Public Document Pack
Health and Wellbeing Board
Dear Member,
You are invited to attend the meeting of the Health and Wellbeing Board to be held as follows for the transaction of the business indicated. Miranda Carruthers-Watt Proper Officer ------DATE: Tuesday, 10 October 2017
TIME: 2.30 pm
VENUE: Salford Suite, Salford Civic Centre, Chorley Road, Swinton
In accordance with ‘The Openness of Local Government Bodies Regulations 2014,’ the press and public have the right to film, video, photograph or record this meeting.
AGENDA
2.30P.M.
1 People's Story (film) - a perspective on health and wellbeing 'Start Well' theme (Charlotte Ramsden / Deborah Blackburn)
2.35P.M.
2 QUESTIONS - From Members of the Public (Chair) (Pages 1 - 2)
3 Introduction and Apologies for Absence (Chair)
4 Declarations of Interest (Chair)
5 Minutes of Meeting held on Tuesday 20th June 2017 (Chair) (Pages 3 - 8)
6 Matters Arising - Review of Action Log (Chair) (Pages 9 - 10)
2.45P.M.
7 Locality Plan - progress update: Quarter 2 2017/18 quarterly (Pages 11 - 42) highlight report and risk register (Anthony Hassall)
2.55P.M.
8 Population Health Plan - verbal update (Siobhan Farmer)
3.15P.M.
9 (To follow) Start Well - issue based 'deep dive' (Charlotte Ramsden / Deborah Blackburn) Discussion with invited speakers, covering a sample of Starting Well outcome priorities, for example: further development of the Early Years Delivery Model, focus on Oral Health, Education Strategy Progress/ headlines, Work and Skills Update, Transition to Adulthood, and Emotional Health and Well-being work: building resilience.
4.05P.M.
10 Salford Suicide Prevention Strategy - including 2017/18 (Pages 43 - 90) Implementation Plan (Chair)
4.10P.M.
11 GM Primary Care Reform Investment Agreement (Anthony (Pages 91 - 146) Hassall)
4.15P.M.
12 Any Other Business (Chair)
4.20P.M.
13 Update Papers (Provided for Information & Assurance Purposes (Pages 147 - 372) Only):
(a) 2017/18 HWB Forward Plan (b) Health Protection Annual Report (c) Update on Living Wage work (d) CCG Annual Report 2016/17 (e) HWB Annual Review 2016/17 (f) Health Watch Salford – Priorities for 2017/18 and Annual Report (g) Safeguarding Children Annual Report - http://www.partnersinsalford.org/sscb/annualreport.htm (h) Safeguarding Adults Annual Report (i) Better Care Fund update (j) Locality Plan – Workforce Strategy update (k) Children and Families Act – Implementation of SEND reforms
14 Date and Time of Next Meeting - Tuesday 14th November 2017 (2 - 4pm): 'Live Well' focus
Contact Officer: Tel No: 0161 793 3011 Mike McHugh, Senior Democratic Services E-Mail: [email protected] Advisior
This page is intentionally left blank Agenda Item 2
From: Skelton, Judd Sent: 20 July 2017 12:49 To: '[email protected]' Subject: Mental Health Service User Forum - query on hoarding
Hi Anne
I hope you are keeping well. I assume you are still Chair of the Mental Health Forum – if not please could you pass this on or let me know who this is so I can do so.
Please see below a response following the questions put to the Salford Health & Wellbeing Board by the Salford Mental Health Forum regarding the issue of hoarding.
1. How can this illness (hoarding) be addressed, if those affected by it do not recognise they are ill themselves, and the services are not trained to support them?
Chris Taylor from Greater Manchester Mental Health Foundation Trust attended a recent Forum meeting to talk about this. Chris had been asked at the previous meeting if he could conduct some research to find out how people who hoard are recorded in Salford and if there are any stats. Chris assured the group that hoarding IS increasingly being recognised, and mental health services will assess people referred to them with this problem and offer treatment and support where appropriate. Chris also informed the group of the following :
Hoarding is now recognised as an illness in its own right and not just associated with the condition known as OCD.
There are 2-5% of the population estimated to have the illness
Using the Salford population figure of 239,000, and using the lower end prevalence estimate of 2%, this means that approx. 4,780 people in Salford would be estimated to have the illness (Hoarders UK) – and if upper estimate of 5% used, then this would rise to 11,950 hoarders
2. How are we going to get a standardised way of collating information about specific diagnosis for hoarding, so we can measure just how many people are in Salford and needing support?
The Salford Safeguarding Adults Board (SSAB) has recently revised and launched a new policy and procedures on self-neglect, which includes hoarding. These documents can be accessed using the following link (click on the tabs on the left hand side of the page to access the actual procedures).
http://www.partnersinsalford.org/asn-self-neglect.htm
The procedures have a specific visual tool to support agencies to identify the level of hoarding related to risk.
Page 1 There are plans to review how this policy and procedure is being applied in practice in March 2018 and there is on-going multi-agency training on the policy and procedure being rolled out funded by the SSAB.
3. Is there a clear pathway of support for people with this illness?
This is outlined in the revised policy and procedures relating to self-neglect. These guidance documents promote a multi-agency response, which includes assessing and managing the risks associated with the hoarding behaviours.
The policy draws on person centred best practice identified through extensive national research and outlines a model with two referral pathways into multi-agency forums to support a multi-agency approach to working with these issues.
The policy recognises that each response to these issues needs to be personalised to that individual, and that for each case there should be a link person to work with them and monitor the situation, feeding back into the multi-agency process as required.
I hope this response addresses your queries satisfactorily . If not please feel free to contact me
All the best
Judd Skelton Assistant Director - Integrated Commissioning NHS Salford Clinical Commissioning Group / Salford City Council Integrated Commissioning 7th Floor St James' House Pendleton Way Salford M6 5FW Tel: 0161 212 5632 Mobile: 07717341953 Fax: 0161 212 6030 Email: [email protected]
Page 2 Agenda Item 5
SALFORD HEALTH AND WELLBEING BOARD
20 June 2017
Meeting commenced: 9.00 a.m. “ ended: 10.51 a.m.
PRESENT: Tom Tasker – in the Chair
Members:
Councillor Jillian Collinson LA Representative Chris Dabbs Manchester Chamber of Commerce Councillor Tracy Kelly LA Representative Councillor Gina Reynolds LA Representative Delana Lawson Healthwatch Salford David Herne Director of Public Health Councillor Lisa Stone LA Representative Anthony Hassall Salford CCG Jean Rollinson Age UK Salford Gill Green Greater Manchester Mental Health Trust Lee Sugden Salford Strategic Housing Partnership
Invitees:
Siobhan Farmer Consultant in Public Health Claire Connor Salford CCG
Officers:
Anne Lythgoe Manager Policy & Partnerships Mike McHugh Senior Democratic Services Advisor
ITEM ACTION BY 1. INTRODUCTION AND APOLOGIES FOR ABSENCE
Tom Tasker welcomed those present to the meeting of the Salford - Health and Wellbeing Board and introductions were made.
Apologies for absence were submitted on behalf of James Sumner, Councillor John Merry, CBE, Alison Page, Margaret Rowe and Charlotte Ramsden.
1 | Page Page 3 Salford Health and Wellbeing Board
20 June 2017
ITEM ACTION BY 2. PEOPLE'S STORY - PERSPECTIVE ON HEALTH AND WELLBEING
Claire Connor and Sue Fisher introduced a video presentation.
Tom Tasker confirmed the importance of the role of members of the public in the future success of this Board.
RESOLVED: THAT an item in respect of this matter be included at the start of each future meeting of the Health and Wellbeing Board.
3. QUESTIONS FROM MEMBERS OF THE PUBLIC
A question was presented on behalf of the Mental Health Forum, as follows -
“The Mental Health Forum would like to know if certain organisations recorded any stats around hoarding, especially when it got people into trouble e.g. eviction or made them live in an unsafe environment.
The group would like to ask -
i) How can this illness be addressed when if they do not recognise they are ill themselves, and the services are not trained to support them ii)How are we going to get a standardised way of collating information about specific diagnosis for hoarding, so we can measure just how many people are in Salford and need support? iii) Is there a clear pathway of support for people with this illness?
They would like to know how they can support the prevention agenda and Salford priorities around homelessness with partnering organisations to gather data and outline a pathway of support.”
RESOLVED: THAT a response be made, in writing, directly to the Judd Skelton representatives of the Mental Health Forum; and that a copy of the response be included on the agenda for the meeting of this Board in September 2017.
4. DECLARATIONS OF INTEREST
There were no declarations of interest.
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20 June 2017
ITEM ACTION BY 5. MINUTES OF PROCEEDINGS
(a) The minutes of the meeting held on 24 January 2017, were - approved as a correct record, subject to Councillor Tracy Kelly being included on the list of apologies for absence recorded at the meeting. - (b) The minutes of the meeting held on 28 March 2017 were approved as a correct record, subject to the attendance list being amended to reflect the correct title of Chris Dabbs’ organisation, as follows: ‘Chris Dabbs - Greater Manchester Chamber of Commerce’
6. MATTERS ARISING - REVIEW OF ACTION LOG
An update was provided in respect of issues contained within the - Action Log.
7. LOCALITY PLAN - ANNUAL UPDATE OF PROGRESS
Anthony Hassall and Siobhan Farmer presented details of the annual update of progress in respect of Salford’s Locality Plan which included information relating to -
- Implementation Plan quarterly highlight report - Locality Plan Finance Update - Progress against Locality Plan outcomes
RESOLVED: (1) THAT the report be noted.
(2) THAT a risk register be provided with all future with Anthony Hassall locality plan programme updates.
(3) THAT the presentation in respect of this item be Mike McHugh / circulated to all members of the Board. Anne Lythgoe
3 | Page Page 5 Salford Health and Wellbeing Board
20 June 2017
ITEM ACTION BY 8. FACILITATED DISCUSSION
David Herne led a discussion which examined the following issues -
- Is Salford broadly on track to achieve the financial and outcomes targets set in our Locality Plan?
- Are there any areas of deviation from our initial expectations?
- If so, do we need to adjust our strategic direction?
- Is there anything additional to what is already happening that Board members must do (individually and collectively)?
A number of matters were considered which included -
- The development and implementation of the ‘My City Salford Project’
- Oral Health
- the ongoing work of the Intelligence team in data modelling and realistic outcomes and targets
- links between poor quality housing and poor quality health
- the requirement to maintain focus on areas of priority
RESOLVED: (1) THAT the new Employment and Skills Strategy for Mike McHugh / Salford be circulated to Board members. Anne Lythgoe
(2) THAT realistic and meaningful targets relating to the Siobhan Farmer outcome measures in the Locality Plan be reported at the next meeting of the Board.
(3) THAT a presentation be given on the opportunity Debbie Brown afforded by My City Salford at the meeting of this Board in October 2017.
(4) THAT the results of the Healthwatch Salford Delana Lawson engagement around Care Homes be provided to Board members.
4 | Page Page 6 Salford Health and Wellbeing Board
20 June 2017
ITEM ACTION BY 9. POPULATION HEALTH PLAN PROPOSITION - FINAL DRAFT PROPOSAL
RESOLVED: THAT an update on the potential impacts of the GM David Herne Population Health Plan for Salford be provided at the meeting of this Board in September 2017.
10. ANY OTHER BUSINESS
10a. PHARMACEUTICAL NEEDS ASSESSMENT (PNA) - UPDATE
Siobhan Farmer submitted a report containing proposals to amend the future process for Health and Wellbeing Board responses to changes in pharmacy provision in Salford.
RESOLVED: (1) THAT Anne Lythgoe and Lesley Waters continue as the named contacts for the alert emails.
(2) THAT alert emails be forwarded to a group, comprising the named members listed below, who will act on behalf of the Health and Wellbeing Board to assess the alert, from a judgement and return a response.
Consultant in Public Health Siobhan Farmer Intelligence Lead Liza Scanlon CCG Meds Management Alicia Robson Council Primary Care Commissioner Peter Varey Chair of Health and Wellbeing Board Tom Tasker / Councillor Kelly
(3) THAT comply with the statutory duty of the Health and Wellbeing Board to publish changes such as a new pharmacy or a change in provision or closure in their PNA, a six monthly update be published to the PNA website, with a contact name for any queries/more up to date information requests.
5 | Page Page 7 Salford Health and Wellbeing Board
20 June 2017
ITEM ACTION BY 11. UPDATE PAPERS
Update reports in respect of the following issues were presented for information and assurance purposes only -
(a) 2017/18 HWB Forward Plan (b) CCG Operational Plan 2017/18 (c) Salford Flu Vaccination Report (d) Memorandum of understanding between the Health & Social Care Partnership and the GM VCSE sector (e) Assurance meeting (Salford Locality and Greater Manchester Health & Social Care Partnership)
12. DATE AND TIME OF NEXT MEETING
RESOLVED: THAT the next meeting of the Board be held on Tuesday 12 September 2017 at 2.00p.m.
6 | Page Page 8 Agenda Item 6
ITEM 6 Salford Health and Wellbeing Board Action Log Date of meeting 10th October 2017 (Prepared BEFORE meeting) Contact Officer Anne Lythgoe (Policy and Partnerships Manager)
Action Person taking Progress update Completed or lead Due date responsibility Pending items: Set up a task and finish group to Chris Dabbs, Further meeting of Task and Finish October 2017 discuss the practical implications of Anne group to be convened in April principles agreed by the Board Lythgoe 2017, with a report on the current around the real Living Wage. position being brought to the Board Report back to the Board in March in September 2017. 2017. See item 13 of this agenda Additional items agreed that this meeting Respond directly to a question from Judd Skelton Response was sent on 20th July End July the Mental Health Forum about 2017. See item 2 of this agenda 2017 hoarding and then submit response September to the HWB at its September 2017 meeting Provide the Board with an update David Herne See item 8 of this agenda and September on the potential impacts of the GM note that Sarah Price, Executive 2017 Population Health Plan for Salford Lead for Population Health and to the September meeting Commissioning at the GM Team has been invited to the November HWB meeting Circulate presentations from this Anne Completed End June meeting and the paper presented Lythgoe 2017 under AOB on arrangements for Pharmacy applications Health Watch Salford to circulate Delana September the results of their engagement Lawson 2017 around Care Homes to Board members Circulate the new Employment Anne Completed End June and Skills Strategy for Salford to Lythgoe 2017 Board members Provide a risk register with locality Adam A summary of risks has been September plan programme updates Hebden incorporated into the Programme 2017 highlight report at item 7 of this agenda Develop realistic and meaningful Siobhan An update will be provided at item September targets relating to the outcome Farmer 8 of this agenda 2017 measures in the Locality Plan and report back to the Board
Page 9 1 Action Person taking Progress update Completed or lead Due date responsibility Provide more information for Board Debbie Originally planned for 3rd October – October 2017 members on the opportunity Brown now superseded by the need to presented by My City Salford understand the PSR strategic assessment. This session ill eb re- scheduled.
Page 10 2 Salford Locality Plan Highlight Report Page 11 Page 29th September 2017 Progress for the period: July-September Agenda Item 7 Key Highlights
PREVENTION: Upgrading population health, prevention and self-care • Population health plan project overview documents completed, bid for £m GM transformation fund being developed. Draft Terms of reference for a Population Health Advisory Board have been developed to oversee the delivery of the plan. • 0-25 Speech & Language Therapy review preparation for schools pilot from Sept 2017 • 0-25 Children with Disabilities preparation for pathfinder in South Locality to go live from Page 12 Page Sept 2017 • Community eating disorder service pilot started in April 2017. Integrated Community Response Service across Manchester and Salford due to start September / October 2017 (phased implementation). • MyCityHealth launched in time for Stoptober • Health Checks and Salford Standard PH targets being reviewed in consultation with GM. • Tender for Substance Misuse Services awarded across Bolton, Salford and Trafford and the service will be operational from January 2018 • GM Health and Work programme developing with GM team. Options appraisal of models being discussed. • Salford Physical Activity Strategy (aligned to the GM Moving strategy) is being launched • Cancer improvement work underway around champions, and developing rapid diagnosis service locally • New PH Consultant appointed and starting in November.
