for respite and end of life care, older people, mental health, physical and sensory disability, people with a learning disability and children and families, but also include support for service user and carer organisations and voluntary sector infrastructure organisations.
There has been an increase in commissioning from the voluntary sector in recent years and we would expect this trend to continue – however, this has often been with larger, national Voluntary and Community Sector (VCS) organisations who have successfully tendered for contracts, as opposed to growing the market locally.
There is recognition that reductions to Local Authority budgets will potentially have an impact on the provision of local voluntary sector organisations and the Cluster is aware of the challenges this will present. Commissioners recognise and value the significant contributions that the third sector makes to health and social care services, outcomes and through arrangements such as the local compacts, is actively seeking to further develop the role of the sector in the market for healthcare services.
Independent Sector - Learning Disability Placements
• South Staffordshire PCT has 19 clients on direct funded placements. • South Staffordshire PCT has 55 clients under joint funded contracts held by Staffordshire Council. • NHS North Staffordshire has 3 clients on direct funded placements. • NHS Stoke on Trent has 10 adults and 1 adolescent client (s) on direct funded placements. • NHS North Staffordshire and Stoke-on-Trent Health Economy have 35 clients in Nursing/residential homes and 3 in Independent Hospitals under Continuing Care Funding.
Hospice Services • South Staffordshire PCT commissions health services from four adult hospices and two children’s hospices. • NHS North Staffordshire commissions health services from one adult hospice. • NHS Stoke on Trent commissions health services from one adult hospice and one children’s hospice.
Nursing Home Services • South Staffordshire PCT commissions both Continuing Health Care (CHC) and funded nursing care (FNC) services from 93 Nursing Homes providers. • NHS North Staffordshire PCT and NHS Stoke on Trent PCT commission Continuing Health Care (CHC) services from 123 Nursing Home providers. • NHS North Staffordshire commission Funded Nursing Care (FNC) from 17 Nursing Home providers. • NHS Stoke on Trent commission Funded Nursing Care (FNC) from 16 Nursing Home providers.
Ambulance Service Ambulance services are provided for Staffordshire and Stoke on Trent PCTs through a SLA with West Midlands Ambulance Service.
Details of the majority of voluntary and other contracts and services are shown at Appendix F.
Page 26 Section 4: Quality
Quality Handover Document In the development of the transition period that the NHS faces, it has been decided nationally that Cluster Organisations should produce a robust transition plan for quality. In April 2012 the National Quality Board (NQB) produced a guideline on how Clusters should begin the preparation to handover quality to ‘Receiver Organisations’ (CCGs’ Local Authorities and NHS Commissioning Board). In line with this guidance, the Cluster has produced an extensive plan detailing all aspects of the quality agenda and outlining how this will be handed over to Receiver Organisations’ during face to face meetings scheduled to take place between October 2012 and March 2013.
The handover document for each ‘Receiver Organisation’ will be produced in both paper and electronic formats and will provide extensive data and information in respect of each key provider for the ‘Receiver Organisation’. A copy of the handover plan and document should be read to obtain full details of all key quality and safety data, achievements and concerns in respect of local providers.
As such the Quality Section in the Legacy document is a summary of some of the main issues as the Quality Handover Document will have more detailed plans and information.
The Quality Handover Document is at appendix G
Quality Summary The Staffordshire Cluster has established a systematic process to ensure quality and safety. The main process by which quality is assured for the main provider organisations is via the Clinical Quality Review Meetings (CQRMs). These review meetings monitor compliance with the quality aspects of the contracts in place with each provider. Additional measures include the Commissioning for Quality & Innovation Scheme (CQUINS) and the Patient Related Outcome Measures (PROMS). In addition to the CQRMs there is a programme of visits to each Trust, which encompass announced and unannounced visits.
For organisations external to the Cluster, work is conducted through the host PCT Cluster arrangements and quality specialists from the Commissioning Support Services (CSS) Contract team attend CQRMs of significant peripheral providers. Over the past months the Cluster has been working to handover the lead and chairing of CQRMs to Clinical Commissioning Groups (CCG) and this is now in place for most providers. Where it is not yet fully handed over, work is underway to ensure CCG ownership by autumn this year.
CQRMs provide a robust mechanism where Commissioners and Providers can work together to identify and strive to meet standards that will serve to deliver services and drive up quality. Relationships are well established to support local accountability and respond to local needs and requirements
The mechanism for providing Exception Reports for non-achievement of quality related KPIs is established and operating in line with the 2012/13 Operating Framework
The Cluster quality team have reviewed and aligned the different PCT processes, for example, CQC Quality and Risk Profile are now produced for all provider organisations across the Cluster. Likewise common and robust processes for managing serious incidents are now in place across the Cluster. Quality dashboard reports are provided for the Cluster Transitional Quality Sub Committee and for CCGs. The Quality Annual Reports form part of the Library of Knowledge and contain all quality information relating to the three PCT areas.
Page 27 Effectiveness
Commissioning Prioritisation Each PCT has an established prioritisation process, which has been used in previous years to provide a rational, robust process to prioritise investment and disinvestment in service areas within the available financial envelope and to inform commissioning and decommissioning decisions. CCGs have established their own prioritisations processes which they are using in the commissioning round for 2013/14.
Key Prioritisation Processes Each PCT has a group or process which oversees the implementation and ongoing development of the PCT’s prioritisation policy and undertakes the prioritisation process. This is carried out or reports to the Clinical Senate (PEC) and more recently CCG, through to Common Trust Board. The main purpose of the group/process is to:
• Inform strategic planning. • Inform annual commissioning cycle by recommending priorities for investment and disinvestment. • Advise on funding of in-year service developments.
From January 2012 all Staffordshire Cluster PCTs have adopted a single fit for purpose Individual Funding Request (IFR) Policy, for requests from individuals for exceptional funding. North Staffordshire CCG and Stoke CCG operate the IFR process as part of their CCG operations. South Staffordshire CCGs operate the IFR process as a single process collectively, with support provided by the Staffordshire CSS. The IFR process, and associated policy, are both reviewed frequently. The current cluster-wide policy was developed from the North Staffordshire PCT process which was tested in 2011 through a judicial review into bariatric surgery.
It is envisaged that the recent work undertaken to develop the latest IFR policy will ensure a smooth transition of the process to CCG responsibility
Patient Experience
Regular quality monitoring of patient experience is carried out which forms part of the Quality Report made to the Cluster Quality Committee.
Provider patient experience is currently being monitored through patient experience reports from providers into their respective CQRM as well as through quality visits from Cluster staff, which have a specific element on feedback on patient own experience and treatment.
Any feedback from the above is assessed for its level of concern, and if the concern is an issue of patient safety then immediate action is taken between the cluster and provider, whilst other concerns are addressed through the provider’s CQRM.
Patient Participation Groups are now active in 64 of the 91 practices in South Staffordshire, all 55 practices in Stoke on Trent and 32 of the 34 practices in North Staffordshire. All patient groups meet on a regular basis and all the practices except one in Stoke-on-Trent are participants in the DES.
In North Staffordshire and Stoke-on-Trent, locality patient groups are currently being established with 5 for North Staffordshire and 3 for Stoke on Trent. These patient locality groups feed up from the PPGS and provide a link to the newly established patient congress at each of the CCGs.
Page 28 The patient congress is the strategic oversight and scrutiny body who work in partnership with the CCG and provide scrutiny of public and patient involvement and the outputs of the insight database.
In South Staffordshire the four CCGs are building on their existing model and developing the district groups to have a new focus and are all working towards setting up a congress that will function in the same way as the north CCGs.
To broaden the spectrum of patient involvement all CCGs are recruiting to a membership. For South Staffordshire the scheme is in its infancy, North Staffordshire’s long established scheme has over 2200 members and Stoke on Trent have now created a new scheme and has over 1200 members. In South Staffordshire work is in progress building on the 100+ members at each of the four clinical commissioning groups.
To support this model of involvement a single repository for all patient feedback has been developed and is used to record all PALS, complaints, PPI, MP letters, social media (patient opinion), mystery shopper, media and soft intelligence. This insight database records the information by the domains of patient experience, safe high quality care, access and waiting, better information, more choice , building better relationships and clean comfortable place to be.
The data recorded is available to all staff via real time dashboards that highlight themes and trends and this data is driving the work programmes for the patient congress and capturing patient feedback at all levels. This work has been recognised at a national level with project gaining recognition in the following awards
• Patient Experience Network National Awards – 2011 – Finalist in the measuring, reporting and acting category • Crème de la Crème Business Awards – 2011 – winner of outstanding business achievement • HSJ Efficient Awards – Finalist 2012 – efficiency in administrative and clerical • EHI Award – Winner 2012 – most promising IT to support clinical commissioning • Patient Experience network national awards – 2012 Runner up in the measuring reporting and acting category
As part of the ‘Patient Revolution’ agenda, there is a drive for greater co-production between patients and professionals. This will be achieved through shared decision making between health professionals and individual patients and carers, particularly in the management of long term conditions. This work will be led by CCGs. The friends and family test is included in the contracts for 2012/13 and will be supported via CQUIN. Local results for the Friends and Family test are reported at CQRM and at the Cluster Transitional Quality Committee.
The first published results of the Friends and Family score were made publically available from April 2012 for Acute Trusts in the Midlands and East SHA. The latest available results for January 2013 are showing a Net Promoter Score of 73.9% positive for the Staffordshire Cluster, showing a largely positive trend.
Staffordshire Cluster Net Promoter Scores 2012/13 YTD (January 2013)
Page 29 NPS, Aug, 73% NPS, Jun, 70%NPS, Jul, 70% NPS, Sep, 70% NPS, Nov,NPS, 70%Jan, 70% Promoters,Promoters, Apr, 66% May, NPS, Dec, 69% NPS, May, 66% Promoters,Promoters, Aug, Promoters, Sep, Oct,Promoters, 71%NPS, Oct,Promoters, Nov, 64% Dec, 71%Promoters, Promoters, Jun, 75% Jul, 74% Promoters,Promoters Jan, 75% NPS, Apr, 58% 77% 75% 75% 74% Passives Detractors NPS
Passives, Apr, 27% Passives, May, 24% Passives, Oct, 23% Passives, Jun,Passives, 20% Jul,Passives, 22% Aug,Passives, 18% Sep, 20% Passives, Nov,Passives, 21%Passives, Dec, 22% Jan, 20%
Detractors,Detractors, Apr, 8%Detractors, May, 5% Detractors, Jun, 5% Detractors, Jul, 4% Detractors, Aug, 4% Detractors, Sep, 5% Detractors, Oct, 6% Detractors, Nov, 5%Detractors, Dec, 4% Jan, 5%
Breaking the Cluster score down to individual trust level, Burton Hospitals are tracking consistently above the SHA Net Promoter Score, with UHNS generally above the regional score, but dipping below it in April and October. Mid Staffs is noticeably below the Midlands and East score, as shown below:
Net Promoter Scores (%) 2012/13 85
80
75
70 Midlands 65 and East 60 BHFT
55 MSFT 50 UHNS 45
40 Apr May Jun Jul Aug Sep Oct Nov Dec Jan
The work on integrating all patient facing activity and collating, aggregating and analysing data into one database has seen the development of real time patient feedback monitoring where the data is available for commissioning managers and clinical leads to access the data for their area of responsibility and take any required actions in real time to address patient concerns. All patient intelligence is now collected in one place.
The data collected at a local level is compared with national data and the patient experience domains to ensure that top line themes are identified and provide a focus for future work
Page 30 Analysis of Complaints
All complaint information is collected and stored on a single user interface a data system
NHS North Staffordshire handled 66 complaints for the period April 2013 – March 2013 (11th March). The Themes for North Staffordshire are: Access and Waiting 13.64% Better info, more choice 10.61% Building closer relationships 9.09% Other issue 1.52% Safe, high quality co-ordinated care 65.15% Total 100.00%
NHS Stoke on Trent handled 117 complaints for the period April 2013 – March 2013 (11th March). The themes are: Access and Waiting 23.08% Better info, more choice 14.53% Building closer relationships 17.09% Other issue 0.85% Safe, high quality co-ordinated care 44.44% Total 100.00%
South Staffordshire handled 155 complaints for the period April 2013 – March 2013 (11th March): The Themes are: Access and Waiting 24.52% Better info, more choice 10.97% Building closer relationships 13.55% Other issue 0.00% Safe, high quality co-ordinated care 50.97% Total 100.00%
Safety Mortality The Dr Foster Intelligence Hospital Guide 2012 has published mortality data for every hospital trust in England (http://drfosterintelligence.co.uk/thought-leadership/hospital-guide/). There are a number of different clinical indicators in the Hospital Guide, including Hospital Standardised Mortality Rates, Summary Hospital Mortality Indicator and Deaths after Surgery. The Hospital Standardised Mortality Rate (HSMR) is an indicator of healthcare quality that measures whether the death rate at a hospital is higher or lower than you would expect. The Summary Hospital Level Mortality Indicator (SHMI) is similar to HSMR but with three main differences:
• HSMR reflect only deaths that occur in the hospitals care, whereas SHMI also includes deaths that occur outside of the hospitals care within 30 days of discharge • The HSMR focuses on a basket of 56 diagnosis groups (which account for 83% of all hospital deaths), whereas SHMI accounts for all diagnosis groups • HSMR takes palliative care into account, whereas SHMI does not
Page 31 Organisation Year SHMI HSMR Deaths after Surgery UHNS 2011/12 106 104 155
2010/11 103 116 146 Mid Staffs 2011/12 93 84 77
2010/11 99 90 90 Burton 2011/12 101 112 60
2010/11 112 112 88
Trend analysis / reference to learning from Serious Incidents Serious Incidents are reported to the Cluster through the Risk Manager, as well as being reported to the SHA, within 48 hours of the incident. From February 2012 the Cluster (in shadow form) took over the role of SI management from the SHA. New Serious Incidents are cascaded to Cluster Quality and CCG Leads as they are reported and combined in one report to Cluster Executives on a weekly basis. CQRM then monitor ongoing investigations and implementation of preventative actions. Monitoring of trends is undertaken by the Cluster Quality Committee via monthly SI reports, and any further analysis is instigated at this level. From April 2012 the Cluster (via CSU) took over responsibility in full and this system now operates effectively across the health economy.
Regular meetings are also held with each of the Trusts and Risk Manager/Quality Leads to review ongoing Sis and agree root cause analysis reports and action plans before closure. At the end of January 2013 SI’s open over 45 days were at zero in Staffordshire and Stoke on Trent. They are being actively managed to ensure they are maintained in single figures.
A new national Serious Incident Framework is being developed. Area Teams will be able to request a new login from the STEIS homepage when the new architecture is set up. The Clinical Directorate will monitor Serious Incidents to ensure that CCG’s are performance managed on their ability to maintain this level of closure and to ensure triangulation of intelligence to highlight signs of poor or deteriorating quality and safety.
Page 32 Initial Notification of Serious Incident – All providers make initial notification within 48 hours (of decision that the incident is to be classified as an SI) to the Lead Commissioner (normally via Risk Manager)
-Risk Team & Quality Leads in CMTs informed automatically by email when new SI logged on STEIS Formal Reporting on STEIS - flow charts in contracts with all -Cluster Quality Team and CCG leads informed of providers detail the arrangements for reporting in and out of details of individual SIs as they are reported hours. PCTs have internal process for reporting commissioning SI’s - Weekly Report to Cluster Executives & and also report SIs on STEIS for South Staffordshire & Shropshire CCG Leads Mental Health Foundation Trust -monthly SI report to Cluster Quality Committee
Commissioner Links with Provider – • Review & agree initial grading (3 days) • Update immediate actions / further details (7 days) • Monthly updates (via STEIS, Clinical Quality Review Meetings / serious Incident sub Groups) see details below* • Investigations should aim to be completed within 45 days ( note 60 days for Grade 2 e.g homicide, national never events) • Closure to be agreed with the Commissioner once STEIS updated with outcome of RCA • Extensions to the 45 days to be agreed with the Commissioner • BHFT – Quality Lead attends internal group and CQRM – informs Risk Manager • MSFT - Risk Manager attends provider Incident review Group who recommend closure to Quality & Safety Group attended by CMT Quality Lead, which in turn reports to Healthcare Quality Assurance group (Commissioner representation at Director level) who report back to CQRM • UHNS & North Staffordshire Combined Healthcare Trust – Monthly SI group meetings & reports to CQRM (written report) • Staffordshire & Stoke-on-Trent Partnership Trust – joint North & South SI review group monthly meeting with Risk Manager and CMT Quality Lead • South Staffordshire & Shropshire Mental Healthcare Trust – bi-monthly meeting between Risk managers - RCA shared with Risk Manager/Clinical Quality Lead – summary report to CQRM
Quality Reporting via Quality reports & Dashboard to Cluster Quality Committee, CCGs & Boards
Infection Prevention and Control Challenges across the Health Economy have included a period of Noro Virus (Winter Vomiting bug) outbreaks over the winter months in 2011/12, this follows a pattern similar to previous years but the outbreaks have not been as severe.
The work to reduce Healthcare Associated Infections (HCAI) is undertaken in partnership, attendance and input to Infection Control meetings is from all health economy organisations. Further detail can be found in the Infection control and Prevention Annual Reports on each PCT website.
HCAI is a catch-all term for a wide range of infections. The most well-known HCAIs include those caused by meticillin-resistant Staphylococcus aureus (MRSA), meticillin-sensitive Staphylococcus aureus (MSSA), Clostridium difficile (C.diff or CDAD), Extended Spectrum Beta- lactamaise organisms (ESBL) and Escherichia coli (E.Coli), but there are many others we need to be aware of. There are target for MRSA bacteraemia and C’diff; E-coli and MSSA have been monitored for the last 18 months which has demonstrated that a significant number of these have presented in patients who have received no healthcare.
We should also be careful not to judge on HCAI targets alone as outbreaks and Periods of Increased Incidence (PII) are equally important as quality markers requiring appropriate investigation and action plans put into place. IP&C issues can be an early warning of other problems within an organisation. RCAs have been undertaken on MRSA bacteraemia and C’diff
Page 33 cases along with C’diff deaths and HCAI on Part 1 of a death certificate for some time with excellent learning’s across the region. Trusts are increasingly undertaking RCAs on other HCAI bacteraemia.
The control and prevention of healthcare associated infections is essential to ensuring patient safety. The nature of HCAI is complex and demands leadership and systems that are supportive and continuously refined which should be an organisation-wide approach to achieve excellence and meet the high public expectations of healthcare delivery.
The Department of Health issued the HCAI trajectories for 2012 – 2013. All organisations are within their target for MRSA Bacteraemia. Mid Staffordshire NHS Foundation Trust and Burton Hospital NHS Foundation Trust have exceeded their Clostridium Difficile targets, whilst University Hospitals of North Staffs NHS Trust are within target but are not reporting in the same way as the other Trusts therefore this could be a low report. To counter this inconsistency between different providers new National Guidelines have now been issued to take effect from April 2012.
HPA There have been increasing requests from the HPA for help from the NHS; as such the Head of Infection Prevention and Control and the Major Incident & Emergency Planning Manager are working on systems and processes to make sure requests are appropriately managed and resourced.
Influenza H1N1 (Swine Flu) Novel H1N1 flu is popularly known as swine flu. It is a respiratory infection caused by an influenza virus first recognised in spring 2009. The new virus, contained genetic material from human, swine and avian flu viruses.
Across the Health Economy all Trusts responded to this year’s potential risk by continuing work on the previous year’s Action Plans which included giving IP&C advice, promoting and providing staff vaccination, staff training on mask fit testing and fitting, education sessions, purchasing and distribution of specialist personal protective equipment, developed guidelines for patient care and escalation plans for outbreaks.
Safeguarding It is a statutory duty for the PCTs to safeguard vulnerable adults and children. For both Staffordshire and Stoke-on-Trent there is one adult safeguarding board and for children there is a board for both Staffordshire and one for Stoke-on-Trent. There are designated lead professionals, Doctors and Nurses and agreed multi-agency policies in place. There has been a gap in respect of Designated Doctor Provision in the South of the county. Work is currently underway to recruit to the post.
The safeguarding lead professionals also undertake serious case reviews.
Multi Agency Safeguarding Hub (MASH) The PCTs have joined forces with Staffordshire Police, Staffordshire County Council, Stoke-on- Trent City Council and representatives from others parts of the NHS in Staffordshire and have come together to form a co-located, co-producing collaboration to protect children and vulnerable adults in the county.
The aim of the MASH is to facilitate the sharing of information at the early stage of the referral process, to offer the best possible intelligence within workable timescales thus improving the quality and responsiveness of the service being provided.
Page 34 Innovation Below is a summary of the key innovative approaches underpinning the delivery of future healthcare.
Innovation Health and Wealth With the transition of commissioning responsibility to CCGs, the PCT Cluster has been working with our 6 CCGs to ensure that the actions within Innovation Health and Wealth are being addressed by the CCGs as part of their core business.
The principles of high impact innovations are included in CCGs clear and credible plans in terms of commissioning best clinical practice, which provide best value for money.
The high impact innovation areas are specifically being addressed by CCGs through the existing contractual processes with providers, to ensure that best practice pathways are being commissioned and delivered.
These contractual processes include: • Commissioning intentions • Contract negotiations, including CQUINs • Monthly contract and quality meetings with providers to review and assess progress • Procurement processes where necessary.
Locally the leadership culture within CCGs to support innovation and spread of best practice is being developed through the CCG authorisation processes, including the NHS Constitution and Organisational Development plans specifically.
Technology The use of assistive technologies forms part of the CCG health economy transformation programmes, to support the transfer of care from acute into community settings and as part of admission avoidance schemes.
This specifically relates to the overarching CCGs’ goal of enhancing the quality of life and improving health outcomes for people with LTCs.
There have been a number of relatively small scale pilots across CCG areas, but there is recognition that for change to have the necessary impact, this needs to be implemented at scale hence linking this to transformation programmes.
Tunstall and Docobo telehealth units are being used across Staffordshire. Stoke on Trent PCT had previously developed ‘Simple telehealth’ or ‘Flo’ which is a mobile phone based vital signs monitoring system and this is being rolled out locally. In the South Staffordshire area there is a pilot of a simple landline based service, due to the rurality of the area and limited mobile phone coverage in certain locations. The benefits of Tunstall / Docobo in comparison with Simple are being evaluated by CCGs. CCGs are also utilising the SHA funding to support the roll out of Simple telehealth.
The local Partnership Trust, which provides community health and adult social care services, is planning large scale implementation of telehealth solutions as part of their efficiency improvements. This also supports the delivery of local transformation programmes.
Collaboration has commenced across health and social care to consider assistive technologies as a whole in terms of being part of an integrated pathway for members of the public and as patients. This work is being undertaken in collaboration with the CCGs.
Page 35 Intra-operative Fluid Management The full implementation of intra-operative fluid management monitoring technologies into practice across Staffordshire is being addressed by CCGs through contract discussions. Specific examples from Burton Hospital Foundation Trust and University Hospital of North Staffordshire include:
• Intra-operative fluid management monitoring technologies incorporated for all colorectal elective and emergency patients as part of their pathway. UHNS are exploring options to introduce to Upper GI and Urology procedures. • All high risk patients are identified at pre-operative assessment by looking at possum scoring and leave with a full plan in place including their HDU stay and the use of intra- operative fluid management. • Updates to their oesophageal doppler monitors (trialling ‘Lidco’ monitors for use on patients during surgery.
Child in a Chair in a Day CCGs have recently awarded a tender for wheelchair services, and ‘child in a chair in a day’ was incorporated into this service specification. By 1st September, the provider of wheelchair services to our CCGs will consistently deliver a wheelchair on the day of the patient’s consultation for those whose needs can be delivered through an ‘off the shelf’ wheelchair i.e. one which does not have to be specifically made for them. For patients who need wheelchairs to be specifically made these will not be available on the day, but to an agreed maximum waiting time.
Digital by Default To work towards reducing inappropriate face-to-face contacts and to switch to higher quality, more convenient, lower cost alternatives in Staffordshire is being addressed by CCGs through the existing contractual processes with providers, to ensure that best practice pathways are being commissioned and delivered.
These contractual processes include: • Commissioning intentions. • Contract negotiations, including CQUINs. • Monthly contract and quality meetings with providers to review and assess progress.
The increased use of technology forms part of the CCG health economy transformation programmes, to support the transfer of care from acute into community settings and as part of admissions avoidance schemes.
Locally CCGs are already commissioning telephone follow ups where clinically appropriate across a range of specialties. This is being further considered as part of contract discussions and will feature in 13/14 commissioning plans, to focus on condition specific area
It would be helpful to have a national view of which services are being commissioned as telephone follow ups, so we can learn from practice which is happening elsewhere.
Trusts are also considering the potential of video conferencing to replace certain outpatient consultations. A pilot is being undertaken in North Staffordshire CCG, which is focusing on nursing home patients and another pilot is being undertaken by the Cluster for prisoners. Consideration is being given to further potential applications of video conferencing.
Trusts are also using digital telemedicine technologies to support their services such as Burton Hospital who are part of the region wide on-call stroke service for thrombolysis using telemedicine to review patients. One of the Consultants at Burton is also considering how telemedicine can support out of hours for intensive care.
Page 36 Another example of where technology is being used in the NHS locally is as part of our quality agenda. Patient feedback is obviously critical and to help collect feedback, hand-held real time monitoring devises are used to capture patient experience.
Support for Carers of People with Dementia To commission services in line with NICE / SCIE guidance on supporting people with dementia CCGs have been focussing significantly on dementia in terms of developing strategies and with specific focus on early diagnosis, management and quality of care provided across primary, community and secondary care. The role of carers has also been central to this work.
This work is being managed through stakeholder working groups and then supported through contract management forums to ensure that planned changes are being implemented.
The NICE / SCIE guidance on supporting people with dementia has been considered as part of this work with 1) the implementation of single point of referral for people with a possible diagnosis of dementia, 2) ensuring that services are accessible to all, 3) working towards a co-ordinated and integrated approach between health and social care to treat and care for people with dementia and their careers and 4) considering the needs of carers in care planning. With the integration of the Partnership trust, referred to above, this facilitates the delivery of these objectives.
Other key activities which CCGs are delivering include:
• Work is being undertaken on raising awareness amongst members of the public regarding dementia.
• A range of development programmes are being undertaken across primary care to support improvements in the recognition and diagnosis of dementia to ensure that patients are referred to services more quickly.
• Work is also ongoing to reduce antipsychotic prescribing, through GP education and work with care home pharmacists and CPNs and also with consultants reviewing antipsychotic prescribing on wards.
• Investment in carer breaks has also been made by CCGs.
• Included in provider quality accounts.
• Rapid Assessment Interface and Discharge (RAID) Acute Services Liaison – A pilot is being delivered across North Staffordshire focussing on In-reach services in A&E and admission portals focussing on patients with dementia, delirium and depression.
• Across South Staffordshire there are Dementia Advisors who help patients navigate to access appropriate local services
Page 37 Section 5: Performance
Quality and service performance to date in 2012/13 shows:
• Decrease in reported Health Care Associated Infections. • Increase in assessment and treatment in 24 hours for Transient Ischemic Attacks (TIAs) and Venous Thromboembolic Events (VTEs). • Improvements in CQUIN achievements. • Sustained improvements in A&E performance in the first half of the year, with significant challenges on sustaining performance in the second half of the year. • Improved Delayed Transfers of Care rates. • Improved Cancer waits and urgent treatment including bowel, breast and cervical screening. • Improvement on admitted and non-admitted Referral to Treatment Times. • Improved 18 week Referral To Treatment (RTT) performance
The Staffordshire system has a number of significant quality and performance pressures across a number of areas. CCGs with support from the Cluster are the leads in dealing with these challenges with relevant providers. The quality and service performance challenges are not new and are areas that Trusts have struggled to resolve for some time.
Cluster Information Reporting Current performance arrangements and approaches are being shared Cluster wide. A Cluster Performance dashboard is provided for the Cluster and reported to Cluster Common Board and individual Boards.. A performance Finance, QIPP and Performance Sub Committee Performance Report is also produced and details of any outcomes are feedback to the Cluster Common Board.
At the end December 2012 (Quarter 3, 2012-13, the key performance issues to note are as follows:-
• A&E performance at BHFT and UHNS failed to achieve the 95% target for total time in A&E (4 hour wait). Mid Staffs achieved 95.14% • Referral to Treatment times for admitted and non-admitted patients at Burton Hospital failed to achieve the 90% and 95% targets • Incidence of Clostridium Difficile exceeded target numbers for South Staffordshire patients • Very small number of breaches in same sex accommodation occurred at Mid Staffs and Burton Hospitals
The key performance issues for the Cluster include maintaining further improvements against the following standards:
• A&E 4 hour maximum wait at BHFT and UHNS • 18 weeks referral to treatment at BHFT • Healthcare associated infections – incidence of Clostridium Difficile. • Mental Health – Improved access to psychological services. • Delivery of QIPP savings.
However the main issues affecting the Cluster as a whole that require the greatest effort to improve performance are:
• A&E 4 hour maximum wait. • 18 weeks Referral to Treatment. • 2 week Cancer waiting times. • Healthcare associated infections – incidence of Clostridium Difficile.
Page 38
PCT and LHE Performance 2011/12
Measure (Target unless PCT South Staffs Stoke-on-Trent North Staffs specific) 9 against a 1 against a 2 against a MRSA Bacteremia target of 14 target of 7 target of 5 Category A calls meeting the 19 95.4% 99.3% 96.6% minute standard (95%) Cancer two week wait from GP 95.0% 99.3% 96.6% referral- symptomatic breast (93%) Cancer 31 day (one month) wait to 99.0% 99.0% 100.0% first definitive treatment (96%) 31-Day Standard for Subsequent 98.0% 100.0% 91.7% Cancer Treatments – Surgery (94%) 31-Day Standard for Subsequent 100.0% 100.0% 100.0% Cancer Treatments – Drug (98%) 31-Day Standard for Subsequent Cancer Treatments – Radiotherapy 98.7% 100.0% 95.8% (94%) Cancer 62 day (two month) wait from 89.2% 78.2% 93.2% urgent referral to treatment (85%) Cancer 62 day wait (referral from NHS Cancer Screening Service) 95.2% 100.0% 80.0% (90%) Cancer 62 day wait (Consultant 90.5% 100.0% 100.0% Upgrade) (94%) Stroke Care: time spent in hospital 73.6% 85.4% 83.1% on a stroke unit (80%) Stroke Care: suspected TIAs assessed and treated within 24 82.8% 88.6% 68.0% hours (60%) Maternity 12 weeks (90%) 109.7% 116.2% 111.6% Mental health measure - early 98 patients 79 patients 35 patients intervention in psychosis Mental health measure - care 96% 97.30% 97.50% programme approach (CPA) (95%) RTT waits (median wait measures): 8.7 weeks 8.5weeks 8.3 weeks admitted (11.1 weeks) RTT waits (median wait measures): 4.4 weeks 4.9 weeks 4.4 weeks non-admitted (6.6 weeks) RTT waits (median wait measures): 5.7 weeks 6.2 weeks 6.1 weeks incomplete pathways (7.2 weeks) 147 cases – 74 cases – 45 cases – should not Incidences of Clostridium Difficile should not should not exceed 194 exceed 65 cases exceed 65 cases cases Mixed Sex accommodation breaches 23 breaches 0 breaches 1 breach Mental health measure - crisis 1065 patients - 619 patients - 362 patients - resolution home treatment target 944 target 576 target 353
Page 39 Measure (Target unless PCT South Staffs Stoke-on-Trent North Staffs specific) Mental health measure – improved 65.8% - target achieved 2.9% 98.3% - target access to psychological services 88.2% target 2.8% 94.3% Coverage of NHS health checks achieved 7.2% - achieved 2.9% achieved 4.9%- (offered) target 18% target of 2.8% target 5% Coverage of NHS health checks achieved 2.55 % achieved 6.1 % achieved 4.7% (screening) achieved 3,248 achieved 2508 achieved 1,326 Smoking quitters against a target against a target against a target of 4,225 of 2700 of 1,337
Page 40 Section 6: Financial History
The Staffordshire Cluster operates under a total commissioning resource envelope of £1.9 billion for 2012/13. The PCT resource allocations announced in December 2011 still leave the Cluster as a whole £86m under its fair shares target funding (under the current allocation formula).
The current finance arrangements and approaches are being shared Cluster wide under the direction of the Cluster Director of Finance.
One Finance report is provided for the Cluster on the performance of the three PCT’s and reported to the QIPP, Finance and Performance sub group of the Common Board, with a highlight report to Board.
PCT Historical Financial Delivery
South Staffordshire PCT
The PCT has previously had a strong record of financial management delivering a surplus position. However 2011/12 and 2012/13 has seen the strength of the South Staffordshire PCT financial position decline, with additional financial support required in order to deliver the financial surplus position. In 2012/13 additional support from the SHA of £9.4m and cross Cluster flexibility of circa £4m has been received to maintain the forecast surplus.
SSPCT received additional support from the SHA in 2011/12 identified as MSFT £5m, MSFT A&E £2.7m and RTT £2.968m
The surplus positions delivered by the PCT are shown below:
• Surplus of £4.600,000 for 2008/09. • Surplus of £4.523,000 for 2009/10. • Surplus of £378,000 for 2010/11. • Surplus of £353,000 for 2011/12. • Forecast outturn surplus of £750,000 for 2012/13 at month 10.
NHS North Staffordshire The PCT has a strong record of financial management having inherited a legacy deficit in 2006/07 but driving an effective turnaround programme and retaining a surplus over the last five years. The PCT delivered a:
• Deficit of £3,650,000m in 2006/07. • Surplus of £1,050,000 in 2007/08. • Surplus of £2,000,000 in 2008/09. • Surplus of £515,000 in 2009/10. • Surplus of £1,162,000 in 2010/11. • Surplus of £714,000 in 2011/12. • Forecast outturn surplus of £1,000,000 for 2012/13 at Month 10
NHS Stoke on Trent The PCT has a strong record of financial management delivering a surplus position over the last five years. The PCT delivered a:
• Surplus of £1.934m in 2007/08.
Page 41 • Surplus of £4.304m in 2008/09. • Surplus of £2.588m in 2009/10. • Surplus of £3.115m in 2010/11. • Surplus of £1.993m in 2011/12. • Forecast outturn surplus of £2m for 2012/13 at Month 10.