Key risks / issues
PREVENTION: Upgrading population health, prevention and self-care
Risks / issues
• Population Health Plan is GM transformation fund dependant - the £3 million relies on a sound business case • Lead for drugs and alcohol is on GM secondment – arrangements in place to pick up Page 13 Page work/manage transition • CCG 0-25 Integration fund only agreed until March 2018
Mitigation • Underspend used to give additional external consultant capacity for population health plan development and GM bid • Opportunities to further pool SCC / SCCG budgets are being considered
Key Highlights
BETTER CARE: Transforming community based care and support and standardising acute and specialist care • Quality - The Safer Salford work programme has been integrated into the transformation programme for the ICO. Safer Care Homes – third learning session held, Care Home managers undertaking peer review visits and sharing good practice. Care Homes Task and Finish Group established to ensure integrated approach to quality
Page 14 Page assurance and improvement, Quality Improvement Network now in place to facilitate integrated approach to improvement across CCG and ICO. Dashboard of indicators for care homes is in development
• Integrated Care – Mobilisation of an enhanced care team and a leadership team in the two neighbourhoods of Swinton and Eccles & Irlam and a city wide crisis response team is underway with planned full implementation in Q4. SPCT successfully launched the Salford Wide Extended Access Project (SWEAP) in August to provide extended access to primary care services to people in Swinton. During August the Salford Together team attended over 20 community events to generate engagement and input from Salford people on future health and care services. An options appraisal has been developed to increase bedded intermediate care nursing capacity in the city. Current closed capacity at The Limes residential intermediate care unit is planned to reopen by November 17 allowing all 30 beds to be utilised pre winter.
Key Highlights
BETTER CARE: Transforming community based care and support and standardising acute and specialist care
• Acute transformation - Full allocation of capital monies for Major Trauma and Healthier Together agreed subject to Full Business Case. The NW Sector programmes are being progressed. Paediatrics is approaching options appraisal with consultation subject to GM timescales, Breast and Dermatology cases for change finalised subject to Page 15 Page approval and the GM Orthopaedics Case for Change to be published imminently. Decommissioning plans are proceeding for MLU on SRFT site to close on 30 September with Bolton Ante Natal clinics now running from Walkden clinic and CMFT Ante Natal clinics moving to Lanceburn in early 2018 (subject to lease/capital works).
• Mental Health and LD – Salford’s shared point of access for Psychological Therapies (IAPT) continues to see improving patient recovery rates over Q1 and into Q2. All age suicide prevention strategy developed with partners and 1 year action plan sets out key objectives to be monitored via the Suicide Prevention Partnership, encompassing the following: Council / CCG / GMMH/ Six Degrees / Fire Service / GMP / Healthwatch.
Key risks / issues
BETTER CARE: Transforming community based care and support and standardising acute and specialist care
Risks / issues
• Capacity of staff working in frontline services to engage in improvement initiatives (quality and integrated care) Page 16 Page • Care Homes improvement – schedule of CQC inspections may impact on ability to evidence that improvement has been secured • Securing longer term Estate solutions for Integrated care and Childrens’ teams. • Greater Manchester public engagement timescales may delay NW Sector plans. • High demand, acuity and complexity in Community Mental Health Teams. Work underway to understand this better to inform commissioner response. Asylum Seeker service capacity constraints (GMMHT) owing to the increase in the asylum seeker population over the past 4 years. Short term capacity addressed and long term solutions being progressed with the ICO. Co-ordinating work regarding Perinatal Mental Health across Children's and Adults and GM Commissioners - ensuring there are no gaps and minimising duplication.
Key Highlights ENABLING TRANSFORMATION: Standardising clinical support and back office services and enabling better public services
• Integrated place - Development of neighbourhood models for Primary Care, ICO, Childrens (0-25) and all age (Eccles) continues. City Council and partners have agreed to explore the principle of bringing 0-25 and Eccles all-age together. Discussions are at an early stage. ‘My City Salford’ interactive demonstration and showcase events with businesses, stakeholders and Eccles Town Team. Page 17 Page • Integrated Commissioning - Agreement reached between SCC and SCCG about way forward in implementation of Place based recommendations of GM Commissioning Review, in particular increased pooled budgets. Salford is playing an active role in GM Commissioning Review Working Group. • IM&T – GP wifi installed in all sites. Patients online access to GP records improving. CCG working to promote access via practices and social media. Salford Intergrated Record all acute data feeds are now in place and in final stages of testing. Plans for user testing in pilot GP practices for the end of October. Bids for GM digital funds completed to gain monies for key projects to assist ICO and SIRC extension. • Estates - Improvement grant secured for conversion of bookable space at Ordsall Health Cetnre for use by new Quays practice to provide primary care capacity in the face of significant population growth. Capital confirmed for major trauma and Healthier Together. Detailed design phase for new Little Hulton Health Centre nearing completion. Key Highlights
ENABLING TRANSFORMATION: Standardising clinical support and back office services and enabling better public services
• Workforce – Wider engagement of the final draft workforce strategy took place through September (including CVS, carers, Police, Fire, housing etc) • Co-production / social value – The leading role of VCSE in a person and community centred approaches is being developed within the population health plan. Salford’s Page 18 Page 10% Better campaign – outcome measures now identified and shared. Living Wage expansion with key H&SC partners is ongoing. • Public engagement - START WELL - PHE approved brownie booklet, badges currently in production, roll out of Locality Sugar Smart pledge been delayed due to staff absence • LIVE WELL – Delivered the Locality Workforce Walking Challenge (with locality staff walking over 400 miles collectively on the day of the event. • AGE WELL – Work undertaken with Salford Community Leisure to develop an infographic to promote 6 exercises that will reduce falls. Film created to support the campaign and provide case studies of people who have fallen & now use Step Up. • PREVENTION STRATEGY – population health group now meeting regularly Key risks / issues
ENABLING TRANSFORMATION: Standardising clinical support and back office services and enabling better public services
Risks / issues and mitigation (where provided)
• Achievement of ‘Integrated Place’ savings and securing ongoing resource requirements for subsequent phases
Page 19 Page • IM&T delays – Salford Integrated record • Withdrawal of funding towards capacity building activities around social value, particularly in VCSE sector will impact upon the ability to deliver part of this programme. Alternative funding sources are being sought. • Confusion between overlap of behaviour change and communications actions as intended by Salford Together and the Locality plan. Joint plan being developed to clarify accountabilities of commissioners and providers.
• Interdependencies of population health and integrated care programmes on enablers
GM Key updates
• During Quarter 3 there will be an number of locality led self assessments (eg; ICO maturity, public sector reform and
Page 20 Page commissioning reviews) to take stock of progress following devolution. These will be undertaken as a parternership in Salford. • Transformation funding also closes in this quarter and attention turns to monitoring the delivery of GM and local programmes and understanding interconnectivity Locality Milestone Plan Refresh
Learnings from other localities (Stockport, Manchester, Wigan):
• Dedicated PMO resource at partnership / locality level as well as programme / organisational level. Commissioner hosting of PMO for Locality Plan delivery • Salford Locality Plan implementation plan has widest coverage (population health, better care and wider enablers)
• 21 Page Common challenge re: benefit realisation – eg; quantification of activity shift, £, better outcomes • HWBB in Salford more visible part of Locality Plan leadership and oversight
Learnings from GM deep dive:
• Salford most developed locality for locality plan delivery • Gaps perceived in: Evaluation and interdependencies. Salford has subsequently shared evaluation framework with GM. Interdependencies were identified as gaps for all localities and GM programmes. These will be addressed in the milestone refresh.
Locality Milestone Plan
HWBB / LPB sub group has agreed to refresh each programme at a project level through October to include:
• Quantification of benefits (£, activity, outcomes) • Project milestones not BAU / operational planning – minimise duplication with other plans
• 22 Page Clear start and end dates, accountable lead for delivery • Clarity of accountable board for each part of the plan • Clear sight line on interconnectivity / link to enablers • Clear plans for each programme (some programmes need further merging)
Last Neighbourhood (Inc. Healthy Communities) 05/09/2017 Title: Updated: Programme SRO: Associate Director Neighbourhood Services Manager S. Wright/S. Hall Acctounable meeting Eg: ICAB, Pop health board, IM&T group etc
Milesto Planned Forecast ID Activity / Milestone Description Ops Lead PM Start Date Status Progress update Benefit Realisation Wider Enablers - Key dependencies ne End Date End Date Collaborative General Practice - Specialist GPs and Clinicians / Templates CN01. £ Activity Outcome Comms & IM&T Estates Workforce Integration Engagement 1 EMIS Clinical Lead appointed S. Capper S.Hall 31/05/17 31/05/17 31/05/17 Blue x 2 EMIS Templates developed S. Capper S.Hall 31/05/17 31/05/17 31/05/17 Blue 3 EMIS Remote Consultation tested and piloted S. Capper S.Hall 30/06/17 30/06/17 30/06/17 Blue x 4 EMIS clinical lead and EMIS Template Development Lead S. Capper S.Hall 01/07/17 31/10/17 31/10/17 resource online Blue x 5 EMIS Template resources rolled out in full Y S. Capper S.Hall 01/09/17 31/03/18 31/03/18 Green 6 Viaduct specification agreed by CCG for the provision of S.Hall TBC unable to estimate start dates - see viaduct dependency Specialist GPs and clinicians element - delivery of specialist clinics Red Appendix A: Detailed Highlight Page 23 Page Reports by Programme (as at 01/08/17)
Salford Locality Plan Programmes
1. PREVENTION: 2. BETTER CARE: 3. ENABLING TRANSFORMATION: Upgrading population health, Transforming community based care Standardising clinical support and back office services prevention and self-care and support and standardising acute and enabling better public services and specialist care
Locality plan governance and delivery programmes: 1.1) Population Health 2.1) Quality of care 3.1) Integrated place 1.2) Best start in life 2.2) Integrated Care system 3.2) Integrated commissioning & streamlining support 1.3) Wider determinants of health and 2.3) Transforming and standardising 3.3) Information management and technology Page 24 Page wellbeing acute and specialist hospital care 3.4) Estates 2.4) Hospital Group – Acute care 3.5) Workforce collaboration 2.5) Mental health and learning 3.6) Co-production and social value disabilities 3.7)Research and innovation 3.8) Public engagement 1. Prevention: 1.1 Population Health SRO: David Herne PM: Siobhan Farmer
Key Deliverables 2016-2018 • Develop plan for population health and accompanying business case • Cluster commissioning of substance misuse services • Physical activity strategy complete and action plan implemented • Review of Health Checks programme in line with GM activity, and as part of the Salford Standard • Cancer screening improvement programme linking to GM Vanguard and local delivery • National diabetes prevention programme mainstreamed Progress this period Progress against • Progress made on population health plan – clearer, smaller set of proposals agreed. Project overview plan documents completed, bid form being developed. CBA advice obtained from GMCA Research Team. Meeting with GM TF team to take place on 25/9, draft TOR for Population Health Advisory Board have been Broadly on track Page 25 Page developed. It remains challenging to meet October deadline for November TFOG date. LPB to be kept versus updated. Papers scheduled for 10th October HWB meeting. milestone plan • MyCityHealth launched in time for Stoptober • Input given to Workforce Strategy for Population Health • Refreshed projections for population health outcomes completed and shared with the Board • Health Checks and Salford Standard PH targets being reviewed in consultation with GM. • Tender for Substance Misuse Services awarded across Bolton, Salford and Trafford and the service will be operational from January 2018 • GM Health and Work programme developing with GM team. Options appraisal of models being discussed. • Salford Physical Activity Strategy (aligned to the GM Moving strategy) is being launched • Cancer improvement work underway around champions, and developing rapid diagnosis service locally • New PH Consultant appointed and starting in November. Planned for next period • Finalise and submit population health plan TF application • Work to develop Population Health Advisory Board and review emerging group and function.
Issues / Risks • Capacity to ensure delivery locally of GM and local priorities • Population Health Plan is GM transformation fund dependant - the £3 million relies on a sound business case • Lead for drugs and alcohol will be going on GM secondment – arrangements in place to pick up work/manage transition 1. Prevention: 1.2 Best Start in Life
SRO: Charlotte Ramsden PM: Debbie Blackburn, Harry Golby Key Deliverables 2016-2018 • Early years (0-25) reviews and Children and Adolescent Mental Health Service (CAMHS) Transformation Plan • Complete 0-25 speech and language, children with disabilities and emotional health and wellbeing reviews • Implement recommendations from the national maternity review • Establish Integrated Community response Service and community eating disorder service (CEDS) for Children and young people up to 18 years • Re-design Community Children’s Nursing Team
Progress this period On track with • Page 26 Page New governance group for CAMHS Transformation and EHWB Test Case has met. Work continues on the key milestones alignment of the GM and Salford perinatal mental health pathways. • CAMHS Schools link pilot evaluation is planned, development of a new model for Salford schools. • Community eating disorder service pilot started in April 2017. Integrated Community Response Service across Manchester and Salford due to start September / October 2017 (phased implementation). • 0-25 Speech & Language Therapy review preparation for schools pilot from Sept 2017 • 0-25 Children with Disabilities preparation for pathfinder in South Locality to go live from Sept 2017
Planned for next period • Plans in place to extend the adult RAID service to all-age provision. • Mobilisation of the pathfinder for Children with Disabilities to include Confirm and begin using outcome measures including family and professional satisfaction surveys to be completed at multi-agency meetings, and arange further briefing / feedback sessions for staff • Mobilisation of the Speech and Language schools pilot and data analysis from Better Communication • Revised specification for Community Children’s Nursing Team finalised • Continued implementation of recommendations of national maternity review, in collaboration with Bolton and Wigan Issues / Risks • Work ongoing to fill some senior lead and project manager roles • Joint governance / pace of decisions • CCG 0-25 Integration fund only agreed until March 2018 1. Prevention: 1.3 Wider determinants of health and wellbeing SRO: David Herne PM: Jacquie Russell, Anne Lythgoe
Key Deliverables 2016-2018 • Development of Salford Poverty Strategy and work of the Salford Poverty Truth Commission • GM Working Well programme • Development of a Salford Skills and Work plan • Review of Community Safety Strategy and work plan to tackle domestic abuse
Progress this period (Last update: June 2017: Note it is proposed that this work will be built into other Progress against programmes in the refresh of locality plan milestones ) plan • Ongoing work towards the development of the Action plan which supports the Anti-Poverty Strategy • 27 Page Poverty Truth Commissioners actively informing the Action plan and ongoing workstreams On track with • Presentation of final version of the Skills and Work Plan to the Skills and Work Board scheduled for 14th key milestones June • A programme of additional work around domestic abuse will be developed, supported by a review of provision and workforce training
Planned for next period • Completion of action plan for Anti-Poverty Strategy • Commencement of early workstreams around anti-poverty strategy, including debt reduction, food banks and sanitary / hygiene and health • Procurement of work around domestic abuse, funded through the Office of the Police and Crime Commissioner • Tender assessment of social value input to the GM work and health programme – aimed at maximising wider wellbeing benefits Issues / Risks • There will be a need to ensure effective co-ordination of this work across a wide range of partners across Salford and GM to deliver the required health and wellbeing outcomes 1.2. Prevention:Better Care: 1.32.1 WiderQuality determinants of Care of health and wellbeing SRO: DavidFrancine Herne, Thorpe Charlotte Ramsden PM:PM: Jacquie Various, Russell, update Anne provide Lythgoe by Adam Hebden
Key Deliverables 2016-2018 • DevelopmentSafer Salford - ofdevelop Salford and Poverty implement Strategy an and economy work ofwide the safety Salford improvement Poverty Truth plan Commission to identify and prevent issues leading to patient • GMharm. Working Implement Well Yearprogramme 2 of the Patient Experience Strategy. Refresh the Quality and Safety Strategy beyond April 2017 • Development of a Salford Skills and Work plan •ProgressReview this of Communityperiod Safety Strategy and work plan to tackle domestic abuse Progress against • The Safer Salford work programme has been integrated into the transformation programme for the ICO. plan • Safer handover – action plans being implemented task and finish group established as a sub-group of the Clinical Standards Board to oversee progress. Review event scheduled for November. Progress this period Progress against • Safer Care Homes – beginning to gain traction, third learning session held, Care Home managers undertaking • Official launch of Anti-Poverty Strategy (February 2017) and development of delivery action plan plan Page 28 Page peer review visits and sharing good practice. Newsletter developed to share good practice. commenced • Care Homes Task and Finish Group established to ensure integrated approach to quality assurance and • Poverty Truth Commission has been collecting evidence from grass roots commissioners of the lived On track with improvement, Quality Improvement Network now in place to facilitate integrated approach to improvement experience of poverty. Presentation given at Councillors’ Policy Forum (December 2016) key milestones across CCG and ICO. Dashboard of indicators for care homes is in development • GM Population Health programme will include activities around Work and Health • Safety improvement dashboard now agreed which contains indicators relating to falls and medicines, currently • Partner consultation around draft Skills and Work Plan being piloted. • The revised Community Safety Strategy and action plan was published in November 2016 • Task and Finish group established to develop an integrated approach to improving quality in care homes in Plannedconjunction for next with period ICO leads and council representatives. • Complete Anti-Poverty Strategy partner delivery action plan Planned for next period • Presentation of final version of Skills and Work Plan to the Skills and Work Board • Encourage staff to test safety improvement dashboard • A programme of additional work around domestic abuse will be developed, funded through the Office of the Police and Crime • Continue to monitor actions around Safer Handover Commissioner • Sustain focus on care homes assurance and improvement • Continue to implement and refine quality assurance processes for providers including primary care • Review innovation bids relating to safety improvement Issues / Risks •IssuesNone / Risks • Capacity of staff working in frontline services to engage in improvement initiatives • Care Homes improvement – schedule of CQC inspections may impact on ability to evidence that improvement has been secured
2. Better Care: 2.2 Integrated Care System SRO: James Sumner, Karen Proctor, Judd Skelton PM: Michelle Urwin, Harry Golby Key Deliverables 2016-2018 • Neighbourhoods: Pilot integrated community neighbourhood model, which includes shift of relevant activity from hospital & enhanced community assets. This includes the introduction of multiagency process for identifying adults at risk, pro-active care planning and rapid response for adults with complex needs /vulnerable adults. • Extended Care: Redesign of intermediate care services, introduction of crisis response service, AHP review, home care redesign and care homes • High Volume Pathways: Implement redesigned high volume across multiple pathways e.g. MSK/Spinal, Falls, • Workforce development plan and estates development plan to support system changes • Implementation of NBH initiatives to enhance primary care services e.g. Diagnostic hub, SWEAP, Acute Visiting Service Progress this period Progress • Two substantial transformation initiatives were successfully approved in August, by the Integrated Care Advisory Board, to be against plan funded from the GM Transformation fund. These projects will see the introduction of an enhanced care team and a leadership team 29 Page in the two neighbourhoods of Swinton and Eccles & Irlam and a city wide crisis response team. Mobilisation of these important projects is underway with planned full implementation in Q4. Broadly on • The enabling functions of IM&T, estates and the workforce requirements for the new care models and the programme have track with key been identified as critical risk factors to implementation. Mitigating action has been taken by the ACS leads and risks have been escalated to appropriate boards in August. milestones • SPCT successfully launched the Salford Wide Extended Access Project (SWEAP) in August to provide extended access to primary care services to people in Swinton. • The city wide campaign to engage the public and staff in the transformation plans for Salford services has continued to gain momentum in August with attendance of the Salford Together team at over 20 community events in the month, the use of media and social media channels and promotion of the campaign through partner organisations to generate engagement and input from Salford people on future health and care services. • Intermediate Care - An options appraisal has been developed to increase bedded intermediate care nursing capacity in the city. Commissioners are currently considering this option appraisal. Current closed capacity at The Limes residential intermediate care unit is planned to reopen by November 17 allowing all 30 beds to be utilised pre winter. . Better Care Fund planning template agreed and submitted, with performance measures in line with Locality Plan and GM Investment Agreement. • Agreement of revised Service Specifications for Cardiac Rehabilitation, Care Call and Community Eye Service. • Completed service review of the Pulmonary Rehabilitation Service. Action plan to increase referrals being taken forward. • Suicide Prevention Strategy 2017 – 2022 completed. • Approval of a business case to develop primary medical care services in Ordsall – is a key deliverable in the last period • Mobilisation of SWEAP service at Swinton site – is a key deliverable in the last period • SHM / SPCT Organisational Change – is a key item planned for the next period 2. Better Care: 2.2 Integrated Care System SRO: James Sumner, Karen Proctor, Judd Skelton PM: Michelle Urwin, Harry Golby
Planned for next period – Sept 17 • Progress mobilisation of the Neighbourhood enhanced care team and the Crisis Response team. Evaluation plans to be finalised and actioned. • Digital workshop to be completed on the 7th September to determine the immediate, medium and long term IM&T requirements of the integrated care transformation programme to shape the IM&T strategy for integration. • To finalise the allocation of the non-recurrent transformation funding across priority initiatives and other transformation requirements for next 2 years by ICAB • Quarter 1 Assurance to be completed with GM Health & Social Care Partnership with GM representative to attend the Integrated Care Advisory Board on the 19th September and the completion of the GM Assurance template • Transfer of all the programme risks to Datix. Exercise to be completed in September • Complete the review of the outstanding GM indicator relating to Permanent Admissions to Care Homes with a proposal to be developed
and 30 Page presented planned to go to ICAB in early October • Transformation workshop to be undertaken on the 26th September with leads from the Accountable Care System Provider Board to review progress since April 2017 and establish next 100 day priority plan for the transformation programme • Complete promotional literature for the programme with design agency • To progress the design and build of an electronic solution to capture the programme documentation/reporting/milestones etc • VCSE conversation event scheduled for the 11th September at Swinton Park Golf Club. Over 50 people from the VCSE sector have registered. • New operational sub group of the Strategic Estates Group (SEG) to meet in September to develop and progress the immediate and short term requirements of the integrated care transformation programme. • Salford Standard new support and escalation process to commence and review of Salford Standard for 18/19 to inform decisions on the Standard for 2019/20 and onwards. • Review of the Maples Service to commence. • Direct to test endoscopy for gastroenterology pilot to start. Issues / Risks • Implementation of Integrated Care programme does not deliver activity /outcomes and anticipated savings in timescale. • IMT – the establishment of a usable integrated care record is critical. Delays and issues with IT threaten service development including IG issues causing delays • Workforce: Recruitment of suitable trained clinical and professional staff to support new models of care in development • Estates - lack of suitable estates in the community for planned clinical / care services. 2. Better Care: 2.3 Transforming and standardising acute and specialist hospital care
SRO: Chris Brookes, Jack Sharp, Karen Proctor PM: Mel Walters, Liz Calder, Harry Golby
Key Deliverables 2016-2018 • Implement the principle receiving site for Major Trauma (MT) in Greater Manchester (GM) at SRFT meeting the national specification. • Implement the Healthier Together (HT) recommendations for General Surgery and Urgent, Emergency and Acute Medicine. • Secure support for the capital business to support these developments at SRFT. • Implement the GM Cancer reconfigurations including developing mobilisation plans for commissioning a single Oesophago-gastric (OG) Cancer Service from SRFT and developing the Uro-oncology and Benign Urology service model. • Delivery of the GM Theme 3 reconfiguration and transformation and NW Sector programmes as defined by the MBI Review. Progress this period Progress against • Confirmation of full allocation of capital monies for Major Trauma and Healthier Together subject to Full Business plan Case. GM Transformation Fund bid also approved full allocation to Salford for transitional costs. • The 31 Page GM OG Cancer Implementation Board continues to develop a phased implementation plan. Dependent on • Draft GM Benign Urology Case for Change issued with standards in development. GM workshop held on 20 approval of the business cases September. including capital • The NW Sector programmes are being progressed. Paediatrics is approaching options appraisal with consultation investment subject to GM timescales, Breast and Dermatology cases for change finalised subject to approval and the GM Orthopaedics Case for Change to be published imminently. • Decommissioning plans are proceeding for MLU on SRFT site to close on 30 September with Bolton Ante Natal clinics now running from Walkden clinic and CMFT Ante Natal clinics moving to Lanceburn in early 2018 (subject to lease/capital works). Planned for next quarter • Implement the next phase of the GM MTC with UHSM switched off from receiving NWAS major trauma pathway positive patients. • Secure final FBC approval for Major Trauma/Healthier Together capital costs and finalise the sector HT business case. • Continue developing plans for GM OG Cancer and Uro-oncology/benign urology implementation. • Decommissioning of the CMFT MLU service at SRFT and planning for the opening of the Bolton FT FMU. • Finalising the Estate and mobilisation plans for the transfer of CMFT Ante-natal and Post Natal Clinics. Issues / Risks • Securing the Capital. • Securing longer term Estate solutions for Integrated care and Childrens teams. • Greater Manchester public engagement timescales may delay NW Sector plans. 2. Better Care: 2.4 Hospital Group – Acute Care Collaboration SRO: Raj Jain PM: Oz Khan
Key Deliverables 2016-2018 • Governance Architecture for Acute Care Collaboration Developed • Control Centre Business Case Development and Execution • Deliver Clinical Decision Support programme to support Digital Health Enterprise, Standard Operating Model and Group reduction of variation supported by Centre of Global Digital Excellence Work. • Transformation of patient acuity, workload management and workforce planning systems through Trend care
Progress this period Progress against
• See 32 Page Locality Programme Board Deep Dive (29/09/17) plan
All milestones on Plan
Planned for next quarter
• See Locality Programme Board Deep Dive (29/09/17)
Issues / Risks • Securing further funding for Group and Control Centre implementation 2018/19 through GM Devolution Transformation fund. 2. Better Care: 2.5 Mental Health and learning disabilities SRO: Jennifer McGovern PM: Judd Skelton Key Deliverables 2016-2018 • Strategy – ensure local commissioning strategy reflects GM mental health priorities • Review - intermediate care services, GMP Triage Pilot • Implement Salford Dementia Standard including comms campaign, delivery of dementia training for primary care teams, develop an acute care pathway for dementia, develop key worker/care co-ordinator model for dementia, review acute hospital transition arrangements for dementia • Establish a clear, strategic suicide prevention approach (work with key partners, launch a strategy, implement MH Trust CQUIN) • Integrated Care Organisation (ICO) – integrate MH services into the ICO, develop governance/assurance processes • Access Standards – ensure Salford delivers to national access standards in relation to early intervention and IAPT • Autism and ADHD (Adults) – procurement of a local service for ASD/ADHD Progress this period Progress against plan • See Locality Programme Board Deep Dive (29/09/17) Page 33 Page Broadly on track with key milestones
Planned for next period
See Locality Programme Board Deep Dive (29/09/17)
Issues / Risks High demand, acuity and complexity in Community Mental Health Teams. Work underway to understand this better to inform commissioner response. Asylum Seeker service capacity constraints (GMMHT) owing to the increase in the asylum seeker population over the past 4 years. Short term capacity addressed and long term solutions being progressed with the ICO. Co-ordinating work regarding Perinatal Mental Health across Children's and Adults and GM Commissioners - ensuring there are no gaps and minimising duplication. 3. Enabling Transformation: 3.1 Integrated Place SRO: Debbie Brown PM: Jacquie Russell
Key Deliverables 2016-2018
• Develop integrated place strategy for Salford and deliver a place based early adopter test in Eccles • Determine objectives of Integrated Place with regard to health and social care neighbourhood working, linking to wider public and third sector structure and services.
• Deliver a new online community platform - My City Salford.
Progress this period Progress against
Page 34 Page plan • Development of neighbourhood models for Primary Care, ICO, Childrens (0-25) and all age (Eccles) continues. Connections have been made with City Council and GP leads for primary care – exploring On track with connectivity between models, and how to maximise opportunities. key milestones • City Council and partners have agreed to explore the principle of bringing 0-25 and Eccles all-age together. Discussions are at an early stage.
• My City Salford interactive demonstration and showcase events with businesses, stakeholders and Eccles Town Team. • My City Salford Exchange Network showcase.
Planned for next period • City Council and partners to further discuss the development of neighbourhood models.
• My City Salford interactive demonstration and showcase events with community groups and residents in Eccles, Winton, Barton, Irlam and Cadishead (Early adopter area). • Create initial profile content in the early adopter area in preparation for platform launch. Issues / Risks • Achieving savings and securing ongoing resource requirements for subsequent phases.
3. Enabling Transformation: 3.2 Integrated Commissioning & streamlining support SRO: Anthony Hassall, Charlotte Ramsden, PM: Harry Golby, Jennifer McGovern
Key Deliverables 2016-2018
• Deliverables to be developed following engagement and involvement of key stakeholders.
For streamlining provider support services – see Better Care 2.4 Acute collaboration
Progress this period Progress against • 35 Page Agreement reached between SCC and SCCG about way forward in implementation of Place based plan recommendations of GM Commissioning Review, in particular increased pooled budgets. • Programme Management arrangements agreed and established in part. On track with • Active role in GM Commissioning Review Working Group. key milestones
Planned for next period • Proposal to be developed in relation to Place based recommendations of GM Commissioning Review, in particular increased pooled budgets, for agreement by SCC and SCCG in November 2017. • Fully establish Programme Management arrangements. • Discussions to begin with SRFT/ICO/SPCT regarding implementation of GM Commissioning Review.
Issues / Risks • None at present 3. Enabling Transformation: 3.3 Information management and technology
SRO:3. Enabling Steve Dixon, TransformationRaj Jain : Integrated CommissioningPM: Caroline Rand, & Rachel streamlining Dunscombe support SRO: Anthony Hassall, Charlotte Ramsden, Jack Sharp, Raj Jain PM: Harry Golby, Jennifer McGovern, Oz Khan Key Deliverables 2016-2018 Key• Building Deliverables a connected 2016-2018 city - network links and Wi-Fi plans • ExploreDigital First options for Salfordians to further develop integrated commissioning arrangements, supported by the Kings Fund • Data and intelligence collaboration - Establish economy wide intelligence and performance group For• Digital streamlining road map provider and connected support cityservices - alignment – see Better work planCare of2.4 Salford Acute partners collaboration to GM roadmap • Salford Integrated Record (health and social care and mental health) • Acute Care Collaboration - Enhancing patient experience and engagement through Digital Patient activation • Acute Care Collaboration - Automation and digitisation of acute care transactions Phase 1 Global Digital Excellence (GDE) move to paperless hospital Progress this period Progress against Progress• 36 Page Second this Integrated period Commissioning workshop held, facilitated by Kings Fund. The outcome was an Progressplan broadly • Localagreement Digital to Plan develop developed proposals with that Salford can IM&T be formally strategy considered group. by Local Authority and CCG governance. on track: • GPFollow wifi- upinstalled meeting in allrelating sites, togo Publiclive delayed Health in has some taken due place. to technical issues which are being worked On track with • through.Follow-up discussions relating to Children’s Services have taken place . Next steps have been considered at Keykey milestonesissue – • Patientsexisting 0online-25 Programme access to GPOversight records Group. improving slowly. CCG working with neighbourhood to promote access delays to SIRC • viaJoint practices business and planning social media.commenced ( all children’s services) • SIRC- all acute data feeds are now in place and in final stages of testing. Plans for user testing in pilot GP Plannedpractices for next for the period end of October. • DevelopmentMy City test period of proposal imminent. for the Some establishment issues with of Information more integrated governance commissioning are being workedarrangement on. of (adult) Public Health • ServicesBids for GM building digital on funds existing completed integrated to gaincommissioning monies for arrangementskey projects to to assist be considered ICO and SIRC through extension Local Authority and CCG Plannedgovernance. for next period • Development of proposal for the establishment of separate integrated commissioning arrangements for Children’s services, to • SIRCbe progressed- soft go live through with GP Local test Authority sites. and CCG governance. • Further develop network links in line with GM technical programme. • My City in full test in one area. • GM Digital to release conclusion about funds. Issues / Risks Issues• None / Risks at present
• SIRC programme is not delivering at the pace required. • GDE programme being reviewed to ensure capacity for change is aligned with priorities. 3. Enabling Transformation: 3.4 Estates SRO: Charlotte Ramsden PM: Elaine Vermeulen, Lindsay McLuskie
Key Deliverables 2016-2018 • Development of a Salford Estates Strategy 2017-2022 • Estate Utilisation - work with providers to improve utilisation and plan to transfer services to community estate - develop Neighbourhood strategy • Exploration of VCSE use of estate infrastructure and develop policy on asset transfer Progress this period Progress against • Detailed design phase for new Little Hulton HC nearing completion plan • Detailed design undertaken for relocation of CMFT antenatal at Lance Burn Health Centre, and heads of terms agreed regarding relocation of Pendleton IC team from Lance Burn to St James to accommodate this. On track with • Contractor on site for Ingleside development key milestones • Improvement grant secured for conversion of bookable space at Ordsall HC for use by new Quays practice Page 37 Page to provide primary care capacity in the face of significant population growth • Six facet surveys completed for all primary care medical premises, regardless of ownership • Feasibility study on existing GP utilisation of Ordsall HC completed • Capital confirmed for major trauma and Healthier Together Planned for next period • Bid for funds for Neighbourhood Asset Review from GM • Six facet surveys to be collated and results analysed for actions in support of primary care estate strategy • Agreement on actions arising from feasibility study on existing GP utilisation of Ordsall HC • Full planning submission for the new Little Hulton Health Centre • Workshop to relaunch the Lower Broughton development • Continuing dialogue with stakeholders for new Irlam development • Feasibility of relocation of another GP practice to Walkden Gateway to be assessed • Joint appointment of out of hospital estates project manager by SRFT and CCG Issues / Risks • Agreement with NHS England dental commissioners to release space at Ordsall HC to accommodate the requirements of the new MediaCity practice, and timely progression of the works to be undertaken by NHS Property Services • Delays in SCC decision on preferred development partner at Lower Broughton may delay relaunch workshop • Slippage in completion of Ingleside development likely, and additional cost pressure identified re CQC compliant fit out..