The Department of Health ‘Handover and Closedown Guidance -Transfer of Claims, Liabilities and related Financial Assets’ explains that the SHA and PCT final year-end aggregate surplus generated in 2012/13 will be carried forward to the NHS Commissioning Board in 2013/14. As set out in the 2012/13 Operating Framework, CCGs will not inherit legacy debt directly, but this balance will transfer to CCGs (surplus/deficits) in line with the provisions of the Act in 2013/14.
Cluster 2011/12 Financial Performance
Each PCT achieved all of its key financial duties in 2011/12:
South Staffordshire • 4 CCGs with delegated responsibility for £729m (77%) of PCTs allocation • Surplus of £0.353m achieved • Spend of £1.628m on capital representing an under spend of £0.622m against capital resource limit • Running costs per weighted head of population is £31.51 against a target of £30.29
North Staffordshire • 1 CCG with delegated responsibility for £270m (77%) of PCTs allocation • Surplus of £0.714m achieved • Spend of £3.4m on capital which, when offset by £0.525m disposables, represents an under spend of £0.196m against capital resource limit • Running costs per weighted head of population is £37.21 against a target of £33.52
Stoke on Trent • 1 CCG with delegated responsibility for £376m (73%) of PCTs allocation • Surplus of £1.993m achieved • Spend of £20.041m on capital which represents an under spend of £5.726m against capital resource limit • Running costs per weighted head of population is £39.94 against a target of £39.98
Better Payment Practice Code The PCT has an ‘administrative’ departmental duty to pay 95% of its invoices within 30 days of receipt of a valid invoice in line with the Better Payments Practice Code. Performance under these criteria was as follows:
South Staffordshire Number of invoices paid • 86.70% of Non-NHS invoices (2010/11 84.34%) • 75.53% of NHS invoices (2010/11 82.09%) Value of invoices paid • 91.54% of Non-NHS invoices (2010/11 89.91%) • 96.81% of NHS invoices (2010/11) 96.37%
Page 42 North Staffordshire Number of invoices paid • 85.07% of Non-NHS invoices (2010/11 90.44%) • 84.99% of NHS invoices (2010/11 79.52%) Value of invoices paid • 86.48% of Non-NHS invoices (2010/11 96.03%) • 98.75% of NHS invoices (2010/11) 98.29%
Stoke on Trent Number of invoices paid • 90.26% of Non-NHS invoices (2010/11 91.52%) • 88.64% of NHS invoices (2010/11 76.25%) Value of invoices paid • 94.27% of Non-NHS invoices (2010/11 94.62%) • 99.00% of NHS invoices (2010/11 94.66%)
In general there has been deterioration in these results during 2012/13 as a result of staffing issues within Staffordshire Shared Business Services (SSBS). This is currently being reviewed by the CSU and ongoing talks with SSBS are being had to understand the issues and improve the service. This will not be a legacy issue for CCGs or the Area Team in 2013/14 as this service will be provided by Shared Business Service on a national footprint as part of the new financial system.
Cluster 2012/13 Financial Performance The below is an extract taken from the 2012/13 Month 10 Finance report as presented to the QIPP, Finance and Performance sub-committee.
South Staffordshire PCT – Month 10 update
The worsening position of South Staffordshire has resulted in a reported overspend of £8.3m at Month 10 2012/13. This is compounded by the non delivery of QIPP (£4.7m). Fortunately, the Cluster has been able to secure additional funding resource support from the SHA totalling £9.4m. With all contingencies now released, this still, however, requires £3.9m of mitigating actions to achieve the required £750k surplus.
Page 43 North Staffordshire PCT – Month 10 update As at month 10 there are no areas of significant concern in the North Staffs PCT position. There are signs of some small over performances against contracts; however these are offset by underperformance elsewhere.
Stoke on Trent PCT – Month 10 update As at month 10 there are no areas of significant concern in the North Staffs PCT position. There are signs of some small over performances against contracts; however these are offset by underperformance elsewhere.
Cluster Commissioner Running Costs The Cluster is on target to deliver its running costs target for 2012/13. Moving in to 2013/14 each CCG will have a revenue allocation for running costs equal to £25 per head of population. They will have designed Management structures that are affordable within this allocation.
Similarly the Area Team has received a set pay budget as part of the wider NHS Commissioning Board running costs target and its structure has been designed to ensure affordability within this allocation.
Financial Risks In 2012/13 a number of financial risks have been identified and mitigating actions designed to manage these risks. The significant risks are detailed below and these will remain pertinent moving in to 2013/14 for CCGs.
Risk Mitigating Action Delivery of QIPP financial savings • Regular monthly monitoring of QIPP plans • Strong PMO arrangements in place • Secure additional in year QIPP to ensure headroom in financial position • Risk sharing arrangements between Commissioners and Providers Managing acute trust activity within agreed • CCG regular monitoring of contract contract values performance • Apply contract terms in full
In year increasing costs and volumes of • Regular reporting to CCG Boards activity relating to Continuing Care • Cluster ‘deep dive’ process
Continuing Care retrospective claims • Secure additional personnel to review claims • Agree a process for provisions with External Audit
All of the above will remain risk areas moving in to 2013/14 and CCGs in 2013/14 will need to ensure that they have robust financial management arrangements in place to identify these risks in a timely fashion and to mitigate against them.
The significant legacy issue for CCGs moving in to 2013/14 is the Continuing Care retrospective claims. Due to the time taken to process and review these claims the process will carry forward into 2013/14. Any claims that are not provided for in 2012/13 PCT accounts will become the liability of CCGs from 1st April 2013. The financial risk associated with this for all of our CCGs is significant and we are not currently able to calculate this risk accurately.
Page 44
The number of claims received by CCG is shown in the table below:
CCG No. of Continuing Care Retro claims Cannock Chase 163 East Staffordshire 132 North Staffordshire 277 South East Staffordshire & Seisdon 203 Stafford & Surrounds 180 Stoke on Trent 294 Total 1,248
Cluster Providers Financial Risks The Providers within the Cluster are facing significant financial challenges during 2012/13 and moving in to 2013/14. With significant cost improvement programmes some of our Providers are facing planned deficit positions.
Mid Staffordshire NHS Foundation Trust They are currently forecasting a significant deficit position for which they will be receiving additional financial support from the Department of Health. This deficit position is recurrent. The Provider will be required to monitor significant cost improvement programmes in 2012/13 to close this financial gap and it will require support from Commissioners with the use of non-recurrent strategic financial assistance.
UHNS The Trust announced an in year deficit position of £10.7m, this position (at month 10) already assumes support from commissioners and includes additional support from the SHA (£8.2m) which has now been confirmed and transacted with the Trust. The PCTs are supporting the Trust on a cash basis to ensure the Trust can meet its short term liquidity requirements. For 2013/14, early indications are that the Trust has an underlying financial deficit approaching £50m, though this detail has not yet been shared with commissioners.
Cluster QIPP Challenge
Background If demand, activity, costs and therefore spend were to increase in line with trends from recent years, a gap will open up between available resources and that level of spend. This “gap” between the anticipated increases in the level of demand with the associated cost increases and the available resources has driven the national focus on Quality, Innovation, Productivity and Prevention. Nationally, this is a transformational challenge to improve the quality of care whilst delivering £20 billion savings by 2014/15. In March 2011 the SHA set out a £1.3bn financial challenge across the West Midlands translating into a financial challenge of £226m for the Staffordshire Cluster. This QIPP challenge represents a 13% efficiency saving challenge over the next four years.
The Cluster believes that the NHS will always need greater efficiency and ‘headroom’ on productivity therefore, although the local financial challenge is set at £226m there is value in maintaining a robust drive on quality and efficiency. In response, the Cluster identified QIPP opportunities valued at £272m during the 2011/12 planning round to create headroom of £46m on the delivery of QIPP. Moving into the planning round for 2012/13 further QIPP opportunities of £83m have been identified, taking the total QIPP opportunity to £355m.
2011/12 2012/13 2013/14 2014/15 Total
Page 45 £000s £000s £000s £000s £000s Commissioner Challenge 47,460 54,240 61,020 63,280 226,000 Price Efficiency 52,765 68,992 67,273 67,932 256,961 Commissioner Disinvestments 16,906 6,945 1,849 300 26,000
Commissioner Schemes 26,343 19,804 20,245 5,638 72,030 Commissioner QIPP 96,014 95,741 89,367 73,870 354,991 The Staffordshire Cluster Savings Opportunity Health System Integrated Commissioner Headroom 48,554 41,501 28,347 10,590 128,991 System Plan for 2012/2013 outlines the plans to meet this challenge. Further details of the financial breakdown of the QIPP challenge can also be found within Integrated System Plan.
2012/13 QIPP Delivery
There has been varied success in QIPP delivery in 2012/13 across the CCGs. While schemes associated with medicines management have delivered significant recurrent financial savings, QIPP schemes associated with reductions in acute activity have been less successful and recurrent savings as originally planned have not been delivered. There have in fact been increases in acute activity, particularly in non electives, during 2012/13 which will result in a legacy issue for CCGs of a greater QIPP challenge moving in to 2013/14.
Page 46 Section 7: Provider Capacity
Current Capacity
The table below summarises current Provider capacity across Staffordshire:
Care Type Provider Geography Estate Bed capacity Single hospital site Northern UHNS from 2012 at Stoke- 1144 Staffordshire on-Trent Main hospital site at South West Stafford MSFT 398 with 90 at Cannock Staffordshire Community Hospital Acute at Cannock Main acute site at Burton 388 South East Community BHFT 39 at Tamworth Staffordshire Hospitals at 41 at Lichfield Tamworth & Lichfield
Main hospital site at Northern Harplands in SOT CHCT Staffordshire 3 community resource centres Mental Health Main IP facility at ST Georges, Stafford. South Further 6 IP units SSSFT Staffordshire/ with Community Shropshire provision for LD and Children’s Services 48 at Cheadle/42 at Leek (Staffordshire Staffordshire Moorlands) 5 community Community SSOTPT Stoke-on- 73 at Bradwell (Newcastle) hospitals Trent 45 at Longton/135 at Haywood (Stoke- on-Trent)
University Hospital of North Staffordshire NHS Trust The Local Health Economy of North Staffordshire has been non-compliant with the 18 week referral to treatment pathway during 2011-12 for admitted patients as the backlog of patients waiting over 18 week have been treated.
In September 2010 there were over 44,000 Outpatient Follow Up (OPFU) patients who had waited longer than their recall date. This backlog has been successfully reduced to an agreed, sustainable level of around 5,000 patients and the health economy has achieved the non-admitted performance target during 2011/12.
Capacity issues were addressed in 2012 in relation to cancer screening and turnaround times for pathology and diagnostic imaging results for 62-day referral to treatment. Department of Health Access Funding was utilised during quarter 4, 2011/12, to resolve capacity problem and improve pathway times.
The Trust currently has an outpatient backlog issue which the CCGs are addressing.
Page 47 Mid Staffordshire Foundation Trust Mid Staffs have capacity issues with Trauma and Orthopaedics and Gastroenterology, which have been addressed.
2 new permanent consultants in T&O started at the Trust in April 2012 and the Trust has revised job plans to increase theatre time and achieve sustainability.
An 18-week Referral to Treatment specialist from NHS IMAS, working for Stafford & Surrounds and Cannock Chase CCG’s has supported support 18-week sustainability at Mid Staffs through 2012/13.
Burton Hospitals NHS FT
Burton Hospitals have seen a deterioration in 18 week admitted performance since November 2012. At a specialty level 8 out 19 specialties did not achieve the 90% target. An action plan has been developed by the trust and agreed with Commissioners. Planned recovery of performance will be from 1/4/2013.
Market Management Initiatives
Any Qualified Provider CCGs and the Cluster have plans in place to offer patients choice of Any Qualified provider. In October 2011, following public engagement, the service choices were made to be procured via the AQP initiative for adult hearing and podiatry (all CCGs), diagnostics (all south CCGs) and continence (North and Stoke CCGs). Informal consultation with service users on AQP was concluded in February 2012 and the service specifications were finalised during March and April 2012. Provider accreditations commenced in August 2012 and will continue over the course of September with many contracts being awarded during September and early October 2012. Service commencement is envisaged to take place during late September and October 2012. Formal transition of contracts to CCGs will take place upon contract award in line with other service contracts.
NHS North Staffordshire NHS North Staffordshire has used different initiatives in improving commissioning of provider services and has used:
• Any Willing Provider • Any Qualified Provider • Partnership Agreements • Full OJEU tenders
The table below outlines the procurements undertaken by NHS North Staffordshire in the last 3 years:
Service Type of Procedure Contract Start Date Elective Care Any Willing Provider April 2011 Audiology Any Willing Provider January 2010 Out of Hours Full OJEU tender (restricted) Not Awarded Dental Access Programme Full OJEU tender (restricted) July 2010 Psychological Therapies Full OJEU tender (restricted) October 2011 Minor Hand Surgery Full OJEU tender (open) October 2011 Pharmacy Services – YOI Werrington Full OJEU tender (open) November 2010 GP Services – High Street Full OJEU tender (restricted) Not Awarded EAPC Full OJEU tender (restricted) April 2009 Breast Screening Partnership Agreement - UHNS April 2010
Page 48 ENT Partnership Agreement - UHNS December 2011 Dermatology Partnership Agreement - UHNS December 2011 Gynaecology Partnership Agreement - UHNS December 2011 Podiatry Any Qualified Provider (AQP) September 2012 Continence Any Qualified Provider (AQP) September 2012 Adult Hearing Any Qualified Provider (AQP) September 2012 111 Full OJEU tender (restricted) April 2013 IV Antibiotics Partnership Agreement – January 2013 SSOTP
Other Procurements: • Bariatric Surgery – clinical prioritisation gatekeeper. • Procedures of Limited Clinical Value. • Individual funding Requests – gate-keeping. • Pathway changes (mainly currently linked to FFtF). • Day Case to Outpatient Procedure shift in line with best practice. • Renal-a potential GPSI service under discussion. • Non-Emergency Patient Transport Services (joint with Stoke on Trent CCG) – about to commence full OJEU tender (restricted). • Out of Hours Services (joint with Stoke on Trent CCG) – currently undertaking full OJEU tender (open). • Sexual Assault Referral Centre (SARC) – currently undertaking full OJEU tender (restricted).
NHS Stoke on Trent NHS Stoke on Trent has not previously sought to procure services themselves through Any Qualified Provider (AQP), but commissioned additional capacity for Elective care at a number of providers. However since the development of the Staffordshire Cluster of PCTs a number of AQP services have been developed. They also sought to bring other acute providers into the local healthcare provision however set up costs for these providers have proved prohibitive.
The table below outlines procurement undertaken over by NHS Stoke on Trent in the last 3 years:
Service Type of Procedure Contract Start Date Podiatry Any Qualified Provider (AQP) September 2012 Continence Any Qualified Provider (AQP) September 2012 Adult Hearing Any Qualified Provider (AQP) September 2012 111 Full OJEU tender (restricted) April 2013 Diabetes Education Full OJEU tender (open) April 2012 Intermediate Care Beds Full OJEU tender April 2011 Expert Patients Any Willing Provider (AWP) September 2011 X-ray Full OJEU tender (open) December 2011 Minor hand surgery Full OJEU tender (open) October 2011 Breast Screening Partnership Agreement - UHNS April 2010 ENT Partnership Agreement - UHNS December 2011 Dermatology Partnership Agreement - UHNS December 2011 Gynaecology Partnership Agreement - UHNS December 2011
Other Procurements: • IAPT – currently undertaking a full OJEU tender (restricted). • Non-Emergency Patient Transport Services (joint with Stoke on Trent CCG) – about to commence full OJEU tender (restricted). • Out of Hours Services (joint with Stoke on Trent CCG) – currently undertaking full OJEU tender (open).
Page 49 • Sexual Assault Referral Centre (SARC) – currently undertaking full OJEU tender (restricted).
South Staffordshire PCT The South Staffordshire PCT has used different initiatives in improving its commissioning of provider services and has used procedures such as:
• Any Willing Provider (AW). • Any Qualified Provider (AQP). • Partnership Agreements. • Out of Area - Acute Provider Services. • Full Tenders.
Service Type of Procurement Contract Start Dementia Services tender (restricted) - via JCU Nov-10 Carer Training tender (restricted) - via JCU Oct-10 Falls Service Tender - open Jul-11 Patient Transport Services Tender OJEU (restricted) Jan-12 Community dermatology Tender - open Oct-11 Pain management Tender - open Jul-11 Day case procedures - various AWP Jul-11 Community Glaucoma services AWP Jul-11 MRI scans Tender - via Mid Staffs FT Jan-12 Featherstone 2 (prison primary care / Tender - restricted May-12 substance misuse / MH) Primary Care MH services Tender - open Aug-09 Primary Care MH services Tender - open May-10 HMP Stafford optometry Tender - open Apr-10 Intermediate Care Beds Tender - open Jan-10 Community Pulmonary Rehabilitation Tender - open Jan-10 Service YOI Swinfen hall - optometry Tender - open Jan-10 HMP Drake hall Primary care medical Tender - open Apr-10 services Community Stroke/Neurological Tender - open not awarded Rehabilitation Service Mental Health Group Work - HM YOI Tender - open Nov-10 Swinfen Hall Apr-09, advert placed Primary Care Services HMP Stafford Tender - open for retender Community Stroke TIA rehab Tender - open Jun-09 Memory Service Tender - open Oct-10 Counselling services Swinfen Tender - open Nov-10 Prison Dental Service Tender - open Oct-10 Primary Medical Services Featherstone Tender - restricted Apr-10 Prison Health GUM Tender - open Apr-10 Telephone call centre Tender - open Nov-10 ASD Tender - restricted Sep-10 Early Supported Discharge Tender - open Oct-11 Podiatry Any Qualified Provider (AQP) September 2012 Diagnostics Any Qualified Provider (AQP) September 2012 Adult Hearing Any Qualified Provider (AQP) September 2012 111 Full OJEU tender (restricted) April 2013 Termination of Pregnancy Services Full OJEU tender (open) April 2012 (TOPs)
Page 50 Wheel chair service Full OJEU tender (open) July 2012 Out of Hours Services Full OJEU tender (open) April 2013 Integrated Substance Misuse Services Full OJEU tender (restricted) October 2012 Diabetes Test Strips Informal tender exercise November 2012
Procurements Already Undertaken
Joint NHS North Staffordshire and NHS Stoke on Trent
• Carpal Tunnel Surgery • Ophthalmology Tier 3 the continued move of Fit for the Future pathways into the community. Effectively all are AWP. • Dermatology Tier 3 activities identified to be reviewed at UHNS and aim for service to be up and running in December 2011. • ENT tier 3 activity identified to be reviewed at UHNS, and aiming for the service to be up and running in December 2011. • Gynaecology Tier 3, activity identified and review with UHNS, aiming for the service to be up and running in December 2011. • Mental health, commissioning intentions to market test significant numbers of North Staffordshire Combined Healthcare Services. • Out of Hours Services
Pan Staffordshire • Sexual Assault Referral Centre
Planned Procurements
Project Name PCT Lead Commissioner Target Date
Vasectomies South Staffordshire CCG TBC
Dermatology South Staffordshire CCG TBC
South Staffordshire; NHS Health Checks North Staffordshire Public Health End of April 2013 (part) South Staffordshire; Prison pharmacy Cluster End of May 2013 North Staffordshire
North Staffordshire Patient Transport Services CCG End of May 2013 Stoke on Trent
Gynaecology Stoke on Trent CCG End of April 2013
North Staffordshire 24 hour tape & Echos CCG TBC Stoke on Trent
North Staffordshire Neurological Rehabilitation CCG TBC Stoke on Trent
Sexual Assault Referral Centre (SARC)
Page 51 The Staffordshire and Stoke-on-Trent SARC opened at Cobridge Primary Care Centre on 30 January 2012. The SARC is a strategic partnership between the three Staffordshire PCTs, Staffordshire Police, Staffordshire County Council and Stoke City Council, driven at national level by the Home Office and Department of Health. The centre is purpose built and provides an integrated sexual health service and follow up for victims of sexual assault 24 hours a day, 365(6) days per year. Initially it is being provided for victims aged 16 years and over with the intention to offer services for children from Cobridge later in 2012. Referral to the Centre is primarily through the Police, following the occurrence of a sexual assault. Self-referrals for in hours only, were st introduced in 1 December 2012.
A pilot core service is in place for up to 18 months with Staffordshire and Stoke-on-Trent Partnership Trust to manage the overall service. SSOTPT hold a sub contract with Savanna and Brighter Futures for victim support and Staffordshire Police provide the Forensic Medical Examiner service. NHS Stoke on Trent are lead Commissioner.
The tender has been awarded to Staffordshire and Stoke-on-Trent Partnership NHS Trust, with a start date of 1st May 2013. This tender is for all ages and includes children and young people. The core service is for the SARC Service staffing e.g. SARC Manager, crisis support workers and Paediatricians who can carry out forensic medical examinations.
Page 52 Section 8: Workforce
The overall approach of the Cluster has been to establish a new structure that fits with the proposed transition set out in the Health and Social Care Act. We have focused on the business critical skill sets that will be required and rapidly assigned or aligned all commissioning staff from each PCT to either, the newly emerging Clinical Commissioning Groups, the Commissioning Support Units, or the Cluster itself. By aligning and assigning staff rapidly there has been minimal disruption to business continuity and business functions are well-placed for remaining changes. At September 2012 The PCTs combined commissioning workforce essentially resided within one of five key groupings:
• Cluster Team. • Six Clinical Commissioning Groups. • Commissioning Support Unit (CSU) including Shared Business Services. • Two Public Health Departments.
A total of 639 (headcount) staff were employed within the commissioning function of the three PCTs at January 2013. Work to assign/align these staff to the following specific transitional areas across the Cluster was completed. At January 2013, these break down as follows (headcount):
• 69 staff assigned to the Cluster. • 50 staff assigned to North Staffs CCG. • 67 staff assigned to Stoke CCG. • 85 staff assigned to the South Staffs CCGs. • 181 staff assigned to Commissioning Support Units • 20 staff assigned to other hosted services (e.g. PCT-led Medical Practices, CLRN). • 103 staff assigned to Shared Business Service. • 31 staff within Public Health in Stoke-on-Trent. • 33 staff within public health in South and North Staffordshire PCTs.
• All staff have now been matched
The Shared Service provides payroll to the three PCTs, University Hospital of North Staffordshire, North Staffs Combined Healthcare and the Staffordshire & Stoke-on-Trent Partnership NHS Trust. They also provide some additional finance support to the three PCTs, North Staffordshire Combined Healthcare and Staffordshire & Stoke-on-Trent Partnership Trust.
The following commissioning staff have been transferred to the PCT Provider Service as their role comprises 50% or more provision of services. Some of these have been ‘shared’ services in the past, located within commissioning:
• 20 transferred to Stoke-on-Trent Community Health Services. • 13 transferred to North Staffordshire Community Health Services - includes Fit For Work hosted service. • 8 transferred to South Staffordshire provider arm.
These are now part of the new Staffordshire & Stoke-on-Trent Partnership NHS Trust as of September 1st 2011.
The Cluster has secured interim arrangements for director level HR and workforce support to support the Cluster, CSU, CCG and Public Health until March 2013 to support this very significant period of commissioner workforce change.
Page 53 The process to formally transfer staff to future receiver organisations has now been completed in line with the national HR Transition programme.
Each of the three PCTs within the Cluster have continued to use their separate employment documents and staff have remained on their PCT terms and conditions and payroll and continued to be governed by the policies of their respective PCT regardless of where they were assigned to work. This also covered staff that were seconded either into or out of the PCTs.
Arrangements have been put in place to ensure HR files are secure:
• HR files for commissioning staff assigned to CCG will remain with HR until April 2013, as staff continue to be employed by the different PCTs until that date. • For staff assigned to CCG, Cluster or CSU. Out-going line-managers will ensure the transfer of personal files and appropriate handover is completed within two weeks of assignment. HR will oversee this process.
Line-managers with staff currently on maternity, long-term sick or secondment, have kept them up to date with developments within the organisation. HR has also provided additional support during the transition as staff are either assigned and/or aligned to organisations.
Members of staff on secondment to external organisations up until April 13 have been separately recorded in the confidential annex to the legacy document.
Specific individual casework, that is confidential in nature, currently sit with the HR team. These are logged in the confidential annex to the legacy document.
The Cluster has established a Joint Staff Partnership Forum with recognised Trade Unions through which staff are formally consulted about changes to the organisation. This is also used as a communication and engagement forum.
Staff are kept up to date with developments across the health economy. The communications team are supporting the Cluster, CSU and CCGs with communication bulletins, the key is ensuring these documents are circulated to the appropriate people in a timely manner. Regular team briefings are taking place throughout the organisation with Cluster wide briefings and briefings specific to the different parts of the Cluster (Cluster HQ, CCGs and CSU) taking place monthly. The CSU also has a monthly newsletter for CSU staff. The Cluster has held whole organisation (Cluster, CSU and CCGs) away days to enable staff to be involved in the future design and direction of the new architecture and more are planned for the future.
The Cluster has been active in supporting senior staff to attend the Aspiring CEO programme and Directors to undertake the Top Leaders programme. In addition there is a dedicated Organisational Development role at Assistant Director level to support CCG development.
All staff have been offered 1:1 review sessions about the future and these have taken place monthly. In addition the Cluster has developed a support programme for all staff which has been shaped by the feedback from the 1:1s and discussions with Trade Unions. This was being launched across the organisation as part of the Organisational Development work
Page 54 Section 9: Summary of Key Changes
Strategic Goals A common set of Strategic Objectives for the Cluster was adopted by the Board (March 2012) that reflects those of the individual PCTs. These were devised using common themes from the PCTs individual goals and used to underpin Cluster assurance and risk governance. The three common goals are:
• Improve health and reduce health inequalities. • Transform healthcare services. • Improve quality, patient experience and outcomes.
Staffordshire Integrated System Plan and QIPP In March 2012 the Cluster submitted the Integrated System Plan for 2012/13 and beyond. This is a Staffordshire health-system wide document that sets out the end state vision for healthcare over the next four years and how providers and commissioners across Staffordshire will deliver this. It also sets out transition plans, providing assurance to the local population and Department of Health on a sustainable local health care system during the transition to new NHS commissioning structures. The System Plan replaced the three PCT’s Strategic Plans and the 2011/12 QIPP System Plan and is a key document moving forward to transition and handover.
Key Changes The focus of QIPP and system redesign in North Staffordshire is the Fit for the Future (FFtF) programme. The majority of planned changes in FFtF have been implemented; however the programme is about to move into phase 2, addressing community services and capacity. Changes in this phase were due to include a decrease in community bed capacity and an increase in community services capacity following the introduction of a new model of care. It was anticipated there would be formal consultation on reducing community bed capacity during 2012, however to date this has not happened.
In the South West the focus of system redesign is the Clinical Services Implementation Programme (CSIP) around Mid Staffordshire FT. The system redesign will result in a smaller, more efficient acute hospital at Stafford and a shift to more care delivered in community settings. The overall vision is for consistent high quality care delivered in the most appropriate place in the most efficient way however the major quality and financial challenges faced by Mid Staffordshire FT and the outcomes of the Public Inquiry into Mid Staffordshire FT will affect its future. The CCGs are taking this work forward in light of the Francis report and the current position of MSFT.
MSFT has received significant financial support from the Department of Health to enable it to meet its short term financial commitments. In September 12 the position was that the local health economy must implement a commissioner-led, radical change programme that secures high quality, appropriate and financially viable services from both Stafford and Cannock Hospitals. The current Monitor work which may seek to appoint a Trust Special Administrator (TSA) to take over the running of the Trust will affect the way this work moves forward.
In line with CSIP, the original proposal at MSFT was for a range of service changes to be proposed for MSFT, commencing with a new integrated Emergency and Urgent Care Centre (E&UCC). CCGs produced a new draft specification for the service in 2012, including Cannock Minor Injuries Unit, which, it was proposed to will become part of the overall delivery of the new emergency and urgent care service. The PCT Cluster and CCGs, in partnership with MSFT, expected to commence a consultation on proposed changes in May 2012. This however is now on hold pending the outcome of the consultation on appointing TSA and the CPT recommended options. A programme of redesign around the Burton area (East Staffordshire) is in the early planning stages and no significant changes have yet been identified. The CCGs and providers in the South
Page 55 East have recently engaged external support to draw up a strategy for change and to review long term sustainability of the trust.
Reconfiguration of Mental Health services has continued from previous years with increased emphasis on community provision and reduced acute mental health bed based activity. A formal consultation on phase 1 reconfiguration at North Staffordshire Combined Healthcare NHS Trust concluded at the end of October 2011 and the planned changes took place from April 2012. These changes primarily concerned re-location of services and the closure of the Bucknall Hospital site.
Phase 2 formal consultation, which affects community beds and day services, commenced in May 2012. The decision on the outcomes of the consultation was made at the end of August 2012 by North Staffordshire and Stoke on Trent PCTs, to close all resource centre beds, to close the Bennett Centre in Shelton and to close the Hazlehurst Unit, Harpfields and Weaver House, Cheadle Day Hospitals. The agreed changes were implemented from September 2012.
In South Staffordshire, consultation on planned reconfiguration of Mental Health services began in October 2011 and a decision on the outcomes was made at the end of March 2012. The decision to close the Margaret Stanhope Centre in Burton was taken by South Staffordshire PCT board on the 28th March 2012 with a phased closure. In September 2012 the Margaret Stanhope Centre in Burton was formally closed.
All proposed service changes, including the recent mental health service reconfiguration and acute sector reconfiguration across the cluster were assessed against the four tests introduced by the Department of Health during July 2010:
• Support from GP Commissioners. • Strengthened public and patient engagement. • Clarity on the clinical evidence base. • Consistency with current and prospective patient choice.
The Cluster has established strong relationships with the Stoke-on-Trent and Staffordshire County Health Overview and Scrutiny Committees (OSC) and LINKs. Local District and Borough Council OSCs are accessed via the Staffordshire County OSC. All major service changes were discussed with OSC Chairs at an early stage to ensure full engagement. As the statutory duty for public involvement remains with the PCTs until April 2013, the Cluster Patient and Public Engagement Committee has assured processes for service reconfiguration and ensured the statutory responsibilities under the NHS Act 2006 are carried out by CCGs and Cluster commissioners.
During 2010/11, informal engagement took place on Any Qualified Providers services and the Regional Trauma engagement process. Pre-engagement was built into all service planning to ensure that public and patients were able to comment and input to developments. Occasionally action has been taken on the grounds of patient safety outside of engagement/ consultation. The temporary closure of A&E at Mid Staffordshire in December 2011 was an example of this.
Each significant service reconfiguration has been subject to a Gateway review and a National Clinical Advisory Team (NCAT) Assessment. Following any formal consultation the Gateway Team are invited back in to give an independent review of the implementation process.
Risk Assessment on Implementation The following log identifies the most significant system-wide risks to implementation during transition. The full risk log can be found in the Integrated System Plan and has been monitored through the QIPP, Finance and Performance Sub Committee of the Board. In accordance with the Cluster Corporate Risk register, major risks have been reported to the Common Board.
Page 56
Risk Impact Likelihood Mitigations Community alternatives to secondary care provision through Rising demand for services due to QIPP initiatives. demographic changes, increased High Medium Effective engagement with the patient expectation outstrips service local population. provision capacity Manage demand across system/pathways. Clinical engagement across all specialties / providers. Acute bed reduction is not matched by Communication and engagement reduction in demand and changes in High Medium with all stakeholders. patient flow, impacting negatively on Community services in place and performance targets and savings effective flow of patients across health system. Joint working to align, coordinate and integrate QIPP, activity QIPP and local strategic service numbers, care pathways. change plans (FftF, CSIP etc) not Transformation programmes aligned. Service changes do not support delivery of QIPP deliver sustainable health economies. High Low efficiencies. Local health economies go into/stay in Close working with providers to financial deficit with Variation in QIPP integrate and align plans and in north and south of Staffordshire contract accordingly. QIPP learning is spread/shared across north and south CCGs. Other activity fills capacity in acute Contract agreements secure sector as bed numbers reduce, High Low reductions in activity and beds to therefore efficiencies not realised. close capacity. Inability to secure a clinically and Ongoing system-wide discussions financially sustainable healthcare High Medium about future end state for health system delivering best quality care in system. Staffordshire for the long term. HWBBs in place with ongoing Health and Wellbeing Boards are not development programmes. well developed and effective High Low Early implementer status will help
development. Robust patient and public Public confidence is needed in the engagement and experience outcomes of transformational change systems in place. otherwise it will impede ability to effect High Medium change Informal and formal engagement
embedded in CCG processes. Transition Plans in place. Public Health loses momentum/focus during process of transition to LAs OD programme with LAs. High Low leading to lack of robust Public Health in the future PH located to LA premises to aid transition. Continuing care volume and price Work with market to control costs. increases leading to increasingly High Medium Ongoing programme of patient and unaffordable levels of continuing care placement reviews. Lack of clarity about directly Link with SHA transition group. commissioned services leads to Local action plan. Medium Low limited ability to plan long term and Close liaison with CCGs re. support transition respective roles. Staffordshire Locality Workforce Staff surveys across Staffordshire Board to address supporting staff show ‘supporting staff’ as a High Low as a common issue. common risk Organisational action plans. Quality and safety is compromised by High Low Workforce assurance toolkit.