3. Enabling Transformation: 3.5 Workforce SRO: Sam Betts PM: Sue Louth, Catherine Sharples
Key Deliverables 2016-2018 • Deliver the year one actions as detailed in the Year 1 action plan agreed by the Workforce Transformation Group including; • Development and implementation of a cross organisation workforce engagement and communication plan • Develop and deliver a workforce learning and development plan to develop workforce capabilities to work in integrated teams utilising a whole system approach for working with citizens • Maximise opportunities presented by the Apprentice Levy • Through a culture and behaviour change strategy establish a shared sense of vision and values and common language across all organisations • Roll out of a joint leadership development programme • Establish a true cross system workforce baseline to underpin future workforce planning needs Page 38 Page Progress this period Progress against plan • See Workforce deep dive Locality Programme Board (29/09/17) On track with key milestones
Planned for next period • Year 1 deliverables to be refreshed to reflect final workforce strategy • Workshop to take place on 13th September with wider workforce group (including CVS, carers, police and fire service) to agree action plan to support implementation of strategy and to establish task and finish groups. • Submission of final workforce strategy. Issues / Risks • Capacity 3. Enabling Transformation: 3.6 Co-production and social value SRO: Alison Page PM: Anne Lythgoe
Key Deliverables 2016-2018 • GM Inclusive Growth and participation in GMISR • VCSE Strategy and investment plan • Partner organisations to sign the 2016/17 Social Value Pledge (10% BETTER) • Feasibility proposal for paying of Living Wage across all HWB partner organisations • Work to influence commissioning arrangements for social value across GM • Develop VCSE offer to articulate contribution to Locality Plan programmes • Develop commissioning policy and toolkit for social value and incorporate within commissioning functions • Support providers to publish ‘social accounts’ alongside their financial accounts Progress this period Progress against • Page 39 Page Engagement around VCSE Strategy at sector conference in June 2017 plan • Launch of the City-wide Volunteering Strategy and Action plan in June 2017 • Continued development of social value work as part of GM Population Health Plan – quick wins identified On track with • Review of Salford’s ‘Social Value Toolkit’ ongoing key milestones • Development of 10% Better campaign – outcome measures now identified and shared • Ongoing discussion with key H&SC partners around payment of the Living Wage Foundation Living Wage • Development of person and community centred approaches section of Population Health Plan and Transformation Fund bid Planned for next period • Submission of TF bid for Person and Community Centred approaches (including neighbourhood social prescribing model) • Investment Round Table discussion around VCSE funding (October) • Launch of 10% Better campaign in Salford (October) • Initiation of review of GM Social Value Policy • Launch of updated social value toolkit (October)
Issues / Risks • Withdrawal of funding towards capacity building activities around social value, particularly in VCSE sector will impact upon the ability to deliver part of this programme. Alternative funding sources are being sought.
3. Enabling Transformation: 3.7 Research and Innovation SRO: Francine Thorpe, Debbie Brown PM: Kirstine Farrer, Stephen Fry
Key Deliverables 2016-2018 • Develop and implement a Salford health and social care research and innovation strategy • Develop an Integrated Salford research group focussed on population health priorities • Secure innovation partners to support the development and testing of technology • Develop an integrated smart data and analytics platform to support a joined up, intelligence led approach across partners. • Launch My City Salford and My City Health platforms to support an asset based, community led approach.
Progress this period (latest update June) Progress against • The Salford research and innovation strategy has been shared with partner and commissioned research plan and innovation organisations and GM CCGs Page 40 Page • Annual research prioritisation completed at the CCG members event - the priorities were diabetes, On track with cardiovascular disease, and mental health in 2016/17. key milestones • IROG has representation from CVS and City Council. • CLES evaluation of £1m 3rd sector and schools innovation fund published (11:1 return on investment) • CCG Team completed IS4L course ‘Broughton Believers’ • Digital technology innovation bids– 124 applications shortlisted to 22 and assessed via a Salford wide market place event and Dragon’s Den panel. 4 successful bids: Guardian Angel project, Salford Active Walk, Salford CTZN App and improving pharmacy communications. Partnership with Trustech. • Non digital - innovation bids: Digital Resilience; Hearing Matters, Empower, Mindsteps, Improving Transfers of Care and Patient safety in Salford Intermediate Care Units, A compassionate cognitive behavioural psychotherapy group for people who self-harm; The Green Curriculum; Acute Home Visiting (AHV) Paramedic service; Ordsall & Claremont Neighbourhood - Primary Care Diagnostic Unit Planned for next period • Innovation calls planned for 17/18; digital call, locality call, safer Salford and SPCT call. • Further develop processes for cascading research findings including how to engage the public and improve the conduit of academic research into commissioning • CLAHRC are conducting a qualitative research project to explore the impact of various initiatives on general practices in Salford designed to relieve pressure on practices e.g. workforce development and practice pharmacists
Issues / Risks None. 3. Enabling Transformation: 3.8 Public engagement SRO: Hannah Dobrowolska PM: Claire Connor Key Deliverables 2016-2018 • START WELL - focussing on making best use of the national Change 4 Life campaign and then working out the best way to deliver the messages to young people and parents in Salford using the resources we have in place. • LIVE WELL - focussing on making best use of the national One You campaign and then working out the best way to deliver the messages to the general adult population in Salford using the resources we have in place. The majority of efforts this year will be towards staff from within the locality partnership, as many are Salford residents. • AGE WELL - focussing on addressing the issue of Salford’s high level of injurious falls and then working out the best way to deliver the messages across Salford using the resources we have in place. • PREVENTION STRATEGY – create an offer for social movement • MY CITY SALFORD – support the digital engagement initiative, ensuring it achieves the HWBB needs Progress this period Progress against
• 41 Page START WELL - PHE approved brownie booklet, badges currently in production, roll out of Locality Sugar plan Smart pledge been delayed due to staff absence • LIVE WELL – Delivered the Locality Workforce Walking Challenge (with locality staff walking over 400 miles On track with collectively on the day of the event. key milestones • AGE WELL – Work undertaken with Salford Community Leisure to develop an infographic to promote 6 exercises that will reduce falls. Film created to support the campaign and provide case studies of people who have fallen & now use Step Up. • PREVENTION STRATEGY – population health group now meeting regularly • MY CITY SALFORD – no progress to report Planned for next period • START WELL – HIS commissioned to deliver Crucial Crew around sugar smart, launch of Brownie booklet • LIVE WELL – Launch of One You Fest across locality (SCC w/c 2/10/17 , other partners w/c 9/10/17). Development of Innovation Funds bid for family friendly walking app (in partnership with SCL and Salford Ramblers) • AGE WELL – Falls engagement session as part of Older Persons Day (launch of film, demo from Step Up, distribution of tea towels with falls exercises and interactive presentation about preventing falls) • PREVENTION STRATEGY – group meeting to work up detailed business case around social movement • MY CITY SALFORD – begin uploading content Issues / Risks This page is intentionally left blank
Agenda Item 10
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l e a n b i u n t d , i p v o id t u e a n l t t ia r l a ly g , e t d o y a b l u s t o a h l a so ve h a as n a i ‘ m rip pa p c le t o ef n fec as t’ t m hat an has ast y a bee at le s 8 n estim affect 0 in ated to directly divi duals in total
Page 43 INTRODUCTION
The Salford Suicide Prevention Partnership that has been tasked with developing this suicide Salford City prevention strategy comprises Salford Royal Council Foundation Salford NHS the following membership: NHS Trust CCG
Greater Manchester In addition to this membership, Police: Salford Six Degrees a wide range of organisations and Division Salford services have kindly agreed to form a Suicide virtual reference group to be consulted Greater Manchester Greater and advise on particular issues relating to Mental Health Prevention Manchester NHS Pubic Health the strategy and associated prevention, Foundation Network Trust Partnership intervention and post-vention actions. Healthwatch HM Prison Forest Bank The Salford Suicide Prevention Partnership would like to thank those individuals affected by suicide who shared their experiences and expertise throughout the development of this strategy. Their involvement has resulted in a more informed and robust strategy, which will benefit all Salford citizens. We remain committed to involving CONTENTS people with personal experience throughout the implementation of the strategy in the years to come.
eptions sconc abou Salford’s Vision Mi t S on uic m id m e o Why do we need a C Myth: People who are suicidal suicide prevention strategy? want to die. What do we currently know? Fact: The majority of people who feel . Objectives and next steps suicidal do not actually want to die; they do not want to live the life they . Help in Salford have. The distinction may seem small but is in fact very important and is why talking through other options at the right time is so vital.
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Preventing suicide in Salford 1 FOREWORD
In 2015, 22 people who felt that they had no 22 people took other choice, 22 people denied a future, 22 sets of family, friends and colleagues their own life who are left behind, bereaved, 22 in Salford preventable deaths, 22 too many.
All public sector partners in Salford are Suicide prevention is most effective when it pledging our commitment to work together is addressed across the life course and when to address the devastating impact that suicide combined with wider prevention strategies that has on families and communities and ensure improve the mental health and wellbeing of the that suicide should always be considered an population and the wider determinants that avoidable occurrence. We pledge to ensure that impact on health, such as employment, low appropriate and accessible support is available income and housing. at a time of personal crisis so that people do not consider suicide as the only solution to the We have established excellent and unique difficulties that they face. relationships across key partners in Salford where we are working together to achieve There is an established a Suicide Prevention common goals. Developing this strategy Partnership to develop a strategy for children, will build on these strong partnerships. Our young people and adults, which will identify key collective vision and purpose will hold us objectives to work on together. This strategy accountable to the people of Salford. highlights key high risk groups and contains pledges to support existing and new prevention and intervention initiatives that promote positive mental health and wellbeing.
Paul Dennett Dr Tom Tasker (City Mayor) – Chair, Salford NHS CCG
Page 45
Preventing suicide in Salford 2 Loss of life through suicide clearly presents an ONE. Salford’s Vision individual tragedy but also has a ‘ripple effect’ Our vision is that Salford is a city where that has been estimated to affect as many as 80 3 suicide is considered to be an avoidable other individuals in the wider community . occurrence. A city where key partners work The Salford Suicide Prevention Strategy together to ensure that appropriate and (2017 – 2022) aims to bring together statutory accessible support is available at a time services, the voluntary sector, and communities of personal crisis. A city where people do in Salford to ensure that appropriate not consider suicide as the only solution to information, advice and support is available at the difficulties that they face. A city which times of crisis. strives towards an aspiration of zero deaths by suicide. Our objectives are: By raising awareness of suicide across Salford, 1. Salford will achieve Suicide Safer we are striving to ensure that individuals Community accreditation experiencing thoughts of suicide will be supported to positively challenge their negative 2. Develop an awareness of suicide thoughts and feelings, so that they no longer prevention and increase capacity view suicide as the only solution to the of individuals and organisations to difficulties they are facing. respond to and engage proactively with individuals in distress and individual This document sets out Salford’s objectives to who are perceived to be at high risk of achieve our aspiration that the act of suicide is suicide. always viewed as being preventable and, as a 3. Provide effective support to individuals consequence, that future incidents of suicide who have been affected by a suicide in Salford will be prevented or, at the very least bereavement the potential of such tragedies occurring will be substantially reduced. 4. Build a wider partnership approach 5. Align and / or incorporate the Salford It is acknowledged that there is a view in Suicide Prevention Strategy with other some exceptional cases, such as for individuals strategies and programmes with a progressive medical condition which 6. Making a difference severely impacts on the quality of their life, that suicide can be seen by that individual as being Suicide prevention is identified as a key priority an informed choice. This strategy does not in the Salford Locality Plan (the ‘blueprint’ for attempt to comment on the loss of life in these Health and Social Care services throughout circumstances, but adopts a focus on providing Salford), with a particular relevance to the effective interventions that will seek to prevent section on ‘Living Well Outcomes’1. loss of life wherever possible.
Suicide prevention is also a key priority in the mental health agenda for Greater Manchester devolution, and Salford has well developed links to engage with initiatives across Greater Manchester. Furthermore, suicide prevention is also a national priority with targets being set for localities to reduce the number of people taking their own life by 10% by 20202.
1. Local suicide prevention planning. Public Health England October 2016 3. Berman A.L., Estimating the Population of Survivors 2. Local suicide prevention planning. Public HealthPage 46 of Suicide: Seeking an Evidence base (Journal of the England October 2016 American Association of Suicidology) (2011) Preventing suicide in Salford 3 TWO. Why do we need a Suicide Prevention Strategy?
The National Suicide Prevention Strategy4 The latest report to update the strategy, published in October 20165 highlights the Salford’s approach will maintain fidelity to the following high risk groups: 2012 National Suicide Prevention Strategy that highlights the following key areas: • men • people who self-harm Area 1: Reduce the risk of suicide in key high- risk groups, • people who misuse alcohol and drugs • people in the care of mental health services Area 2: Tailor approaches to improve mental • people in contact with the criminal justice health in specific groups, system Area 3: Reduce access to the means of suicide, • specific occupational groups, such as doctors, nurses, veterinary workers, farmers Area 4: Provide better information and support and agricultural workers to those bereaved or affected by suicide, Area 5: Support the media in delivering sensitive approaches to suicide and suicidal onceptions ab isc out behaviour, M Su on ic m id m e Area 6: Support research, data collection and o C Myth: monitoring. Most suicides happen in the winter months.
Fact: Suicide is more common During this engagement process, the in the spring and personal journeys of those affected by summer months. suicide and the barriers individuals and families have experienced have been heard. This includes contact from front line emergency services, the Coroners Court as well as support services. These views need to influence change so that those who are touched by suicide receive empathy, have a voice and receive sufficient levels of support quotes from people who have been affected by suicide
4. National Suicide Strategy, “Preventing Suicide in England: A cross Government outcomes strategy to 5. Local suicide prevention planning. Public Health save lives” (2012) England October 2016 Page 47
Preventing suicide in Salford 4 Greater Manchester Suicide The Five Year Forward View Prevention Strategy for Mental Health6 The GM Suicide Prevention Strategy was The Five Year Forward view for Mental Health launched in February 2017. It identified six key requires: priorities: • All areas to have a multi-agency suicide • All ten boroughs (and GM as a whole) prevention plan in place by 2017. will achieve Suicide Safer Communities • The prevention plan has to contribute to Accreditation (the ‘nine pillars of suicide the national target for a 10% reduction in prevention) by 2018 suicides by 2020/21 (i.e. a 10% reduction • Mental Health Service Providers will when compared to 2016/17 levels) for collaborate to work towards the elimination Salford this would mean two to three of suicides for in-patient and community fewer deaths by suicide based upon 2015 mental health care settings by continuous numbers. quality improvement in relation to 10 key ways for improving patient safety. • We will strengthen the impact and contribution of wider services • We will offer effective support to those who are affected ptions sconce abou • We will develop and support our workforce Mi t Su on ic m ide to better assess and support those who may om be at risk of suicide C Myth: You have to be mentally ill • We will use the learning from evidence, to think about suicide. data and intelligence to improve our plan and our services. Fact: Most people have thoughts of suicide from time to time and not all people who die by suicide have mental health problems at the time of death. However, many people who take their own lives do suffer with their mental health, typically to a serious degree. Sometimes it’s known about before the person’s death and sometimes not. Approximately two thirds of people who die by suicide have not been in contact with mental health services.