Page 57 Risk Impact Likelihood Mitigations reduced workforce and changing skill mix Engagement of CCG, LA and Loss of staff capacity and effective transition planning. organisational memory through the High Low transition of functions to CCG, NHS Ongoing updating of Legacy CB and Local Authority Documents. Ensuring capacity in place on Specialist public health and health critical functions, shared across improvement workforce shortages. High Low both PH departments. Risk to delivery of statutory PH duties. Leads identified for critical areas. QIPP schemes scaled back where risk of full savings not being achieved and contingencies built Slippage across the QIPP programme High Medium in. resulting in unachievable savings Work between CCGs and providers to ensure alignment and delivery. Support providers with Strategic Change Reserve to deliver transformational change and CIP efficiency programmes not efficiencies. delivered by providers. High Medium Quality monitoring systems in Delivery of CIPs puts service quality place which take account of CIP and performance at risk impact. Provider internal CIP quality assurance systems in place. CCG Engagement strategies. Lack of GP Engagement puts system CCGs have Primary Care change and clinical commissioning at High Low development roles and locality risk sub-structures. CCG Configuration is not sustainable, Detailed plans for CCG specifically South East Staffordshire High Medium development set out rationale for CCG and Seisdon peninsula CCG CCG configuration. Organisational Development programme in place to support Capacity/capability of CCGs for future skills/knowledge and expertise. role, including clinical leadership, Work with CCG Chairs to enable identification of Accountable Officers personal leadership development. and adequacy of Commissioning High Medium Work on defining Support. skills/competencies for CCG and Accountable Officer posts. CCG designed Structures exceed CCGs defining do/share/buy management cost allocation options. CCGs working to £25 per head. Early and detailed confirmation of activity reductions to give UHNS, Delivery of combined QIPP and CIP CHCT, SSOTPT time to plan activity reductions and planned High Low efficiencies and savings and to savings destabilises aspirant FTs develop business in other areas to close gap. Retain focus on ensuring Aspirant FTs do not deliver quality sustainable systems are in place to and/or performance standards and/or meet all key standards. Medium High service transformation Ensure reporting of metrics are in place and being monitored to ensure delivery. Service performance not delivering Recovery plans in place for Trusts targets on achievement of 18 weeks High High being monitored by CCGs and and RTT backlogs reported to DH. Service performance not delivering CCGs working with Providers to High High targets on Accident and Emergency 4 ensure that 4 hour standard is
Page 58 Risk Impact Likelihood Mitigations Hours maintained and where problems occur early interventions are taken. Service performance not consistently Close monitoring of standards delivering targets for Cancer High High where they vary from norm. Standards Nominated leads. Monthly meetings with providers. Non achievement of key public health Timely monitoring information. outcome targets e.g. screening targets Medium Low Effective plans in place.
Regular monitoring.
Internal and external quality and Overall levels of Provider quality and safety reviews/ committees/ visits safety concerns. etc/CQRMs. Non delivery of the quality aspects of High Medium CQUINs (including a robust the contract. decision making and monitoring Patients receive sub optimal care. process).
Providers not achieving compliance being supported to Non delivery of targets for elimination High High deliver MSA, performance being of Mixed Sex Accommodation monitored and discussed through CQRM Significant monitoring of standards, Providers not delivering quality targets serious incident reporting, Route High Medium for MRSA / C.Diff Cause Analysis all managed through CQRM arrangements Significant monitoring of standards, Providers not delivering quality targets serious incident reporting, Route High Medium for pressure sores Cause Analysis all managed through CQRM arrangements Assignment of quality leads from contract management teams to CCGs do not undertake the full quality CCGs. agenda as part of the commissioning Assistant Directors of quality to process. have strategic role across the High Medium Quality does not improve ,or CCGs and Cluster. deteriorates during the transition to Robust CQRMs with providers – CCGs and FTs increasing CCG involvement in CQRMs. CQUINs. Identified lead Director in place. Lack of robust emergency planning Lead staff in place for emergency High Low across Staffordshire planning. Plans in place. Public Health funding including any 10/11 PH spend reported to DOH. gaps emerging in Local Authority Medium Low Work ongoing with LA colleagues. public health services
Page 59 Section 10: Organisational Assets and Liabilities
Physical Assets The physical assets of the organisations include property, equipment, computers, information systems, software etc, and are managed in a number of different ways.
Fixed Assets The Finance Shared Services Agency maintains the register of fixed assets. These Fixed Assets or Non-Current assets include land, buildings, capital equipment/machinery, office equipment etc. The Fixed Asset Register itself is a very large accounting resource and is maintained to ensure compliance with legislation and governance etc. It also includes the tracking of each fixed asset, ensuring control and preventing misappropriation of assets.
Individual sites and departments maintain their own asset registers / inventories which are periodically audited.
Property Significant capital and revenue investment has been made to improve the quality of premises from which services are commissioned. All three PCTs are legal partners in a Local Improvement Finance Trust Company (Prima200 – ‘LIFTCo’) formed to drive community premises development and working under a 25 year partnership with the private sector company PRIME. The PCTs Strategic Service Development Plans (SSDP’s) set out the PCTs estates plans and a number of modern premises, bringing together primary and community care services in new GP and Primary Care Centres. These have been successfully delivered via LIFT and Third Party Developments (3PD’s). Together with UHNS, Stoke-on-Trent PCT is also a legal partner to the ‘Fit for the Future’ PFI contract, specifically, Stoke on Trent PCT contracts with Equion for the operation of the Haywood Hospital and UHNS undertake the PFI contract monitoring. Stoke on Trent PCT is also in partnership with Stoke-on-Trent City Council Bentilee Neighbourhood Centre PFI development where SoTCC take the lead role in contract management.
In the South, the approach has been to provide capital improvement grants to GPs or to fund third party developments to secure premises development. South Staffordshire PCT has become a legal partner in LIFT Co therefore enabling the same access to premises development opportunities as the other PCTs.
In 2011, a Staffordshire Strategic Property Group was established to co-ordinate and monitor property related matters across the Cluster and with Local Authorities. This group reports to the Cluster Capital Planning & Property Sub Group, which replaced the previous individual PCT groups, and is supported by a Property Team.
Approximately 28% of PCT property will be transferred to the Staffordshire and Stoke-on-Trent Partnership Trust (SSoTPT) in line with national guidance. Of the remaining, 12% will transfer to Burton Hospitals Foundation NHS Trust and it is anticipated that the PCT Retained Property (60%) will transfer to the NHS Property.. In compliance with DH and SHA guidance ‘Non-Current Asset Schedules’ have been approved and agreed with SSoTPT. Appropriate occupation agreements are to be established which mirror arrangements for commissioners and third party providers to occupy SSoTPT property.
Information Technology (IT) The Chief Information Officer within the Commissioning Support Unit (CSU) is the asset owner for IT. At September 2012, assets located within the PCTs and GP practices were as follows:
PCT PC’s Laptops Printers
Page 60 NHS North Staffordshire 1,057 270 698
NHS Stoke on Trent 1,641 399 917
South Staffordshire PCT 4,377 530 3,315
As part of the handover/closedown arrangements, further audits have beenl carried out to ascertain exact IT assets, their location and intended destination. All of these are recorded on the formal Transfer Orders to be transferred to a Receiver organisation.
Contracts for Support The PCTs hold a number of support contracts with other NHS and external agencies for the supply of specific services. These are detailed below and will either cease or be transferred to a receiver organisation on 1 April 13 in line with the PCTs Transfer Orders.
Accessed North Staffordshire Stoke Service South Staffordshire Service Area Hosted by by Service Provider Provider Service Provider Dudley PCT (moving Dudley PCT (moving Dudley PCT (moving CSU Pass HCS Stoke/North over to Birmingham & over to Birmingham & over to Birmingham & thru Black Country CSU) Black Country CSU) Black Country CSU) Health Combined Healthcare Combined Healthcare South Staffs & CSU Pass Stoke/North Informatics NHS Trust NHS Trust Shropshire thru Staffordshire County JCU - Adult Stoke/North Stoke City Council Staffs County Council CCGs Council Staffordshire County JCU - Childrens Stoke/North Stoke City Council CCGs Council Finance/ Stoke/North CSU Pass Stoke PCT Stoke PCT Stoke PCT Registration /South thru Procurement Stoke/North Disputed with provider CSU Pass Healthtrust Europe Hub /South - no service thru Occupational CSU Pass Stoke/North Telford & Wrekin PCT Telford & Wrekin PCT MSGH / Burton Health thru Price, Waterhouse & CSU Pass External Audit Stoke/North Audit Commission PWC Coopers thru CSU Pass Internal Audit Stoke/North RSM Tenon RSM Tenon RSM Tenon thru CSU Pass Legal fees Stoke/North Mills and Reeves Mills and Reeves Mills & Reeves thru Combined Healthcare CSU Pass Estates Stoke/North Part of CHCT ITT NHS Trust thru Estates Mgmt Combined Healthcare Combined Healthcare CSU Pass Stoke/North Fees NHS Trust NHS Trust thru CSU Pass Supplies Stoke/North UHNS UHNS UHNS thru West Midlands West Midlands West Midlands CSU Pass Courier Service Stoke/North Ambulance Ambulance Ambulance thru Stoke on Trent Public Public Library Services Stoke/North UHNS Libraries Health Research/ Public Academic Stoke N/A Keele University Health Sessions Emergency Staffs Fire and Staffs Fire and Stoke/North Cluster Planning Rescue Rescue CHC Inter Trust Combined Healthcare Stoke N/A N/A Cluster Trade NHS Trust Infection Stoke/North UHNS UHNS N/A Control Dr Foster North Dr Foster Nil N/A CSU Software
Page 61
Section 11: Key Cluster Stakeholder Map
Area Organisation Midlands & East Specialised Commissioning Team. Commissioners Joint Commissioning Unit (JCU) North Staffordshire Combined Health Care Trust (NSCHCT). Staffordshire & Stoke-on-Trent Partnership NHS Trust (SSOTP). South Staffordshire and Shropshire Healthcare Foundation Trust (SSSHFT). Providers University Hospitals of North Staffordshire NHS Trust (UHNS). Mid Staffordshire Foundation Trust (MSFT). Burton Hospitals Foundation Trust (BHFT). West Midlands Ambulance Service (WMAS). Bill Cash, MP Stone. Michael Fabricant MP Lichfield. Gavin Williamson MP South Staffordshire. Christopher Pincher MP Tamworth. Andrew Griffiths MP Burton and Uttoxeter. Jeremy Lefroy MP Stafford. MPs Aidan Burley MP Cannock. Karen Bradley MP Staffordshire Moorlands. Paul Farrelly MP Newcastle-under-Lyme. Rob Fellow MP Stoke South. Joan Walley MP Stoke North. Tristram Hunt MP Stoke Central. Staffordshire County Council. Newcastle-under-Lyme Borough Council. Staffordshire Moorlands District Council. East Staffordshire District Council. Councils and Lichfield District Council Local Authorities Cannock Chase District Council South Staffordshire District Council. Stafford Borough Council. Tamworth District Council. Stoke-on-Trent City Council. Department of Health (DH). Care Quality Commission (CQC). Health Bodies NHS Commissioning Board Special Authority Midlands & East Strategic Health Authority (SHA) Cluster. Newcastle-under-Lyme Borough Council Health Scrutiny Committee. Staffordshire Moorlands District Council Health Scrutiny Committee. East Staffordshire District Council Health Scrutiny. Health Scrutiny South Staffordshire District Council Health Scrutiny. Committees Tamworth District Council Health Scrutiny. Cannock Chase District Council Health Scrutiny. Lichfield District Council Health Scrutiny. Stafford Borough Health Scrutiny.
Page 62 Area Organisation Staffordshire County Council Health Scrutiny Committee. Stoke-on-Trent Adults and Neighbourhoods Scrutiny Committee. County/City Staffordshire Health and Wellbeing Board Based Partnerships Stoke-on-Trent Health and Wellbeing Board Local Dental Committees. Local Local Medical Committees. Representative Committees Local Optometry Committees. Local Pharmaceutical Committees. Staffordshire LINk. Stoke-on-Trent LINk. Voluntary Voluntary Action Stoke-on-Trent (VAST). Services Staffordshire CVS x 5. Staffordshire Consortia for Infrastructure Organisation (SCIO) North Staffordshire Clinical Commissioning Group. Stoke-on-Trent Clinical Commissioning Group. Stafford and Surrounds Clinical Commissioning Group. CCGs East Staffordshire Clinical Commissioning Group. Cannock Chase Clinical Commissioning Group. South East Staffordshire and Seisdon Peninsula CCG Staffordshire Police. Staffordshire Fire and Rescue Service. Others Keele University. Staffordshire University.
The above list of stakeholders have been actively engaged with the Cluster in all aspects of the day to day running of the current services and with the continuing transition process within the national and local health economy.
Many stakeholders are active partners in this transition and system redesign process.
Page 63 Section 12: Governance
PCT Common Board In July 2011 a Staffordshire Cluster Board was formed as a Sub–Committee of the Boards of NHS North Staffordshire, NHS Stoke on Trent and South Staffordshire Primary Care Trust with delegated powers of responsibility and accountability. The key role of the Cluster Board was to manage common PCT agendas and proposed transition.
This was superseded in November 2011 with a new model of governance, in line with national guidance, that created a Common Board for all three PCTs. Under this arrangement the existing three PCT Boards and Cluster Board, together with the respective sub-committees, were disbanded and replaced with the single Common PCT Board which discharged the respective statutory functions of the constituent three PCT organisations.
The new Chair (previous Chair of South Staffordshire PCT), and seven Non-Executive Directors (NEDs) were appointed to the Common Board with effect from the 1st December 2011, with all appointments being confirmed by the Appointments Commission. The NEDs were appointed from the three PCTs and, together with the Chair, enable a good level of corporate NED memory to be retained. CCG Chairs and Staffordshire and Stoke-on-Trent LINks are non-voting members of the Common Board. The Common Board meets monthly.
From a legal perspective the three PCT Boards remain as bodies corporate so the Common Board consists of 3 PCT Boards with common membership, meeting in the same room with a common agenda.
Members of the Cluster Common Board are: Name Role (*voting member) Date Graham Urwin Chief Executive* Alex Fox MBE Chair* Until December Tony Matthews Director of Finance* 2012 From January Ros Francke Director of Finance* 2013
Jan Warren Director of Nursing and Quality* Until March 2012 Brigid Stacey Director of Nursing & Quality* From April 2012 Dawn Wickham Director of Partnerships and Planning* Dr Ken Deacon Medical Director* Director of Primary Care and Specialist Until December Sue Price services* 2012 From January Sultan Mahmud Director of Commissioning* 2013 Director of Public Health NHS North Dr Aliko Ahmed Staffordshire and South Staffordshire PCTs* Acting Director of Public Health NHS Dr Zafar Iqbal Stoke on Trent* Mr Barry Machin (Audit Non-Executive Director* Chair) Mr John Non-Executive Director* Howard Mrs Lynn Kemp Non-Executive Director* Mr Lloyd Cooke Non-Executive Director*
Page 64 Mr David Ibbs Non-Executive Director* Mrs Lynne Non-Executive Director* Smith Mr André Burns Non-Executive Director* Until December Dr Prasad Rao Stoke-on-Trent CCG Chair 2012 Dr Mark Until December North Staffordshire CCG Chair Shapley 2012 Until December Steve Powell Stafford and Surrounds CCG 2012 Dr Johnny Until December Cannock Chase CCG Chair McMahon 2012 Dr Charles Until December East Staffordshire CCG Chair Pidsley 2012 South East Staffordshire and Seisdon Until December Dr John James Peninsula CCG Chair 2012
Common Board Sub-Committees As of March 2012 the following sub-committees of the Common Board were in place:
• Audit Committee • Remuneration and Terms of Services Committee • Primary Care Committee • Clinical Senate • QIPP, Finance & Performance Committee • Patient & Public Engagement Committee • Quality Committee • Midlands & East Specialised Commissioning Group • Individual Funding Panel (x 3) • CCG Committee (x 6)
The Cluster on behalf of the PCTs has been responsible for the overall management of the Clinical Commissioning Groups, Public Health, and Commissioning Support Units.
Executive Director Team With the development of the Cluster and Common Board, the arrangements for the Directors of Public Health for Stoke-on-Trent and North/South Staffordshire did not change. They remain Executive Directors of their respective PCTs and members of the corporate Executive team.
The Executive Director Team meet weekly and is joined by one of the Directors of Public Health at each meeting.
Clinical Commissioning Groups (CCGs) There are six Clinical Commissioning Groups across Staffordshire. The Cluster have moved quickly to release management resources, funding and expert support to ensure that each consortium can develop into a successful statutory commissioning consortium as well as deliver its key priorities and objectives.
All CCGs have designate Chairs, Accountable Officers, Chief Finance Officers and, where applicable, Chief Operating Officers all have their Governing Bodies in place and are in the final stages of the authorisation process. Staff assignments to CCGs have been ongoing since early 2011 with finalising of structures throughout August 2012.
Page 65 Since the October 2011 Legacy update which reported seven emerging CCGs, Seisdon Peninsula merged with South East Staffordshire to create a single CCG. Although South east and Seisdon Peninsula do not have a common boundary, they have similar populations and both commission with common peripheral providers in Derby, Sutton Coldfield, Wolverhampton, Walsall and Dudley.
All CCGs completed the cost model to ensure they can manage within the potential resources available and buy-in the level of Commissioning support required. A programme of organisational development support has taken place with each Group. The Director of Partnerships and Planning has had overall responsibility for CCG development.
North Staffordshire CCG and Stoke-on-Trent CCGs are in Wave 1 of the process for CCG authorisation, Cannock Chase CCG and Stafford & Surrounds CCG are in wave 3 and East Staffordshire CCG and South East Staffordshire & Seisdon Peninsula CCG are in wave 4.
The make-up of the CCGs is:
Area CCG Population Chair
North Staffordshire 225,000 Dr Mark Shapley North Stoke-on-Trent 270,000 Dr Prasad Rao Stafford & Surrounds 150,000 Dr Margaret Jones South West Cannock 130,000 Dr Johnny McMahon East Staffordshire 135,000 Dr Charles Pidsley South East South East Staffordshire and 205,000 Dr John James Seisdon Peninsula
All CCGs have a formal shadow Governing Body meeting, which is a sub-committee of the Common Board and each have been allocated an aligned Board NED to work with them to support them in their development during the transition.
To allow CCGs to develop their skills and build for the future, between 70-80% of the PCT’s budgets are now managed by the six CCGs through delegated powers. This means the shadow CCGs will move to full authorisation with a significant amount of responsibility already resting with them. The scheme of delegation clearly sets out the devolved responsibilities/accountability and allows the CCGs to demonstrate that they have a proven ‘track’ record and can meet the challenges of authorisation.
All of the six shadow CCGs are operating as the lead commissioning body on all aspects of delegated commissioning.
The Cluster continues to monitor progress using the objectives outlined in the Shared Operating Model and has a performance management matrix in place to monitor CCG development and QIPP delivery.
In August 2011 the Cluster undertook a diagnostic exercise to understand CCG development needs during the transitional period and from this co-produced a development programme with the CCGs. The programme operates at three levels: Master classes, Skills Development and Bespoke Board Development.
Commissioning Support Unit (CSU)
The evolution of Staffordshire CSU stems from legacy commissioning organisations and the core design principles have been guided and shaped by the developments started 18 months ago when the CEO of the Staffordshire cluster of PCTs, sponsored the first of two workshops with senior staff of the then three Staffordshire PCTs and CCG representation, which marked the start of the development of SCSU.
Page 66
In early 2012/2013 the “system architecture” within Staffordshire was established so that the Cluster, CCGs and CSU were each established with a culture of meaningful delegation and support which enabled these fledgling organisations to develop. By July 2012 all staff from the PCTs were “assigned” or “aligned” within that emerging architecture, giving them a tangible sense of ownership, direction and purpose. SCSU has been led from the beginning by Derek Kitchen.
A series of “Voice of the Customer” events were held (April to June 2012) by SCSU at which the future requirements of potential CSU customers were established, leading to the development of a product matrix. This work has underpinned strengthening of robust relationships with CCG customer leads. The early versions of the CSU product matrix has been tested through delivery in the current year and resulted in significant review and refinement working with our customers to ensure it is updated, reflects their needs and requirements and is fit for purpose.
Staffordshire CSU has successfully passed checkpoints 1, 2, 3 and 4 of the NCB BDU CSU assurance process, demonstrating financial viability and fitness for purpose. A detailed development plan underpins BCSU work and progress made and ongoing. In addition to this, the learning from the early days has resulted in significant growth reflected in the success of SCSU in being appointed as the preferred supplier to Herefordshire, Shropshire and Telford & Wrekin CCGs
In May 2012 a formal scheme of delegation was approved by the Cluster Board and in July 2012 Derek Kitchen was formally appointed as Managing Director by the NHSCBA. SCSU have established monthly performance reporting with the majority of services and products and their agreed KPIs measured and reported by CCG. Our approach has been extended and adapted to respond to the needs of new customers including those at distance geographically such as Herefordshire, who have benefited for the model without compromising local delivery
At March 2013 the following senior management posts were accountable to the Managing Director: • Chief Financial Officer – Carl Usher • Delivery Director – Staffordshire Paula Furnival • Delivery Director – Lancashire Linda Riley • Director of HR & OD Position currently vacant
Specific services delivered by the CSU include: • Business Intelligence • Communications & Engagement • Continuing Health Care • Contract Management • Employment services • Financial Support services • Information Technology • Quality support services • Procurement
Public Health Transition Work is currently ongoing, led by the two Directors of Public Health with Stoke City Council and Staffordshire County Council, in preparation for transition in 2013. Strategic oversight groups have been set up with Chief Executive Officer and Director level representation.
Page 67
The Public Health departments have produced their own detailed transition documents in preparation for transfer to the Local Authority. These were completed in March 2012 and will form part of a handover suite of documents which will also include a Public Health Legacy/Transition Document
The Directors of Public Health and Finance/HR and other officers from the Cluster have worked with Staffordshire County and Stoke City Councils on aligning work and preparing for formal transition. This has included:
• Future Vision and Shaping of Public Health Improvement functions in Staffordshire and Stoke. • OD requirements within both public health and Councils in preparation for transfer. • Public Health Workforce development needs. • Public Health input and support to emerging Commissioning landscape • Financial planning and scoping of budgets
As part of the transition plan, both public health directorates re-located to Council premises to aid joint working and transition. Stoke-on-Trent Public Health moved to the Civic Centre in October 2011 and North and South Staffordshire Public Health moved at the end of November 2011. In Staffordshire, Public Health staff are located both at County and District Council premises to support integrated working at both levels.
Key Corporate Policy Documents These are listed under the Library of Knowledge and are available on request from the Staffordshire Cluster Corporate Affairs Team.
A review of all policies is currently in place with a particular focus on creating harmonised Cluster wide based policies for use by the existing PCTs and emerging CCGs. The review will allow policies to have an Equality Analysis, as part of the Cluster compliance and commitment to the national Equality Delivery System.
Cluster Corporate Policies Since October 2011 the Cluster has developed the following common policies that apply to all three PCTs:
• IFR Policy. • Media Policy. • Standing Orders, Reservation and Delegation of Powers and Standing Financial instructions (Revised version based on NHS Stoke). • Cluster on Call Policy. • Information Governance Policies. • Clinical Accreditation for Practitioners with a Special Interest (PwSI) Policy. • Performance Management of Individual Independent Contractors/Performers Policy. • Jointly Developed Section 117 (Mental Health Act) Aftercare Policy.
PCT Policies In addition to the above, the following key Corporate Polices are still in place for each PCT, please note some PCT’s use a different title to others. For a breakdown by each PCT please see the Library of Knowledge.
• Standards of Business Conduct and Ethics for Employees. • Fraud and Corruption Response Policy. • Raising Concerns at Work Policy (Whistleblowing).
Page 68 • Comments and Complaints Policy and Procedure. • Volunteer Policy. • Risk Management Strategy and Policy • Policy and Procedure for the Performance Management of Individual Independent Contractors/Performers • Disclosure of Health Records Policy • Mental Capacity Act Policy • Commercial Sponsorship Policy • Policy for Records Management • Policy for Display Screen Equipment Use • Procedure for Lone Workers • Policy for Research Governance • Policy for Handling Complaints • Adverse Incident Reporting Policy • First Aid Policy • Code of Confidentiality • Claims Management Policy • Policy for Patient Advice Liaison Service (PALS) • Health and Safety Organisational Arrangements Policy • Policy for Fire Safety • Professional Registration • Security Management Policy • Policy for Business Continuity • NICE Management and Implementation Policy • Policy for Clinical reviews Related to Investigations of Deaths in Custody • Policy for the Reporting and Registering of Losses & Special Payments
Corporate Risk The Cluster has developed a single risk register across the three PCTs. The risk register is monitored by Audit Sub Committee. As of September 2012, the corporate register contains the Comment [WD(SC1]: Need latest following high rated summarised risks. one pasting in to replace this
Description of Risk PCT Area Score Rating CLINICAL Initial Risk Risk Initial Residual Risk
Increasing demand on acute services - contract continues to exceed agreed activity and 20 20 Y
CCG general demand for service continues to increase due to demographics and public need SSPCT
SS MSFT - system not financially and clinically stable 20 20 N CLUS
Risks to QIPP delivery are that identified schemes do not deliver to the level or in the 20 12 Y ALL
CCG timescale required across the Cluster.
MSFT - difficulty in retention and recruitment of permanent senior experienced staff to
SS 20 12 Y deliver high quality leadership across the Trust CLUS
Lack of Designated Doctor for Safeguarding Children in the South since early 2011 - risk
SS 16 16 Y of failing to protect children and risk of reputational damage from an Ofsted report CLUS
MSFT-Service & Quality are potentially compromised during service/system changes and 16 16 Y redesign-staff and services changing, patients travelling to different areas. CLUS SSPCT
Page 69
All SOT SSPCT ALL SSPCT ALL All SOT PCT
CLUS/CCG CCG CLUS CLUS CLUS Cluster CLUS CLUS Area ts not assessed within timescale) within timescale) assessed not ts (patien policy repatriation by abide to Failure made. decision Board Trust 20 before as rated initially Risk 1/12/1. from - safely 24/7 A&E run 11- November unlikely. A&E 24 hour a of Sustainability CQC. the from notice warning in a resulted has This Department. Commi needs. nursing have who people to care providing from home the prevent would registration of condition proposed Their registration. of condition additional an impose can they where 2008, Act Care Social and Health the of 31 Section through be would powers their of use proportionate and targeted most . The home the in people protect to action take to need they that concluded and Home aNursing of review a management through position their assessed have CQC providers on Assurances effectively; used - - anti in locally investment proper the Make level. alocal at strategy national Protect NHS the Deliver stre their Demonstrate to: need will providers and CCGs that highlighted have Protect NHS organisation. health every in required is post This PCTs/CCGs/CSS. of Cluster the across available Service Specialist Management Security Local accredited no is There MSFT andFTs CCGs to transition the during deteriorates ,or improve not does Quality process. commissioning the of part as agenda quality full the undertake donot CCGs needed redesign service radical healthcare the of Sustainability robust. sufficiently be not may established is Board Commissioning National the until PCT/Cluster the with initially short the that Risk 4. ce confiden public of lack to leading Interest of Conflicts Potential 3. care of provision upon impacting decisions suboptimal of s/t) (in risk Increased 2. system untried and developing and emerging yet as an to delegated budget of 80% 1. Description Risk Mountain, Stor Mountain, - Management Records issues. resolve to rapidly resource focus to parties senior alerted has This target. hour 4 the of achievement and economy, health the through flow general discharges, on impacting is which admissions, and attendances both in activity increased considerable has UHNS at ECC The needs. their meet could that provision care alternative to require a high level of resource to apportion correct successor organisations. successor correct apportion to resource of level high a require records the of ownership that a risk is there reforms, NHS current With services). provider PCT former (from records clinical and corporate are taxpayer, the by provided as resources, that and way; secure and asafe in received and delivered be can care That Constitution: NHS the in commitments key two meeting robust contractual arrangements and monitoring mechanisms also support the NHS in in NHS the support also mechanisms monitoring and arrangements contractual robust post in investigators professional trained fully ngthened local accountability. accountability. local ngthened ssioners would need to have in place contingency plans to remove those persons, persons, those remove to plans contingency place in have to need would ssioners - - Insufficient staffing to provide continuity of care in MSFT A&E in care MSFT of continuity to provide staffing Insufficient -a-
File and other commercial storage firms. The records will comprise both both comprise will records The firms. storage commercial other and File - term governance arrangements for accountability for CCG rests rests CCG for accountability for arrangements governance term the Cluster of PCTs has anumber has PCTs of Cluster the decision made to close A&E between 10pm and 8am as 8amas and 10pm between A&E close to made decision
significant financial pressures and and pressures financial -significant Staffordshire in system
Description of Risk of Description -
Crime Risk Assessments Risk Crime crime measures including: measures crime
MSFT Trust Board decided unable to to unable decided Board Trust MSFT
and any subsequent transfer will will transfer subsequent any and
of archiving stores stores archiving of
- - Iron Iron
15 16 16 16 16 15 15 Initial Risk
15 Rating Page 70 Page 12 16 12 12 15 16 12 15 Residual Risk
Score N N N Y Y Y y y
CLINICAL Add in systems risk log
Page 71 Staffordshire Cluster: System Delivery Risk Log : March 2013 Update
Source Description of Risk L C Controls to mitigate risk Progress/Further actions identified and
Type of Risk Lead Receiver Date Risk Added Officer/Reviewer Last Review Date Initial Risk Rating Residual Risk Score
1. System/QIPP
Community alternatives to secondary Despite the implementation of QIPP schemes directed Rising demand for services due
care provision through QIPP initiatives. at Admission avoidance demand for NEL activity to demographic changes, 12
- System/ Effective engagement with the local continues to rise. Work underway, with CCG's to
increased patient expectation 3 4 12 12 QIPP population proactively manage demand from primary Care DW CCGs Apr outstrips service provision
Manage demand across perspective and the full utilisation of community 13
capacity - system/pathways services Mar North Staffs CCGs working with all providers to Acute bed reduction is not Clinical engagement across all manage demand and patient flow. North Staffs LHE
matched by reduction in specialties / providers. Communication agreed to keep open a number of beds planned to 12
- System/ demand and changes in patient and engagement with all stakeholders .
3 4 12 close due to increase in demand. Planned Bed 12 QIPP flow, impacting negatively on Community services in place and DW CCGs Apr closures for the Burton LHE under review due to
performance targets and effective flow of patients across health 13
current level of demand. Bed closures relating to - savings system CSIP at MSFT have yet to materialise Mar
QIPP and local strategic service Joint working to align, coordinate and change plans (FftF, CSIP etc) integrate QIPP, activity numbers, care Increased alignment between North and South CCGs not aligned. Service changes pathways. Transformation programmes
e.g. Surgical alliance, A&E. Cluster taking an do not deliver sustainable support delivery of QIPP efficiencies 12
- System/ overview of the overall health system, delivery and health economies. Local health 2 3 6 Close working with providers to integrate 6 QIPP sustainability of each LHE in Staffordshire. Confirm DW CCGs Apr economies go into/stay in and align plans and contract and Challenge sessions with each LHE taking place financial deficit with Variation in accordingly. QIPP learning is Sept 2012 13
QIPP in north and south of spread/shared across north and south - Staffordshire CCGs Mar
Other activity fills capacity in
12
- System/ acute sector as bed numbers Contract agreements secure reductions Interim plans in place to keep open a number of 2 3 6 6 13 DW
QIPP reduce, therefore efficiencies in activity and beds to close capacity planned bed closures - CCGs Apr not realised Mar
Page 72 3. Workforce 3. Commissioning Direct 2. NHSCB NHSCB PH CCGs CCGs Receiver
Apr-12 Apr-12 Apr-12 Apr-12 Apr-12 Date Risk Added CGs Cluster/C QIPP System/ Risk of Type and Source ioning Commiss Direct sioning Commis Direct Health Public
of continuing care increasingly unaffordable levels price increases leading to Continuing care volume and effectto change ability impede it will otherwise transfor the outcomes of Public confidence is needed in Risk of Description Staffordshire for the long term. best quality care in healthcare system delivering and financially sustainable Inabilityclinically to a secure and supporttra limited ability to plan long term to leads services commissioned Lack of clarity about directly Health in the future leading to lack of robust Public process of transition to LAs during momentum/focus Public Health looses
mational change nsition
3 3 2 2 2 L 3 3
4 4 3 3 4 4 C 4 4
6 12 8 8 12 Initial Risk Rating Controls to mitigate risk mitigate to Controls respective roles action plan. Close liaison with CCGs re. Link with SHA transition group. Local reviews. placement Ongoing programme of patient and Work with marketto control costs. aid to premises programme with LAs. PH located to LA Transition Plans in place. OD embedded in CCG processes Informal andformal engagement and experience systems in place. Robustpatient andpublicengagement future endstateforhealth system Ongoing system
transition - wide discussionswide about
Progress/Further actions identified actions Progress/Further end September. documents andstarting'soft handover'CCGsto from and vice- services. Transition of services from Cluster to CCGs DH guidance clearer on Directly commissioned c CCGs Risk rating reduced in November from 12 to 8 as and sustainability of the health system CCGs working closely together to ensure alignment ongoing across Staffordshire. Staffs Cluster and Service redesign and reconfiguration of servi cost. situations with providers have incurred additional patients andplacement taken place to increase the number and frequency of commissioners on controlling cost. Recruitment has Work continuesthe with marketandother Work ongoing.
onfirm robust embedded PPI processes. versa versa commenced. Preparing handover
reviews. Several difficult difficult Several reviews.
ces ces
Lead SM SM AA / ZI DW DW Officer/Reviewer Page 73 Page
6 12 8 8 12 Residual Risk Score
Mar-13 Mar-13 Mar-13 Mar-13 Mar-13 Last Review Date 4. Finance 4. CCGs PH N/A CCGs Receiver
Apr-12 Apr-12 Apr-12 Apr-12 Date Risk Added ce Workfor Risk of Type and Source Finance ce Workfor ce Workfor
unachievable savings programme resulting in Slippageacross the QIPP duties during Transition to LA. Risk to delivery of statutory PH Authority a CB NHS CCG, the transition of functions to organisational memorythrough Loss of staff capacity and mix workforce and changing skill compromised by reduced Quality andsafety is Risk of Description
nd Local
3 3 2 2 L 2 2
3 3 4 4 C 3 3
12 8 6 8 Initial Risk Rating Controls to mitigate risk mitigate to Controls financial performance being sought to create headroom in alignment and delivery. Additional QIPP CCGs and providers to ensure contingencies of full savings not being achieved and QIPP schemes scaled back where risk Processes detailed plans for Structure & HR areas. Development of Clear and departments. Leads identified for critical functions, sharedacrossboth PH Ensuring capacityin place on Legacy Documents transition planning. Ongoing updating of Engagement of CCG, LA and effective Assured through CQRM process or providerSignoff workforce plans, Director of Nursing and Medical Director
built in. betweenWork
critical critical
Progress/Further actions identified actions Progress/Further required. LHE QIPP Board in place in North - deliver financial position. contingency plans to close the financial gapand an action plan has been created to identify plans in South has resulted in over performance and CCG's in place. Significant slippage against QIPP reviewing QIPP delivery andfinancial position of Process for the south whole system LHE approach for workforce data will continue at CQRMs. Committee in August 2012. Ongoing monitoring of Quality off and this was approved Transitional at plan submissions by providers. These were signed medical directorate and HR to review all workforce Quality andNursing representatives worked with the Staffordshire reviewed at SHA. Both PH departments in Transition plans well underway. PH self assessments Document. and willinform and be informed by the Legacy Document. A PCT Closure plan is in development progress Marc 2013. Quality Transition Plan developed and in Legacy Document refresh Sept 2012 and again in
- this will beintegral to t
he Legacy continued focus
Lead AA /ZI DW BS RF Officer/Reviewer Page 74 Page
9 8 6 8 Residual Risk Score
Mar-13 Mar-13 Mar-13 Mar-13 Last Review Date 5. Commissioning Development Commissioning 5. CCGs CCGs CCGs CCGs CCGs Receiver
Apr-12 Dec-12 Apr-12 Apr-12 Apr-12 Date Risk Added Finance Risk of Type and Source ment Develop sioning Commis Finance Finance ational) gic/Oper al/Strate (Financi Cttee Quality
commissioning at risk risk at commissioning system change and clinical Lack of EngagementGP puts forecast deficit pressures in 12/13 c.27m UHNS in 2011/12 (c.£7.7m) authorisation. Significant deficit Burton complexity. deliveryimprovementsof dueto inertia, causes delays in beingwork obsolete, creates changes & redesign. Potential w sustainable. Impact of Monitor and clinically stable and MSFT quality andperformance at risk Delivery of CIPs puts service delivered by providers. CIP efficiency programmes not Risk of Description ork, resulting in external - - -
system not financially financially not system significant financial in breach of
2 2 5 4 3 3 3 L
4 4 4 3 3 3 4 4 C
8 20 12 20 12 Initial Risk Rating Controls to mitigate risk mitigate to Controls and locality-structures. sub have Primary Care development roles EngagementCCG strategies. CCGs CCG's Trust seeking support from SHA and supportthe Trust's transformationplan The PCT is using SCR monies to recov a has Trust The reconfiguration consultationsfuture on service SCR via monies andthrough 2011/12 System Plan in place. DH support for Financial andPerformance monitoring. 5.5% NHS trusts where CIP is greater than Dof to DOF challenge to take place with CIP quality assurance systems in place. account of CIP impact. Provider internal monitoring systems in place which take change and efficiencieQuality s. Reserve to deliver transformational Support providersStrategic with Change
- 2013/14. PCT also supporting
ery plan in place.
settlement being agreed. positionfinalisedbeing withfinancial Trust with regarding level of financial support. Year end contract Ongoing discussions between Trust and CCG CFO identified actions Progress/Further of authorisation process membershiporganisation. Practices partup as to sign developed to ensure clear understanding of a events and improved communication. Constitutions CCGs continuing to engage GPs with stakeholder Implementation of Recovery is plan ongoing Ju on Mid Staffs A&E reconfiguration commenced early System wide discussions about future. Consultation delivery in 12/13 all providers with the exception of UHNS , a full Review and progress of Provider CIP has resulted in ongoingoutcome with expectedFeb/March. Monitor work regarding the future of Mid Staffs is
ly. ly.
Lead DW RF RF RF RF Officer/Reviewer Page 75 Page
8 20 12 12 9 Residual Risk Score
Mar-13 Mar-13 Mar-13 Mar-13 Mar-13 Last Review Date 7. Performance 7. 6. Provider Development CCGs CCGs NHSCB N/A Receiver
Apr-12 Apr-12 Apr-12 Apr-12 Date Risk Added ment Develop sioning Commis Risk of Type and Source ment Develop Provider ment Develop Provider ment Develop sioning Commis
transformation standardsand/or service quality and/or performance Aspirant FTs do not deliver FTs aspirant destabilises savings activity reductions and planned combined QIPP and CIP Successful delivery of cost allocation Structures exceed management Support. CCG designed adequacy of Commissioning Accountable Officers and of leadership, identification future role, including clinical Capacity/capability of CCGs for sustainable. CCG Configuration is not Risk of Description
2 2 2 2 2 L 3 3
4 4 4 4 3 C 3 3
9 8 8 12 Initial Risk Rating Controls to mitigate risk mitigate to Controls ensure delivery. placeinare andbeing monitoredto standards. Ensure reporting of metrics systems are in place to meet all key Retainensuringfocus on sustainable areasother to close gap savings and to develop busi SSOTPT time to plan efficiencies and activity reductions to give UHNS, CHCT, Early anddetailed confirmation of head.workingto £25per defining do/share/buy options. CCGs Accountable Officer posts. CCGs and CCG for skills/competencies defining on Work development. enable personal leadership expertise. with CCGWork Chairs to to supportplacein skills/knowledge and Organisational Development programme out rationale for CCG configuration set development CCG for plans Detailed
ness in in ness Progress/Further actions identified actions Progress/Further scheduledpost 13 march been reviewed. UHNS have not submitted their IBP - assurance process. NSCHC & SSOTP have both appreciative review according to an agreed Each of the 3aspirant FT's will have a cluster internal exception of UHNS providers forecasting end of year delivery with recommendationCCGsfor to ongoing monitoring.All furtherand action subjected to aCluster internal appreciative review their re have NSCH providers CIP. been &SSOTP assurance process to ascertain assurances from all The cluster is in the process of developing arobust for going further. risk reduced to 8in October clarified. Shared posts being implemented but scope head but some risk remains as demands still being commissioning support. All CCGs within the £25 per CSS to develop relationships and deliver Do/buy/shareoptions definedongoing andwork with assessment centre and will supported be in this. development plan arising from the national chairs in post for each CCG. Each has a personal plans for Authorisation. submitted have CCGs All envelope. financial the dependent on capacity andcapability to deliver within assessment and are rated green. Sustainability CCGs have gone through the configuration risk AOs appointed including East Staffordshire CCG and
re CIP delivery been has sort and
Lead DW DW DW DW Officer/Reviewer Page 76 Page
9 8 8 6 Residual Risk Score
Mar-13 Mar-13 Mar-13 Mar-13 Last Review Date CCGs CCGs CCGs Receiver
Apr-12 Apr-12 Apr-12 Date Risk Added Risk of Type and Source ance Perform ance Perform ance Perform
performance Inconsistent cancer BHFT and UHNS and Emergency 4Hours at delivering targets on Accident Service performance not backlogsRTT achievementof 18weeksand delivering targets on Service performance not Risk of Description
2 2 2 L 3 3
4 4 4 C 4 4
8 12 12 Initial Risk Rating Controls to mitigate risk mitigate to Controls they vary from norm. Close monitoringstandards of where taken. is where problems occur earlyintervention that 4 hour standard is maintained and CCGs working with Providers to ensure monitored by CCGs and reported to DH. Recovery plans in place for Trusts being
Progress/Further actions identified actions Progress/Further standard in Dec 12. experienced underperformance on62 day screening on 62 day standard in Dec' 12. North Staffs PCT although SOT PCT experienced underperformance consistent cancer performancethroughout 12/13 Commissioners acrossStaffordshire have seen 31/3/2013 consultant support in place. Delivery trajectories from Remedial 1/3/2013.year The specialties in Dec 12. Planned recovery from Recovery planned from 31/3/2013. UHNS failed 4 May 13. BHFT failed overall admitted target Dec 12. not2013 but sustainableuntil staff appointments in Urology. All specialties at MSFT delivered for January specialties (Upper Vascular;GI, Colorectal), and remain around General Surgery andits- sub targets by the end of August 2012 - all achieve will in June they how 2012 to evidence Trust the from received trajectories Revised achieved. and Incomplete pathways target of 92% now being Admitted targets. All waiting lists now fully validated remain with Mid Staffs around Admitted and Non- 1 and continue to achieve in Q2 2012/13. Issues Burton and UHNS achieved all RTT targets in quarter
Action plans in place. Management
-end position unlikely to improve
however issues issues however
Lead DW DW DW Officer/Reviewer Page 77 Page
8 12 12 Residual Risk Score
Mar-13 Mar-13 Mar-13 Last Review Date 8. Quality CCGs CCGs CCGs CCGs PH Receiver
Apr-12 Apr-12 Apr-12 Apr-12 Apr-12 Date Risk Added
ance Perform Risk of Type and Source Quality Quality Quality Quality
targets for pressure Ulcers Providers not delivering quality targets MRSA for /C.Diff Providers not delivering quality Mixed Sex Accommodation Non delivery of elimination of care Patients receive sub optimal aspects of the contract. screening targets health outcome targets eg. achievementNon of keypublic Risk of Description Non delivery of the quality
2 2 3 3 L 2 2 2 3 3
4 4 4 4 C 4 4 4 4 4
12 12 8 12 12 Initial Risk Rating Controls to mitigate risk mitigate to Controls arrangements Analysisall throughmanaged CQRM serious incident reporting, Route Cause Significant monitoring of standards, committee arrangements andInfectionControl Analysisall throughmanaged CQRM serious incident reporting, Route Cause Significant monitoring of standards, discussed through CQRM performancebeing monitored and being supported to deliver MSA, compliance achieving not Providers making andmonitoring process). CQUINs (including a robust decision etc visits committees/ reviews/ Internal and external quality safety and Regular monitori information. Effective plans in place. with providers. Timely monitoring Nominated leads. Monthly meetings
ng
/CQRMs. /CQRMs.
Progress/Further actions identified actions Progress/Further double counting with providers. and PU steering group. Work underway to eliminate ulcers by Dec 12. Data monitored through CQRM the SHA ambition to eliminate avoidable pressure Providers all currently being monitored with regard to appropriateto address. where required. Meetings with providers as areas to address and monitor continues. SHA linked exceeded. Increased focus with Head of IPC in these Ongoing monitoring continues. Some targets already overall risk reduced to 8 in Nov 12 compliance. Likelihood of Risk reduced to 2 with undertaken with all providers includes areview of breaches reported recently. Visiting programme Minimal compliant. remain providers of majority The Ongoing Issues addressedthey as arise. Monitoring continues in line with normal processes.
Lead BS BS BS BS AA / ZI Officer/Reviewer Page 78 Page
12 12 8 8 8 Residual Risk Score
Mar-13 Mar-13 Mar-13 Mar-13 Mar-13 Last Review Date 9. Public Health Public 9. N/A PH NHSCB N/A Receiver
Apr-12 Apr-12 Apr-12 Apr-12 Date Risk Added Quality Risk of Type and Source Health Public Health Public Health Public
Information in Data capture and Health PH (CSS) supporting Services Lack of Commissioning Support Authority public health services any emerging gaps in Local Public Health funding including transition period arrangements duringthe and lack of formalised emergency planning systems resilience due to different of organisationalLack transitionCCGsto andFTs deteriorates during the Quality not improve does ,or commissioning process. quality agenda partas of the CCGs do not undertake the ful Risk of Description
l
3 3 2 3 3 L 2 2
3 3 4 2 2 C 3 3
9 6 6 8 Initial Risk Rating 10. Information & Technology (IM&T) Controls to mitigate risk mitigate to Controls for PH for intelligence and reporting frameworks supports the sustainabilitydata of developingbusiness a arrangement that PH to work closely with CSS in Work ongoing with LA colleagues 10/11 PH spends reported to DOH. immunisation plans including implementation of mass response to public health emergencies Plans in place Test and review provider staff in place for emergency planning Identified lead Director in place. CQUINs CQRMs. – Cluster. Robust CQRMs with providers strategic role across the CCGs and Assistant Directors of quality have to contract management teams to CCGs. Assignment of quality leads from
increasing CCG involvement in in involvement CCG increasing
Lead
Progress/Further actions identified actions Progress/Further post Aprpost 13 on-going. been risk assessed and arrangements for access completed of all data access points. These have proposal being developed. Also anaudit has been identified.post Memorandum of understanding StokeIn Trans engaged. CCG's supported and challenged through Quality Surveillance Committee established and CCG respect of attendance at quality committee meetings. CQRM's andare aware of planned changes in strategy in place. CCGs are now picking up all Quality committees with under pinning Q complement of Quality teams all established have Qualityleads remain in CSU. CCGs now have full September. carried out and due for completion by endof Addi 10/11 out turn reconciled with 2013/14 liabilities. Ongoing
tional checks and balances currently being itional Quality Committee Quality itional -on Trent additional funding for data facilitator
uality uality
Lead AA / ZI AA / ZI AA / ZI BS Officer/Reviewer Page 79 Page
9 6 6 8 Residual Risk Score
Mar-13 Mar-13 Mar-13 Mar-13 Last Review Date CCGs CCGs CCGs CCGs Receiver
Apr-12 Apr-12 Apr-12 Apr-12 Date Risk Added Risk of Type and Source IM&T IM&T IM&T IM&T
(OAGPR) (OAGPR) Line Access' to recordsGP Clinical Leadto manage 'On No formal project board / SRO / project managementresource availability of adedicated Staffordshire due to non Lack of SCR progress in South Lead) structure (no SRO & Clinical associated governance Monitoring Board and the Programme Management / wide IM&T Project and Failure to establish a cluster Risk of Description Shared IT service review and associated single network Lack of progress in Local
across cluster
4 3 3 L 3
3 3 4 C 4
12 12 9 12 Initial Risk Rating Controls to mitigate risk mitigate to Controls National Guidelines yet to bepublished dedicated Project Manager in progress Star Chamber application to recruit a Cluster Director of Finance SRO responsibility allocated now to Under Review Under
Progress/Further actions identified actions Progress/Further report) completed by 2015) ( No change from the previous recently Howeveranational target has through beenset Still noclarity onnational approach/guidelines. progressing withouta clinical lead. North Staffs progressing as usual. . Project engagement sessionsbeen have planned. Stoke and uploaded and further 2in progress. Further Three South Staffordshi from the previous report) the overall risk is still remain as high ( No change projects are progressing (SCR andEPS). However have its first meeting. Two of the three priority No Clinical Leadas yet. Programme Board yet to Andrew Hartshorne at the request by Helen Ashley. Strategic Review ongoing and is undertaken by
12 to 18 months time scale to complete. published Information Strategy (to be
re practicehave been
Lead RF RF RF RF Officer/Reviewer Page 80 Page 12 12 9 12 Residual Risk Score
Mar-13 Mar-13 Mar-13 Mar-13 Last Review Date Section 13: Corporate Responsibility
Sustainable Development A single Sustainable Development Management Plan (SDMP) for Staffordshire was developed from the existing PCT SDMPs. This set out the commitments and roles of respective organisations. This paper has been approved by the Cluster Board and is being used by CCGs in their authorisation processes. The Cluster will take an overview of sustainable development delivery across the Staffordshire system during the process of transition. With the establishment of the Staffordshire and Stoke-on-Trent Partnership Trust the majority of PCT estate has transferred, therefore the majority of the contribution on realising the carbon reduction footprint in the future will be met by Provider trusts. CCGs as Commissioners will focus on sustainable procurement.
All CCGs have developed Sustainable Development policies as part of their Authorisation process.
Caldicott Function Confidentiality and data protection is a key element of Information Governance agenda and each NHS organisation must ensure that there are adequate arrangements in place. In line with this the Cluster has appointed the Medical Director as Caldicott Guardian to the Staffordshire Cluster. The role of the guardian is to ensure that the highest practical standards are maintained for the handling of patient identifiable information through the correct procedures and guidance of the Information Governance function across all organisations in the Staffordshire Cluster.
Equality & Diversity A key component of the equality agenda for Staffordshire is to ensure that the Public Sector Equality Duty is met and all communities have equal access to services. Each of the three PCTs, the six CCGs and Provider Trusts have formally signed up to implementing the national Equality Delivery System (EDS) and the Cluster Common Board has a nominated Executive Lead, the Director of Partnerships and Planning, to provide leadership across the Cluster system.
The Cluster has established a governance structure with a Provider steering group, which enables providers to learn from each other and to co-ordinate links with community representatives from the nine ‘protected groups’ and which also provides assurance to the Cluster on progress against the Public Sector Equality Duty and EDS. Engagement with CCGs has been on a one to one basis, to support commissioners to review existing business processes in line with the EDS in the light of the new NHS commissioning structures, develop equality strategies and undertaken baseline EDS assessments. Assurance on Equality and Diversity delivery is reported to the Patient and Public Engagement sub-committee of the Trust Board.
In terms of commissioning, the 18 EDS outcomes focus on those areas which are of most concern to patients, carers, communities, NHS Staff and Boards. Commissioners and Providers are currently in the process of reviewing commissioned services against the EDS protected groupings and developing objectives and action plans to embed the principles of EDS into the ways of working in the new healthcare system across Staffordshire, including links with Local Authorities. An assessment of performance against the outcomes is currently being undertaken which will be graded, in partnership with communities, including those representing the nine ‘protected groups’. Equality objective(s) have been identified and were published in April 2012.
Page 81 Section 14: Views of CQC & Monitor
Monitor
Monitor currently regulates 3 providers within the PCT area, Mid Staffordshire Foundation Trust, Burton Hospitals Foundation Trust and South Staffordshire & Shropshire Healthcare Foundation Trust.
Monitor Risk Ratings at a glance (Q1 2012/13)
Foundation Trust Financial Rating Governance First 1=Highest Risk Rating Authorised 5=Lowest Risk R-A-G Mid Staffordshire FT 1 Red* 01/11/2008 Burton Hospitals FT 1 Red* 01/02/2008 South Staffordshire & 4 Green 01/05/2006 Shropshire Healthcare FT *Currently in Significant Breach of Terms of Authorisation
For more details on the most recent Monitor Reviews, please use the links below:
Mid Staffordshire Foundation Trust http://www.monitor-nhsft.gov.uk/about-nhs-foundation-trusts/nhs-foundation-trust- directory/mid-staffordshire-nhs-foundation-trust
Burton Hospitals Foundation Trust http://www.monitor-nhsft.gov.uk/about-nhs-foundation-trusts/nhs-foundation-trust- directory/burton-hospitals-nhs-foundation-trust
South Staffordshire and Shropshire Healthcare Foundation Trust http://www.monitor-nhsft.gov.uk/about-nhs-foundation-trusts/nhs-foundation-trust- directory/south-staffordshire-and-shropshire-health
Page 82 Care Quality Commission
Most Recent Review feedback
University North Staffordshire & West Midlands Hospitals North Staffordshire Stoke-on-Trent Ambulance Staffordshire Combined Partnership Service Health Care Trust Trust Visit Date 20/07/2012 14/11/2011 Not yet 23/08/2011 reviewed Treating People with All Met All Met - All Met Respect Standards of care, All Met All Met - All Met treatment and support Standards of caring All Met All Met - All Met for people safely Standards Standards of staffing All Met All Met - All Met Quality and All Met All Met - All Met sustainability of management
For more information on the inspections completed at each provider, please use the links below:
University Hospitals of North Staffordshire NHS Trust http://www.cqc.org.uk/directory/rjehq
North Staffordshire Combined Health Care Trust http://www.cqc.org.uk/directory/rly
Staffordshire & Stoke-on-Trent Partnership Trust http://www.cqc.org.uk/directory/r1eg3
West Midlands Ambulance Service http://www.cqc.org.uk/directory/rya05
Tripartite Formal Agreements
The following Trusts are currently progressing through the Foundation Trust assessment process. The tripartite agreement for each is attached below:
University Hospitals of North Staffordshire NHS Trust http://www.uhns.nhs.uk/LinkClick.aspx?fileticket=S7EdL-Su-6M%3D&tabid=605
Staffordshire & Stoke-on-Trent Partnership Trust http://www.staffordshireandstokeontrent.nhs.uk/About- Us/Tripartite%20Formal%20Agreement.pdf
West Midlands Ambulance Service http://www.wmas.nhs.uk/get_involved/idoc.ashx?docid=50d06955-601f-4476-8ac7- c915e98e3c29&version=-1
Page 83 Section 15: Transition, Close Down Plans and Handover Arrangements
The Staffordshire Cluster of PCTs has produced a transition/closure plan based on the model developed by the Strategic Health Authority.
This transition/closure plan is to ensure that all PCT legal responsibilities and liabilities are either transferred to a receiving organisation or closed down. All other service and commissioning transfers will take place outside of the plan. The plan is overseen by a transition/closure project group which reports to the Audit Committee. The project group will not be doing/directing the work but will be providing assurance that there are clear processes in place across the PCTs to ensure the work is happening.
The Plan will be a live document and therefore be updated as necessary to reflect the emerging arrangements locally for Clinical Commissioning Groups, the Commissioning Support Unit and the Local Area Team of the Commissioning Board.
In relation to handover arrangements, The Cluster of PCTs have been in close discussion with the emerging commissioning organisations since the reforms were first announced through the ‘White Paper’ and further since the establishment of the Health and Social Care Act 2012. A careful process of delegating responsibilities and duties has seen many of the CCGs become involved in statutory duties and understand their role.
There have been various meetings between the Cluster Executive team and key management and personnel within the CCGs as well as dedicated working groups of specific areas.
Formal handover meetings with Accountable Officers and senior managers of CCGs will take place using the suite of transition documents as a basis of handover during March 2013. In addition
Page 84
Section 16: Development and Approval of Legacy Document
The Cluster legacy document submitted in September 2011 (published October 2011) was developed through the integration of the separate three PCT legacy documents. These documents along with the Cluster legacy Document were approved and signed off by the September Trust Boards and Cluster Board meeting.
Following the creation of a Common Board of Staffordshire PCTs in December 2011, the Cluster Legacy document has been discussed at Directors meeting and each Chapter/Section is owned by a Director who will have the responsibility for updating information and agreeing final sign off. A project plan was submitted and approved based on the original guidance from the Midlands and East SHA Cluster.
The Cluster Legacy document update for September 2012 was presented to the Cluster Directors meeting at the end September for approval and sign off before being submitted to the Midlands and East SHA Cluster.
The Cluster Legacy Document was presented to the Directors Meeting of the Staffordshire Cluster of PCTs on the 26th September 2012 for approval. The final Legacy Document will be presented to the PCT Cluster Board on 20 March 2013 and published on PCT websites.
Page 85 Library of Knowledge
The following section is a depository of all useful resources such as key contacts, strategy documents, consultancy reports etc.
Key Contacts
Staffordshire Cluster of PCTs - Executive Directors (March 2013) Name Role Email Address Graham Urwin Chief Executive [email protected] Ros Francké Director of Finance [email protected] Brigid Stacey Director of Nursing and Quality [email protected] Dawn Wickham Director of Partnerships and Planning [email protected] Dr Ken Deacon Medical Director [email protected] Sultan Director of Commissioning [email protected] Mahmud Dr Aliko Ahmed Director of Public Health NHS North [email protected] Staffordshire and South Staffordshire PCT Dr Zafar Iqbal Acting Director of Public Health NHS [email protected] Stoke on Trent
Staffordshire Cluster of PCTs – Non Executive Directors (March 2013)
Name Role Email Address Alex Fox MBE Chair For contact details of the Board Members please contact the Board Committee Officer:
[email protected] Barry Machin Non-Executive Director (Audit Chair) John Howard Non-Executive Director Lynn Kemp Non-Executive Director Lloyd Cooke Non-Executive Director Mr David Ibbs Non-Executive Director Lynne Smith Non-Executive Director André Burns Non-Executive Director
CSU Senior Managers
Name Role Email Address Derek Kitchen Managing Director [email protected] Carl Usher Chief Finance Officer [email protected] Paula Furnival Delivery Director – [email protected] Staffordshire Linda Riley Delivery Director – Lancashire [email protected] N/A Director of HR & OD Position currently vacant
Clinical Commissioning Groups (All Designate Appointments) CCG Name Role Email Address Stoke-on- Dr Prasad Rao Chair [email protected] Trent
Page 86 Dr Andrew Chief Clinical Officer [email protected] Bartlam Sandra Chief Operating [email protected] Chadwick Officer Tony Matthews Chief Finance Officer [email protected]
Dr Mark Shapley Chair [email protected]
Dr David Hughes Chief Clinical Officer [email protected] North Staffordshire Chief Operating [email protected]. Marcus Warnes Officer uk Tony Matthews Chief Finance Officer [email protected]
Dr Margaret Chair [email protected] Jones Stafford and Andy Donald Accountable Officer [email protected] Surrounds Andy Chandler Chief Finance Officer [email protected]
Dr Johnny Chair [email protected] McMahon Cannock Andy Donald Accountable Officer [email protected] Chase Andy Chandler Chief Finance Officer [email protected]
Dr Charles Chair [email protected] Pidsley East Tony Bruce Accountable Officer [email protected] Staffordshire Wendy Kerr Chief Finance Officer [email protected]
South East Dr John James Chair [email protected] Staffordshire Rita Symons Accountable Officer [email protected] and Seisdon Interim Chief Finance Stuart Hydon [email protected] Peninsula Officer
Key Documents
NHS North NHS Stoke on South Cluster (All PCTs) Function Staffordshire Trent Staffordshire PCT (Estate and LIFT Cluster Legacy Business Plan Business Plan plans) Document Towards a Risk Management Risk Management Common Board healthier future: 5 Assurance Assurance Agenda’s, minutes and year Strategic Plan Framework Framework reports. 2009-2014. OD plan OD plan OD plan Integrated System Plan Corporate Standing Orders, Reservation and WCC Panel Report WCC Panel Report WCC Panel Report Delegation of Powers (May 2010) (May 2010) (May 2010) and Standing Financial Instructions Your guide to NHS Your guide to NHS Corporate Risk
services services Register
Page 87 NHS North NHS Stoke on South Cluster (All PCTs) Function Staffordshire Trent Staffordshire PCT Sustainable development Sustainable Sustainable management Data Protection Policy development Policy development policy plan/active travel plan Freedom of Information Annual Reports Annual Reports Annual Reports Procedures Freedom of Information Board papers and Board papers and Board Papers and Act and Environmental Minutes Minutes Minutes Information Regulations Policy Local Delivery CCG Scheme of CCG Scheme of Information Security Plans/Annual Delegation Delegation Policy Operating Plans Public Consultation Public Consultation Information Real Accountability Documents Documents Governance Policy PCT Code of Complaints Policy Information Sharing Volunteer policy Conduct and Procedures Policy Policy for Complaints Policy PPI engagement Procedures - Prior Cluster Media Policy and Procedures Approvals Policy for Corporate Serious Untoward Equality Delivery Procedures - Prior guidelines on PPI Incident Policy System Plan Approvals Clinical Risk Serious Untoward CCG scheme of Management Incident Policy delegation Strategy Clinical Risk Public Consultation Management Grievance Policy Documents Strategy Complaints Policy Grievance Policy Disciplinary Policy and Procedures Confidentiality of Policy for Patient & Disciplinary Policy Procedures - Prior Employee Personal Approvals Information Confidentiality of Patient & Serious Untoward Information Employee Personal Incident Policy Governance Policy Information Clinical Risk Information Quality Annual Management Governance Policy Reports Strategy