We need to raise awareness of suicide prevention in order to tackle stigma – promote that it is ok (and right) to talk about our mental wellbeing quotes from people who have been affected by suicide
6. NHS England Mental Health Taskforce :Implementing the Five Year Forward View for Mental Health (NHS England July 2016)
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Preventing suicide in Salford 5 There are specific contributory factors Preventing suicide is achievable that increase the risk of suicide11 It is known from data on suicide and suicidal The most significant predictive indicators that behaviour12 that a range of protective factors someone may be at additional risk of suicide are also evident, which include: include: • effective coping and problem solving skills, • previous episodes of self-harm, • presence of reasons for living, hopefulness • mental ill health, and optimism, • depression / stress (which may not have • being in control of behaviour, thoughts, been formally diagnosed), emotions, • alcohol and substance misuse, • high self-efficacy, • debt and unemployment, • physical activity and health, • living in an area of deprivation, • family connectedness, • adverse life events (e.g. relationship • supportive schools, breakdown), • religious belief / traditions, • individual vulnerabilities and coping • engagement in sport. mechanisms, • social isolation / living alone. A number of these protective factors in combination potentially reduces a person’s risk However, it also needs to be acknowledged profile significantly. that although specific risk indicators are known, suicide occurs in all population groups, and targeting high risk groups alone will be unlikely to substantially impact the total number of suicides in Salford.
It is also evident that risk factors are often multi-faceted and although an individual may be exposed to several risk indicators, this does not inevitably mean that they are personally at increased risk. Individual coping mechanisms Listen to those who have experienced will critically influence the individual’s response to areas of stress in their life. Our aim is to loss from suicide – we want to prevent deliver a comprehensive strategy that both others going through the pain we enhances individual coping strategies and have. People helping people supports community awareness and resilience through a range of integrated interventions. quotes from people who have been affected by suicide
11. Appleby L et al (2016) National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. The University of Manchester. 12. Risk and Protective Factors for Suicide and Commissioned by the Healthcare Quality Suicidal Behaviour: A Literature Review. Scottish Improvement Partnership (HQIP) Government Social Research (2008)
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Preventing suicide in Salford 6 Suicide has a wide impact There are specific groups of people at higher risk of suicide10 There were 4,882 deaths registered from suicide in England in 20147 (this is the most recent year From the high risk groups identified in section for which complete data is available). two, for example, men are recognised as the highest risk group. Three in four deaths by Although suicide rates could be viewed as being suicide are men. Suicide is the biggest killer of at a relatively low level in the wider population, men under 49 and the leading cause of death its aftermath is profound and far-reaching, with in men aged 15 - 29. Increasingly, middle as many as 80 additional people being affected aged men (particularly) and older men are by any one incident8. represented in the data on deaths by suicide.
Additionally, for each adult who died from This National view on the prevalence of suicide it is estimated that there may have been suicide amongst males is mirrored in Salford’s more than 20 others who self-harmed9. experience.
onceptions ab isc out M Su on ic m Myth: id m e o C Once a person has made a serious suicide attempt, that person is unlikely to make another.
Fact: People who have tried to end their lives before are significantly more likely to eventually die by suicide than the rest of the population.
Why is one of my most common thoughts. Why have I been left to deal with this? quotes from people who have been affected by suicide
7. Office for National statistics in the UK in 2014 (2016) 8. World Health Organisation Department of Mental Health and Substance Misuse, “Preventing Suicide: how to start a survivors group”, Geneva WHO (2008) 10. National Suicide Strategy, “Preventing Suicide in 9. WHO. Preventing Suicide: A Global imperative England: A cross Government outcomes strategy to (2014) save lives” (2012) Page 50
Preventing suicide in Salford 7 Suicide is everybody’s business Support to people who have been affected by suicide bereavement is crucial Statutory services, voluntary sector organisations, transport organisations and Compared with people bereaved through other members of the wider community all have a causes, individuals bereaved by suicide can have role to play in supporting Salford citizens in an increased risk of suicidal ideation, psychiatric times of crisis, which can often be centred hospital admission and depression, as well as around providing the opportunity to “start a poor social functioning13. supportive conversation” with a person who may be contemplating suicide.
Restricting access to the means Being affected by suicide opens for suicide is effective a ‘Pandora’s box’ creating an escape, a solution, which otherwise This is one of the most evidenced areas of suicide prevention and can include physical wouldn’t have been considered an interventions (e.g. barriers on bridges), as well option when life gets too much as opportunities for positive interventions (e.g. signage providing contact details for support quotes from people who have been affected by suicide services).
nceptions ab isco out S n M uic mo ide om C Myth: Talking about suicide is a bad idea as it may give someone the idea to try it.
Fact: Suicide can be a taboo topic in society. Often, people feeling suicidal don’t want to worry or burden anyone with how they feel and so they don’t discuss it. By asking directly about suicide you give them permission to tell you how they feel. People who have felt suicidal will often say what a huge relief it is to be able to talk about what they are experiencing. Once someone starts talking they’ve got a better chance of discovering other options to suicide.
13. Effects of Suicide Bereavement on Mental Health and Suicide Risk. Dr A Pitman et al, The LANCET Psychiatry Vol 1, No.1 p86 – 94 (June 2014) Page 51
Preventing suicide in Salford 8 Responsible media reporting is critical The social and economic cost of suicide justifies investment in Although there are already clear guidelines suicide prevention work for the media14,15 the House of Commons Health Committee highlights that the main Estimates of the years of life lost through issue relating to the media is the failure to suicide for the 3 year period 2012–14 are universally implement the available guidance16. averaged as 35 years (54.5 years for men, The World Health Organisation also identifies and 14.8 years for women)18. Additionally, links between media coverage and imitative as previously highlighted, each suicide can behaviours: potentially affect as many as 80 other people19.
“Vulnerable individuals may be influenced The social impact and associated economic to engage in imitative behaviours by costs relating to suicide are therefore extremely reports of suicide, particularly if the significant and provide additional impetus to coverage is extensive, prominent, invest in effective suicide prevention work. sensationalist and / or explicitly describes the method of suicide”17.
onceptions abo isc ut n M Su o ici m de om C Myth: People who threaten suicide are just attention seeking and shouldn’t be taken seriously.
Fact: People who threaten suicide should always be taken seriously. It may well be that they want attention in the sense of calling out for help, and giving them this attention may save their life.
14. Media Guidelines for Reporting Suicide 5th Edition, The Samaritans (September 2013) 15. Preventing suicide in public places: A practice resource. Public Health England (November 2015) 16. Suicide Prevention: interim report. House of Commons Health Committee HC300 (December 18. PHE Fingertips Tool 2016) 19. Berman A.L., Estimating the Population of Survivors 17. Preventing Suicide – A Resource for Media of Suicide: Seeking an Evidence base (Journal of the Professionals, WHO (2008) American Association of Suicidology) (2011) Page 52
Preventing suicide in Salford 9 National, Regional and Local data Sudden / unexpected deaths of children for 2014 (the latest year for which there is completed data)20 Every sudden and unexpected death of a child or young person under the age of 18 years There were 4,882 deaths from Suicide and is referred to the Greater Manchester Rapid Injuries Undetermined in 2014 in England, of Response team. This team meets with families which: and collects information from other agencies to help determine why the child has died. They co- • 277 were in Greater Manchester, ordinate support to the family and look for any • 48 were in Manchester, preventable factors. This is reported directly to • 27 were in Salford. the Coroner and then the Child Death Overview Panel (CDOP), who review the deaths of all children.
CDOPs review the deaths of all children, both expected and unexpected. There were a total of 72 childhood deaths notified to the Bolton, Salford and Wigan CDOP in 2015/16. The CDOP reviews of unexplained deaths in young people are complex. The intention of the individuals in these deaths, involving in the main adolescents, is often unclear.
onceptions abo isc ut n M Su o ici m de om C Myth: If a person is serious about killing themselves then there is nothing you can do.
Fact: Often, feeling suicidal is temporary, even if someone has been feeling low, anxious or struggling to cope for a long period of time. This is why getting the right kind of support at the right time is so important.
20. ONS Suicide registrations by Local Authority http:// ons.gov.uk/peoplepopulationandcommunity/ birthsdeathsandmarriages/deaths/datasets/ suicidesbylocalauthority Page 53
Preventing suicide in Salford 10 Trends in suicide prevalence Area of home address of people who died from suicide or injury Suicides and Injuries Undetermined undetermined 2005 – 2015 22 (S&IU) averaged over a 3 year period (2013 – 2015)21 • England – 10.1 per 100,000 population, • North West – 11.3 per 100,000 population, • Manchester – 10.5 per 100,000 population, • Salford – 13.1 per 100,000 population.
Data comparing Salford with England rates from 2001 to 2015
The geographical distribution of home address correlates to a large degree with areas of Salford with higher levels of deprivation.
The strategy recognises the link between welfare reform and high levels of deprivation and poverty and how this impacts on mental health and wellbeing. The strategy therefore makes links to Salford’s Anti-Poverty Strategy, with actions relating to suicide prevention, welfare rights and debt advice.
As the above chart highlights Salford has had Incidents of self-harm that led to a similar profile to the England average (yellow hospital admissions 2014/15 circles) for much of this period. However, the As highlighted previously, self-harm is a key risk latest comparison (2013/15, shown by the blue indicator in relation to the prevalence of suicide circle) shows that Salford currently has a higher (whether by design or as an unintentional incidence than the England average. outcome) Similarly (above), Salford also has a higher Of admissions arising from self-harm, women comparable rate than both the North West and and girls comprised 62% of the total. Manchester.
22. Salford City Council, “Suicide and injury undetermined in Salford 2005 – 2019 – a 21. Suicide Prevention Profile 2013-2015. Public Health geodemographic analysis of people and place”, England (October 2016)
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Preventing suicide in Salford 11 The graph below shows the percentage change Data comparing Salford with National and in admissions due to self-harm by gender and regional data24 illustrates that Salford has a overall admissions for September 2005 to significantly higher comparable rate of hospital August 201523 at a national level: admissions arising from self-harm.
All age Age 10 –
35% admissions 24 years 06 ) -
05 30% per 100,000 admissions (2 0
e 25% n i
e l population per 100,000
a s 20% b
o m 15% Male England 191.4 398.8 Female 10% ange f r Total FAEs North West 257.7 514.5 c h t
n 5% c e
e r Manchester 224.9 391.7
P 0% Salford 390.5 756.5
Year
NB: Not all incidents of self-harm will lead to a hospital presentation and of those that do not This data also highlights that although all will result in a hospital admission. The total admissions for males who self-harm have been incidence of self-harm will therefore be at a reducing since 2011/12, the overall trend is greater level that the above information alone increasing, driven by a marked increase in can capture. female presentations.
It is challenging to find out what support there is and where – and then trying to access it
quotes from people who have been affected by suicide
23. Provisional monthly hospital admissions caused by self-harm September 2014 to August 2015. Health and Social Care Information Centre 24. PHE Public Health Profiles
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Preventing suicide in Salford 12 THREE. What do we currently know?
The 2015 Salford Annual Audit25 on death From the information collated from the case arising from suicide and undetermined injuries files: considered the files relating to 22 cases. 73% were male and 27% were female. The suicide audit collects information on contributory factors that are evident from coronial files. In 2015, 68% of people were aged 40- 59 years – although the prevalence of suicide and injury undetermined was just more pronounced among those aged 40-49 years (40-49 has 8 occurrences; 50-59 had 7 occurrences).
Number of suicides by age group in Salford 2012 - 2015
9 8 8 8 8 7 7 6 6 7 6 5 5 2012 5 4 4 2013 4 3 3 3 2014 3 3 2 3 2015 Although there are groups for 2 1 1 1 bereavement, it would be good to 1 0 prevent the act from happening < 30 30-39 40-49 50-59 60+
quotes from people who have been affected by suicide Source: Primary care mortality database (PCMD)
73% of recorded cases were White British.
Most people don’t try and take their own life because they want to 73% of cases had a mental health die; they just want support to live diagnosis, with the majority (55%) being more than 12 months prior to quotes from people who have been affected by suicide death (depression / anxiety being the most prevalent, although schizophrenia; bipolar; anxiety / phobia and personality disorder were also recorded) – this is a 25. Suicide Audit Report: Reporting suicides and deaths marked increase over previous recent years from injuries with undetermined intent occurring in when it has been approximately 50%. 2015. Salford City Council (August 2016)
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Preventing suicide in Salford 13 37% had been identified as having a 28% were not in employment history of alcohol problems and 23% had (being unemployed) and of a history of drug problems (N.B. some the 32% in employment, many individuals may not have seen either tended to be in insecure jobs. of these as a problem themselves).
36% had previously self-harmed. 50% died from hanging, strangulation and / or suffocation and 32% died from self-poisoning (for men the most 45% had previously attempted suicide. common methods in Salford are ‘hanging, strangulation and suffocation’ followed by poisoning, whereas for women it is poisoning followed by ‘hanging, 59% had been (or were) in contact strangulation and suffocation’). with specialist mental health services.
64% died at their home address and 55% had been in contact with a GP (19% 32% occurred in nominally public places within 1 month prior to death, 19% – but typically secluded places, such within 1 year prior to death and 15% as open spaces / parks, golf courses, more than 12 months prior to death. road / rail bridges and waterways.
50% lived alone (either being single, divorced, separated or widowed).
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Preventing suicide in Salford 14 FOUR. Objectives and next steps
Objective ONE: Salford will achieve “Suicide Safer Community” Accreditation:26 The “Suicide Safer Community” is a recognised model of good practice that was developed in Canada by LivingWorks Education Inc. throughout the early 1990’s.
Accreditation as a “Suicide Safer Community” requires the submission of evidence to show that the 10 areas contained in the model (as detailed in the action plan below) have been rigorously addressed. As such, accreditation gives a high level of assurance that an area achieving the status of a “Suicide Safety Community” has positively and pro-actively sought to address and prevent death by suicide as far as this is possible.
Aligns with National Strategy Area(s): 1; 2; 3; 4; 5 Key Actions: Timescale for Completion 1. Establish a “Suicide Safer Community” Committee (supplementing or May 2017 replacing the Suicide Prevention Partnership) 2. Establish the population size of our community (via / utilising Mental Dec 2017 Health Needs Assessment / JSNA) 3. Identify organisations to be represented on our committee May 2017 4. Create and agree an action plan or strategy with identified priorities June 2017 5. Scope and specify accessible suicide intervention approaches March 2018 (review every 6 months) 6. Support and commission accessible suicide bereavement support. Scope March 2018 feasibility of a Salford SOBS, with reference to wider GM provision. (review every 6 months) 7. Support and commission promotion of mental health and wellness March 2018 activities (review every 6 months) 8. Support and commission proactive suicide prevention activities March 2018 9. Deliver training to identified groups and individuals March 2018 10. Participate in World Suicide Prevention Day (10th September every year), Sept 2017 using this time to update Salford people on progress and future planning Who for? Individuals who are at risk (high risk groups and vulnerable groups) in: • Primary Care Services, • Secondary Care Services, • Schools and colleges, • In the wider community. By whom? Salford Suicide Prevention Partnership (to become the “Suicide Safer Community” Committee), reporting to Salford Health and Wellbeing Board.
26. PHE Public Health Profiles Page 58
Preventing suicide in Salford 15 Objective TWO: Develop an awareness of suicide prevention and increase capacity of individuals and organisations to respond to and engage proactively with individuals in distress and individuals who are perceived to be at high risk of suicide by: • raising suicide awareness amongst front-line staff to identify individuals who may be at an increased risk • challenging the stigma associated with suicide and also with mental illness • raising suicide awareness beyond health and social care professionals to raise awareness of suicide prevention amongst the wider community (in particular those people in the community who are in contact with identified vulnerable groups e.g. Military Veteran’s services, sports therapists, hairdressers / barbers, pub landlords, carers organisations, schools and criminal justice services) • providing an effective initial response and signposting information, • providing access to advice and support services • maintaining awareness of methods employed to die by suicide, and mitigate / minimise as far as possible associated risks
Aligns with National Strategy Area(s): 1; 2; 3; 4; 5 Key Action: Timescale for Completion 1. Training using a variety of types of media (e.g. on-line, face-to- Review progress quarterly face, 1:1’s, forums, front line support staff, ‘backroom’ staff, via the Suicide Safer etc) to be provided in Statutory services; the voluntary sector; Community Committee community groups and members of the community. (i.e. 14 Sept 2017; 14 Dec 2017; 8 March 2017) Who for? • Primary Care (Exploring existing training for primary care and the potential development of a Salford Standard) • The Integrated Care Organisation (SRFT; GMMH; Salford Council; Salford CCG), • Voluntary groups / community groups, youth groups, schools and colleges • Members of the community • Youth groups, schools and colleges. By whom? • Salford Suicide Prevention Partnership to oversee, • GMMH lead in terms of identifying training opportunities to roll out across the ICO (Learning from CQUIN to inform developments), • Salford Primary Care Together, • Salford CVS, • Health improvement services. • Schools and colleges • Voluntary groups / community groups / youth groups.
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Preventing suicide in Salford 16 Objective THREE: Provide effective support to individuals who have been affected by a suicide bereavement by: • developing ‘real time’ information that will allow a timely supportive response to people who have been affected by suicide bereavement. (By ‘real time’, we mean a system that enables any death where the circumstances suggest that suicide may be the cause of death to be considered in advance of the inquest conclusion in order to enable an appropriate and timely response), • enhancing existing liaison arrangements between commissioned bereavement services and Representatives of Funeral Services to ensure that individuals who may be in need following suicide bereavement are appropriately identified and offered appropriate advice and support, • providing support, as required, over the potentially lengthy timescales that are involved in the Coroner’s Court process and procedures following a death suspected to be a suicide.
Aligns with National Strategy Area(s): 1; 4; 5; 6 Key Actions: Timescale for Completion 1. Partnership working, whereby together service Review progress quarterly via commissioners, providers and users in Salford collaborate in the Suicide Safer Community the provision of suicide bereavement support, such as: Committee (i.e. 14 Sept 2017; 14 Dec 2017; 8 March a) SRFT’s Bereavement and Donor Support services, 2017) b) Six Degrees, c) Salford CC Bereavement Service, d) Funeral service representative(s). e) Gaddum 2. Development of ‘Real Time’ data and timely responses. Review progress quarterly via the Suicide Safer Community Committee (i.e. 14 Sept 2017; 14 Dec 2017; 8 March 2017) Who for? People directly and indirectly affected by a suicide bereavement: • Family, • Friends, • Work Colleagues, • Community members. By whom? • Salford Suicide Prevention Partnership • Joint Mental Health Commissioning Group
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Preventing suicide in Salford 17 Objective FOUR: Build a wider partnership approach: • ensuring that a Suicide Prevention Network incorporating statutory services, the voluntary sector and the wider community is supported to develop increasingly effective links and have an effective governance structure overseen by the Salford Health and Wellbeing Board, • evaluating the impact of the strategy, • linking with Greater Manchester and national suicide prevention work and cross-locality initiatives
• improving the processes for the identification of suicide risk factors at a primary care level to initiate effective multi agency response
• Analysis of data relating to suspected deaths by suicide to achieve ‘real-time’ data analysis
• Share appropriate information with key partners to inform approaches
• Collate and consider themes from support agencies and people affected by suicide to inform approaches to interventions
• Improve links with employment support organisations e.g. job centre plus, advice and information services.
Aligns with National Strategy Area(s): 1; 2; 3; 4; 5; 6 Key Action: Timescale for Completion 1. Ensure a Salford Suicide Prevention Network incorporating Review progress quarterly statutory services, the voluntary sector and the wider via the Suicide Safer community (including those bereaved by suicide) is supported Community Committee to develop increasingly effective collaborative links and (i.e. 14 Sept 2017; 14 Dec prevention, intervention and post-vention services. 2017; 8 March 2017) Who for? • Statutory services, • Voluntary Organisations, • University of Salford / Colleges / Schools, • Community groups. By whom? Salford Suicide Prevention Partnership
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Preventing suicide in Salford 18 Objective FIVE: Align and / or incorporate the Salford Suicide Prevention Strategy with other strategies and programmes including: • Salford Locality Plan. Start Well, Live Well, Age Well. Our Salford, • No One Left Behind. Tackling Poverty in Salford, • Joint Strategic Needs Assessments, • Mental Health and Wellbeing strategies, • Crisis Care Concordat, • Sustainability and Transformation plans, • Salford Children and Adolescents Mental Health Services (CAMHS) Transformation Plan • Commissioning of Substance Misuse services, • Greater Manchester Suicide Prevention Strategy 2017-2022, • Transport for Greater Manchester, Network Rail and Highways England covering road, rail, bus, tram / metro and waterway services and infrastructure,
Aligns with National Strategy Area(s): 4; 5; 6 Key Action: Timescale for Completion 1. To ensure that the Salford Suicide Prevention Strategy is not a Review progress quarterly ‘stand-alone’ initiative, but one that informs and is informed by via the Suicide Safer other strategic initiatives through inclusion of relevant partners/ Community Committee (i.e. stakeholders on the “Suicide Safer Community” Committee, 8 June 2017; 14 Sept 2017; Salford Suicide Prevention Network and / or raising awareness 14 Dec 2017; 8 March of suicide prevention at the City Leaders Group. 2017) Who for? • The Locality Plan for Salford, • Joint Strategic Needs Assessments, • Mental Health and Wellbeing strategies, • Crisis Care Concordat, • Sustainability and Transformation plans, • Salford Children and Adolescents Mental Health Services (CAMHS) Transformation Plan, • Commissioning of Substance Misuse services, • Greater Manchester Suicide Prevention Strategy 2017-2022, • Tackling Poverty in Salford Strategy, • Transport for Greater Manchester, Network Rail and Highways Agency covering road, rail, bus, tram / metro and waterway services and infrastructure. By whom? Salford Suicide Prevention Partnership (to become the “Suicide Safer Community” Committee), reporting to the Salford Health and Wellbeing Board
Further detail on our action plan can be found at: www.salfordccg.nhs.uk/suicidesupport
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Preventing suicide in Salford 19 Objective SIX: Making a difference: We will monitor progress against each of our objectives as set out within this Suicide Prevention Strategy 2017-2022 and the Suicide Prevention Strategy 2017-2022 Implementation Plan: 2017/18 (to be drafted by the Salford Suicide Prevention Partnership between April-June 2017).
Together these are very positive examples of different partners, stakeholders and organisations from the voluntary, statutory and independent sectors, alongside service users, working collaboratively to achieve a common aim.
A Community Impact Assessment has been undertaken in parallel to the development of the strategy and plan, thus ensuring that individuals most ‘at risk’ of, and affected by, suicide have suitably appropriate intervention, prevention and post-vention measures.
The Plan contains the specific activities against which this strategy will be delivered, acting as a tool for measuring and evaluating our objectives. It will be refreshed each year by the Salford Suicide Prevention Partnership (to become the “Suicide Safer Community” Committee), and will be informed by quarterly updates.
We will evaluate the impact of the strategy by monitoring the following areas:
1. Inviting and valuing the views and feedback of people who have been affected by suicide bereavement,
2. Monitoring the views and experiences of service users and their carers,
3. Monitoring the views of professional staff,
4. Inviting and valuing feedback from community groups and individuals,
5. Local suicide rates; attempts and admissions and incidents of self-harm,
6. Help-seeking behaviours, such as use of telephone help lines,
7. The numbers recorded as experiencing suicidal ideation,
8. The use of standard questionnaires to monitor depression and anxiety, and the improvements in waiting times, access and completion rates for treatment of depression.
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Preventing suicide in Salford 20 Aligns with National Strategy Area(s): 1; 2; 3; 4; 5; 6 Key Action: Timescale for Completion 1. To ensure via quarterly update reports and an annual review Annual Salford Suicide that the Salford Suicide Prevention strategy continues to Audit (June – August); develop and evolve to meet the objective to prevent death by Quarterly Performance suicide in Salford Commissioning Reports; Greater Manchester Suicide Prevention Executive; Who for? People directly and indirectly affected by a suicide bereavement, partners and stakeholders, to learn from and incorporate areas identified for improvement from:-
• consideration of any additional reports that will inform the 2015 Salford Suicide Audit, • inviting and valuing the views and feedback of people who have been affected by suicide bereavement • monitoring the views and experiences of service users and their carers, • monitoring the views of professional staff, • inviting and valuing feedback from community groups and members of the local community, • local suicide rates and attempts, admissions and incidents of self-harm, • help-seeking behaviours, such as use of telephone help-lines, • the numbers recorded as experiencing suicidal ideation, • the use of standard questionnaires to monitor depression and anxiety, and the improvements in waiting times, access and completion rates for treatment of depression. By whom? Salford Suicide Prevention Partnership (to become the “Suicide Safer Community” Committee)
Achievement of our objectives relies upon a combination of leadership, continued collaboration and responding to service user’s experiences.
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Preventing suicide in Salford 21 Next Steps: to reflect the commitment of all in Salford to reduce the impact of suicide – tackling and Suicide prevention is most effective when it is addressing the ‘risk factors’ and encouraging combined as part of wider work addressing and supporting the ‘protective factors’. the social and other determinants of poor health, wellbeing or illness. We believe that By improving the mental health and wellbeing our strategy and plan, taking account of and of the populations of Salford by effectively reflecting the consultation and engagement preventing mental health problems and activity that was undertaken in there ensuring appropriate access and delivery of preparation, does this. mental health and social care services, together we can support the reduction in the local rates We are confident that the working relationships of suicide and self-harm. and service delivery arrangements that have been created and established will continue
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Preventing suicide in Salford 22 FIVE. Help IN Salford
We are not starting from scratch. In an emergency or crisis, support is There is a range of mental-wellbeing and available from: suicide-prevention resources, services and support available for people in Salford. Samaritans 116 123 (free to call) Samaritans offer For more information contact: emotional support 24 hours a day - email us at [email protected] / on-line at Greater Manchester Mental Health NHS www.samaritans.org.uk Foundation Trust www.gmmh.nhs.uk/salford The Sanctuary 0300 003 7029 The Sanctuary provides support Salford CCG from 8pm-6am support for adults in crisis www.salfordccg.nhs.uk/mental-health- and those experiencing anxiety, panic attacks, services-in-salford depression or suicidal thoughts www.salfordccg.nhs.uk/preventsuicide www.selfhelpservices.org.uk/sanctuary
Salford City Council Mind In Salford www.salford.gov.uk/health-and-social- 0300 123 3393 - provides information on types care/health-services/mental-health-support of mental health problems, where to get help, medication and alternative treatments and Salford Children and Young People’s emotional advocacy 9am-6pm weekdays - email us at health and wellbeing directory [email protected] / on-line at www.partnersinsalford.org/ www.mindinsalford.org.uk youngemotionalhealth.htm Papyrus HOPElineUK Young people’s emotional health and wellbeing 0800 068 4141 Text: 07786 209697 this is a online resources confidential suicide prevention helpline service www.wuu2.info/emotional-health-and- for young people, open 10am-10pm weekdays, wellbeing/ 2-10pm weekends, 2-5pm bank holidays, thinking about suicide or for anyone concerned Children and Young People’s emotional health about a young person - email us at and wellbeing resources [email protected] www.partnersinsalford.org/3224.htm www.papyrus-uk.org
Welfare Rights and Debt Advice If you are concerned about an immediate risk of Salford City Council Welfare Rights and Debt harm - either to yourself or someone else - call Advice Service 999 or go to your nearest A&E department. www.salford.gov.uk/advice-and-support/ welfare-rights-and-debt-advice-service/
Salford Citizen’s Advice Welfare Rights, Debt and Consumer Advice https://salfordcab.org.uk/
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Preventing suicide in Salford 23 Page 67 This page is intentionally left blank SUICIDE PREVENTION STRATEGY 2017-2022 Page 69 Page IMPLEMENTATION PLAN & YEAR ONE ACTION PLAN (2017-18)
The responsibility to deliver this action plan sits with the Salford Suicide Safer Committee and therefore the Chair of this group holds overall accountability and responsibility.
1 IMPLENTATION PLAN Page 70 Page 2017-2022
2 OBJECTIVE ONE: SALFORD WILL ACHIEVE ‘SUICIDE SAFER COMMUNITY’ ACCREDITATION
The “Suicide Safer Community” is a recognised model of good practice that was developed in Canada by LivingWorks Education Inc. throughout the early 1990’s.Accreditation as a “Suicide Safer Community” requires the submission of evidence to show that the 10 areas contained in the model (as detailed in the action plan below) have been rigorously addressed. As such, accreditation gives a high level of assurance that an area achieving the status of a “Suicide Safety Community” has positively and pro-actively sought to address and prevent death by suicide as far as this is possible.
Aligns with National Strategy Area(s): 1; 2; 3; 4; 5 Key Actions: Timescale for Completion 1. Establish a ‘Suicide Safer Community’ Committee (supplementing or replacing the Suicide May 2017 Prevention Partnership) 2. Establish the population size of our community (via / utilising Mental Health Needs Dec 2017 Assessment / JSNA) 3. Identify organisations to be represented on our committee May 2017 4. Create and agree an action plan or strategy with identified priorities June 2017 Page 71 Page 5. Scope and specify accessible suicide intervention approaches March 2018 6. Scope and commission accessible suicide bereavement support. Scope feasibility of a March 2018 (review every 6 months) Salford SOBS, with reference to wider GM provision. 7. Support and commission promotion of mental health and wellness activities March 2018 (review every 6 months) 8. Support and commission proactive suicide prevention activities March 2018 9. Deliver training to identified groups and individuals March 2018 10. Participate in World Suicide Prevention Day (10th September every year) using this time September 2017 to update Salford people on progress and future planning Who For? Individuals who are at risk (high risk groups and vulnerable groups) in: Primary Care Services Secondary Care Services Schools and Collages Wider Community By Whom? Salford Suicide Prevention Partnership (to become the ‘Suicide Safer Community Committee), reporting to the Salford Health and Wellbeing Board.