Quality Annual Infection Control Grievance Policy Reports Annual Report Infection Control Complaints Annual Disciplinary Policy Annual Report Report Confidentiality of Complaints Annual Patient & Safeguarding Report Employee Personal Annual Reports Information Standards of Safeguarding Complaints Annual Business Conduct Annual Reports Report and Ethics for Employees Standards of Fraud and Business Conduct Quality Annual Corruption and Ethics for Reports Response Policy Employees Fraud and Raising Concerns Infection Control Corruption at Work Policy Annual Report Response Policy (Whistle blowing)
Page 88 NHS North NHS Stoke on South Cluster (All PCTs) Function Staffordshire Trent Staffordshire PCT Policy and Policy and Procedure for the Procedure for the Raising Concerns Authorisation and Authorisation and at Work Policy Management of Management of (Whistle blowing) Individual Funding Individual Funding Requests Requests Policy and Procedure for the Authorisation and Safeguarding Volunteer Policy Management of Annual Reports Individual Funding Requests Volunteer Policy Volunteer Policy Standards of Business Conduct and Ethics for Employees Fraud and Corruption Response Policy Raising Concerns
at Work Policy (Whistle blowing) Policy and Procedure for the Authorisation and Management of Individual Funding Requests Joint Strategic Joint Strategic Joint Strategic Needs Assessment Needs Assessment Needs Assessment Public DPH reports DPH reports DPH reports
Health Health & wellbeing Health & wellbeing Health & wellbeing Strategy Strategy Strategy Transition Plan Transition Plan Transition Plans Primary Care Primary Care Primary Care Strategy Strategy Strategy QOF framework CHEC report QOF framework Primary
Care QIF framework x 3 Poor Performers documents Poor Performers Policy Poor Performers Policy Policy Fit for the Future Fit for the Future Medicines Full Business Case Full Business Case Management (revised 2006) (revised 2006) Fit for the Future Fit for the Future Annual Operating assurance assurance Plans Document Document Practice-Based Commission Medicines Commissioning ing Management Annual Reports Annual Operating Medicines Funding Request Plans Management Policy Annual Operating Funding Request Plans Policy Funding Request Policy Financial Strategy Financial Strategy Financial Strategy – Long Term – Long Term – Long Term Finance Sustainability Sustainability Sustainability Model 2011/12- Model 2011/12- Model 2011/12-
Page 89 NHS North NHS Stoke on South Cluster (All PCTs) Function Staffordshire Trent Staffordshire PCT 2014/15 2014/15 2014/15
Finance Reports Finance Reports Finance Reports Estates Strategy Estates Strategy Estates Strategy Procurement Policy Procurement Policy Procurement Policy Quality and Quality Strategy performance Quality Strategy strategy RISK Management ASSURANCE FRAMEWORK Performance 2008/09 (on N Framework drive) CQC Reports Quality and Quality Annual Pen portraits of Use of Resources Performanc Reports Acute Trusts Report e Infection Control Quality Annual Quality Annual Annual Report Reports Reports Complaints Annual Infection Control Infection Control Report Annual Report Annual Report Safeguarding Complaints Annual Complaints Annual Annual Reports Report Report Safeguarding Safeguarding Annual Reports Annual Reports Workforce Staff Survey Staff Survey Staff Survey Staff Survey UHNS Appreciative UHNS Appreciative enquiry (A&E) enquiry (A&E) External Francis Report Francis Report Reports AETNA AETNA NHS Atlas: Variations in Care Mid Staffs Inquiry
Other Legacy/Transition Supporting Documents
• Contract Transition 2012-13 Index Sheet • Cluster Quality Handover Document • Real Accountability Reports 2012 • Complaints Annual reports 2011-12 • Staffordshire Cluster Financial Plan • Staffordshire Cluster System Plan 2012-13 • PCT Property Schedules as of 31st August 2012 • Contracted Services Summary (non clinical) • PCT Asset Registers • Corporate Risk Register (as of 17th September 2012) • Staffordshire Cluster Combined Assurance Framework • Cluster Governance Close Down & Transition Plan
Page 90 Staffordshire Commissioning Support Units – Policy Check The CSU have carried out a project to look at the corporate policies across all three PCTs. The following table shows similar policies for each PCT
South Staffordshire PCT NHS Stoke NHS North Staffordshire
Corp 03 Risk Management Policy 2.5 Risk Management Strategy 4.6 Risk Management Strategy
Corp 13 Policy for the 4.22 A Policy for the Development 1.07 Development and Control of Development and Management of and Management of Policies & Policies Policies Procedural Documents
2 Organisation Wide Policy / 1.22 Management of Clinical Corp 32 Claims Management Clinical Negligence & Personal Negligence and Personal Injury Policy Injury Claims Claims
Complaints PALS Policy 4.27 Patient Advice & Liaison Corp 33 Pals Policy Procedure Service (PALS) Corp 24 Policy for Handling Complaints PALS Policy 4.2 Complaints Policy and Complaints Procedure Procedures
6.2 Major Incident Response and Business Continuity Policy None Recovery Plan
Clin 51 Procedure for Producing 1 Guidance for Patient Information None Patient Information Leaflets Leaflets
Corp 22 Research Governance 6.14 Research Governance Policy None Policy
Corp 25 Incident/Accident 2.13 Organisation Wide Policy Investigation including guidance on Reporting Management of None Root Cause Analysis Policy Incidents and SUIs
Corp 29 Violence & Aggression 4.3 Management of Violence None Policy Aggression Policy
Corp 33 Risk Assessment Policy 2.18 Risk Marker Policy None
Corp 40 Policy for the 4.14 Fraud Corruption Response Management of Fraud and None Policy Corruption
Corp 44 Being Open - Communicating Patient Safety 1a Being Open Policy None Incidents with Patients and Their Carers
Corp 47 Security Management 1.3.1 General Security Policy None Policy Race Equality Policy None 4.7 Race Equality Policy
Corp 50 Policy for the reimbursement of Out of Pocket None None Expenses for Volunteers
Corp 54 Reporting and Registering 4.04 Condemnations losses and None of Losses and Special Payments Special Payments
Procedure for External Agency V1 Protocol for External Agency Assessments, Inspections and Assessments, Inspections and None Accreditations Accreditations
Corp 07 Interpreter Policy None None
Page 91 South Staffordshire PCT NHS Stoke NHS North Staffordshire Corp 27 Adverse Incident None None Reporting Policy Corp 12 Commercial Sponsorship None None Policy None 4.09 Patients Property None
4.10 Partnerships with the None None Pharmaceutical Industry and Allied Private Sector
None None 1.5 Attendance at Coroner’s Court
None 6.13 Intellectual Property Policy None
2.17 SOT Health and Safety Policy Corp 39 Health and Safety Policy and Arrangements of Risk / H&S None Organisational Arrangements Advice for Equipment & Substances
Corp 46 Information Governance 6.10a Information Governance 4.24 Information Governance Policy Policy Policy
Corp 36 Policy for the Preservation, retention and 1.16 Protection, Retention of 4 Archiving Policy destruction of health records and Patient Documentation other corporate records
Corp 38 Policy for Information Information Security & Data 6.03 Information Security Policy Security Protection Policy Corp 15 Records Management None 4.21 Records Management Policy
Corp 31 Code of Confidentiality 4.17 Confidentiality of Patient & None Policy Employee Personal Information
Corp 35 Privacy Impact None None Assessment Procedure
Corp 42 Safe Haven Guidance None None
Clin 02 Clinical Record Keeping None None Policy Corp 02 Information Lifecycle None None Policy
Corp 51 Data Quality Policy None None
None 6.04a Internet/ intranet access None
None 6.04b Email Guide None
6.09 Freedom of Information & None None Environmental Policy
Page 92
Appendices
Appendix A - Primary Care Contracts and Services
NHS North Staffordshire
GP Practices
Patient List Contract Size Practice Practice Name Address Type 01.07.12 Code
2 Heathcote Street, Chesterton Heathcote Street Surgery GMS 6775 M83005 Newcastle Under Lyme, Staffordshire. ST5 7EB
49 High Street, Wolstanton The Village Surgery GMS 6466 M83007 Newcastle Under Lyme, Staffordshire. ST5 0ET
Ash Bank Road, Werrington Werrington Village Surgery GMS 7843 M83011 Stoke-on-Trent. ST9 0JS Fountain Street, Leek, Staffordshire Leek Health Centre GMS 8089 M83012 ST13 6JB
Moss Lane Surgery Moss Lane, Madeley, Stoke-on-Trent. CW3 9NQ GMS 6670 M83015
School Lane, Ashley, Market Drayton Ashley Surgery GMS 3810 M83017 Shropshire. TF9 4LF
Park Medical Centre, Ball Haye Road Stockwell Surgery GMS 4585 M83019 Leek, Staffordshire. ST13 6QP Mount Road, Kidsgrove Kidsgrove Medical Centre - Rabie PMS 10020 M83023 Stoke-on-Trent. ST7 4AY
Miller Street, Off King Street Miller Street Surgery GMS 7456 M83025 Newcastle Under Lyme, Staffordshire. ST5 1JD
Vale Pleasant, Silverdale Silverdale Medical Centre PMS 10809 M83034 Newcastle Under Lyme, Staffordshire. ST5 6PS
Biddulph Medical Centre, Well Street, Biddulph Well Street Medical Centre (King) GMS 9985 M83046 Stoke-on-Trent. ST8 6HD
Church Street, Audley Audley Health Centre PMS 9404 M83054 Stoke-on-Trent. ST7 8EW
Palmerston Street, Wolstanton Wolstanton Medical Centre GMS 10451 M83056 Newcastle Under Lyme, Staffordshire. ST5 8BN
Lyme Valley Road Lyme Valley Practice PMS 5742 M83067 Newcastle Under Lyme, Staffordshire. ST5 3TF
Park Medical Centre, Ball Haye Road John Kelso Practice GMS 7577 M83071 Leek, Staffordshire. ST13 6QR Dyson House, Regent Street, Leek, Staffordshire. Moorlands Medical Centre PMS 8575 M83079 ST13 6LU Mount Road, Kidsgrove, Stoke-on-Trent. ST7 Kidsgrove Medical Centre - Holland GMS 7120 M83084 4AY
Biddulphdoctors, The Medical Centre, Well Street Biddulph Medical Centre GMS 10580 M83089 Biddulph, Stoke on Trent. ST8 6HD
Page 93 Patient List Contract Size Practice Practice Name Address Type 01.07.12 Code
5-9 Queen Street, Cheadle The Tardis Surgery GMS 6344 M83096 Stoke on Trent, Staffordshire. ST10 1BH
Allen Street, Cheadle, Stoke on Trent The Surgery GMS 4282 M83103 ST10 1HJ
Well Street Medical Centre, Well Street, Cheadle, Well Street Medical Centre - Cheadle GMS 7277 M83108 Stoke-on-Trent, Staffordshire. ST10 1EY
Old Road, Tean, Stoke-on-Trent The New Surgery GMS 6189 M83121 ST10 4EG Waterfall Lane, Waterhouses, Stoke-on-Trent, Waterhouses Medical Centre PMS 3340 M83122 ST10 3HY Higherland Surgery 3 Orme Road, Poolfields. ST5 2UE GMS 3812 M83140 Kingsbridge House, Kingsbridge Avenue, Clayton. Kingsbridge Medical Centre GMS 7787 M83141 ST5 3HP Hurstons Lane, Alton Alton Primary Care Centre GMS 2234 M83640 Staffordshire. ST10 4AP
Milehouse Primary Care Centre, Millrise Village, Lymebrook Way, Milehouse, Newcastle-under- Dr Malis & Partner GMS 1463 M83658 Lyme, Staffordshire, ST5 9GA
19 Wright Street, Butt Lane R J Mitchell Medical Centre GMS 4262 M83665 Kidsgrove, Stoke-on-Trent, ST7 1NY University of Keele, Keele University Medical Centre GMS 5391 M83670 Staffordshire. ST5 5BG
Main Road, Betley, Wrinehill, Nr Crewe Betley Surgery GMS 1882 M83691 CW3 9BL
Milehouse Primary Care Centre Milehouse Medical Practice Millrise Village, Lymebrook Way, Milehouse, GMS 1867 M83697 Newcastle-under-Lyme, Staffordshire. ST5 9GA
Talke Pits Clinic High Street, Talke Pitts. ST7 1QQ GMS 3666 M83701
Loomer Road, Chesterton Loomer Road Surgery GMS 2504 M83723 Newcastle Under Lyme, Staffordshire. ST5 7JS
Newcastle High Street Medical Practice, 5-9 High 5-9 High Street Street APMS 3414 Y00040 Newcastle-under-Lyme, Staffordshire. ST5 1RB
Morston House, The Midway, Newcastle Under Midway Medical & Walk-in Centre Lyme APMS 1920 Y02570 Staffordshire. ST5 1QG Milehouse Primary Care Centre, Millrise Village, Lymebrook Way, Milehouse, Newcastle-under- Lymebrook GMS 3581 Y03430 Lyme, Staffordshire, ST5 9GA
Optometrists Additional Mandatory Services Practice/Contract Holder Address Contract (Domiciliary) Contract 3 Cawdry Buildings, Leek, Staffordshire ST13 A Hurd Opticians Yes Yes 6JP Wolstanton Retail Park, Wolstanton Newcastle Asda Opticians Yes No Under Lyme, Staffordshire ST5 0AP
Page 94 Additional Mandatory Services Practice/Contract Holder Address Contract (Domiciliary) Contract 34 Ironmarket, Newcastle Under Lyme, B Newbold Opticians Ltd Yes Yes Staffordshire ST5 1RP 49 St Edward Street, Leek, Staffordshire, ST13 B Newbold Opticians Ltd Yes Yes 5DN 33 Merrial Street, Newcastle Under Lyme, Browns Opticians Yes Yes Staffordshire ST5 2AE 60-62 High Street, Newcastle Under Lyme, A J Optometric Services Ltd Yes No Staffordshire ST5 1QL Boots Opticians 44 Derby Street, Leek, Staffordshire ST13 5AJ Yes No 6 Friar Street, Newcastle Under Lyme Stevenson Jones Yes No Staffordshire ST5 2DZ 65 Liverpool Road, Kidsgrove, Stoke-on-Trent, L Thompson Optometrist Ltd Yes No Staffordshire 31 High Street, Biddulph, Stoke-on-Trent, NuSyte Optical Ltd Yes No Staffordshire 50 High Street, Cheadle, Stoke-on-Trent ST10 NuSyte Optical Ltd Yes No 1EA 109a High Street, Wolstanton Newcastle Under NuSyte Opticians Ltd Yes No Lyme, Staffordshire Specsavers Ltd 9 Derby Street, Leek, Staffordshire ST13 6HN Yes No Specsavers (Newcastle Under Lyme 35 High Street, Newcastle Under Lyme, Yes No Vision Plus Ltd) Staffordshire ST5 1QZ 92 Liverpool Road, Kidsgrove, Stoke-on-Trent, S W Cotton Optometrist Yes Yes Staffordshire 75 High Street, Biddulph, Stoke-on-Trent ST8 S W Cotton Optometrist Yes Yes 6AA Catherine Townsend Three Ways, Birchall lane, Leek, ST13 5RA No Yes Clear Day Ltd T/as The Right Vision 34 Birmingham Street, Oldbury, B69 4DS No Yes Ophthalmic Optician Community Eyecare Ltd T/as Vision 125 Cambuslang Rd, Glasgow, G32 8NB No Yes call Complete Price Eyewear Ltd T/as 7 Wood Street, Old Town, Swindon, SN1 4AN No Yes The Outside Clinic 36 Trinity Street, Hanley, Stoke-on-Trent. ST1 Glyn Jones Hanley No Yes 5LA Unit 5 Titan Court, Laporte Way, Luton. LU4 Healthcall Optical Services No Yes 8EF 941 Alum Rock Road, Ward End, Birmingham Home Eye Clinic Ltd No Yes B8 2LX 58 Cheshire Street, Market Drayton, Shropshire, M Viggars No Yes TF9 1PR Pauline Raeburn T/as Your Home 1 Tenby Road, Macclesfield, Cheshire, SK11 No Yes Eyecare 8TQ 266 Uttoexter Road, Blythe Bridge, Stoke-on- Gillian Scarisbrick No Yes Trent ST11 9LY NB: Where a contractor has additional premises, these are main premises and not branch practices, both addresses are included in the contract
Dental Type of Practice Provider Address Contract
Milehouse Dental Practice RODERICKS Ltd 8b Brooke Way, Newcastle, Staffs, ST5 6AZ GDS
131-135 Ball Haye Green, Leek, Staffs, ST13 TLC 4 Smiles TLC 4 Smiles Ltd. GDS 6BH 193 London Road, Chesterton, Newcastle, Elm Villa Dental Practice Mroke Limited GDS ST5 7HZ
Page 95 Type of Practice Provider Address Contract 10 The Westbury Centre, Westbury Road, Westbury Dental Practice MR TC DICKERSON GDS Newcastle, Staffs, ST5 4LY
The Avenue Dentistry MR JF SCANNELL 2 The Avenue, Cheadle, Staffs, ST10 1EG GDS
AUDLEY DENTAL 31 Church Street, Audley, Stoke-on-Trent, Audley Dental Practice GDS PRACTICE ST7 8DA University of Keele, Keele, Newcastle, Staffs. Keele University Dental Dept MR W URWIN GDS ST5 5BG 40-42 Tape Street, Cheadle, Stoke-on-Trent, Millennium Dentistry MR M SEGAL GDS ST10 1EP
St Edward St Dental Practice MR PJ PHILLIPS 47 St Edward Street, Leek, Staffs, ST13 5DN GDS
79 Liverpool Road, Kidsgrove, Stoke-on-Trent, Kidsgrove Dental Practice MR S RIPLEY GDS ST7 4EW
Russell St Dental Practice MR CE BROOME 7 Russell Street, Leek, Staffs, ST13 5JF GDS
Hanover Dental Practice MR D SINGH 12 King Street, Newcastle, Staffs, ST5 1EL GDS
Unit 2, Well Street, Biddulph, Stoke-on-Trent, Keen Dental Practice MISS FH CUTHILL GDS ST8 6HS 5 Ellison Street, Wolstanton, Newcastle, ST5 Wolstanton Dental Practice MR P NAJRAN GDS 0BJ
Cherry Orchard Dental Practice MR ME NEELD 1 Cherry Orchard, Newcastle, Staffs, ST5 2UB GDS
497 Ash Bank Road, Werrington, Stoke-on- Werrington Dental Practice MR KS HUGHES GDS Trent, ST9 0DT 67 High Street, Biddulph, Stoke-on-Trent, ST8 Horizons Dental Practice MR A SHAMSI GDS 6AA 57 Cheadle Road, Cheddleton, Leek, Staffs, Cheddleton Dental Practice MR JM ATKINSON GDS ST13 7HN 136 Congleton Road, Talke, Stoke-on-Trent, Butt Lane dental Surgery MR JA BLAYNEY GDS ST7 1LX
London Road Dental Practice MR W JOVANOVIC 56 London Road, Newcastle, Staffs, ST5 1LL GDS
102 Liverpool Road, Kidsgrove, Stoke-on- Kidsgrove Bank Dental Practice MR RJ COOPER GDS Trent, ST7 4EH 1 High Street, Wolstanton, Newcastle, Staffs, M N Devlin Dental Surgery MR MN DEVLIN GDS ST5 0EY 7 Greyhound Court, Madeley, Crewe, CW3 Madeley Dental Surgery Mroke Limited PDS 9EA 121 Newcastle Street, Silverdale, Newcastle, Silverdale Dental Surgery MR NS RAI PDS ST5 6PL
Silk Mill Dental Practice MR AE WOODCOCK 18 Stockwell Street, Leek, Staffs, ST13 6DS PDS
102 Liverpool Road, Newcastle, Staffs, ST5 Lyme Dental Practice MR KS AULAK PDS 2AX PDS Park Dental Practice MR D SINGH 16 Ball Haye Road, Leek, Staffs, ST13 6QR Plus
Pharmacies
Pharmacy Pharmacy Name Address 1 Address 3 City Post Code Code
Page 96 Pharmacy Pharmacy Name Address 1 Address 3 City Post Code Code
FGO77 Asda Pharmacy Asda Superstore Wolstanton Newcastle-under-Lyme ST5 0AY Blythe Bridge FWC02 240 Uttoxeter Road Blythe Bridge Staffordshire ST11 9LY Pharmacy FYA00 Boots the Chemist 60-62 High Street Staffordshire Newcastle-under-Lyme ST5 1QL
FV490 Boots the Chemist 47 High Street Cheadle Staffordshire ST10 1AR
FAK33 Boots the Chemist 13 Derby Street Leek Staffordshire ST13 6HT
FGY12 Bradwell Pharmacy 111 Hanbridge Avenue Bradwell Newcastle-under-Lyme ST5 8HX
FWX70 Butt Lane Pharmacy 147 Congleton Road Kidsgrove Stoke-on-Trent ST7 1LL Co-Operative FVM54 Audley Health Centre Audley Staffordshire ST7 8EW Pharmacy Co-Operative FVC56 58-60 King Street Newcastle-under-Lyme ST5 1HX Pharmacy Co-Operative Biddulph FY784 396 New Street Stoke-on-Trent ST8 7LR Pharmacy Moor Co-Operative FF299 Unit 12, Freeport Talke Stoke-on-Trent ST7 1QD Pharmacy Co-Operative FNE23 62 High Street Biddulph Stoke-on-Trent ST8 6AS Pharmacy Co-Operative FDQ29 21-23 London Road Chesterton Newcastle-under-Lyme ST5 7EA Pharmacy Co-Operative FMJ81 London Road (Instore) Chesterton Newcastle-under-Lyme ST5 7DY Pharmacy Co-Operative FFC36 Well Street Biddulph Stoke-on-Trent ST8 6HY Pharmacy Co-Operative FD422 16-20 Ball Haye Street Leek Staffordshire ST13 6JW Pharmacy Co-Operative FNH89 Mount Road Kidsgrove Stoke-on-Trent ST7 4AY Pharmacy Co-Operative FTH43 46-48 Derby Street Leek Staffordshire ST13 5AJ Pharmacy FCP54 Cornwells Chemist 11 High Street Newcastle-under-Lyme ST5 1RB
FCHL37 Cornwells Chemist 5 The Parade Silverdale Newcastle-under-Lyme ST5 6LQ Hollowood Chemists FKR45 Kingsbridge House Clayton Newcastle-under-Lyme ST5 3HP Ltd FY129 J C Ratcliffe Ltd 44a High Street Cheadle Staffordshire ST10 1AF
FH277 J C Ratcliffe Ltd 42 Ashbourne Road Cheadle Staffordshire ST10 1HQ
FXP00 Lloyds Pharmacy 7 The Westbury Centre Clayton Newcastle-under-Lyme ST5 4LY
FX575 Lloyds Pharmacy 2/4 Rosebank Street Leek Staffordshire ST13 6AG
FAE84 Lloyds Pharmacy 117/119 High Street Wolstanton Newcastle-under-Lyme ST5 0EP
FXN39 Lloyds Pharmacy Units 1&2 High Street Wolstanton Newcastle-under-Lyme ST5 9ER 15 - 15a Fountain FQX25 Lloyds Pharmacy Leek Staffordshire ST13 6JS Street FFA51 Lloyds Pharmacy 42 Market Street Kidsgrove Stoke-on-Trent ST7 4AB
FMM55 Loggerheads Pharmacy 9 Eccleshall Road Loggerheads Market Drayton TF9 4NX Middle FT583 Millers Chemist Newcastle Road Nr Crewe CW3 9JP Madeley FNQ56 Millers Chemist 165 Cheadle Road Cheddleton Stoke-on-Trent ST13 7HN
FL191 Millwards (Chemist) Ltd 65 Milehouse Lane Cross Heath Newcastle-under-Lyme ST5 9JZ Milehouse Primary FN585 Morrells Pharmacy Milehouse Newcastle-under-Lyme ST5 9GA Care Centre FH040 Sainsbury's Pharmacy Liverpool Road East Newcastle-under-Lyme ST5 2AP
Page 97 Pharmacy Pharmacy Name Address 1 Address 3 City Post Code Code
FGL41 Tean Pharmacy 19 High Street Tean Staffordshire ST10 4DY
FYC67 Tesco Pharmacy Liverpool Road East Kidsgrove Staffordshire ST7 1DX
FG207 Trent Health Pharmacy 339 Ash Bank Road Werrington Stoke-on-Trent ST9 0JS
FAT34 Well Street Pharmacy Well Street Biddulph Stoke-on-Trent ST8 6EZ Wm Morrisons In-Store FCQ33 Goose Street Newcastle-under-Lyme ST5 3HY Pharmacy FNT09 WS Low 101 High Street Wolstanton Newcastle-under-Lyme ST5 0EP
Page 98 NHS Stoke on Trent
GP Practices Patient Contract List Practice Practice Name Address Type Size Code 01.07.12 Cobridge Community Health Centre, Church Apsley House Surgery PMS 5399 M83627 Terrace, Cobridge. ST6 2JN Trent Vale Medical Practice, 876 London Rd, ST4 Trent Vale Medical Centre GMS 8708 M83014 5NX Meir Primary Care Centre, Weston Road Dr HP Borse Practice GMS 5016 M83713 Meir. ST3 6AB The Health Centre, Dunning Street, Tunstall, ST6 Dr Bose GMS 1791 M83650 5AP Foden Street Surgery 32 Foden Street, Stoke, ST4 4BX GMS 3809 M83134 Hanley Health Centre/Leek Woodhead Road, Abbey Hulton, ST2 8DH PMS 6858 M83625 Road Surgery Surgery of Dr Chand/Rosslyn 22 Rosslyn Road, Longton, ST3 4JD GMS 2316 M83133 Road Millrise Medical Practice, 12 Millrise Road, Milton, Dr Cresswell GMS 8125 M83061 ST2 7BW Longton Health Centre, Drayton Road Longton, Drayton Road Medical Practice PMS 3263 M83629 ST3 1EQ Weston Street Surgery 28-30 Western Street, Adderley Green, ST3 5DQ GMS 1897 M83661 Orchard Surgery, Knypersley Road, Norton, ST6 Orchard Surgery GMS 10373 M83038 8HY Hanley Health and Wellbeing 69/71 Stafford Street, Hanley, ST1 1LW APMS 2667 Y02868 Meir Primary Care Centre, Weston Road Weston Coyney Surgery GMS 1354 M83708 Meir. ST3 6AB Dr Jones, Brinsley Avenue 11 Brinsley Avenue, Trentham, ST4 8LT GMS 3710 M83601 Surgery Goldenhill Medical Centre Goldenhill Medical Centre, High Street, Goldenhill GMS 4080 M83143 Trinity Medical Centre, Uttoxeter Road, Blythe Trinity Medical Centre PMS 4072 M83632 Bridge, ST11 9HQ Stoke Health Centre Stoke Health Centre, Honeywall, ST4 7JB GMS 1432 M83714 The Haymarket Health Centre, Dunning Street, Haymarket Health Centre GMS 11580 M83082 Tunstall ST6 5BE Longton Hall Surgery 186 Longton Hall Road, Blurton,, ST3 2EJ GMS 5973 M83126 Dunrobin Medical Centre Medical Centre, Dunrobin Street,, ST3 4LL GMS 3883 M83090 Lucie Wedgwood Health Lucie Wedgwood Health Centre, Chapel Lane, PMS 6333 M83682 Centre Burslem, ST6 2AB Mayfield Surgery, 54 Trentham Road, Longton , Mayfield Surgery GMS 12321 M83004 ST3 4DW Moorcroft Medical Centre, Botteslow Street, Moorcroft Medical Centre GMS 8080 M83146 Hanley ST1 3NJ Meir Primary Care Centre, Weston Road High Ridge Surgery GMS 1258 M83695 Meir. ST3 6AB Middleport Newport Lane, Middleport ST6 3NP APMS 1790 Y02867 Surgery of Dr Miles Meir Health Centre, Saracens Way, Meir, ST3 7DS GMS 3797 M83100 Blurton Health Centre, Ripon Road, Blurton, ST3 Blurton Health Centre GMS 3105 M83725 3BS Moss Green Surgery, Bentilee Neighbourhood Moss Green Surgery APMS 6428 Y00592 Centre, Dawlish Drive, Bentilee, ST2 0EU Packmoor Medical Centre. Thomas Street, Packmoor Primary care Centre PMS 3407 M83739 Packmoor, ST7 4SS Brook Medical Brook Medical Centre, 98 Chell Heath Road, PMS 14427 M83094 Centre/Smallthorne Bradeley, ST6 7NN Longton Health Centre, Drayton Road, Longton, Surgery of Dr Patel GMS 3083 M83631 ST3 1EQ Cobridge Community Health Centre, Church Waterloo Road/Cobridge GMS 3775 M83127 Terrace, Cobridge. ST6 2JN Shelton Primary Care Centre, Norfolk Street, Penton House Surgery GMS 7442 M83075 Shelton, ST1 4PB Willowbank Meir Pickford Place, Meir, ST3 7DY APMS 7081 Y02521
Page 99 Patient Contract List Practice Practice Name Address Type Size Code 01.07.12 Harley Street Medical Centre, Harley Street, Harley Street Medical Centre GMS 11150 M83076 Hanley, ST1 3RX Furlong Medical Centre, Furlong Road, Tunstall, Furlong Medical Centre GMS 10374 M83021 ST6 5UD Belgrave Medical Centre, 116 Belgrave Road, Belgrave Medical Centre PMS 11207 M83068 Dresden, ST3 4LR Shelton Primary Care Centre, Norfolk Street, Snowhill Medical Centre PMS 4529 M83623 Shelton, ST1 4PB Stoke Health Centre Stoke Health Centre, Honeywall, , ST4 7JB GMS 1797 M83619 Birches Head Medical Centre, Diana Road, Birches Head PMS 6386 M83123 Birches Head ST1 6RS Meir Primary Care Centre, Weston Road Dr Sarin - Uttoxeter Road GMS 4935 M83047 Meir. ST3 6AB Fenton Health Centre, Glebedale Road Fenton, , Fenton health Centre PMS 6994 M83028 ST4 3AQ Two Towns Medical, Hanford Health Centre, New Dr Shah GMS 4891 M83138 Inn Lane, Hanford, ST4 8EX Shelton Primary Care Centre, Norfolk Street, Five Towns APMS 2686 M83700 Shelton, ST1 4PB Cambridge House, 124 Werrington Road, Cambridge House Surgery GMS 2546 M83624 Bucknall, ST2 9AJ Tunstall Primary Care Centre, Alexandra Park Dr Sonnathi GMS 3284 M83669 Scotia Road, Tunstall. ST6 6BE Practice of Dr Sinha/Rosslyn 16 Rosslyn Road, Longton , ST3 4JD GMS 2864 M83712 Road Potteries Medical Centre, Beverley Drive, Bentilee Potteries Medical Centre GMS 4258 M83102 ST2 0JG Hanford Health Centre. New Inn Lane, Hanford, Surgery of Dr Talpur/Hanford GMS 2155 M83678 ST4 8EX Baddeley Green Surgery, 988 Leek New Road, Baddeley Green Surgery GMS 5198 M83709 Baddeley Green ST9 9PD Trentham Mews Medical The Surgery, Trentham Mews, New Inn Lane, PMS 3430 M83711 Centre Trentham, ST4 8PX Dr Dent Longfield 1 Longfield Road, Hartshill, , ST4 6QN GMS 5933 M83066 Surgery/Hartshill Dr Yadava Merton Surgery Merton Surgery, Longton, , ST3 1LG GMS 4792 M83128 Phoenix Practice** GP Services, 511 Etruia Road, Basford APMS 31 Y00451 * These two practices hold one contract but are two separate ** This practice is for de-registered patients only surgeries.