3 OBJECTIVE TWO: DEVELOP AN AWARENESS OF SUICIDE PREVENTION AND INCREASE CAPACITY OF INDIVIDUALS AND ORGANISATIONS TO RESPOND TO AND ENGAGE PROACTIVELY WITH INDIVIDUALS IN DISTRESS AND INDIVIDUALS WHO ARE PERCEIVED TO BE AT HIGH RISK OF SUICIDE BY:
raising suicide awareness amongst front-line staff to identify individuals who may be at an increased risk challenging the stigma associated with suicide and also with mental illness raising suicide awareness beyond health and social care professionals to raise awareness of suicide prevention amongst the wider community (in particular those people in the community who are in contact with identified vulnerable groups e.g. Military Veteran’s services, sports therapists, hairdressers / barbers, pub landlords, carers organisations, schools and criminal justice services) providing an effective initial response and signposting information improving the processes for the identification of suicide risk factors at a primary care level to initiate effective multi agency response providing access to advice and support services maintaining awareness of methods employed to die by suicide, and mitigate / minimise as far as Page 72 Page possible associated risks
Aligns with National Strategy Area(s): 1; 2; 3; 4; 5 Key Actions: Timescale for Completion 1. Training using a variety of types of media (e.g. online, face-to-face, 1:1’s, forums, front Review progress quarterly via the Suicide line support staff, ‘backroom’ staff, etc) to be provided in Statutory services; the Safer Community Committee (i.e. June 2017, Voluntary Sector; Community Groups; individuals and members of the community. September 2017, December 2017, March 2018) Who For? Primary Care (Exploring existing training for primary care and the potential development of a Salford Standard) The Integrated Care Organisation (SRFT, GMMH, Salford Council, Salford CCG) Voluntary Groups / Community Groups / Youth Groups Members of the Local Community Schools and Colleges By Whom? Salford Suicide Safer Community Committee to oversee GMMH to lead in terms of identifying training opportunities to roll out across the ICO (learning from CQUIN to inform developments) Salford Primary Care Together
4 Salford CVS Health Improvement Services Voluntary Groups / Community Groups / Youth Groups Schools and Colleges Page 73 Page
5 OBJECTIVE THREE: PROVIDE EFFECTIVE SUPPORT TO INDIVIDUALS WHO HAVE BEEN AFFECTED BY A SUICIDE BEREAVEMENT BY:
developing ‘real time’ information that will allow a timely supportive response to people who have been affected by suicide bereavement. (By ‘real time’, we mean a system that enables any death where the circumstances suggest that suicide may be the cause of death to be considered in advance of the inquest conclusion in order to enable an appropriate and timely response), enhancing existing liaison arrangements between commissioned bereavement services and Representatives of Funeral Services to ensure that individuals who may be in need following suicide bereavement are appropriately identified and offered appropriate advice and support, providing support, as required, over the potentially lengthy timescales that are involved in the Coroner’s Court process and procedures following a death suspected to be a suicide. Aligns with National Strategy Area(s): 1; 4; 5; 6 Key Actions: Timescale for Completion Page 74 Page 1. Partnership working, whereby together service commissioners, providers and users in Review progress quarterly via the Suicide Salford collaborate in the provision of suicide bereavement support, such as: Safer Community Committee (i.e. September a) SRFT’s Bereavement and Donor Support services 2017, December 2017, March 2018) b) Six Degrees c) Salford CC Bereavement Service d) Funeral service representative(s) e) Gaddum 2 Development of ‘Real Time’ data and timely response Review progress quarterly via the Suicide Safer Community Committee (i.e. September 2017, December 2017, March 2018) Who For? People directly and indirectly affected by a suicide bereavement: Family Friends Work Colleagues Community Members By Whom? Salford Suicide Safer Community Committee Joint Mental Health Commissioning Group
6 OBJECTIVE FOUR: BUILD A WIDER PARTNERSHIP APPROACH:
ensuring that a Suicide Prevention Network incorporating statutory services, the voluntary sector and the wider community is supported to develop increasingly effective links and have an effective governance structure overseen by the Salford Health and Wellbeing Board, evaluating the impact of the strategy, linking with Greater Manchester and national suicide prevention work and cross-locality initiatives. Analysis of data relating to suspected deaths by suicide to achieve ‘real-time’ data analysis Share appropriate information with key partners to inform approaches improving the processes for the identification of suicide risk factors at a primary care level to initiate effective multi agency response Collate and consider themes from support agencies and people affected by suicide to inform approaches to interventions
Aligns with National Strategy Area(s): 1; 2; 3; 4; 5; 6 Page 75 Page Key Actions: Timescale for Completion 1. Ensure a Salford Suicide Prevention Network incorporating statutory services, the Review progress quarterly via the Suicide Voluntary Sector and the wider community (including those bereaved by suicide) is Safer Community Committee (i.e.September supported to develop increasingly effective collaborative links and prevention, 2017, December 2017, March 2018) intervention and post-vention services. Who For? Statutory services Voluntary organisations University of Salford / Colleges / schools Community Groups By Whom? Salford Safer Suicide Community Committee
7 OBJECTIVE FIVE: ALIGN AND/ OR INCORPORATE THE SALFORD SUICIDE PREVENTION STRATEGY WITH OTHER STRATEGIES AND PROGRAMMES INCLUDING:
Salford Locality Plan. Start Well, Live Well, Age Well. Our Salford, No One Left Behind. Tackling Poverty in Salford, Joint Strategic Needs Assessments, Mental Health and Wellbeing strategies, Crisis Care Concordat, Sustainability and Transformation plans, Salford CAMHS Transformation Plan, Commissioning of Substance Misuse services, Greater Manchester Suicide Prevention Strategy 2017-2022, Transport for Greater Manchester, Network Rail and Highways Agency covering road, rail, bus, tram/ metro and waterway services and infrastructure Page 76 Page
8 Aligns with National Strategy Area(s): 4; 5; 6 Key Actions: Timescale for Completion 1. To ensure that the Salford Suicide Prevention Strategy is not a ‘stand-alone’ initiative, but Review progress quarterly via the one that informs and is informed by other strategic initiatives through inclusion of Suicide Safer Community Committee relevant partners / stakeholders on the ‘Suicide Safer Community’ Committee, Salford (i.e. September 2017, December 2017, Suicide Prevention Network and / or raising awareness of suicide prevention at the City March 2018) Leaders Group. Who The Locality Plan for Salford For? Joint Strategic Needs Assessments Mental Health and Wellbeing strategies Crisis Care Concordat Sustainability and Transformation Plans Salford CAMHS Transformation Plan Commissioning of Substance Misuse services Greater Manchester Suicide Prevention Strategy 2017-2022 Page 77 Page Tackling Poverty in Salford Strategy Transport for Greater Manchester, Network Rail and Highways Agency covering road, rail, bus, tram/metro and waterway services and infrastructure. By Salford Safer Suicide Community Committee reporting to the Salford Health and Wellbeing Board. Whom?
9 OBJECTIVE SIX: MAKING A DIFFERENCE
We will monitor progress against each of our objectives as set out within this Suicide Prevention Strategy 2017-2022 and the Suicide Prevention Strategy 2017-2022 Implementation Plan: 2017/18 (to be drafted by the Salford Suicide Prevention Partnership between April-June 2017). Together these are very positive examples of different partners, stakeholders and organisations from the voluntary, statutory and independent sectors, alongside service users, working collaboratively to achieve a common aim. A Community Impact Assessment has been undertaken in parallel to the development of the strategy and plan, thus ensuring that individuals most ‘at risk’ of, and affected by, suicide have suitably appropriate intervention, prevention and post-vention measures. The Plan contains the specific activities against which this strategy will be delivered, acting as a tool for measuring and evaluating our objectives. It will be refreshed each year by the Salford Suicide Prevention Partnership (to become the “Suicide Safer Community” Committee), and will be informed by quarterly updates. We will evaluate the impact of the strategy by monitoring the following areas:
Page 78 Page 1. Inviting and valuing the views and feedback of people who have been affected by suicide bereavement 2. Monitoring the views and experiences of service users and their carers 3. Monitoring the views of professional staff 4. Inviting and valuing feedback from community groups and individuals 5. Local suicide rates; attempts and admissions and incidents of self harm 6. Help-seeing behaviours, such as the use of telephone help lines 7. The numbers recorded as experiencing suicidal ideation 8. The use of standard questionnaires to monitor depression and anxiety, and the improvements in waiting times, access and completion rates for treatment of depression.
10 Aligns with National Strategy Area(s): 1; 2; 3; 4; 5; 6 Key Actions: Timescale for Completion 1. To ensure via quarterly update reports and an annual review that the Salford Suicide Prevention strategy continues to develop and evolve to meet the objective to prevent death by suicide in Salford. Who People directly and indirectly affected by a suicide bereavement, partners and stakeholders, to learn from and incorporate areas For? identified for improvement from: Consideration of any additional reports that will inform the 2015 Salford Suicide Audit Inviting and valuing the views and feedback of people who have been affected by suicide bereavement Monitoring the views of service users and their carers Monitoring the views of professional staff Inviting and valuing feedback from community groups and members of the local community Local suicide rates and attempts, admissions and incidents of self-harm Help-seeking behaviours, such as the use of telephone helplines The numbers recorded as experiencing suicidal ideation Page 79 Page The use of standard questionnaires to monitor depression and anxiety and the improvements in waiting times, access and completion rates for the treatment of depression By Salford Suicide Safer Community Committee Whom?
11 Page 80 Page YEAR ONE ACTION PLAN 2017-2018
Red Not completed by due date / Major risk of non-completion Amber Underway but not complete / At risk of missing deadline Green Completed / on target
12 Overarching Action Lead(s) Method Resources Timescale Action Additional Strategy Status (RAG) Comments Objective Scope and specify Public Health March 2018 accessible suicide intervention approaches Integrated Commissioning Objective One Scope and specify Integrated March 2018 accessible suicide Commissioning bereavement support,
Page 81 Page including scoping of a local SOBS, recognising the need to align with GM wide provision. Agree training approach Integrated March 2018 including mapping of Commissioning targeted training against high risk groups (e.g. GMMH middle age males as high risk groups, training may Public Health target sports leaders, pub landlords military Engagement veterans services and criminal justice services, housing providers, job Emotional Health centres and faith groups) and Wellbeing / CAMHS
13 Develop a specific Transformation training offer for Project Group children and young people linking into the plans above, with a particular focus on young males in schools and colleges Roll out training to Public Health From December Objective Two agreed communities, 2018 individuals and groups Integrated Commissioning
Engagement Page 82 Page Roll out training to key Public Health employers in Salford e.g. Council / CCG / SRFT / Integrated GMMH / Tesco / Commissioning Morrisons etc Engagement
Include basic suicide Service October 2017 prevention awareness Improvement pack in salford standard for GPs Integrated Commissioning Evaluate effectiveness of Engagement September training via engagement 2018 activities Integrated Commissioning
14 Communications Proactively engage with Public Health From December workers in the 2018 construction industry Communications across areas identified in Salford’s growth agenda Engagement to increase suicide prevention awareness. Proactively engage with GMMH March 2018 people who are identified as high risk to support a multi-agency response
Page 83 Page Proactively engage with Public Health March 2018 members of the LGBT community to increase Communications suicide prevention awareness Engagement
CYP LGBT Working Group Undertake regular audit Public Health March 2018 of methods and locations employed by people dying by suicide and develop approaches to mitigate / minimise as far as possible associated risks.
15 Develop Salford Together June 2017 communications plan Partners relating to suicide awareness and Communications challenging stigma / Teams better media reporting, including Engagement communications appropriate for children and young people (e.g. via schools and colleges) Objective Three Scope the approach to a Public Health March 2018 ‘real time’ information system CCG Quality
Page 84 Page Improve information Engagement March 2018 available to people immediately after a Communications death (including information suitable for Public Health children and young people), informed by Services supporting people’s shared people bereaved experiences and stories. Enhancing liaison Integrated March 2018 arrangements + Commissioning consistent pathway between commissioned bereavement services Partners (e.g. Salford Royal Foundation Trust Bereavement Services, Six Degrees
16 Bereavement Service, Salford City Council’s Bereavement Team, Gaddum and Representatives of Funeral Services). Review membership of Integrated June 2017 the Suicide Prevention Commissioning Partnership and widen network working Public Health Objective Four towards suicide prevention to include voluntary sector and people with personal experience of suicide
Page 85 Page Share / learn from best Integrated March 2018 practice approaches Commissioning across GM Partnership working with Integrated Advice and Information Commissioning Services - explore immediate appointment Advice and access for crisis Information situations relating to Services advice and info issues from GPs referring to the SPA Advice and Information Advice and Services to support with Information the analysis of the data from PH from an advice Public Health information perspective.
17 Take strategy through Integrated September 2017 governance processes, Commissioning including discussions with the Health and Partners Wellbeing Board to Objective Five inform wider health and Health and wellbeing approaches. Wellbeing Board Share GM Strategy with Criminal Justice September 2017 Prison Partnership Colleagues Board, Health and Wellbeing Board Integrated Commissioning Provide 12 month Integrated September 2018 update report to CCG Commissioning
Page 86 Page Governing Body Participate in World Salford Together September 2018 Suicide Awareness Day and other engagement Partners opportunities e.g. Objective Six mental health awareness Communications week to include provision of feedback to Engagement local people of progress made against the strategy and gathering views to inform future actions.
18 Page 87 Page
19 This page is intentionally left blank ‘most people don’t try to take their own life because they want to die; they just want support to live’ Quote from someone personally affected by suicide
Does someone you know need to talk? Would you know what to do? What to say? Listen, don't judge, offer help. For more information and advice visit: www.salfordccg.nhs.uk/preventsuicide
Do you need to talk to someone? Samaritans offer emotional support 24 hours a day on their free phone number: 116 123
Salford Suicide Prevention Partnership : working together towards Page 89 our aspiration of being a city where there are no deaths by suicide This page is intentionally left blank Agenda Item 11
Item no. insert Agenda Item No.
Salford Health and Wellbeing Board
Title of report Primary Care Investment Agreement Date October 2017 Contact Officer Anna Ganotis, Head of Service Improvement, NHS Salford CCG
1. Executive Summary
Why is this report being brought to the The projects that form part of the Salford Board? - Relevance of this report to the Primary Care Investment Agreement are priorities of the Joint Health and Wellbeing aligned to the vision for primary care as set out Strategy, the Joint Strategic Needs in the Locality Plan for Salford. Assessment or integrated working Health and Wellbeing Board’s duties or • Determine priorities for local action – focus responsibilities in this area collective efforts and resources on an agreed set of priorities and outcomes Key questions for the Health and Wellbeing The Primary Care Investment Agreement has Board to address - what action is needed been shared with Health and Wellbeing Board from the Board and its members? members for information and noting. What requirement is there for internal or Each of the projects within the scope of the external communication around this issue? Investment Agreement will have a communications plan.
2. Introduction
The Greater Manchester (GM) Programme for Primary Care Reform has secured a £41.2m investment over the next four years from the GM Transformation Fund. This investment seeks to deliver on the commitments of the GP Forward View and is aligned to the GM Primary Care Strategy which was published in October 2016. As this funding sits within the GM Transformation Fund, it is bound by an investment agreement between the Greater Manchester Health and Social Care Partnership and each locality area. GM CCGs were given two weeks in August to complete and submit an investment agreement which sets out local plans, including key milestones and a financial plan. Investment agreements will be reviewed by a panel and signed by the Greater Manchester Health and Social Care Partnership in order to make available the first tranche of funding within quarter 2 of 2017/18. Due to the short timescales involved, the completed Salford agreement was approved virtually by the CCG’s Primary Care Commissioning Committee (PCCC), but it has come to the Salford Health and Wellbeing Board for information.
Page 91 1 3. Key issues for the Board to consider
The Salford Primary Care Investment Agreement is attached as Appendix 1. The Investment Agreement predominantly relates to the delivery of 3 key projects: 1) Provision of 7 Day Access Provision of neighbourhood based primary care ‘hubs’ offering access to general practice in evenings and weekends. 2) Training Care Navigators and Medical Assistants Training reception and clerical staff to undertake enhanced roles in signposting patients and management of clinical correspondence. 3) Provision of Online Consultation Software The introduction of an online consultation system for patients to connect with their general practice. The CCG’s Primary Care Commissioning Committee will make decisions in relation to the Salford Primary Care Investment Agreement and will oversee delivery. The PCCC will report to the Locality Plan Programme Management Board to ensure consistency of approach with the other two programmes funded by GM Transformation Funding and alignment to Salford’s Locality Plan. Opportunities for joint working and / or shared learning with the Salford Population Health and Integrated Care Programmes will be sought wherever possible.
4. Recommendations for action
Salford Health and Wellbeing Board members are asked to note the content of the Salford investment agreement and note that it aligns to and supports the delivery of the Locality Plan for Salford.
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GREATER MANCHESTER HEALTH AND SOCIAL CARE TRANSFORMATION SALFORD INVESTMENT AGREEMENT GM PRIMARY CARE REFORM PROGRAMME
CONTENTS
PARTIES BACKGROUND
1. Definition and Interpretation of Terms 2. Timescales covered by this agreement 3. Objectives of the Agreement 4. Confirmation of support for the Programme by the Health and Wellbeing Board 5. Agreed Milestones 6. Transformation Funding 7. Flow of Funding 8. Senior Leader responsible for delivery 9. Reporting and evaluation 10. Performance 11. Variations 12. Confidentiality 13. Dispute Resolution 14. General
SCHEDULES:
SCHEDULE 1 GM Primary Care Reform Programme SCHEDULE 1A GM Primary Care Strategy SCHEDULE 2 Locality Mobilisation Plan and milestones SCHEDULE 3 Locality based initiatives for primary care reform SCHEDULE 4 National Requirements – Primary Care Contribution SCHEDULE 5 GM Metrics SCHEDULE 6 Dispute Resolution SCHEDULE 7 Locality Management and Governance Arrangements
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PARTIES
This is an agreement between:
(1) NHS England, 3 Piccadilly Place, London Road, Manchester, M1 3BN
(2) NHS Salford Clinical Commissioning Group, St James’s House, Pendleton Way, Salford, M6 5FW
(3) Salford Primary Care Together, 3rd Floor, 2 City Approach, Albert Street, Eccles, Manchester, M30 0BL
(4) Salford and Trafford Local Medical Committee, c/o 5th Floor St James’s House, Pendleton Way, Salford, M6 5FW each a Party and together, the Parties.
BACKGROUND
(A) Pursuant to the GM devolution agreement between Government and GM local authorities and the MoU developed between GM local authorities, GM CCGs and NHS England (which created a framework for the delegation and ultimate devolution of health and social care responsibilities to GM), from April 2016, the NHS bodies and local authorities in GM have taken control of £6bn of public money to run health and social care throughout the region.
(B) The Greater Manchester Health and Social Care Devolution Memorandum of Understanding (‘MOU’) sets out the ambition for full devolution of funding and decision making for health and social care in GM. It describes the principles for how partners will work together, including a commitment to collaborate and make decisions in the best interests of patients and the people of GM.
(C) The NHS bodies and local authorities in GM have developed a comprehensive GM Strategic Plan (‘Taking Charge’) to address the key challenges facing health and social care. The GM Strategic Plan sets out how, in pursuing five transformation themes, the NHS bodies and local authorities in GM will achieve clinical and financial sustainability.
(D) NHS England agreed in December 2015 that £450m would be made available over a five year period for the establishment of a 'Transformation Fund' on the basis that the GM HSCPB would oversee the deployment of this fund within GM to deliver the major change programme set out in the GM Strategic Plan, whilst securing locally the outcomes to which NHS England is committed as a consequence of the November 2015 Comprehensive Spending Review.