Optometrists Name Address Mandatory Additional Type Yes No Partnership A Hurd Opticians (Hanley) 15 Regent Road, Hanley, ST1 3BT Boots Opticians (Previously Unit 30, The Potteries Shopping Yes No Corporate Dolland + Aitchison) Centre, Hanley, Staffs. ST1 1PS 33 Merrial Street, Newcastle Under No Yes Partnership Browns Opticians Lyme, Staffs. ST5 2AE 24 - 26 Bennett Precinct, Longton,ST3 Yes No Individual Burge Optics Ltd 2JA Three Ways, Birchall Lane, Leek. ST15 No Yes Individual Catherine Townsend 8TU Community Eye Care (UK) Ltd - Caroline House, 146 Audenshaw Road, No Yes Corporate T/A Vision Call Manchester. M34 5HQ Complete Price Eye Ware Ltd 10 - 14 High Street, Old Town Court, No Yes Corporate (Outside Clinic Opticians) Swindon. SN1 3EP 16 Tontine Street, Hanley, Staffs. ST1 Yes No Corporate Crown Eyeglass T/A Direkt Optic 1NQ
Page 100 Name Address Mandatory Additional Type Yes Yes Corporate Ernest G Hanwell Ltd (Stoke) 11 Glebe Street, Stoke, ST4 1HP 3 - 5 Upper Market Square, Hanley, Yes No Corporate Eyeris T/A Boots Opticians ST1 1PZ Yes Yes Corporate Glyn Jones 36 Trinity Street, Hanley, ST1 5LA Yes Yes Corporate Ernest G Hanwell Ltd (Tunstall) 8 Tower Square, Tunstall, ST6 5AA 36-37 Leslie Hough Way, Salford, No Yes Corporate Healthcall Optical Services Ltd Manchester, M6 6AJ 2 Garfield Avenue, Hanford, Staffs, Yes Yes Individual James Harry Heath ST4 8ES Yes Yes Partnership James Herd Opticians 59 High Street, Tunstall, ST6 5TA Yes Yes Partnership Kenneth Wright 340 Hartshill Road, Hartshill, ST4 7NX 36 -38 Market Street, Longton, Staffs, Yes No Corporate Longton Spec Savers Ltd ST3 1BS Yes Yes Individual Mehta Rajnikant Kashalchand 31 The Strand, Longton, ST3 2JF Yes No Corporate Nusyte Optical - Burslem 45 Queen Street, Burslem, ST6 3EH 93 Ford Green Road, Smallthorne, ST6 Yes Yes Corporate Nusyte Optical - Smallthorne 1NT Yes Yes Corporate Nusyte Optical - Tunstall 115 High Street, Tunstall, ST6 5TA 3 Littleton Close, Kingsmead, No Yes Individual Opti-call Northwich CW9 8FL Yes Yes Corporate Portland Eye Care Services Ltd 21 Market Street, Longton, ST3 1BE Yes Yes Individual Razvi Optometrists 1 Cornelious Street, Meir, ST3 6AF Yes No Individual RG Edwards 6 South Wolfe Street, ST4 4AA Yes Yes Partnership CJ Royle Opticians 77 The Strand, Longton, ST3 2NS Yes Yes Partnership The Specs place 46a Market Street, Longton, ST3 1BS Yes No Corporate Scrivens Opticians 37 Market Place, Burslem, ST6 3AG Yes No Corporate Specsavers Opticians 2 -4 Piccadilly, Hanley, ST1 1DF The Potteries Shopping Centre, Market Yes No Corporate Vision Express Opticians Square, Hanley, ST1 1PS 941 Alum Rock Road, Birmingham. B8 No Yes Corporate Home Eye Clinic Ltd 2LX 97 Roundwell Street, Tunstall, ST6 Yes No Individual Burgess 5AW Tesco Longton Extra, Bath Road, Yes No Corporate Tesco Opticians Longton Longton, ST3 2JB Tesco Hanley Extra, Clough Street, Yes No Corporate Tesco Opticians Hanley ST1 4AJ
Dental Type of Practice Provider Address Contract 1441 Leek Road, Abbey Hulton, Abbeyside Dental Surgery Mr B S Ahitan GDS ST2 8BY Queen Anne Street, Shelton, ST4 Alchemy Dental Practice Alchemy Dental Practice PDS 2EQ Ashlands Avenue, Hartshill, ST4 Ashlow Orthodontics Services Mr J D Muir PDS 6NB Blurton Dental Centre Mr S King 89 Blurton Road, Heron Cross, ST3 GDS
Page 101 Type of Practice Provider Address Contract Mr K Millington 2BS Mr F Sutherland Mr S Tomkinson 107 Bucknall New Road, Hanley, BNR Dental Practice Mr F Harrington GDS ST1 2BG 73 The Boulevard, Tunstall, ST6 Boulevard Dental Practice Boulevard Dental Practice GDS 6BD
Campbell Dental Practice Ms A Mirza 3 Campbell Road, Stoke, ST4 4EA GDS
14 Diana Road, Birches Head, ST1 Diana Road Dental Care Mr S C Bullock GDS 6RS Dividy Road Dental Practice Mr J Dougherty 237 Dividy Road, Bucknall, ST2 0BJ GDS Partnership
Miss Z Wray Alder House, Station Road, Endon, Endon Dental Surgery GDS ST9 9DR Mr G Riley
58 Newcastle Street, Burslem, ST6 A R Fee Dental Practice Mr A R Fee GDS 3QF
Genesis Dental Practice Mr A Shamsi 679 Leek Road, Hanley, ST1 3NF PDS Plus
Hanford Dental Centre Mr G Cummings 1 New Inn lane, Hanford, ST4 8HA GDS
736 London Road, Oakhill, ST4 Grosvenor Dental Practice Mr A N Gray GDS 5NP 26 Liverpool Road, Stoke-on-Trent, Liverpool Road Dental practice Primecare Oral Health PDS Plus ST4 1AT Petrie Tucker & Partners Ltd Longton Dental Centre 537 King Street, Longton, ST3 1HD GDS (Integrated Dental Holdings) Petrie Tucker & Partners Ltd Meir Dental Centre 1 Penfleet Avenue, Meir, ST3 6BP GDS (Integrated Dental Holdings)
Mr P J Middleton P J Middleton & Associates 6 Stoke Road, Shelton, ST4 2DP GDS Mrs E A Middleton
Pall Mall Dental Practice Pall Mall Dental Ltd 10 Pall Mall, Hanley, ST1 1ER GDS
26 Rosslyn Road, Longton, ST3 Rosslyn House Dental Practice Mr S R Fisher GDS 4JD Mr S King Mr K Millington GDS Mr F Sutherland Shelton Dental Centre 26 Stoke Road, Shelton, ST4 1AR Mr S Tomkinson Miss C Banks PDS Miss C D Hollins
Mr G W S De Silva 85-87 Ford Green Road, Smallthorne Dental Practice GDS Mrs S Kapali-De Silva Smallthorne, ST6 1NT 125 Hanley Road, Sneyd Green, Sneyd Green Dental Practice Sneyd Green Dental Practice GDS ST1 6BG Stoke Orthodontic Services Unit 7 Whittle Court, Town Road, Stoke Orthodontic Services PDS Ltd Hanley, ST1 2QE
Stoneyfields Dental Practice Mr N J Hammond 587 Etruria Road, Basford, ST4 6HL GDS
Page 102 Type of Practice Provider Address Contract
Teeth For Life Dental Practice Mr N O'Donovan 1 Liverpool Road, Stoke, ST4 1AR GDS
Victoria Dental Practice Mr A Farahzad 68 Victoria Road, Fenton, ST4 2JX GDS
Mr M Abdollahian 239 Waterloo Road, Cobridge, ST6 Waterloo Dental Practice PDS 2JB Mrs I Hoglund
Pharmacies
Pharmacy Pharmacy Name Address 1 Address 3 Post Code Code
FRF34 Angelway Chemist 240 Waterloo Road Cobridge ST6 3HL
FJ346 ASDA Pharmacy Scotia Road Tunstall ST6 6AT
FYY97 BHCP Limited Lucie Wedgewood Health Centre Burslem ST6 2AB
FC322 Birches Head Pharmacy 12 Diana Road Birches Head ST1 6RS
FKX58 Birchill & Watson 20 Knypersley Road Norton in the Moors ST6 8HX
FQK77 Blurton Pharmacy 7 Ingestre Square Blurton ST3 3JT
FRQ52 Boots the Chemists 39 Trentham Rd Longton ST3 4DF
FKV79 Boots the Chemists 114/116 High Street Tunstall ST6 5TA
FDF31 Boots the Chemists 25 Bennett Precinct Longton ST3 2HX
FDH31 Boots the Chemists 3/5 Upper Market Square Hanley ST1 1PZ
FFV80 Boots the Chemists 41 Queen Street Burslem ST6 3EH
FK255 Boots the Chemists Bentilee Neighbourhood Centre Bentilee ST2 0EU
FL883 Boots the Chemists Unit 5 Festival Park Hanley ST1 5SJ
FCF81 Co-op Healthcare Ltd 112 Broad Street Hanley ST1 4EJ
FVH09 Co-op Healthcare Ltd 16 Furlong Road Tunstall ST6 5UD
FDD16 Co-op Healthcare Ltd 237 Blurton Road Blurton ST3 2AF
FX449 Co-op Healthcare Ltd 30 Wilson Road Hanford ST4 4QQ
FJF88 Co-op Healthcare Ltd 361-363 London Road Stoke ST4 5AN
FPM96 Co-op Healthcare Ltd 42 Dunning Street Tunstall ST6 5AP
FP768 Co-op Healthcare Ltd 57 Biddulph Road Chell ST6 6SW
FDA05 Co-op Healthcare Ltd 688-690 London Road Oakhill ST4 5BA
FXC80 Co-op Healthcare Ltd 9/15 Dunning Street Tunstall ST6 5AP
FD454 Co-op Healthcare Ltd 97 High Lane Burslem ST6 7DF
FC847 Co-op Healthcare Ltd Anne Street Goldenhill ST6 5QJ
FL330 Co-op Healthcare Ltd Brook Medical Centre Bradeley ST6 7NN
FP182 Co-op Healthcare Ltd Trent Vale Health Centre Trent Vale ST4 5NY
FYG14 Co-op Healthcare Ltd Winton House Shelton ST4 2RW
FE186 Co-op Healthcare Ltd 57/59 Weston Road Meir ST3 6AB
Page 103 Pharmacy Pharmacy Name Address 1 Address 3 Post Code Code
FDV51 Co-op Healthcare Ltd 7/9 New Kingsway Weston Coyney ST3 6NA
FXJ57 Co-op Healthcare Ltd 792-794 Uttoxeter Road Meir ST3 7AE
FCC64 Day & Night Pharmacy 13 Howard Place Shelton ST1 4NN
FR864 Eaton Park Pharmacy 2 Southall Way Eaton Park ST2 9LT
FDF74 Grahams Pharmacy 99 Ford Green Road Smallthorne ST6 1NT
FTV00 Hartshill Pharmacy 430 Hartshill Road Hartshill ST4 7PL
FRQ98 Heron Cross Pharmacy 2-4 Duke Street Heron Cross ST4 3BL
FM588 Lloyds Pharmacy 128 Werrington Road Bucknall ST2 9AJ
FA530 Lloyds Pharmacy Fenton Health Centre Fenton ST4 3AQ
FRF63 Lloyds Pharmacy 22 The Strand Longton ST3 2JH
FRQ37 Lloyds Pharmacy 25-27 Stoke Road Shelton ST4 2QW
FF170 Lloyds Pharmacy Norfolk Street Shelton ST1 4PB
FHX48 Lloyds Pharmacy 29 Derby Street Hanley ST1 3LE
FP476 Lloyds Pharmacy 35a Trentham Rd Longton ST3 4JA
FPQ04 Lloyds Pharmacy 72/74 Milton Road Sneyd Green ST1 6HD
FAQ31 Lloyds Pharmacy 84 Upper Huntbach Street Hanley ST1 2BU
FVG99 McMullen D Alder House Endon ST9 9DR
FMW17 Meir Hay Pharmacy Unit 3, Amison Street Longton ST3 1LD
FKF83 Middleport Pharmacy 185 Newcastle Street Middleport ST6 3QJ
FRL56 Millers Chemist 114 Belgrave Road Longton ST3 4LR
FWR25 Milton Pharmacy 29 Millrise Road Milton ST2 7BN
FT323 Miltons Chemists 1375 Leek Road Abbey Hulton ST2 8BW
FF910 Miltons Chemists 15-19 Campbell Place Stoke ST4 1NH
FJ413 Morrisons Pharmacy Morrisons Supermarket Festival Park ST1 5NY
FCK23 Packmoor Pharmacy 1 Samuel Street Packmoor ST7 4SR
FTF87 Queen St Pharmacy 38 Queen Street Burslem ST6 3EG
FKT14 Ridgway's Chemist 73 Baddeley Green Lane Milton ST2 7JL
FVP94 Rowlands Pharmacy 17 Werburgh Way Trentham ST4 8JT
FLW89 Sainsbury's Pharmacy London Road Stoke ST4 7QD
FHK 61 Superdrug Pharmacy 125/127 High Street Tunstall ST6 5EA
FCY14 Superdrug Pharmacy Potteries Shopping Centre Hanley ST1 1PS
FN679 Tesco Instore Pharmacy Clough Street Hanley ST1 4AA
FAM95 Tesco Instore Pharmacy 291 Newcastle Road Trent Vale ST4 6PL
FFJ77 Tesco Instore Pharmacy Baths Road Longton ST3 2JB
FQV32 Tesco Instore Pharmacy Lysander Road Meir Park ST3 7WB
FJW30 Waterloo Pharmacy 159 Waterloo Road Cobridge ST6 2ER
FAV78 Waterloo Pharmacy 68 The Strand, Longton ST3 2NR
Page 104 South Staffordshire PCT
GP Practices Contract List Size Practice Practice Address Type 01/07/2012 Code DOVE RIVER Gibb Lane, Sudbury, Derbyshire GMS 8,434 C81018 HORSEFAIR PRACTICE Springfields, Lovett Court, Rugeley APMS 11,101 M83001 Greenhill Health Centre, Church Street, THE WESTGATE PRACTICE GMS 18,053 M83006 Lichfield, Staffordshire The Surgery, Sandy Lane, Brewood, BREWOOD GMS 10,099 M83009 Stafford 72 Gordon Street, Burton on Trent, GORDON STREET GMS 10,316 M83010 Staffordshire YOXALL Savey Lane, Yoxall, Staffordshire GMS 5,105 M83013 HIGH STREET SURGERY High Street, Cheslyn Hay GMS 5,310 M83016 Gravel Hill Surgery, Wombourne, GRAVEL HILL PMS 7,278 M83018 Wolverhampton Cumberland House Surgery, 8 High CUMBERLAND HOUSE GMS 12,803 M83020 Street, Stone Great Haywood Surgery, Hazeldene HAZELDENE HOUSE SURGERY PMS 8,373 M83022 House, Great Haywood Castlefields Surgery, Newport Road, CASTLEFIELDS PMS 5,960 M83024 Stafford Carlton Street, Burton on Trent, CARLTON STREET GMS 8,458 M83026 Staffordshire Branston Medical Centre, Main Street, TRENT MEADOWS GMS 11,384 M83027 Branston, Staffordshire Langton Grange Medical Centre, THE LANGTON MEDICAL GROUP PMS 10,865 M83030 Eastern Avenue, Lichfield, Staffordshire Russell House, Bakers Way, Codsall, RUSSELL HOUSE GMS 6,876 M83031 Wolverhampton THE ALDERGATE MED.PRACT. The Mount, Salters Lane, Tamworth PMS 13,173 M83032 Hednesford Valley Health Centre, DR JS CHANDRA PMS 2,446 M83033 Station Road, Hednesford Exchange Road, Alrewas, Burton on ALREWAS GMS 5,521 M83035 Trent, Staffordshire Rising Brook Health Centre, Merry RISING BROOK PMS 10,387 M83036 Road, Rising Brook, Stafford Monk Street, Tutbury, Burton on Trent, TUTBURY GMS 6,691 M83037 Staffordshire Moss Grove Surgery Kinver, Kinver MOSS GROVE SURGERY KINVER PMS 5,024 M83041 Health Centre, Kinver St Peters Street, Stapenhill, Burton on BRIDGE GMS 10,087 M83042 Trent, Staffordshire Glascote Health Centre, Caledonian, ANCHOR MEDICAL PRACTICE GMS 1,997 M83043 Tamworth, Staffordshire BROWNING STREET Browning Street, Stafford GMS 9,453 M83044 Penkridge Medical Practice, Pinfold PENKRIDGE MEDICAL PRACTICE GMS 10,084 M83045 Lane, Penkridge, Stafford THE NILE PRACTICE Park Street, Cheslyn Hay GMS 5,413 M83048 Holmcroft Surgery, Holmcroft Road, HOLMCROFT PMS 10,464 M83049 Stafford The Wolverhampton Road Surgery, WOLVERHAMPTON ROAD PMS Plus 10,624 M83050 Wolverhampton Road Wetmore Road, Burton on Trent, WETMORE GMS 9,715 M83051 Staffordshire Weeping Cross Health Centre, Bodmin WEEPING CROSS PMS 18,039 M83052 Avenue, Stafford Mill Bank Surgery, Water Street, MILL BANK GMS 10,043 M83057 Stafford School House Lane, Abbots Bromley, ABBOTS BROMLEY PMS 3,877 M83059 Staffordshire, 12 Albert Road, Tamworth, LAUREL HOUSE SURGERY PMS 13,260 M83062 Staffordshire Norton Canes Health Centre, NORTON CANES HEALTH CENTRE PMS 3,313 M83063 Brownhills Road, Norton Canes
Page 105 Contract List Size Practice Practice Address Type 01/07/2012 Code Parson Street, Wilnecote, Tamworth, WILNECOTE SURGERY PMS 7,767 M83064 Staffordshire Short Lane, Barton-under-Needwood, BARTON GMS 6,627 M83065 Staffordshire Mansion House Surgery, Abbey Street, MANSION HOUSE GMS 13,362 M83069 Stone Gnosall Health Centre, Brookhouse GNOSALL PMS Plus 7,680 M83070 Road, Gnosall, Stafford Rugeley Road, Chase Terrace, SALTERS MEADOW HEALTH CTR PMS 12,466 M83072 Burntwood, Staffordshire Fyfield Road, Stapenhill, Burton on STAPENHILL GMS 9,813 M83073 Trent, Staffordshire BALANCE STREET Balance Street, Uttoxeter, Staffordshire PMS 13,539 M83074 Greenhill Health Centre, Church Street, CLOISTERS MEDICAL PRACT. GMS 8,802 M83078 Lichfield, Staffordshire Great Wyrley Health Centre, Wardles LANDYWOOD LANE SURGERY GMS 2,136 M83080 Lane, Great Wyrley Tamworth Health Centre, Upper HOLLIES PRACTICE PMS 15,098 M83088 Gungate, Tamworth, Staffordshire Crown Surgery, 23 High Street, CROWN SURGERY PMS 7,190 M83092 Eccleshall, Stafford Dale Medical Practice, Planks Lane, DALE MEDICAL CENTRE PMS 6,406 M83093 Wombourne Bilbrook Medical Centre, Brookfield BILBROOK PMS 7,550 M83097 Road, Bilbrook BIDEFORD WAY SURGERY 24 Bideford Way, Cannock PMS 3,236 M83107 Hednesford Valley Health Centre, DR VK SINGH GMS 2,605 M83109 Station Road, Hednesford Glascote Heath Health Centre, HEATHVIEW MEDICAL CENTRE GMS 2,159 M83110 Caledonian, Tamworth, Staffordshire 41-42 Balfour, Riverside, Tamworth, RIVERSIDE SURGERY GMS 1,654 M83111 Staffordshire Stonydelph Health Centre, Ellerbeck, DR KHARE'S SURGERY GMS 2,098 M83113 Stonydelph, Tamworth, Staffordshire 11 Longfellow Road, Boney Hay, DR AHMAD'S SURGERY PMS 1,842 M83115 Walsall, Staffordshire Tamworth Health Centre, Upper CROWN MEDICAL PRACTICE GMS 4,708 M83117 Gungate, Tamworth, Staffordshire CLAVERLEY The Surgery, Spicers Close, Claverley PMS 4,484 M83125 Heath Hayes Health Centre, HEATH HAYES HEALTH CENTRE PMS 8,368 M83129 Gorsemoor Road, Heath Hayes RED LION SURGERY 86 Hednesford Street, Cannock PMS 4,016 M83130 STAFFORD ROAD SURGERY 60 Stafford Road, Cannock PMS 2,187 M83131 Lakeside Medical Centre, Church LAKESIDE GMS 6,109 M83132 Road, Perton MOSS STREET SURGERY Moss Street, Chadsmoor, Cannock GMS 4,995 M83139 29/31 High Street, Chasetown, CHASETOWN MEDICAL CENTRE PMS 1,881 M83144 Burntwood, Staffordshire Peel Court, Aldergate, Tamworth, THE PEEL MEDICAL PRACTICE PMS 12,911 M83148 Staffordshire Great Wyrley Health Centre, Wardles QUINTON PRACTICE GMS 3,675 M83608 Lane, Great Wyrley Great Wyrley Health Centre, Wardles WARDLES LANE SURGERY GMS 2,059 M83613 Lane, Great Wyrley GP SUITE SURGERY GP Suite, Cannock Hospital, Cannock PMS 8,673 M83616 St Chads Health Centre , Dimbles THE SPIRES PRACTICE GMS 9,624 M83617 Lane, Lichfield, Staffordshire CHADSMOOR MEDICAL PRACTICE Princess Street, Chadsmoor, Cannock PMS 4,102 M83637 THE COLLIERY PRACTICE 60 Hednesford Street, Cannock PMS+ 13,448 M83638 Hednesford Valley Health Centre, DR A YI PMS 3,032 M83639 Station Road, Hednesford Mill Street, Mill Street, Rocester, ROCESTER PMS 1,960 M83641 Staffordshire NEWHALL STREET SURGERY 14-16 Newhall Street, Cannock GMS 2,279 M83662 TAMAR Tamar Medical Centre, Severn Drive, GMS 3,265 M83668
Page 106 Contract List Size Practice Practice Address Type 01/07/2012 Code Perton, Wolverhampton NORTH GATE Church Street, Uttoxeter, Staffordshire GMS 5,149 M83680 28 All Saints Road, Burton on Trent, ALL SAINTS SURGERY PMS 7,444 M83681 Staffordshire Burntwood Health Centre, Hudson FULFEN PRACTICE PMS 4,002 M83692 Road, Burntwood, Staffordshire 130 Tamworth Road, Amington, TRI-LINKS MEDICAL PRACTICE PMS 5,861 M83693 Tamworth, Staffordshire SOUTHFIELD WAY SURGERY 2a Southfields Way, Great Wyrley PMS 3,102 M83698 BRERETON SURGERY Main Road, Brereton, Rugeley PMS 3,956 M83703 Stonydelph Health Centre, Ellerbeck, DR YANNAMANI'S SURGERY GMS 1,810 M83705 Stonydelph, Tamworth, Staffordshire Stonydelph Health Centre, Ellerbeck, DR VIJE'S SURGERY PMS 2,100 M83706 Stonydelph, Tamworth, Staffordshire Featherstone Family Health Centre, Old FEATHERSTONE PMS 4,179 M83715 Lane, Featherstone Norton Canes Health Centre, NORTON CANES SURGERY PMS 3,001 M83717 Brownhills Road, Norton Canes Lichfield Street, Burton on Trent, PEEL CROFT PMS 3,276 M83718 Staffordshire RAWNSLEY SURGERY Rawnsley Road, Rawnsley, Cannock PMS 4,022 M83719 Hednesford Valley Health Centre, DR M MURUGAN PMS 3,545 M83722 Station Road, Hednesford King Street, Burton on Trent, KING STREET GMS 2,909 M83726 Staffordshire Norton Canes Health Centre, NORTON CANES PRACTICE PMS 4,414 M83727 Brownhills Road, Norton Canes 154 Cannock Road, Burntwood, SPRINGHILL MEDICAL CENTRE GMS 786 M83732 Staffordshire 267 Lichfield Street, Fazeley, FAZELEY SURGERY PMS 2,536 M83733 Tamworth, Staffordshire Greenhill Health Centre, Church Street, THE MINSTER PRACTICE PMS 1,834 M83735 Lichfield, Staffordshire AELFGAR SURGERY Church Street, Rugeley PMS 4,716 M83738 Melbourne Avenue, Winshill, Burton on WINSHILL PMS 3,478 Y00078 Trent, Staffordshire Sandy Lane Health Centre, Sandy SANDY LANE SURGERY APMS 10,800 Y02354 Lane, Rugeley BURNTWOOD HEALTH & High Street, Chasetown, Burntwood, APMS 2,425 Y02414 WELLBEING CENTRE Staffordshire Essington Medical Centre, Hobnock ESSINGTON MEDICAL CENTRE APMS 1,826 Y02594 Road, Essington
Optometrists Name Address Mandatory Additional 88 Wolverhampton Road, Birches Bridge, Codsall, WV8 4 Sight Eyecare Centre Yes Yes 1PE A J Optometric Services T/as 39 Gaolgate Street, Stafford, ST16 2NR Yes No Boots Opticians Ltd
Ados Sightcare 1 Ridgewood Gardens, Great Barr, Birmingham, B44 8JG No Yes
Alliance Optical Company 2 Swan Island Shopping Precinct, Chase Road, Yes No T/as Colin Lee Opticians Burntwood, WS7 0DW Alliance Optical Company 33 Market Street, Lichfield, WS13 6LA Yes No T/as Colin Lee Opticians Alliance Optical T/as Colin 1 Shrewsbury Mall, Market Square, Rugeley, Yes No Lee Opticians Staffordshire, WS15 3DL Asda Stores Ltd Ventura Retail Park, Tamworth, , Staffordshire, B78 3HD Yes No Boots Opticians Ltd 88 Market Street, Hednesford, , Staffordshire, WS12 1AG Yes No Boots Opticians Ltd 2 Brook Street, Rugeley, Staffordshire, WS15 3DL Yes No
Page 107 Name Address Mandatory Additional Burton Place Shopping Centre, , Burton On Trent, Boots Opticians Ltd Yes No Staffordshire, DE14 1BU Unit 14 Burntwood Shopping Centre, Cannock Road, Boots Opticians Ltd Yes No Chase Terrace, WS7 1JR Boots Opticians Ltd 2 Bakers Lane, Lichfield, , Staffordshire, WS13 6NF Yes No Bridge Street Optometrists Ltd T/as Webb Lucas 8 Bridge Street, Stafford, ST16 2HL Yes Yes Optometrists Carolyn Parker Optometrist Crown Bridge, Penkridge, Stafford, ST19 5AA Yes No Chase Eyecare 25 Market Street, Hednesford, , Staffordshire, WS12 1AY Yes Yes Community Eyecare UK Vision Call, Cambuslang Investment Park, 125 Yes Limited Cambuslang Road, Glasgow, G32 8NB Complete Price Eyewear T/as The Outside Clinic, Old Town Court, 10-14 High Street, No Yes The Outside Clinic Swindon, SN1 3EP David Arthur Opticians 9 Market Street, Lichfield, , Staffordshire, WS13 6JX Yes No 9 Ankerside Shopping Centre, Tamworth, , Staffordshire, Dolland & Aitchison Yes No B79 7LG Dolland & Aitchison 5 Princes Street, Stafford, ST16 2BN Yes Yes Donald Eyewear Ltd T/as Tutbury Mill Mews, Lower Street, Tutbury , Staffordshire, Yes No Tutbury Opticians DE13 9LU Elks Opticians 12 Midland Road, Swadlincote, , Derbyshire, DE11 0AG Yes Yes 44 Ankerside Shopping Centre, Tamworth, Staffordshire, Eye Society Yes Yes B79 7LG Eyecare Mobile Opticians Ltd 456 Bearwood Road, , Smethwick, B66 4BT No Yes Go Opticians Ltd T/A Perrigo The Willows, Maypole Street, Wombourne, WV5 9JB Yes No Opticians Goodwin & Edge Ltd T/A Mincher-Lockett Optometric Station Road, Gnosall, Stafford, ST20 0EZ Yes Yes Group Goodwin & Edge Ltd T/A Mincher-Lockett Optometric 18 Stafford Street, Stafford, Staffordshire, ST16 2BP Yes Yes Group Healthcall Optical Service Unit 5, Titan Court, Laporte Way, Luton, LU4 8EF No Yes Home Eye Clinic 941 Alum Rock Road, Ward End, Birmingham, B8 2LX No Yes Home Eyecare Unit 8, No 17 Winyates Centre, Redditch, B98 ONR No Yes In Home Eyecare 67 Bagworth Road, Barlestone, Nuneaton, CV13 OEQ No Yes Jenks Opticians 31 George Street, Tamworth, , Staffordshire, B79 7LJ Yes No Kelcher Optometrists 88a Wardles Lane, Great Wyrley, Walsall, WS6 6DY Yes Yes 51 High Street, Kinver, Stourbridge, West Midlands, DY7 Kinver Opticians Yes Yes 6HE 15 The Square, Wolverhampton Road, Codsall, L G Flint & Partners Yes Yes Wolverhampton, WV8 1PT L G Flint & Partners The Surgery, Sandy Lane, Brewood, ST19 9ES Yes Yes Lam Ltd T/as Boots Opticians 69 High Street, Cannock, , Staffordshire, WS11 1BN Yes No Ltd Lichfield Road, Hopwas, Tamworth, Staffordshire, B78 Longlea Optical Practice Yes Yes 3AG McCracken Opticians 11 Market Place, Uttoxeter, Staffordshire, ST14 8HY Yes No Mobile Professional Eyecare 11 Shipley Fields, Erdington, Birmingham, B24 9BW No Yes Services Mr B Hitchin The Old Vicarage, Radford Street, Stone, ST15 8AD No Yes Mr M D Gray 56 High Street, Eccleshall, Stafford, ST21 6BZ Yes Yes 743 Cannock Road, The Scotlands, Wolverhampton, Mr M Overton No Yes WV10 8PN Mr P Bowers 63a High Street, Stone, , Staffordshire, ST15 8AD No Yes
Page 108 Name Address Mandatory Additional Nusyte Opticians 1/2 Oddfellows, Adies Alley, Stone, ST15 8YQ Yes No On Call Opticians 61 Trafalgar Road, , Oldbury, B69 1RE No Yes 2 South Crescent, Featherstone, Wolverhampton, WV10 Optical & Hearing Centre Yes Yes 7AU 15 St Modwens Walk, Burton on Trent, , Staffordshire, Optical Express Yes No DE14 1HL Corner of Conduit Street, Lichfield, Staffordshire, WS13 Optical Express Lichfield Yes No 6NG Optical Express Tamworth 11 Colehill, Tamworth, Staffordshire, B79 7HE Yes No Perton Eyecare, Unit 4, Anders Square, Perton, Perton Eyecare Yes No Wolverhampton, WV6 7QH Philip Howard Opticians 4a Market Place, Cannock, Staffordshire, WS11 1DD Yes No Philip Howard Opticians 23 Market Street, Tamworth, Staffordshire, B79 7LR Yes No Pinder & Moore Optometrists Mill House, 58 Market Street, Kingswinford, DY6 9LE No Yes 104 Hednesford Road, Heath Hayes, Cannock, Portland Eyecare Ltd Yes Yes Staffordshire, WS12 3EA Portland Eyecare Ltd T/as A 15a Market Place, Cannock, Staffordshire, WS11 1BZ Yes Yes R Bickley Portland Eyecare Ltd T/As J J 19 Upper Brook Street, Rugeley, Staffordshire, WS15 2JT Yes Yes Potts & Partners Portland Eyecare Services 48 Church Street, Tamworth, Staffordshire, B79 7DE Yes No Limited 193 Station Street, Burton on Trent, Staffordshire, DE14 Prince & Bates Yes Yes 1BH Puri Healthcare Ltd T/as 75 High Street, Cannock, Staffordshire, WS11 1BN Yes Yes Chase Eyecare Rayner Professional Services 198 Station Street, Burton on Trent, Staffordshire, DE14 Yes No Ltd T/as Lancaster & Thorpe 1AN Rayners Professional 16a Upper Brook Street, Rugeley, Staffordshire, WS15 Services Ltd T/as Lancaster Yes No 2DN & Thorpe
RJR Optical Ltd School House, Brook End, Longdon, Rugeley, WS15 4PL No Yes Sha Abdi Ophthalmic 403 Witton Road, Aston, Birmingham, B6 6SP No Yes Optician Specsavers Opticians 41/43 Market Street, Lichfield, Staffordshire, WS13 6LA Yes No Unit 19, The Ankerside Centre, George St, Tamworth, Specsavers Opticians Yes No Staffordshire, B79 7LG SPH Opticians 18 Great Bridge, , Tipton, DY4 7HA No Yes 31 Rugeley Road, Chase Terrace, Burntwood, Stidwills Ltd Yes No Staffordshire, WS7 8AG Taylor Biddle Opticians 34 Windmill Bank, Wombourne, WV5 5JD Yes No Tesco Opticians Church Street, Lichfield, Staffordshire, WS13 6DZ Yes No The Eye Works No 4, St Mary's Mews, Stafford, ST16 2AP Yes No The Right Vision 34 Birmingham Street, , Oldbury, B69 4DS No Yes 2 Underhill Walk, Coopers Square, Burton On Trent, Vision Express Yes No DE14 1DE Vision Express 15 Market Place, Uttoxeter, Staffordshire, ST14 8HY Yes No
Vision Express 21/23 Levetts Square, Lichfield, Staffordshire, WS13 6NN Yes No
45 Ankerside Shopping Centre, Tamworth, Staffordshire, Vision Express Yes No B79 7LG Vision Express Unit 9, Guildhall Centre, Stafford, ST16 2BB Yes No Vision Plus Ltd T/as 19 Cannock Shopping Centre, Cannock, Staffordshire, Yes No SpecSavers Opticians WS11 1WS
Page 109 Name Address Mandatory Additional Vision Plus T/as SpecSavers 5 Upper Brook Street, Rugeley, Staffordshire, WS15 2DP Yes No Opticians Vision Plus T/as Specsavers 3 High Street, Uttoxeter, Staffordshire, ST14 7HN Yes No Opticians Vision Plus T/as SpecSavers 176 High Street, Burton on Trent, Staffordshire, DE14 Yes No Opticians 7HN Vision Plus T/as Specsavers 20 Gaolgate Street, Stafford, ST16 2BQ Yes No Opticians
Visionary Eyecare Limited Thetis House, 184 St Saviours Road, Leicester, LE5 3SG No Yes
Zeidan Ophthalmic Opticians 4 Lower Gungate, Tamworth, Staffordshire, B78 7AB Yes No Ltd
Dental
Type of Name or Company Name Company Address 1 Address 2 Postcode contract
OASIS DENTAL CARE LTD 1 Coniston Way Cannock WS11 1DT GDS MR AA DUGGAL 1 Hillcrest Stafford ST17 9YA GDS MR JS HEAR 1 New Road Featherstone Wolverhampton WV10 7PY GDS MRS CM ARCHER GDS 1 Tutbury Road Burton Upon Trent DE13 0NU MRS JD ROBSON GDS Whitecross Dental Care 10 High Street Stone ST15 8AW GDS Limited MR N AHMED 100A Market Street Hednesford Cannock WS12 1AG GDS MR SS DEHAL 11 Church Street Lichfield WS13 6DZ GDS MR P CASWELL 11A Wolverhampton Road Cannock WS11 1AP GDS MR LG THOTA 137 Wolverhampton Road Coven Wolverhampton WV8 1PF GDS OASIS DENTAL CARE LTD 14 Wolverhampton Road Stafford ST17 4BP GDS MR CJ KEETON 15 Enville Road Kinver Stourbridge DY7 6AB GDS MR EJ DUKE 15 High Street Gnosall Stafford ST20 0EX GDS A D Deane Dentistry Ltd GDS MAF Dentistry Ltd GDS MISS CL VINEY 15-16 Albert Road Tamworth B79 7JN GDS MR AL CUFFLIN GDS MTM Dentistry Ltd GDS MR E MOORE 15A Wolverhampton Road Cannock WS11 1AP GDS MR SS NANDHRA (Central 16 Ankerside Street Tamworth B79 7LQ PDS Ortho) MR PB GARBUTT 16 Sandy Lane Brewood Stafford ST19 9ET GDS MR P SANGHA 171 Walsall Road Great Wryley Walsall WS6 6NL GDS MR PJ WRIGHT 17-19 Horse Fair Rugeley WS15 2EJ GDS MR CN GROCOTT GDS 18 Wolverhampton Road Stafford ST17 4BP MR D VLOK GDS Mr P A Thomasson 2 Friars Terrace Stafford ST17 4AU GDS MR B Patel 2 Southfield Way Walsall WS6 6JZ GDS MR C BIRD 2 Wolverhampton Road Cannock WS11 1AH GDS Tamworth House Dental 21 Church Street Tamworth B79 7DH GDS Practice MR PR BASON 21 High Street Uttoxeter ST14 7HN GDS MR NT JENKINS 21-24 Anders Square Perton Wolverhampton WV6 7QH GDS MR JB REAVEY 24 Bore Street Lichfield WS13 6LL GDS
Page 110 Type of Name or Company Name Company Address 1 Address 2 Postcode contract Whitecross Dental Care 24 Eastgate Street Stafford ST16 2LZ GDS Limited MR A BROTHERTON GDS 24A Lichfield Street Tamworth B79 7QE MR PJ BRICKETT GDS MR AI PARUK 26 Ellerbeck Wilnecote Tamworth B77 4JA GDS High Street Dental Practice 267 High Street Burntwood WS7 3XJ GDS ADP Dental Co Ltd 27 High Street Chasetown Burntwood WS7 3XE GDS OASIS DENTAL CARE LTD 3 Station Street Burton Upon Trent DE14 1AN GDS MR JP HEALY 34 Rugeley Road Armitage Rugeley WS15 4BD GDS MR SS MULLA 36 Hednesford Road Heath Hayes Cannock WS12 3EA GDS Avondale House Surgery Ltd 37 Anson Street Rugeley WS15 2BA GDS MR PB SITLU 37 High Street Kinver Stourbridge DY7 6HF GDS MR KR GRUNDY 39 Heron Street Rugeley WS15 2DZ GDS Meir Health Dental Surgery 404 Sandon Road Stoke-on-Trent ST3 7LH GDS ADP Dental Co Ltd 41 Station Road Hednesford Cannock WS12 4DH GDS Beaufort Dental Health 45b Roliston Road Burton Upon Trent DE15 9RQ GDS Centre Ltd MR R GRIFFITHS 5 Lion Court Wade Street Lichfield WS13 6HL GDS MR N BARCHHA 5 Ounsdale Road Wombourne Wolverhampton WV5 9JE GDS MR MB WARAICH 5 St Mary's Place Stafford ST16 2AR GDS Jandu & Bhambra 52 Duck Lane Codsall Wolverhampton WV8 1HF GDS Partnership Whitecross Dental Care 5-6 Trinity Square Uttoxeter ST14 8TH GDS Limited MR NP HARRISON 57 Albert Road Tamworth B79 7JN GDS The Tutbury Dental Practice 59 Monk Street Tutbury Burton Upon Trent DE13 9NA GDS Ltd MR N ROBSON 6 Castle Street Eccleshall Stafford ST21 6DF GDS MISS SC DUNCAN GDS 6 St Peter's Street Burton Upon Trent DE15 9AW MR AP JAMES GDS RODERICKS LTD 65/68 High Street Burton Upon Trent DE14 1LE GDS MR S SABZEVARI 67 Shortbutts Lane Lichfield WS14 9BU GDS MRS DM PICKERING 76 Upper St John Street Lichfield WS14 9DX GDS MR I SIMPSON 7-8 Friars Road Stafford ST17 4AA GDS MR MC GOODWIN 7-8 Friars Road Stafford ST17 4AA GDS MR TJ RATLABYANE 80 Upper St John Street Lichfield WS14 9DX GDS MR H RAVAL 89 Rising Brook Stafford ST17 9DH GDS LEHANE, Jilka, Amit GDS Robert Bates Dental Practice 9 Abbey Street Stone ST15 8PA GDS Limited MISS SS SULEMAN GDS 9 Church Lane Stafford ST16 2AW MR GP MANZIE GDS MISS EA WALL 9 Dam Street Lichfield WS13 6AE GDS MR PG OWEN GDS MR RL CULLY (Modwena) PDS 9 Lichfield Street Burton Upon Trent DE14 3QZ MR WJ HUGHES GDS MRS JA DAVIES GDS MR RK NAHAR 92A Eskett Street Hednesford Cannock WS12 1AP GDS Cannock Dental Centre Bank Chambers Market Place Cannock WS11 1BP GDS Brookhouse Dental Practice Brookhouse Road Gnosall ST20 0GP GDS MR BS BHANDAL Cadogan Road Dosthill Tamworth B77 1PQ GDS
Page 111 Type of Name or Company Name Company Address 1 Address 2 Postcode contract
Mrs NC Lavelle Castle Way Stafford ST16 1BS GDS MISS SJ WORSKETT GDS MR A KERSLAKE GDS Church Street Uttoxeter ST14 8AF MR IH KHAN GDS MR JG LANGLEY GDS Health & Well-Being Centre High Street RODERICKS LTD Burton Upon Trent DE15 9LD GDS Stapenhill MR DR JARRETT GDS High Street Wombourne Wolverhampton WV5 9DP MR IK JARRETT GDS MISS SS KHAIRA Market Street Penkridge ST19 5DH GDS DR AJ FAGG GDS Oriel House, 16 South Walls Stafford ST16 3AA DR AS SADHRA GDS MR PB NADIN Roase Garth Brewery Lane Great Haywood ST18 0SN GDS Salter's Meadow Medical Centre MR SS MULLA Burntwood WS7 1AQ GDS Rugeley Road Chase Terrace The Dental Surgery Severn Drive Wolverhampton WV6 7QL GDS Regency House Dental Station Road Stone ST15 8JP GDS Practice Ltd MR I GERASIMOV GDS MR K GILANI GDS The Hollies 25 Albert Road Tamworth B79 7JS MR KW POON GDS MR Y GOLHOSSEINI GDS Stop the Clock Dental Care Unit 18, Eastgate Business Park, Burton Upon Trent DE13 0AT GDS Ltd Eastern Avenue Dental Perfection @ Unit 4, 87 Burton Road, Branston Burton Upon Trent DE14 3DW GDS Branston
Pharmacies Pharmacy Code Pharmacy Name Address 1 Address 2 Address 3 Postcode FDA70 All Saints Pharmacy 28 All Saints Road Burton on Trent DE14 3LS DE13 FJP07 Alrewas Pharmacy Main Street Alrewas Burton on Trent 7AE DE14 FX012 Asda Pharmacy The Octagon Centre Orchard Street Burton on Trent 3TN FGV24 Asda Pharmacy ASDA Stores Ventura Park Tamworth B78 3HB Asda Pharmacy (100 FL014 hour) Asda Superstore Queensway Stafford ST16 3TA 160-162 Hednesford WS12 FF153 Bains Pharmacy Road Heath Hayes Cannock 3DZ FHT42 Bills Pharmacy 29 High Street Kinver Stourbridge D77 6HF FPD65 Birchill & Watson 16 High Street Stone ST15 8AW FYJ04 Birchill & Watson 46 Eccleshall Road Walton Stone ST15 0HN FD015 Blounts Pharmacy 1 Chenevare Mews Kinver Stourbridge DY7 6HF WS13 FVQ69 Boots Pharmacy c/o Waitrose Store Stonnyland Drive Lichfield 6RX WS11 FQG31 Boots The Chemist 1 Church Street Cannock 1DE FG424 Boots The Chemist 6 High Street Uttoxeter ST14 7HT DE14 FAO76 Boots The Chemist 1 Cooper Square Burton on Trent 1DG FLG51 Boots The Chemist 4/8 Tamworth Street Lichfield WS13 6JJ FFK69 Boots The Chemist 6 Burnett Road Streetly Sutton Coldfield B74 3EJ
Page 112 Pharmacy Code Pharmacy Name Address 1 Address 2 Address 3 Postcode FFV61 Boots The Chemist Unit A Ventura Retail Park Tamworth B79 7LQ FX835 Boots The Chemist 18/24 Ankerside Tamworth B78 1BS WS15 FDL64 Boots the Chemist 5 Brook Square Rugeley 2DT FKF76 Boots the Chemists 10/14 Market Square Stafford ST16 2BD FGQ49 Boots UK Ltd Queens Retail Park Silkmore Lane Stafford ST17 4SU FQK12 Boots UK Ltd 18-22 High Street Stone ST15 8AW DE14 FF403 Branston Pharmacy Main Street Branston Burton on Trent 3EY WS15 FDF17 Brereton Pharmacy 88 Main Road Brereton Rugeley 1HT WS12 FEV94 Colliery Pharmacy Colliers Way Huntington Cannock 4UD Co-op Health Care FX642 Ltd 62 Hednesford Street Cannock WS11 1DJ Co-op Health Care WS11 FQD63 Ltd 57/59 High Green Market Place Cannock 1BP Co-op Health Care WS11 FT240 Ltd 7 Devon Court Bideford Way Cannock 1NP Co-op Health Care WS12 FX259 Ltd 2 Festival Court Pye Green Road Hednesford 2RP 23-25 Burntwood WS11 FE295 Co-op Pharmacy Road Norton Canes Cannock 3RE FE727 Co-op Pharmacy Castlefields Pharmacy Castle Way Newport Road ST16 1BS FNT13 Co-op Pharmacy 128 West Way Highfields Stafford ST17 9YF FKC07 Co-op Pharmacy Burton Square Rising Brook Stafford ST17 9LT WS11 FPC69 Cornwells Chemists 235 Cannock Road Chadsmoor Cannock 2DD FGQ52 Cornwells Chemists 126 Wardles Lane Great Wyrley Walsall WS6 6DZ Cornwells Chemists FAC36 Ltd 51 Bodmin Avenue Weeping Cross Stafford ST17 0EF Cornwells Chemists FA274 Ltd Holmcroft Road Stafford ST16 1JG Cornwells Chemists FAK06 Ltd Weston Road Stafford ST18 0BF FC999 Coven Pharmacy 25 Brewood Road Coven Wolverhampton WV9 5BX FFM27 David Siswick 146 Masefield Drive Leyfields Tamworth B79 8JA DE15 FRG03 Dean & Smedley Ltd 71 Main Street Stapenhill Burton on Trent 9AP DE13 FQ993 Dean & Smedley Ltd Unit 1 Main Street Stretton Burton on Trent 0DZ FN793 Dean & Smedley Ltd 16 High Street Tutbury Burton on Trent DE13 9LP 65-67 Horninglow DE14 FJN78 Dean & Smedley Ltd Street Burton on Trent 2PP FQV17 Dosthill Pharmacy 57 High Street Dosthill Tamworth B77 1LG FD976 Eason Chemist 215a Watling Street Wilnecote Tamworth B77 5BJ FA163 Eccleshall Pharmacy 8 High Street Eccleshall Stafford ST21 6BW FED64 Exley Pharmacy Unit 4 Exley Centre Belgrave Tamworth B77 2LA FR046 Fazeley Pharmacy 11 Coleshill Street Fazeley Tamworth B78 3RB Fernwood Drive WS15 FHD24 Pharmacy 89 Fernwood Drive Rugeley 2PY ST20 FG745 Gnosall Pharmacy Gnosall Health Centre Brookhouse Road Gnosall OGP Essington Community WV11 FN104 Hawthorne Chemists Centre Hobnock Road Essington 2RF FN752 Haywood Pharmacy 3 Trent Close Great Haywood Stafford ST18 OSS Healthcare & Home DE14 FTX40 Ltd Fifth Avenue Centrum 100 Burton on Trent 2WS
Page 113 Pharmacy Code Pharmacy Name Address 1 Address 2 Address 3 Postcode Jhoots Healthcare Ltd T/as Jhoots St Chads Health WS13 FAV30 Pharmacy Centre Dimbles Lane Lichfield 7HT FX543 Kitsons Chemist 8 Orchard Place Barlaston Stoke-on-Trent ST12 9DL Greenhill Health FG221 Lichpharm Ltd Centre Church Street Lichfield WS13 6JL Hednesford Valley WS12 FEY42 Lloyds Pharmacy Ltd Health Centre Station Road Hednesford 4DH WS12 FEV89 Lloyds Pharmacy Ltd 50 Market Street Hednesford 1AH Sandy Lane Health FEF63 Lloyds Pharmacy Ltd Centre Sandy Lane Rugeley WS15 2LB WS15 FAD60 Lloyds Pharmacy Ltd 11 Upper Brook Street Rugeley 2DP FXL73 Lloyds Pharmacy Ltd 7 Lichfield Road Burntwood WS7 0HH Burntwood Shopping FP926 Lloyds Pharmacy Ltd Unit 3 Centre Burntwood WS7 8JR FHQ00 Lloyds Pharmacy Ltd 4 Rugeley Road Chase Terrace Burntwood WS7 8AQ FFM49 Lloyds Pharmacy Ltd Broadgate House 6 Market Place Brewood ST19 9BS 86 Wolverhampton FKC45 Lloyds Pharmacy Ltd Road Codsall Wolverhampton WV8 1PE FYQ63 Lloyds Pharmacy Ltd Irvine House 9 - 11 Church Road Codsall WV8 1EA FGG01 Lloyds Pharmacy Ltd 8 Bilbrook Road Codsall Wolverhampton WV8 1EZ FGJ42 Lloyds Pharmacy Ltd 2-3 Anders Square Perton Wolverhampton WV6 7QH FT197 Lloyds Pharmacy Ltd Millbank Stafford ST16 2AG FL764 Lloyds Pharmacy Ltd 9–10 Burton Square Rising Brook Stafford ST17 9LT DE13 FJH45 Manor Pharmacy 171 Calais Road Burton on Trent 0UN DE14 FC046 Manor Pharmacy 192 Horninglow Street Burton on Trent 3BT DE14 FR167 Manor Pharmacy 251 Branston Road Burton on Trent 3BT FM118 MEBA Services Ltd Browning Street Stafford ST16 3AT Medi-care Pharmacy FKK87 UK Ltd 1 Meadow View High Street Pattingham WV6 7BD WV10 FDY35 Millstream Pharmacy The Avenue Featherstone Wolverhampton 7AX WS11 FC397 Minster Pharmacy 29 Market Hall Street Cannock 1EB FTL56 Morrisons Pharmacy Market Street Rugeley WS15 2JJ FRG53 N & J's Chemist 10 Morley Road Burntwood Walsall WS7 9AZ Northwood FNN97 Dispensing Chemist 23 High Street Chasetown Walsall WS7 8XE Northwood Dispensing Chemist T/as Fradley Unit 6 The Stirling FAH40 Pharmacy Centre Tye Lane Fradley WS13 8ST Northwood FGX21 Dispensing Chemists Pinfold Lane Penkridge Stafford ST19 5AP Northwood FPH88 Dispensing Chemists Market Street Penkridge Stafford ST19 5DH Northwood FVC35 Dispensing Chemists 65 Weston Road Stafford ST16 3RL WS11 FRT97 Nucare Pharmacy 3 Hamilton Lea Brownhills Road Norton Canes 3SE FMM93 PCP Direct (online) 30 Hospital Street Tamworth B79 7EB FCL27 Peel Court Pharmacy 2 Aldergate Tamworth B79 7DJ
Page 114 Pharmacy Code Pharmacy Name Address 1 Address 2 Address 3 Postcode Pharmacy @ Balance Street Health ST14 FWQ93 Balance Street Centre Balance Street Uttoxeter 8HP Primary Care FXK47 Pharmacy 30 Hospital Street Tamworth B79 7EB FK409 Rajja Ltd 29 Ellerbeck Stonydelph Tamworth B77 4JA FEV77 Rawnsley Pharmacy Rawnsley Road Rawnsley Cannock WS12 1JF FQG62 Rowlands Pharmacy 54 Albert Road Tamworth B79 7JN FN540 Rowlands Pharmacy 161 Marston Road Stafford ST16 3BS Sainsbury’s FWQ35 Pharmacy (100 hour) Chell Road Stafford ST16 2TF Sainsburys WS11 FLD85 Pharmacy Voyager Drive Cannock 8XP Sainsburys Sainsburys DE14 FXV15 Pharmacy Supermarket Union Street Burton on Trent 1AA Sainsburys FNF97 Pharmacy Sainsburys Superstore Bonehill Road Tamworth B78 3HB FXE34 Shenstone Pharmacy 33b Main Street Shenstone Lichfield WS14 0LZ Stapenhill Day Night DE15 FW628 Pharmacy 35-36 St Peters Street Stapenhill Burton on Trent 9AW FRE06 Stevenson Chemists 3 High Street Cheslyn Hay Walsall WS6 7AB FF426 Superdrug Pharmacy 18 Greengate Street Stafford ST16 2HS FKP71 Taylors Pharmacy 266 Tamworth Road Amington Tamworth B77 3DQ Tesco In-store WS12 FVA00 Pharmacy Heath Way Heath Hayes Cannock 5YY FN564 Tesco Pharmacy Tesco Superstore Brookside Uttoxeter ST14 8AU FQ702 Tesco Pharmacy Tesco Superstore St Peters Bridge Burton on Trent DE14 3RJ WS13 FJT41 Tesco Pharmacy Tesco Superstore Church Street Lichfield 6NZ The Co-operative DE15 FAA98 Pharmacy Fyfield Road Stapenhill Burton on Trent 9QD The Co-operative ST14 FPX02 Pharmacy 44 Market Place Uttoxeter 8HP The Co-operative Barton under DE13 FQR97 Pharmacy 52-54 Main Street Needwood Burton on Trent 8AA The Co-operative FDA10 Pharmacy 1-5 Church Street Tamworth B79 7DH The Co-operative 3 Boley Park Shopping WS14 FEF80 Pharmacy Centre Ryknild Street Lichfield 9XU The Midcounties Co- WS12 FD678 op Pharmacy 94 Market Street Hednesford Cannock 1AG FV213 V J Magrath Chemist 68 Caledonian Glascote Tamworth B77 2ED DE14 FHF60 Waterloo Pharmacy 172 Waterloo Street Burton on Trent 2NQ Whittington FFY19 Pharmacy 13b Main Street Whittington Lichfield WS14 9JU The Co-operative FPJ52 Wildwood Pharmacy Centre Cannock Road Stafford ST17 4RA FF829 Winshill Pharmacy Melbourne Avenue Winshill Burton on Trent DE15 0EP Wm Morrisons Morrisons FXE07 Pharmacy Supermarket Wellington Road Burton on Trent DE14 2AR Wolverhampton 112 Wolverhampton FE603 Road Pharmacy Road Stafford ST17 4AH Wombourne FWP30 Pharmacy 45a Planks Lane Wombourne Wolverhampton WV5 8DX Your Local Boots 67 New Armitage WS15 FL584 Pharmacy Road Armitage Rugeley 4AA
Page 115 Pharmacy Code Pharmacy Name Address 1 Address 2 Address 3 Postcode Your Local Boots Langton Medical FJR35 Pharmacy Centre Eastern Avenue Lichfield WS13 7FA Your local Boots FCH60 pharmacy High Street Wombourne Wolverhampton WV5 9DP Your local Boots FVT62 pharmacy 5 & 6 Giggetty Lane Wombourne Wolverhampton WV5 0AW Your local Boots FDH34 pharmacy 1/7 Park Road Cannock WS11 1JN
Page 116 Appendix B – Acute Contracts and Services
NHS North Staffordshire Approx Contract OT OT OT CQC NHSLA Provider Value 08/09 09/10 10/11 Registration Accreditation 11/12 £000's £000's £000's £000's Birmingham Childrens 291 Yes Yes 138 210 320 Birmingham Womens 90 Yes Yes 114 Burton Hospitals 292 Yes Yes 289 286 283 Central Manchester 595 Yes Yes 434 316 990 Christie 629 Yes Yes 287 583 Derby Hospitals 1,144 Yes Yes 1,088 1,124 1,130 Dudley Group of Hospitals 33 Yes Yes 34 East Cheshire Hospitals 7,603 Yes Yes 5,873 7,551 7,156 Heart of England 92 Yes Yes 104 133 98 Mid Cheshire 1,678 Yes Yes 1,551 1,858 1,759 Mid Staffs 520 Yes Yes 708 655 491 Nations SSPCT 174 Yes Yes 635 169 412 Nottingham 87 Yes Yes 187 169 99 Nuffield Chester 62 Yes Yes 61 Nuffield Derby 72 Yes Yes 10 5 72 Nuffield Newcastle 1,302 Yes Yes 253 1,100 2,801 Nuffield Shrewsbury 94 Yes Yes 94 Nuffield Wolverhampton 32 Yes Yes 31 Robert Jones AH 676 Yes Yes 565 657 683 Rowley Hall 112 Yes Yes 276 154 122 Royal Orthopaedic 150 Yes Yes 114 147 78 Royal Wolves 78 Yes Yes 110 90 108 Sandwell and West Birm 157 Yes Yes 171 212 144 Shrews and Telford 105 Yes Yes 125 81 113 South Manchester 276 Yes Yes 219 342 SPIRE 99 Yes Yes 60 Stockport 357 Yes Yes 131 354 327 UHNS 91,671 Yes Yes 89,405 98,828 102,806 University Birmingham 757 Yes Yes 606 725 760 University of Leicester 54 Yes Yes 39 35 15 University of South Manchester 319 Yes Yes 605 990 Walsall Hospitals 191 Yes Yes 86 267
Services Provided Accident and Emergency Clinical Haematology Learning Disability Perinatal Psychiatry Addiction Services Clinical Pharmacology Maternity Physiotherapy Adult Mental Illness Colorectal Surgery Neurosurgery Plastic Surgery Allergy Critical Care Medicine Obstetrics and Gynaecology Podiatry Anaesthetics Diabetic Medicines Ophthalmology Prosthodontics
Page 117 Oral and Maxillo-facial Anticoagulant Service Dietetics Rehabilitation Surgery Audiological Medicine Eating disorders Oral Surgery Respite Care Speech and Language Audiology Endocrinology Orthodontics Therapy Blood and Marrow ENT Orthoptics Spinal Injuries Transport Breast surgery Gastroemterology Paediatric dentistry Surgical Dentistry Gastrointentestinal Burns Care Paediatric Surgery/care Thoracic Surgery Surgery Cardiac Surgery General Surgery Paediatric Urology Transplantation Surgery Cardiothoracic Surgery Haemophilia Pain Management Trauma and Orthopaedics Chemical Pathology Hepatology Palliative Medicine Tropical Medicine Clinical Physiology Infectious Diseases Pancreatic Surgery Urology Clinical Genetics Intermediate Care Peridontics Vascular Surgery
NHS Stoke on Trent Approx Contract CQC NHSLA OT OT OT Provider Value 11/12 £ Registration Accreditation 08/09 £ 09/10 £ 10/11 £ UHNS 168m Yes Yes 136m 153m 158m Birmingham Childrens 648k Yes Yes 230k 412k 658k Birmingham Dental 54K Yes Yes 0 61k 56k Birmingham Womens 43k Yes Yes 22k 31k 28k Burton Hospitals 105k Yes Yes 91k 81k 97k Christie 168k Yes Yes 63k 99k 154k Central Manchester 676k Yes Yes 333k 602k 619k Derby Hospitals 161k Yes Yes 236k 252k 162k Dudley Group of Hospitals 36k Yes Yes 8k 60k 26k East Cheshire Hospitals 865k Yes Yes 572k 580k 902k Heart of England 276k Yes Yes 344k 273k 278k In health 92k Yes No 1189k 291k 109k Mid Cheshire 859k Yes Yes 142k 779k 937k MFS 433k Yes No 129k 211k 255k Mid Staffs 713k Yes Yes 662k 716k 731k Nuffield 2.5M Yes Yes 903k 150k 3.6M Robert Jones & AH 285k Yes Yes 280k 379k 239k Royal Orthopaedic 134k Yes Yes 95k 123k 113k Ramsey Care 84k Yes Yes 298K 150K 118K Royal Wolves 110k Yes Yes 212k 127k 98k Shrews and Telford 55k Yes Yes 78k 119k 51k Sandwell and West Birm 233k Yes Yes 326k 327k 165k South Warwickshire 14k Yes Yes 3k 7k 21k University Birmingham 695k Yes Yes 737k 680k 715k Walsall Hospitals 251k Yes Yes 215k 295k 231k Worcester Hospitals 42k Yes Yes 15k 56k 36k
Services Provided Addition Services Diabetic Medicine Maternity Podiatry Audiology
Page 118 Obstetrics and Adult Mental Health Dietetics Restorative Dentistry Gynaecology Speech and Language Audiological Medicine Eating Disorder services Ophthalmology Therapy Blood and Marrow ENT Oral Surgery Transplantation Surgery Transport
Breast Surgery Gastrointestinal Surgery Orthodontics Trauma and Orthopaedics
Clinical Genetics General Surgery Orthotics Urology
Clinical Haematology Haemophilia Medicine Paediatric Dentistry Vascular Surgery
Clinical Pharmacology Hepatology Pancreatic Surgery
Clinical physiology Learning Disability Services Physiotherapy
South Staffordshire PCT Approx 11/12 CQC NHSLA Provider OT 10/11 £ Contract Registration accreditation Value £ ROWLEY HALL HOSPITAL 2,279,213 Yes Yes 2,725,025 WALSALL HEALTHCARE NHS TRUST 9,956,080 Yes Yes 9,665,149 SOUTH WARWICKSHIRE NHS FOUNDATION TRUST 69,397 Yes Yes 64,963 MID STAFFORDSHIRE NHS FOUNDATION TRUST 131,823,918 Yes Yes 129,855,666 UNIVERSITY HOSPITAL OF NORTH 19,017,080 Yes Yes 17,628,956 STAFFORDSHIRE NHS TRUST BURTON HOSPITALS NHS FOUNDATION TRUST 84,468,870 Yes Yes 78,642,703 UNIVERSITY HOSPITALS COVENTRY AND 669,780 Yes Yes 780,020 WARWICKSHIRE NHS TRUST ROBERT JONES AND AGNES HUNT ORTHOPAEDIC 2,180,215 Yes Yes 1,789,957 AND DISTRICT HOSPITAL NHS TRUST THE ROYAL WOLVERHAMPTON HOSPITALS NHS 33,599,395 Yes Yes 34,468,973 TRUST GEORGE ELIOT HOSPITAL NHS TRUST 656,200 Yes Yes 631,754 BIRMINGHAM WOMEN'S NHS FOUNDATION TRUST 228,069 Yes Yes 212,476 THE DUDLEY GROUP OF HOSPITALS NHS 8,941,821 Yes Yes 9,296,508 FOUNDATION TRUST BIRMINGHAM CHILDREN'S HOSPITAL NHS 2,959,718 Yes Yes 3,068,606 FOUNDATION TRUST HEART OF ENGLAND NHS FOUNDATION TRUST 38,008,185 Yes Yes 38,916,308 THE ROYAL ORTHOPAEDIC HOSPITAL NHS 2,818,206 Yes Yes 2,726,193 FOUNDATION TRUST UNIVERSITY HOSPITALS BIRMINGHAM NHS 10,416,443 Yes Yes 9,976,123 FOUNDATION TRUST DERBY HOSPITALS NHS FOUNDATION TRUST 14,752,636 Yes Yes 14,493,606 UNIVERSITY HOSPITALS OF LEICESTER NHS 1,793,035 Yes Yes 1,991,819 TRUST WORCESTERSHIRE ACUTE HOSPITALS NHS 274,406 Yes Yes 307,589 TRUST NOTTINGHAM UNIVERSITY HOSPITALS NHS 2,286,967 Yes Yes 2,274,996 TRUST SANDWELL AND WEST BIRMINGHAM HOSPITALS 2,138,282 Yes Yes 2,050,003 NHS TRUST SHREWSBURY AND TELFORD HOSPITAL NHS 1,304,293 Yes Yes 1,253,675 TRUST UNIVERSITY HOSPITALS OF LEICESTER 1,793,031 Yes Yes 1,824,958 Cost Per NUFFIELD HEALTH Yes Yes Cost per Case Case Cost Per SPIRES HEALTHCARE Yes Yes Cost per Case Case BMI Cost Per Yes Yes Cost per Case
Page 119 Approx 11/12 CQC NHSLA Provider OT 10/11 £ Contract Registration accreditation Value £ Case NATIONS HEALTHCARE 8,798,000 Yes Yes 14,532,161
Services Provided Services currently commissioned from Mid Staffordshire Foundation Trust are detailed below; CLINICAL GENERAL SURGERY OBSTETRICS PHYSIOTHERAPY HAEMATOLOGY OCCUPATIONAL UROLOGY CARDIOLOGY PLASTIC SURGERY THERAPY CARDIOTHORACIC BREAST SURGERY DERMATOLOGY DIETETICS SURGERY TRAUMA & RESPIRATORY MEDICINE NEUROLOGY ORTHODONTICS ORTHOPAEDICS INTERVENTIONAL ENT RHEUMATOLOGY DIAGNOSTIC IMAGING RADIOLOGY GENITOURINARY OPHTHALMOLOGY GERIATRIC MEDICINE ANAESTHETICS MEDICINE 24 HOUR ECG / BP ORAL SURGERY GYNAECOLOGY NEUROSURGERY MONITORING CLINICAL ONCOLOGY PAIN MANAGEMENT (previously REHABILITATION ECHOCARDIOGRAM RADIOTHERAPY) ACCIDENT & SPEECH AND LANGUAGE HEARING AID GENERAL MEDICINE EMERGENCY THERAPY ASSESSMENT GASTROENTEROLOGY PAEDIATRICS CHEMICAL PATHOLOGY ULTRASOUND SCAN
Services currently commissioned from Burton Hospitals Foundation Trust are detailed below; ACCIDENT & PAEDIATRIC DIAGNOSTIC IMAGING IMMUNOPATHOLOGY EMERGENCY NEUROLOGY ANTICOAGULANT MEDICAL DIETETICS PAEDIATRICS SERVICE MICROBIOLOGY AUDIOLOGICAL ENT MEDICAL ONCOLOGY PAEDIATRICS DIABETES MEDICINE BLOOD BANK GENERAL MEDICINE NEPHROLOGY PALLIATIVE MEDICINE CARDIOLOGY GENERAL SURGERY NEUROLOGY PHLEBOTOMY GENITOURINARY CHEMICAL PATHOLOGY OBSTETRICS PHYSIOTHERAPY MEDICINE OCCUPATIONAL CLINICAL CHEMISTRY GERIATRIC MEDICINE PLASTIC SURGERY THERAPY CLINICAL GYNAE REPRODUCTIVE RESPIRATORY OPHTHALMOLOGY HAEMATOLOGY MEDICINE PHYSIOLOGY COMMUNITY MIDWIFERY GYNAECOLOGY ORAL SURGERY REHABILITATION CRITICAL CARE HAEMATOLOGY ORTHODONTICS RHEUMATOLOGY MEDICINE TRAUMA & DERMATOLOGY HISTOPATHOLOGY ORTHOPTICS ORTHOPAEDICS DIABETIC MEDICINE HIV / AIDS ORTHOTICS UROLOGY
Page 120 Appendix C – Tertiary Contracts and Services
Provider Listing Below is a list of Tertiary Service Providers for Staffordshire Cluster which is part of the Staffordshire and Shropshire Local Collaborative Commissioning Board.
Indicative Current Services CQC NHSLA Provider Geographic Contract Provided Registration Accreditation Boundary Served Length University Hospital North Staffs - Shropshire and Acute 1 year Yes Yes All services excl renal Staffordshire University Hospital North Staffs - Renal Shropshire and 1 year Yes Yes Renal Dialysis Staffordshire Shrewsbury and Telford Hospitals - Renal Shropshire and 1 year Yes Yes Renal Dialysis Staffordshire Shrewsbury and Telford Hospitals - Specialised Shropshire and 1 year Yes Yes Cardiac Catheters Cardiology Staffordshire University Hospital Birmingham - Shropshire and Acute 1 year Yes Yes All services excl renal dialysis Staffordshire University Hospital Birmingham - Renal Shropshire and 1 year Yes Yes Renal Dialysis Dialysis Staffordshire Shropshire and Birmingham Childrens Hospital Acute 1 year Yes Yes Staffordshire Shropshire and University Hospital Leicester Acute 1 year Yes Yes Staffordshire Royal Wolverhampton Hospitals - Shropshire and Acute 1 year Yes Yes Cardiac Staffordshire Royal Wolverhampton Hospitals - Renal Shropshire and 1 year Yes Yes Renal Dialysis Staffordshire Shropshire and South Birmingham PCT - WMRC Rehabilitation 1 year Yes Yes Staffordshire Heart of England NHS Foundation Shropshire and Acute 1 year Yes Yes Trust Staffordshire Heart of England NHS Foundation Renal Shropshire and 1 year Yes Yes Trust - Renal Dialysis Staffordshire Shrops/Staffs Healthcare - Shropshire and Mental Health 1 year Yes Yes Perinatal Staffordshire Eating Shropshire and Shrops/Staffs Healthcare - ED 1 year Yes Yes Disorders Staffordshire Renal Shropshire and Derby Hospitals - Renal 1 year Yes Yes Dialysis Staffordshire Specialised Shropshire and Mid Staffs Hospital 1 year Yes Yes Cardiology Staffordshire Renal Shropshire and South Staffordshire PCT - Renal 1 year Yes Yes Dialysis Staffordshire Shropshire and Nottingham University Hospitals Acute 1 year Yes Yes Staffordshire Shropshire and Walton Neurosurgery Neurosurgery 1 year Yes Yes Staffordshire University Hospitals Coventry & Renal Shropshire and 1 year Yes Yes Warwickshire - Renal Dialysis Dialysis Staffordshire University Hospitals Coventry & Renal Shropshire and 1 year Yes Yes Warwickshire - Renal Transplant Dialysis Staffordshire University Hospitals Coventry & Shropshire and Acute 1 year Yes Yes Warwickshire - Other Staffordshire Renal Shropshire and Dudley Group of Hospitals - Renal 1 year Yes Yes Dialysis Staffordshire Renal Shropshire and North East Wales - Renal 1 year Yes Yes Dialysis Staffordshire Shropshire and United Bristol Healthcare Acute 1 year Yes Yes Staffordshire
Page 121 Services Provided
Secure Services, High Acquired Brain Injury Fetal Medicine Neonatal Special Care Medium and Low
Specialist Paediatric Fulminant Hepatic Liver Adult Burns Neonatal Surgery Services at Birmingham Failure Children's Hospitals
Blood and Marrow Specialist Rehabilitation Growth Hormone Neurosurgery Transplants Services
Cardiac Surgery Haemophilia Paediatric Burns Spinal Cord Injuries
Cardiology including Inherited Metabolic Percutaneous Coronary Paediatric Intensive Care Stereotatic Radiosurgery Disorders Interventions Child & Adolescent Mental Thoracic Surgery including Health Services Inpatient Eating Disorders Perinatal Pathology Lung Volume Reduction (CAMHS)Tier 4
Inpatient Perinatal/Mother Clinical Genetics Psychotherapy Transport - Neonatal and Baby Services
Transport Paediatric Cystic Fibrosis Laboratory Genetics Radiotherapy Retrieval Service
Electrophysiology including Renal Dialysis (End Stage Implantable Cardioverter Neonatal High Dependency Renal Failure) Defibrillators (ICDs)
Emergency and Urgent Neonatal Intensive Care Renal transplantation Ambulance Services
Page 122 Appendix D – MH and LD Contracts and Services
NHS North Staffordshire Approx Current OT OT Services Contract CQC NHSLA OT Provider Contract 08/09 09/10 Provided Value Registration Accreditation 10/11£ Length £ £ 11/12 £ North Mental Contract Staffordshire health and to end 23,904,00 29,189 28,573 25,076 Combined Health Learning Yes Yes March 0 ,000 ,000 ,000 Care Trust Disability 2012 (CHCT) care
South Mental Staffordshire and Contract health and Shropshire to end Learning 66,000 Yes Yes 46,000 31,000 Healthcare March Disability Foundation Trust 2013 care (SSSHFT)
NHS Stoke on Trent Approx Current OT OT Services Contract CQC NHSLA OT Provider Contract 09/10 10/11 Provided Value Registration Accreditation 08/09 £ Length £ £ 11/12 £ Mental North health Contract Staffordshire and to end 40,259, 42,162 32,14 Combined Health 32,084,530 Yes Yes Learning March 101 ,747 1,052 Care Trust Disability 2012 (CHCT) care South Mental Staffordshire and health Contract Shropshire and to end 133,71 144,0 108,000 Yes Yes 112,251 Healthcare Learning March 6 91 Foundation Trust Disability 2013 (SSSHFT) care
In-patient Services Out-patients Services Adult acute psychiatry Adult acute psychiatry Child & adolescent psychiatry Liaison psychiatry Perinatal psychiatry Child & adolescent psychiatry Rehab psychiatry EMI memory Clinic Neuropsychiatry Substance misuse drug and alcohol EMI - complex care Neuropsychiatry EMI assessment Perinatal psychiatry EMI respite/crisis care Rehab psychiatry Substance misuse drug and alcohol Psychotherapy Elderly care acute, assessment and rehab Elderly Care Stroke services
Community Services Domiciliary Visits CPNs Adult acute psychiatry Assertive outreach Child & adolescent psychiatry
Page 123 Crisis resolution EMI MH early intervention Neuropsychiatry Substance misuse alcohol and drugs Rehab psychiatry Liaison psychiatry nursing Liaison psychiatry Perinatal psychiatry nursing Psychotherapy nursing CAMHS Psychology Physiotherapy Autistic Spectrum disorder service
South Staffordshire PCT Current Approx Services CQC NHSLA Provider Contract Contract OT 10/11£ Provided Registration Accreditation Length Value 11/12 £ South Staffordshire Mental health and Shropshire 53,014,741 54,132,275 and Learning 3 Years Yes Yes Healthcare Foundation Disability care Trust (SSSHFT) No Formal North Staffordshire Mental health Mental Combined Health Care and Learning N/A Yes Yes 1,147,984 Health Trust (CHCT Disability care Contract
Mental health Derbyshire County and Learning 1 Year 316,704 Yes Yes 445,020 PCT Disability care
Dudley and Walsall Mental health 185,760 Mental Health and Learning 1 year 280,451 Yes Yes
Partnership NHS Trust Disability care
Birmingham and Mental health 1 year 163,893 144,432 Solihull Mental Health and Learning Yes Yes
NHS Foundation Trust Disability care
Page 124 Appendix E – Community Healthcare Contracts and Services
NHS North Staffordshire Services provided by NHS North Staffordshire and NHS Stoke on Trent provider arm, transferred to Staffordshire & Stoke-on-Trent Partnership NHS Trust 1st September 2011. Children and Young People: Adults: Specialist Services: Childrens Hospital at Home Service Community Hospitals Long Term Conditions Childrens Occupational Therapy Biddulph Day Unit Physiotherapy Cancer and Palliative Care Health Visitors Team Physio Direct Speech and Language HMYOI Werrington Healthcare Community Matrons Therapy Continence Advisory and Infant Feeding Programme Treatment Service Occupational Therapy Safeguarding Children District Nursing Community Rehabilitation School Nursing Intermediate Care Nurse Specialists Ultrasonography Respiratory Leek Minor Injuries Unit Cardiac Outpatient Services Musculoskeletal X-ray Services (Leek) Learning Disability Tissue Viability Services Diabetes Community Intervention Services (Joint Intermediate Care & Treatment) Rapid Response Team
NHS Stoke on Trent Services provided by NHS Stoke on Trent and North Staffordshire Provider Arm, transferred to Staffordshire & Stoke-on-Trent Partnership NHS Trust on 1st September 2011.
Children, Young People & Families: Children’s Airway support team Health Visitor, including Mum to Mum Services School Nursing Sexual Health Service
Acute/Planned Care: All bed based & other services at Haywood Hospital, including Stroke rehabilitation and Early Supportive Discharge Pain management services All bed based & other services at Longton Cottage Hospital Patient appliances Asylum Seekers support team Physiotherapy Cancer support team Podiatry Primary Care Learning Disability Community Matrons Nurse Community outpatient services, dermatology Rheumatology Services – beds and & ENT outpatients, and community Community Rehabilitation Single Point of Care
Page 125 Specialist neuro rehab services – Dental Services beds and community District Nursing including night nursing & Specialist teams in Heart Failure, twilight COPD and Diabetes Intermediate care Speech and Language Therapy Musculoskeletal Service Tissue Viability Walk-In centre including DVT Occupational Therapy Service and Fracture Clinic Orthotics Wheelchair service
Children and Young People: Adults: Children and Young Persons Diabetes Community Hospitals Childrens Hospital at Home Service Cancer and Palliative Care Team Childrens Occupational Therapy Community Matrons Community Children’s Nursing Continence Advisory and Treatment Team Service Health Visitors District Nursing Palliative Care Intermediate Care Safeguarding Children Leek Minor Injuries Unit School Nursing Outpatient Services Speech Therapy Tissue Viability Services Continence Service Speech Therapy Constipation service Occupational therapy Home Enteral feeding Physiotherapy
South Staffordshire PCT Services provided by South Staffordshire PCT Provider arm, transferred to Staffordshire & Stoke- on-Trent Partnership NHS Trust on 1st September 2011.
Children, Young People & families: Children’s Airway support team Health Visitor, including Mum to Mum Services School Nursing Sexual Health Service
Acute/Planned Care: Pain management services Patient appliances Pain management services Physiotherapy Cancer support team Podiatry Primary Care Learning Disability Community Matrons Nurse Community outpatient services, dermatology Rheumatology Services – beds and & ENT outpatients, and community Community Rehabilitation Single Point of Care Specialist neuro rehab services – Dental Services beds and community District Nursing including night nursing & Specialist teams in Heart Failure, twilight COPD and Diabetes
Page 126 Intermediate care Speech and Language Therapy Musculoskeletal Service Tissue Viability Occupational Therapy DVT Service Orthotics Wheelchair service
Page 127 Appendix F – Other Contracts and Services
NHS Stoke on Trent
Ambulance Approx Contract Current Value OT OT OT Services Contract 11/12 CQC NHSLA 08/09 09/10 10/11 Provider Provided Length £000's Registration Accreditation £000's £000's £000's West 31st July Midlands 2009 to No Ambulance 1,692 Yes Yes 1,128 1,692 Ambulance 30th July Contract Service 2012
Voluntary Sector Services
Provider Services Provided
Action for Blind People To support people with failing sight, their careers and family members.
To enable older people to have a voice in the planning, implementing and monitoring of Age Concern personal health and social care services and other issues of importance affecting their lives
Day Care for older people with mental health needs and Dementia Adviser service to advise Approach Patients with Dementia. To provide independent one to one advocacy for people over the age of 18 from Black Minority Assist BME and Ethnic communities who have learning disabilities, physical disabilities and/or mental health issues.
Assist IMHA To provide independent advocacy services for those with mental health difficulties
Beat the Cold To reduce the incidence of cold related illness by reducing fuel poverty.
Beth Johnson To provide specialist advocacy support to people with dementia at key times of transition or Advocacy change.
Beth Johnson Health To improve the health and wellbeing of people aged 50+ living in Stoke-on-Trent, through the Improvement development and delivery of health promotion and prevention activities.
Brighter Futures Provide a recovery based service to people with mental health needs and their carers
To provide the local population with continued access to accessible and open-ended recovery Changes and wellness services, resulting in improved emotional wellbeing.
Citizens Advice Bureau Advocacy Service for Chronically Sick/ Disabled
To relieve the stresses experienced by carers of people with terminal illness by offering a Crossroads respite care service within the home through the provision of community based carer support workers.
Deaflinks Community based support service for hard of hearing and deafened people
Disability Solutions To provide an impartial and confidential information and advice line on all aspects of disability.
Page 128 The Donna Louise Children’s Hospice Trust provides respite and end of life care to life limited Donna Louise or life threatened children up to the age of 19. Douglas MacMillan 24/7 Specialist Advice End of Life care Pilot Douglas MacMillan End of Life care Hospice
To improve emotional wellbeing by providing counselling services to people affected by Dove Service bereavement and illness and as a result experiencing pathological anxiety and/or depression
To improve the quality of life, health outcomes, and recovery of those affected by acquired Headway brain injury.
To ensure that the Health and Social Care needs of African and African-Caribbean Elders are Hibiscus met by services that are of a high quality and that are culturally sensitive.
To help alleviate stress in families with young children and help prevent family crisis and Homestart breakdown To support and assist the carers of people with mental health needs to enable them to Making Space maintain their caring role. To give a voice to carers in the planning and delivery of Health and Social Care services
Marie Curie The provision of 'end of life' palliative nursing care services
To promote positive perceptions and awareness of mental health issues by collaborative Media Action working with the media and the general public in order to achieve a greater understanding of mental distress and related issues. To provide information and emotional support to carers, • To encourage carers support groups North Staffs Carers and give advice on how to set up and run them.
North Staffs Furniture To provide the less well-off people of Stoke-on-Trent with access to either free or low cost Mine good quality household furniture and electrical goods.
North Staffs Mind To provide a counselling service for individuals experiencing mental distress
North Staffs Stroke To provide a service for stroke families, giving them information, emotional support, helping Association them adjust to the changes caused by the stroke and reintegrating them into the community.
North Staffs User To monitor and influence mental health services in North Staffordshire. To represent the Group interests of mental health service users.
Rethink Healthy Minds The Healthy Minds Network provides support for people with anxiety, depression and other common mental health problems.
Staffordshire Buddies Support to Patient of Stoke-on-Trent with HIV
VAST Support and strengthen voluntary sector in Stoke-on-Trent
NHS North Staffordshire
Ambulance Approx Current OT OT OT Services Contract CQC NHSLA Provider Contract 08/09 09/10 10/11 Provided Value 11/12 Registration Accreditation Length £000's £000's £000's £000's
Page 129 West Midlands Ambulance Service Ambulance 1 year 5,672 Yes Yes 5,068 5,669 5,624
Prisons Popn Prison Type Prison Operator Size
Juvenile centre (15-18 years olds), male, remand Werrington and sentenced Public Sector 160
Voluntary and Other Services Current Contract Provider Services Provided Length ABBOTT Enteral Feeding Ongoing ADSIS Community Alcohol Services 1 year AETNA AGE CONCERN INFORMATION AND ADVICE Information and Advice patient service 1 year Discharge support with NUL re-ablement AGE CONCERN REHABILITATION 1 year team APPROACH Mental Health 1 year ASIST-HARPLANDS & GENERIC Advocacy 1 year ASSIST - MENTAL CAPACITY ACT Mental Health 1 year BEAT THE COLD AFFORDABLE Affordable Warmth where health related 1 year BEAT THE COLD EMERGENCY Emergency Warmth where Health related 1 year BETH JOHNSON - HEALTH IMPROVEMENT 50+ Health Improvement 1 year BETH JOHNSON-SPECIAL ADVOCACY Mental Health 1 year BRADWELL HALL Learning Disabilities Nursing 1 Year BRIGHTER FUTURES Supported Accommodation 1 year BRIGHTER FUTURES - CLUBHOUSE Day Service 1 year BRIGHTON HOUSE MH Nursing Care 1 year BURSLEY HOUSE Learning Disabilities Nursing 1 Year C&YP CONTINUING CARE RESERVE Nursing care NA CARE UK (INDIVIDUAL PLACEMENT Care Provider-individual placements 1 year PROVIDER) CARE UK MH PARTNERSHIP Mental Health services 1 Year CHANGES Self Help Groups 1 year CHEADLE HOMELINK Advisory Service to patients 1 year Annual rolling CONTINUING CARE Nursing care contract COUNSELLORS Counselling Services 1 Year CROSSROADS Domiciliary Respite End-of-Life 1 year DEAFLINKS Support to Deaf Patients 1 year DOUGLAS MACMILLAN Palliative Care 1 year DOVE SERVICE Bereavement support and counselling 1 year DRUBBERY LANE Learning Disabilities Nursing 1 Year DRUGLINK Mental Health 1 year ENTERAL FEEDING Community Services 1 Year EVOLUTION HOMECARE 1 Year Annual rolling FREE NURSING CARE Nursing care contract
Page 130 Current Contract Provider Services Provided Length HANDLEY DRIVE Learning Disabilities Nursing 1 Year HEADWAY HOUSE-DAY CARE FACILITIES Day service for head injuries 1 year HOMESTART Parenting Support 1 year LEONARD CHESHIRE Mental Health services 1 Year LIGHT HOUSE HEALTHCARE Learning Disabilities Nursing 1 Year LIGHTHOUSE (INDIVIDUAL PLACEMENT Nursing Care 1 year PROVIDER) LIGHTWOOD ROAD Learning Disabilities Nursing 1 Year MACMILLANS HOSPICE DRUGS Drug Services 1 year MARIE CURIE Cancer Care 1 year MEDTRONIC Insulin Pumps and Consumables 1 Year MOORLANDS CVS-COMMUNITY Community Engagement 1 year ENGAGEMENT MOORLANDS HOMELINK-OLDER PEOPLE & Day Services Information & Advice 1 year OFRIC NEWCASTLE-U-LYME CVS Healthlink Project 1 year NORTH STAFFS CARERS YOUNG & ADULT Info and Advice Carer support 1 year NORTH STAFFS MIND Mental Health 1 year NORTH STAFFS USER GROUP Mental Health 1 year NUTRICIA Enteral Feeding Ongoing RETHINK - COMMUNITY SUPPORT SERVICES Mental Health 1 year RETHINK - DAY OPPORTUNITIES Mental Health 1 year RETHINK - GROVE COURT Mental Health 1 year ROCHE Insulin Pumps and Consumables 1 Year SIGN HEALTH 1 year STAFFORDSHIRE BLIND - CORE SERVICES Facilities for blind patients 1 year STAFFORDSHIRE HELPS Prevention home safety vulnerable families 1 year STAFFS CC EMPLOYMENT SUPPORT Employment Support 1 Year STAFFS CC MENTAL HEALTH AND Mental Health 1 Year WELLBEING STAFFS CC SOCIAL CARE Various, Nursing and Social care (S256) 1 Year STAFFS COUNTY COUNCIL - CARERS INFO Carers info pack 1 Year PACK S28A
STAFFS COUNTY COUNCIL - CONTINUING Nursing Care 1 Year CARE (CHILDREN) STAFFS COUNTY COUNCIL - LDDF Learning Disabilities Development Fund 1 Year STAFFS COUNTY COUNCIL - LEARNING DIS: Learning Disabilities 1 Year CHOICES STAFFS COUNTY COUNCIL - LOAN STORE Equipment Loan Store 1 Year STAFFS COUNTY COUNCIL - LOAN STORE Equipment Loan Store 1 Year (CHILDREN)
STAFFS COUNTY COUNCIL - S28A CARE CO- Care co-ordination 1 Year ORDINATION STAFFS COUNTY COUNCIL - S28A ECS Elderly Care services 1 Year STAFFS COUNTY COUNCIL - S28A LEARNING Learning Disabilities 1 Year DIS: STALLINGTON REPROVISION
STAFFS COUNTY COUNCIL - S28A MENTAL MH Capacity 1 Year CAPACITY
STAFFS COUNTY COUNCIL - S28A Reablement services 1 Year REABLEMENT
Page 131 Current Contract Provider Services Provided Length STAFFS COUNTY COUNCIL - S28A Patient Telephone Helpline 1 Year TELEPHONE HELPLINE
STAFFS COUNTY COUNCIL - SECTION 256 - Mental Day Care 1 Year MENTAL DAY OPPORTUNITIES
STAFFS COUNTY COUNCIL - SUBSTANCE Substance misuse 1 Year MISUSE
STAFFS COUNTY COUNCIL- S75 POOLED Pooled Budget-nursing/social care 1 Year BUDGET STAFFS HOUSING Safe housing-distressed patients 1 Year STOKE CITY COUNCIL - RICHMOND Richmond Fellowship 1 Year FELLOWSHIP
STOKE CITY COUNCIL - ST EDWARDS MH Resettlement 1 Year RESETTLEMENT
STOKE-ON-TRENT S28A MENTAL HEALTH Mental Health 1 Year CARERS STROKE ASSOCIATION Info and Advice Carer support 1 year THE RETREAT (INDIV PLACEMENT Mental Health 1 Year PROVIDER) WEIGHT WATCHERS Healthy living support NA WERRINGTON YOI SUBSTANCE MISUSE Mental Health-substance abuse to detainees
Page 132 South Staffordshire PCT
Ambulance Approx OT OT OT Current Contract CQC NHSLA Services 08/09 09/10 10/11 Provider contract Value Registrati accreditati Provided £000' £000' £000' length 11/12 on on s s s £000's West Midlands 14,80 Ambulance Service Ambulance 3 Years 15,492 Yes Yes N/A N/A 7
Prisons
Prison Type Prison Operator Popn Size Young male adults (18-21 years old.). Sentenced and Brinsford remand, 11 inpatient healthcare beds Public Sector 577
Dovegate Adult male sentenced and remand prisoners. Private Sector (Serco) 1135 Drake Hall Women sentenced prisoners 18 years + Public Sector 315 Featherstone Adult male sentenced prisoners. Public Sector 655 Stafford Adult male sentenced prisoners. Public Sector 741 Swinfen Hall Young adult male (18-25) longer sentenced prisoners. Public Sector 654 Oakwood Adult male sentenced prisoners. Private Sector (G4S) 1605
* opened April 2012
Local Authority, Voluntary Sector, and Independent Sector Contracts Indicative Current Type of Contract Description Services Provided Geographic Contract Boundary Served Length GP SLA (DOH Brewood Dermatology Community Dermatology Stafford 1 year Community Contract) Service GP SLA (DOH Cannock Dermatology Community Dermatology Cannock 1 year Community Contract) Service GP SLA (DOH Carpal Tunnel Community Carpal Tunnel 1 year Community Contract) GP SLA (DOH W'Ton Rd Ent Service Community ENT Stafford Community Contract) GP SLA (DOH Headache Service Community Headache Cannock 1 year Community Contract) GP SLA (DOH Littleton Ward - Int Care Intermediate Care Beds Cannock 1 year Community Contract) SLA Brook Advisory Service 1 year Grant Crossroads Stone Project Carers Respite Service Stone 1 year Council For Voluntary Cannock, Stafford Grant Voluntary Support 1 year Services & Seisdon M'Dist Homes For Aged - SLA Extra care Xcare SLA Action for the Blind 1 year
DOH Community Falls Prevention Age Falls Service Cannock 1 year Contract Concern DOH Community Health Promotion Sexual Staffordshire Buddies All South Staffs 1 year Contract Health SLA Bac O Connor Beds Substance misuse 3 years SLA Bac O Connor Beds A&E Worker at BHFT East Staffordshire 3 years
Page 133 Indicative Current Type of Contract Description Services Provided Geographic Contract Boundary Served Length DOH Mental Health Starfish Mental Health Cannock & Primary Care Mental Health 3 years Contract Service Stafford Westgate GP 1 year SLA Cab Service (Westgate) Westgate GP's CAB service Practice Only rolling DOH Mental Health Casp Counselling Cannock & Mental Health Counselling 1 year Contract Service Stafford DOH Community Alcohol & Drug Adsis Intervention Project All South Staffs 1 year Contract Interventions South Staffordshire SLA Mac UK Neuroscience Dementia Service 3 years PCT Alzheimer’s Soc - South Staffordshire SLA Dementia Service 3 years Dementia Adv PCT Training for carer of South Staffordshire SLA Approach 3 years dementia patients PCT South Staffordshire SLA Resmed CPAP Machine service 4 years PCT Grant Homestart - Stafford Homestart Stafford 3 years SLA Marie Curie palliative 1 year DOH Mental Health Mental Health Drop In Cannock & Mind Drop In 1 year Contract Assessment Stafford Rethink Weekend SLA Mental health 1 year Service Carers Assoc South SLA Staffs PDSS DOH Community Cannock & Stroke Association Community Stroke 1 year Contract Stafford Cruse Bereavement Care SLA Bereavement Counselling 1 Year (Burton) Cruse Bereavement Care SLA Bereavement Counselling 1Year (Lichfield) DOH Community Cannock Cab Pilot Citizens Advice Cannock 1 year Contract Project Counselling service for East SLA Burton Mind East Staffordshire 1 year Staffs Support for family with SLA Homestart - Lichfield Lichfield 1 year Children under 5 Support for family with SLA Homestart - Tamworth Tamworth 1 year Children under 5 Support for family with SLA Homestart - East Staffs East Staffordshire 1 year Children under 5 Mencap - Community Stafford & Grant Learning Disability 1 year Support Cannock
Nursing Homes and Hospices and Other Information is available on request. Comment [WD(SC2]: ??
Page 134
© Staffordshire Cluster of PCTs 2013
Page 135
East Staffordshire Clinical Commissioning Group Quality Committee
Minutes of the Meeting held on Wednesday 24th April 2013 Meeting Room 1, Edwin House, Burton upon Trent
Present: Heather Johnstone (HJ) - Chair Susan Bamford (SB) Dr Elizabeth Gunn (LG) Ann Tunley (AT) Tony Bruce (TB) Debbie Vucetic (DV) Mark Doran (MD) Joined later by Michelle Escombe (ME)
Action 2013/1. Welcome & Apologies:
Apologies from Paul Winter.
2013/2. Minutes of previous meeting:
These were agreed as an accurate record.
Matters Arising:
SB confirmed that a meeting still has to be set up regarding Shared Care.
Action for GR will now be undertaken by Emily Davies.
2013/3. Actions from meeting on 27th March 2013:
Enclosed.
Patient Safety/Effectiveness – clear and useful measures 2013/4. Quality Reports: Key providers:
i. Burton Hospitals NHS Trust Full Report:
Members received the report.
DV still waiting for the break-down in staff which had been requested at the last CQRM meeting and she confirmed that money has been lost on CQUIN scheme. Continued complaints regarding medication with an increase over last year of 4 to-date and concerns in Ward 8 Emergency Department. 1
PALS – 290 registered this month but equal to last year. Compliments have increased; 53 in January and 48 this month.
43s – Mortality Review due on 23 May but DV though not involved will hear the outcome. Members registered their surprise DV not involved.
DV confirmed an unannounced visit to Darwin Ward in February and a Radiology review on 10th March. She reported 2 concerns regarding the nursing staff one of which is resolved as it was due to sickness.
Meditec system does not link with other systems in place but this too will be resolved shortly. LG asked what was the remit of the Keogh Review and whether it was due to too few doctors? DV confirmed it had been discussed at the last CQRM meeting and the whole process is being looked at. LG reiterated her concerns that problems do not seem to be resolved. HJ stated that reporting seems to be the real issue with Soft Intelligence highlighting a delay in reporting a cancer patient and the need to reduce reporting time in the contract. LG concerned at not having consultant reports resulting in a Tutbury patient dying and on-going problems with Radiology.
HJ confirmed that information is being gathered regarding Radiology but LG concerned with loss of staff from the department. DV agreed the need for an unannounced visit to clarify why there are delays in reporting as well as the general standard of reports. TB concerned about the possibility of legal action and the need to closely monitor. He also stated the need to look at the grades of staff; who is doing what and whether lower grade staff receive adequate training.
DV reported 3 retained cannulas in January/February. She also reported on one mortality from a heart defect in paediatrics. Work remains on-going with cannulas as well as pressure ulcers which did not achieve CQUIN. Slip, trips and falls have not improved despite extra equipment and staff training. AT asked if falls are occurring on the actual wards and DV confirmed this. HJ agreed this situation cannot be ignored especially as it has been raised previously. TB agreed that patients want independence but in some cases it may be because they have been ignored. HJ will watch closely. DV explained the difficulty with not wishing to cause any difficulties with the good relationship with BHFT as they are very good and open in their reporting.
DV reported a reduction in C Diff. SB said she will be going to the Infection Control Board on Thursday and will feed-back to members. She would continue to attend although not necessarily on a regular SB basis. DV explained that the Electronic Bank system has just gone live with the aim to reduce agency staff but Bank will continue to cause problems as staff are often working double shifts leading to 2
increased sickness which in turn results in more agency staff. DV confirmed RCA concerns were raised at CQRM but very little detail is clear in the report. The Chief Nurse is looking at this issue. SIs have been raised and will be looked at in more detail in June CQRM together with any associated issues.
HJ confirmed an increase in complaints to 32% this year with mortality figures standing at 89 in September 2012 but 104 in January 2013, consistently higher than expected. TB felt this should be a red flag issue and HJ confirmed that it will be raised at BHFT CQRM. 780 incidents are currently waiting for management review. Members voiced their concerns at such a high number especially in light of the Francis Report – HJ to call Brendon Brown to discuss. HJ
Michelle Escombe (ME) joined the meeting.
LG reported she attends the Mortality meetings but these are not minuted resulting in little evidence. Craig Stenhouse had completed an audit approximately 18 months ago but no further work has been undertaken. LG agreed to feedback to members at the next meeting. LG
TB expressed his overall concerns regarding targets but DV confirmed there are none and the honesty of the Trust is relied upon. She expressed her concern that if targets are rigidly imposed then the goodwill of the Trust will be lost and they will stop providing any reports. TB said that there must be some marker to gauge acceptability or not. The Area Team have not so far imposed any expectations but members must have more explicit information and asked when this would be likely. HJ and DV confirmed this would be soon.
Patient Experience – HJ confirmed Friends and Family reports are completed by patients.
TB asked if members consider patients are safe at BHFT. HJ confirmed that in her opinion patients are safe but there do remain several areas of concern which need to be monitored. MD said he has looked at the staff survey reports and BHFT was always the best in the county but no longer so over the past 2 years. It remains better than Mid-Staffs and UHNS but there are no signs of improvement from 2012. A full report will be available next month but he feels a lot has deteriorated. TB asked if MD has read the paper. MD confirmed he wishes to know more; is incorrect coding of deaths hiding the true picture? Are there shortfalls in Radiology?
HJ had raised concerns re this at CQRM but the consensus there had been that it was a quality rather than safety issue. TB asked what members felt needs to be done to improve and asked how far we are from removing the Trust from Choices menu? HJ confirmed very close but progress has been made although it appears that when one issue is resolved another takes its place. AT asked how long Brendan Brown has been in post and stressed the need for a cultural change which his appointment may resolve. HJ confirmed 3
he has already made some radical changes which are already having an impact but not all concerns are nursing issues and mortality and quality remain high areas of concern.
TB asked if members feel there is an approaching issue or whether they felt a corner may have been turned? He also asked when is an “enough is enough” situation would be reached and the removal from Choice; what is the tipping point?
HJ confirmed that more problems are occurring.
MD asked;- 1. Can they resolve the problems in reasonable time? and 2. Are they capable of getting any early warnings?
TB asked members to give some thought to these concerns before the next QC meeting. Members concluded that the risk is not high enough to stop sending patients but nevertheless remains concerning.
2013/6. Other Providers:
SSSFT
MD gave a brief over-view of his report which he confirmed is longer than usual due to the inclusion of SIs. He felt the Dashboard is not fit for purpose for Mental Health but HJ confirmed there is now a new form to pull together all providers. MD concerned about the level of SIs with the key issue being that community respond to unexpected deaths which may be natural causes – this remains unclear for up to 6 months until determined by the Coroner. He felt there is no evidence of an increase in suicides but maybe the correct questions are not being asked. MD and HJ confirmed they had attended a Workshop regarding the Staffordshire Suicide Strategy. Commissioning priorities for Mental Health remain unclear within the strategy and require clarification with members agreeing that work needs to be done by Public Health on this.
MD confirmed that South Staffs have no bereavement service and there is a high incidence of suicide. LG said that there is CRUSE. TB asked again whether it was felt the service was safe. MD confirmed that the tools to measure and monitor services is not effective but are safe. He has not been aware of any problems resulting from the closure of Margaret Stanhope Centre or of any major shortfalls. AT asked what else might be available but MD agreed this is not clear and that more time is needed. TB asked whether the group felt less is being done than by SSPCT but HJ did not agree as meetings have been restored to every month; lessons have been learnt from the Francis Report and the contract is now tighter. All agreed that reporting monitoring is now robust.
ME agreed to check the position with Bereavement Services and ME report back to the group.
4
SSOTP
MD confirmed that the pressure ulcer target has not been achieved although March figures are not yet available. The graph on page 6 of the report shows no reduction in incidents. This may not be the fault of SSOTP as some problems are beyond their control but are still counted as SIs against the Trust e.g. nursing home pressure ulcers.
HJ felt it would be better to end the graph at January to prevent any confusion. MD concluded that the problem may simply be down to a change in staff. HJ reported this had been discussed at CQRM. MD said that there had only been 7 Friends & Family which was too small a number to draw any conclusions from. TB asked if service is safe. MD agreed that individual branches of the service require attention rather than the overall Trust but there is no evidence of shortfalls and the service appears to be safe. There remain problems with Heart-failure but these are local issues regarding staffing and the service is safe. TB asked about the District Nurse HJ/TB review and the need for further clarification in the South. HJ agreed to discuss outside the meeting with TB as this had already been discussed by the group.
Derby
DV confirmed that further information is required. HJ explained that Derby work very differently but she is in dialogue with South Derbyshire CCG regarding both BHFT and Derby Hospitals and will ask for further details.
2013/7. Safeguarding update:
As already discussed.
2013/8. Medicines Management:
SB reported that Dr Charles Pidsley has signed 3 Standing Operation Procedures and PGDs are also signed. A letter has been sent to all practices regarding falls medication and Mark Seaton is writing a paper for the Quality Committee to update prescribing guidelines. HJ asked if he is reporting to any CCG in particular and agreed to discuss further with SB.
SB confirmed that SSOTP have lost both prescribing leads and now have an Interim Lead working 3 days per week. TB asked if there is a dashboard to establish the safety of Medicines Management and how it is possible to know what is happening and whether there is good quality compliance. HJ said that she had asked ME to attend as there are concerns around prescribing and the Quality
5
Committee does not see any information from Primary Care Quality. AT asked if there is a new Waste leaflet but SB explained there had been a copyright issue with the previous leaflet.
Patient Experience – Transparent sharing of information - 2013/9. Complaints, PALS and Soft Intelligence:
HJ confirmed there will be a quarterly report from Leslie Goodburn and they will be meeting next week to discuss this in more detail.
Soft Intelligence
HJ confirmed concerns but no report is available at present. LG asked for more clarification and guidance for GPs as to what exactly they need to do. HJ agreed and explained that the information will be logged on Datix once the system has been set up and a monthly report will be available to feed-back to GPs.
Strategy – Addressing the cultural issues in Health Service 2013/10. Clinical Risk Register:
Key updates to be done.
Tim Jones to update group regarding the Easter Bank Holiday 111 TJ provision.
Alison Heseltine has been appointed to Queen Elizabeth Hospital, Birmingham so there is now a low risk with Infection Control. Allison’s contribution to Infection Control locally was acknowledged.
2013/11. Primary Care Quality:
ME confirmed there is no quality information available at this time although she has requested an update which she will bring to the next meeting if received. TB explained that progress has been made with more sharing of information in future although there is no formal agreement at present.
2012/112. Patient Stories:
None.
Onward Reporting 2013/13. Items to report to Governing Body:
BHFT concerns.
2013/14. Items to report to other CCG committees:
None.
6
2013/15. Items for Risk Register:
Already discussed. 2013/16. Any other Business:
LG raised concerns regarding Ambulance Services. GPs need to know about delays, for example one of her patients had experienced an 8 hour delay admitting a patient to Derby despite WMAS having been called by the practice and another case of a patient experiencing delays regarding an admission to Barton. ME agreed to send a reminder to practices regarding the need to report ME soft intelligence.
2013/17. Date & Time of next meeting:
The next meeting will take place at 1.30pm – 3.30pm on 29th May 2013 in Meeting Room 3, Edwin House, Burton upon Trent.
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EAST STAFFORDSHIRE CCG QIPP, Finance and Performance Committee
Minutes of the Meeting held on Wednesday 24 April 2013, at 11.00 a.m., in Meeting Room 1, Edwin House, Burton-on-Trent
(DH) David Harding, Governance Lay Member (Chair of Committee) (CP) Dr Charles Pidsley, ESCCG Clinical Chair (TB) Tony Bruce, Chief Accountable Officer, ESCCG Present: (SL) Sarah Laing, Chief Operating Officer, ESCCG (LG) Dr Liz Gunn, ESCCG Clinical Lead part meeting (AM) Anthony Moss, Head of Contracting, Finance and Performance, CSU (PW) Paul Winter, Head of Performance and Governance, ESCCG (ID) Ilona Davies, Secretary to CFO and Chief Nurse, ESCCG (Minutes) In attendance: (MR) Martin Richards, Senior Financial Control Manager, CSU
Apologies: (WK) Wendy Kerr, Chief Finance Officer, ESCCG
ITEM ACTION 1. Apologies As recorded above.
2. Declarations of Interest None stated.
3. Draft Minutes of the Meeting of 27 March 2013 The minutes were approved as an accurate record.
4. Action Log from the Meeting of 27 March 2013 The action log was updated as follows.
27.2.2013#2 – SL confirmed Tim Jones was setting up meetings involving Derbyshire GPs regarding A&E. CLOSED 27.2.2013#4 – QIPP scoping undertaken. Looking at narrowing down from 50 to 32 indicators. Conclusion expected by end of October. Agreed item to be kept on the agenda.
27.3.2013#2 – AM confirmed action plan was in place to achieve 95% by the end of June. TB asked for 2 milestones prior to end of June agreed with BHFT to ensure on track towards target. ACTION: AM / 22 May 2013 AM 27.3.2013#3 – AM confirmed financial penalties were applied on providers not achieving 18 weeks, where we are associates. Southern Derbyshire CCG have not confirmed regarding penalties for Nuffield. AM felt assured the penalties were applied where appropriate. CLOSED
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5. Finance Report – Month 12 (Closure of Accounts 22 April 2013)
MR gave an update on Month 12 – Closure of Accounts financial position. They submitted the PCT’s accounts on Monday 22 April, achieving £750k surplus. The next step was to split it down to CCG level across 19 practices, which was nearly completed. MR was not able to give an exact figure due to work still ongoing on BHFT.
AM confirmed there were a couple of issues: Derby Hospital has over performed significantly; Burton contract was currently being discussed. DH queried whether they achieved forecasted £1m. AM responded that not yet.
TB asked for clarification of the forecasted figure. MR said he expected the final figure to be better than £700k but possibly not £1m. MR explained there were central reserves and contingencies, which they could phase out and achieve £1m but added the directive from WK was to achieve a recurrent position.
DH concluded the last year’s financial position in the range as forecasted above, would be acceptable.
6. Performance Report Enc. 6a and 6b – Papers circulated prior to the meeting.
Performance Report – Month 12 2012/13
PW explained the end of year 2012/13 report was still pending receipt of year end data.
End of year performance data in Table 1 has been provided just for A&E and Ambulance measures.
The Committee noted Ambulance performance, now reported at Staffordshire Cluster level, was deteriorating. PW confirmed that South Staffordshire PCT at PCT level was failing on a number of targets. It was noted that A&E at Burton would not be at 95% and possibly 18 weeks too.
DH questioned how these issues could be resolved going forward and how the targets could be achieved. CP felt the assumption should not be that money would provide resolution of these problems. AM said they tried to manage performance at BHFT by offering subcontracting, etc. but the issues were relating to internal processes. The solution lies in correcting A&E performance, and thus correcting elective planned care performance, to help achieve all targets.
AM confirmed that in the contract with BHFT there was a level of performance management. Success criteria are defined through the Planning Framework – Everybody Counts, and are reflected in the contract. BHFT are required to report their delivery against those on a monthly basis. In addition, there is a commitment from BHFT via their action plan to deliver 18 weeks. AM confirmed the biggest risk in terms of non-financial performance was Urgent Care and Urgent Care Access in A&E. These are the key priorities for the commissioners and the provider to turn around. SL confirmed the issues were being addressed from the Primary Care perspective by talking to practices and looking at non-elective activity; working with SSOTP to address highlighted issues; and looking at ambulatory care pathways. AM said they were targeting a reduction in admission by 6 per day.
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The Committee agreed the following in answer to PW’s questions in relation to the current year performance. - Exception reports were satisfactory for the purpose of assurance; - Contractual processes for 2012/13 A&E/ CQUINs (pressure ulcers) should not be applied as per National Contract owing to a settlement on the 2013/14 contract offer; - Regarding Cancer Waits reporting, the Area Team continue to have access to Exeter Cancer Database and should share what they own.
LG arrived.
A discussion took place around contracts. TB confirmed that going forward fines should be applied as per contract terms and as resolved by the Governing Body. Exceptions will need to be agreed by the Governing Body.
DH proposed to put as an agenda item for next meeting a discussion around the policy towards penalties, their estimated value and reinvestment to help providers. WK/ID
Performance Report – Proposal 2013/14
PW asked the Committee if the format of the proposed report was acceptable. It was noted the report had no live data as yet. TB found the report useful and asked if it was integrated with the reports used to drive the performance and delivery of QIPP/CCG programmes. PW confirmed this report was a by-product of other reports used to drive programmes. SL added that she has presented the report format to the Programme Board to be used for their reporting.
The Committee agreed the format of the report.
DH thanked PW.
7. Budget 2013/14 Update Enc. 7 – Paper circulated prior to the meeting.
MR gave and update on budget for 2013/14. MR confirmed that since March a number of additional investments were required resulting in £329k additional funding to be identified within the plans. The value has been taken off the contingency as opposed to rebasing the QIPP.
The overall QIPP figure has not changed. The value to be identified has increased as a result of the slippage in the BHFT schemes.
Progress has been made in identifying Specialised Services top-slice reductions. Currently still £1.7m remained unidentified.
MR confirmed the plan had been done but was undergoing minor adjustment. DH asked if the plan would be ready for the Governing Body meeting in May. MR expected it to be finalised by then.
DH commented he would have liked a plan to be ready before the start of the financial year. TB agreed with the principle but acknowledged early plans would be subject to change due to ongoing contract negotiations at year end.
TB provided a background to the plan. TB confirmed they were aiming to deliver 3% improvement this year.
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DH thanked MR for the update.
8. QIPP 2013/14 Enc. 8 – Paper circulated prior to the meeting.
SL asked the Committee if the format was clearer. PW felt it was a good format as an accompanying report for the planned performance dashboard. DH said it would be helpful to have clearer financial data. TB felt that for the purpose of
assurance for the Committee the report needed more information around the programme. SL concluded SL and PW had to do more work on this report. SL/PW
There were no questions around QIPP.
9. Hospitality Policy Enc. 9 – Paper circulated prior to the meeting.
A discussion took place about the policy. PW confirmed that this policy was part of ESCCG’s overall requirements for procurement and conflicts of interests. It was a draft policy that has been brought before the Committee for approval. Once approved the policy will be disseminated to staff ensuring their awareness of the content. PW clarified the policy did not apply to GPs only to Exec GPs, or
individual GPs providing managerial support to the CCG as a contracted employee.
The Committee approved the Hospitality Policy.
DH thanked PW.
10. Risk Register (Non-Clinical Risks) Enc. 10 – Paper circulated prior to the meeting.
PW gave an overview of the Risk Register. PW confirmed the trend arrows had been incorporated as requested by the Audit Committee. The Cluster risks have been closed down with risks relating to the CCG copied into the relevant area.
DH asked if the Committee were assured on the management of these risks. The Committee agreed.
There were no further questions or new additions to the Risk Register.
11. Items for Escalation to Governing Body None were requested.
12. AOB There was no other business.
A brief self-assessment took place following the meeting. The Committee members felt positive about the meeting and felt it provided them with assurance.
DH closed the meeting.
Date of Next Meeting: Wednesday 22 May 2013, 11:00 – 13:00, Meeting Room 2, Edwin House, Burton-upon-Trent.
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