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(E) The objectives of the Transformation Fund are to support solutions which deliver clinical and financial sustainability across GM and at locality level and improve the health and social outcomes included in the GM Strategic Plan.
(F) The specific purpose of the Transformation Fund is: investment in new systems, processes and infrastructure; and/or additional costs involved in developing and implementing new services while existing services are decommissioned.
(G) In order to access the Transformation Fund a Locality must have in place a robust Locality Plan agreed by all key parties in the Locality Area, which is wholly aligned to the broader vision for health and social care transformation in GM and the specific schemes identified in the GM Strategic Plan.
(H) Access Criteria for the Transformation Fund have been developed and agreed by the GM HSCPB.
(I) These criteria have been adopted by the GM Chief Officer on behalf of NHS England.
(J) The overall governance and accountability of the Transformation Fund is the responsibility of the GM Chief Officer and Head of Paid Service, GMCA, both supported by the GM HSCPBE.
(K) The Transformation Fund will be subject to the GM Accountability Framework, which will specify a full range of outcomes across health and social care to be delivered by the Transformation Fund.
(L) NHS England has delegated responsibility internally to the GM Chief Officer for allocating the awards from the Transformation Fund. The GM HSCPBE has considered the Transformation Fund proposal outlining the GM Primary Care Reform Programme and made a recommendation to the GM Chief Officer for actioning. The GM Chief Officer having considered the application accepted this recommendation on [DATE].
(M) This Agreement sets out the terms and conditions upon which funding from the Transformation Fund has been awarded to the CCG for distribution within the Locality Area.
(N) This Agreement should be read in association with other key documents:
(i) GM Primary Care Reform programme (Schedule 1) (ii) GM Primary Care Strategy (Schedule 1A) (iii) Locality mobilisation plan – Primary Care Reform (Schedule 2) (iii) Locality based initiatives for primary care reform (Schedule 3)
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1. Definition and Interpretation of terms 1.1 The definitions and rules of interpretation in this clause apply in this Agreement
Access Criteria: criteria agreed on in March 2016 by the GM HSCPB1 and adopted by NHS England that must be satisfied in order for a Locality to be granted Transformation Funding: Deliver the GM vision Enable transformational change Consolidate resources Secure value for money Facilitate learning for others
Agreement: this agreement between the Parties comprising these terms and conditions together with all schedules attached to it
CCG: the Clinical Commissioning Group specified as a Party to this Agreement and which is receiving Transformation Funding in accordance with this Agreement
Commencement Date: [date]
Expiry Date: At the end of [date]
Five Year Forward View: the document published in October 2015 by NHS Improvement, the Care Quality Commission, Public Health England and Health Education England setting out a new shared vision for the future of the NHS based around new models of care2
GP Forward View: the document published in April 2016 acknowledges the pressures faced in General Practice and sets out a programme of support to General Practice in respect of investment, workforce, workload, infrastructure and care design.
GM: the Greater Manchester region comprising 10 local authority areas: Bolton, Bury, Manchester, Oldham, Rochdale, Salford, Stockport, Tameside, Trafford, and Wigan
GM Accountability Framework: A GM Accountability Framework to set the approach to be undertaken internal to GM describing thresholds and levels of intervention and how the GM system can have oversight of its own
1 https://www.greatermanchester- ca.gov.uk/download/meetings/id/753/04a_transformation_fund_criteria
2 https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
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performance to inform any national requirements." Timescale for completion of the Framework is August 20163
GM Chief Officer: means the NHS England officer appointed to lead the GM health and social care devolution programme
GMCA: Greater Manchester Combined Authority
GM HSCPB: the Greater Manchester Health and Social Care Partnership Board governed by the terms of reference set out in Schedule 5, which is responsible for setting the overarching strategic vision for the GM health and social care economy
GM HSCPBE: the Greater Manchester Health and Social Care Partnership Board Executive a group comprised of members of the GM HSCPB which was established to provide support to the GM HSCPB
GM Primary Care Strategy: the GM Primary Care Strategy ‘Delivering Integrated Care across Greater Manchester – The Primary Care Contribution’ sets out the direction of travel for primary care transformation going forward and is aligned to the 10 Greater Manchester Locality Plans.
GM Strategic Plan: the GM Strategic Sustainability Plan – Taking Charge4 and the implementation plan set out within, aligned to the Five Year Forward View, which sets out how GM will achieve clinical and financial sustainability during a five year period underpinned by a number of principles agreed in the MoU signed in February 20155
Health and Wellbeing Board: the forum established by the Health and Social Care Act 2012 where key leaders from the health and care system work together to improve the health and wellbeing of their local population and reduce health inequalities and, in the context of this Agreement, refers to the relevant Health and Wellbeing Board for the Locality Area.
Inter Authority Transfer: An Inter Authority Transfer (IAT), is the mechanism used by CCGs, NHS England and NHS England local area teams to transfer
3 https://www.greatermanchester-ca.gov.uk/download/meetings/id/1166/07_taking_charge_- _implementation_plan
4 https://www.greatermanchester- ca.gov.uk/homepage/73/taking_charge_of_our_health_and_social_care_in_greater_manchester
5 https://www.greatermanchester- ca.gov.uk/downloads/download/40/greater_manchester_health_and_social_care_devolution_mem orandum_of_understanding
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resource known as allocations. It cannot be used with other organisations such as NHS providers or LAs
A sending and receiving organisation is required (like a budget transfer between budget holders in a standard organisation)
Key Milestones: has the meaning set out in Clause 5.2
Local Authority: the local authority specified as a Party to this Agreement
Local Authority Transformation Funding: the proportion of the Transformation Funding payable to a Local Authority to enable it to deliver the Locality Plan
Locality: the GM Local Authority, the CCG and the Providers who are Parties to this Agreement
Locality Area: The geographical area covered by the Local Authority
Locality Cost Benefit Analysis: the detailed financial analysis and evaluation of the costs and benefits associated with the Locality Plan [and which is attached at Schedule 8 to this Agreement]
Locality Plan: a 5 year plan for health and social care and wider public service reform, which has been developed and agreed between the commissioners and providers within the Locality Area [and which is attached at Schedule 1[A] to this Agreement]
Locality Plan Implementation Plan: the plan describing the implementation of the Locality Plan, which was endorsed by the GM HSCPB [and which is attached at Schedule 1B to this Agreement]
MoU: the Greater Manchester Health and Social Care Devolution Memorandum of Understanding, an agreement between the GM local authorities, the GM CCGs and NHS England which was signed in February 2015 and which creates a framework for the delegation and ultimate devolution of health and social care responsibilities to GM
NHS Act: National Health Service Act 2006
NHS England: the National Health Service Commissioning Board established by section 1H of the NHS Act and known as NHS England
NHS Improvement: the operational name for the organisation bringing together Monitor, the NHS Trust Development Authority and certain patient safety and service change teams
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NHS Improvement Agreement: any agreement entered into between NHS Improvement (or one of its constituent legal entities) and a provider in the Locality Area relating to an allocation from the Sustainability and Transformation Fund
Programme: the GM Primary Care Reform Programme, a programme of reform (set out in Schedule 2) created in accordance with the Locality Plan or transformation theme, for which Transformation Funding has been awarded
Provider Transformation Funding: the proportion of the Transformation Funding payable to a NHS Trust/Foundation Trust to enable it to deliver the Locality Plan
Recipients: those Parties who have been identified in the Locality Plan Implementation Plan as proposed recipients of the Transformation Funding
Senior Leader: the person appointed by the Locality responsible for delivering the Programme and for delivering value for money from the funds awarded to the Locality.
Stronger Together: the GM strategy published in 2013 by GMCA and the Local Enterprise Partnership (LEP) around the twin themes of Growth and Reform that sets out a series of priorities that will drive sustainable economic growth and reform the way that public services are delivered
Sustainability and Transformation Fund: the national transformation fund established to support delivery of the Five Year Forward View
Taking Charge: the GM Strategic Plan
Transformation Fund: the £450m fund that NHS England has agreed to allocate to GM to deliver the major change programme set out in the GM Strategic Plan, whilst securing locally the outcomes to which NHS England is committed as a consequence of the November 2015 Comprehensive Spending Review, and which represents GM's share of the available transformation budget over the period 2016 to 2021
Transformation Funding: the sum of funding allocated by NHS England from the Transformation Fund to the CCG to distribute to the Recipients
Transformation Fund Proposal: the proposal documentation that was submitted by the Locality to secure access to Transformation Funding [and which is attached at Schedule 8 to this Agreement]
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1.2 Clause, Schedule and paragraph headings shall not affect the interpretation of this Agreement.
1.3 The Schedules form part of this Agreement and shall have effect as if set out in full in the body of this Agreement. Any reference to this Agreement includes the Schedules.
1.4 A reference to a statute or statutory provision is a reference to it as it is in force for the time being, taking account of any amendment, extension or re- enactment and includes any subordinate legislation for the time being in force made under it.
1.5 A reference to a document is a reference to that document as varied (other than in breach of the provisions of this Agreement) at any time.
1.6 References to clauses and Schedules are to the clauses and Schedules of this Agreement. References to paragraphs are to paragraphs of the relevant Schedule.
2. Term
2.1 This Agreement shall take effect on the Commencement Date and shall continue until the Expiry Date, unless extended in accordance with clause 2.2 or terminated sooner in accordance with the provisions of this Agreement.
2.2 The Parties may extend this Agreement by such period as they agree.
3. Objectives of the Agreement
3.1 By entering into this Agreement the Parties re-affirm their commitment to:
(i) deliver the transformation of health and social care services in GM and the wider reform of public services in GM as set out in the GM Strategic Plan. (ii) deliver the commitments of the GM Primary Care Reform Programme (iii) collaborate and cooperate with each other, in line with the principles set out in the MOU, and work within the agreed GM Health and Social Care partnership governance arrangements.
3.2 Each Party confirms that implementation of its obligations under this Agreement is consistent with its statutory obligations, and that it has complied with any relevant requirements imposed upon it by legislation or regulatory authority, and will continue to do so.
3.3 The aim of the additional investment is to take forward a number of elements of the Primary Care Strategy, specifically strengthening resilience within
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General Practice and improving access, quality and outcomes for our 2.8M residents.
3.4 There are a number of specifically funded elements within this investment agreement:
Provision of 7 Day access Training Care Navigators and Medical Assistants Development of a GM Resilience Programme Provision of a Clinical Pharmacy Programme Provision of on-line consultation software
These are described in more detailed in the papers attached at Schedule 1A and 1B, and the detailed metrics and milestones set out in Schedule 2. These describe how the specific schemes will be delivered in the context of a wider programme of reform of primary care.
The NHS Contract, Operational and Planning Guidance sets out national requirements for primary care. The GM Primary Care Reform Programme is clear that the funding within this investment agreement must enable system wide transformation by ensuring sustainable general practice. Schedule 4 outlines those national requirements relating to primary care in order for the locality to indicate its plans.
It is acknowledged that to address some of the resilience challenges, GMHSCP, CCGs, LMCs and GP Federations will need to work together. For this reason, they are all signatories to the Investment Agreement, although will have different responsibilities under the agreement.
The GMHSCP GP Resilience Programme, known as ‘GP Excellence’ will also have the remit to support GP practices to improve quality and outcomes for their patients. To support this, GMHSCP are developing a primary care dashboard which all GP practices will have access to and uses data which is in the public domain. The dashboard will mature over time and the indicators will change to reflect the priorities of GMHSCP, CCG commissioners and the GP community. The GP Excellence Team will also hold quarterly meetings with locality GP provider clinical quality and commissioning leads with an aim to review the position across Greater Manchester and to also share good practice.
To support the GP Excellence Programme, partners across the system need to commit to working together to understand current quality (using the dashboard and other local data) and address issues. The mechanism for this will be further developed, and may include a Quality Primary Care ‘Congress’ to pull together learning across GM. Each CCG will have a quality lead and
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providers are expected to nominate a lead for clinical quality who will work in collaboration with the CCG quality lead and their local practices to review the data and support changes where these are indicated.
4. Confirmation of support for the Programme by the Health and Wellbeing Board
4.1 The Locality confirms that details of the Primary Care Reform Programme have been discussed at the Health and Wellbeing Board; and the Health and Wellbeing Board is supportive of the objectives and approach of the Programme. The Primary Care Reform Programme plan has been approved by the joint chair of the Health and Wellbeing Board and will go to the next meeting on 10 October 2017 for information. In Salford, it has been agreed that decision making responsibility should sit with the Primary Care Commissioning Committee who have approved this plan.
5. Agreed milestones
5.1 The Parties have agreed key milestones which are outlined in schedule 2 (Key Milestones).
6. Transformation funding
6.1 To support the delivery of the Programme the GM Chief Officer has agreed to allocate £3,253,802 of Transformation Funding to the Locality. (See Clause 9.1 for funding flow).
6.2 The profile of this funding is:
Quarter Funding Q1 2017/18 [£X] Q2 2017/18 £578,085 Q3 2017/18 £254,796 Q4 2017/18 £254,795 2018/19 £1,084,671 2019/20 £1,039,021 2020/21 £42,434
Note: The duration of the period of fixed funding and the profile of fixed funding will be determined by the GM Chief Officer (with the support and advice of the GM HSCPBE), in the light of the specific Locality Plan under
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consideration, and the proposed Key Milestones to meet under that Locality Plan.
Please note that in order to receive the totality of the access funding of £6ph, localities will need to fulfil all requirements for improving access ensuring that the reasonable needs of patients are met during core hours, as outlined in schedule2, (pg 19). Any transitional funding to support localities in meeting the improved access requirements should be factored into quarterly milestone payments and outlined in local trajectories.
6.3 The Transformation Funding awarded may only be used for the purpose for which it is intended, as set in the Transformation Fund Proposal – Primary Care Reform.
6.4 Recipients of Transformation Funding are required to adhere to their own Standing Financial Instructions. However, with the exception of reports prepared by advisors for regulatory purposes, expenditure incurred on external consultancy contracts in excess of £50,000 (advisory or management capacity) will be subject to the approval of the GM Chief Officer.
7. Flow of funding
7.1 Table 1 below outlines the funding flows of the Transformation Funding for each of the elements of the Primary Care Reform Programme:
Table 1 – funding flows
Element Receiving organisation Funding flow
Provision of 7 day CCG Inter Authority Transfer access Training Care CCG Inter Authority Transfer Navigators and Medical Assistants Development of a GM GM HSCP Budget transfer Resilience Programme Provision of a Clinical APMS Contract Holder* Invoice Pharmacy Programme Provision of online CCG Inter Authority Transfer consultation software
7.2 The CCG shall distribute the Transformation Funding to the Recipients as required to deliver the Programme as defined in Schedules 1 and 2 with the exception of the Clinical Pharmacy Programme where the funding will be paid to the APMS contract holder.
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8. Senior leader responsible for delivery
8.1 The Locality has appointed Anthony Hassall as the Senior Leader responsible for delivering the Programme and for delivering value for money from the funds awarded to the Locality as set out in in Clause 8 of this Agreement.
9. Reporting and evaluation
9.1 The Senior Leader will provide regular updates and assurance to the GM HSCPB and GM HSCPBE (in a form and at a frequency to be determined by the GM HSCPB and GM HSCPBE) and to the Health and Wellbeing Board on the Locality’s progress towards achieving the Key Milestones.
9.2 The Senior Leader will provide all such information, documents, records and other items and assistance as the GM Chief Officer may reasonably require in connection with the performance of any Party's obligations under this Agreement.
9.3 The Locality will participate in any evaluation of the Programme in a form to be agreed with the GM HSCPB as part of the ongoing operation of the GM Accountability Framework.
9.4 The Locality will ensure the Locality Plan and the Programme associated with this Agreement is monitored through its governance and programme management arrangements, as set out in Schedule 7. The GM Chief Officer and / or their representatives will have the right to attend Locality meetings that relate to the distribution or use of the Transformation Funding and/or the delivery of the Programme.
10. Performance
10.1 The GM HSCPB and the Locality agree to work together for the successful implementation of the Programme and to work collaboratively to address any issues that arise or are foreseen. The investment should deliver improvements in access and quality and high level outcomes will be developed and agreed across GMHSCP, CCGs and stakeholders. These will be monitored via a rolling programme.
10.2 If the Locality:
(i) fails to deliver any Key Milestone; (ii) delivers the Key Milestones out with the timescales for delivery specified in Schedule 2; or (iii) commits a material breach of this Agreement and either such breach is in the reasonable opinion of the GM Chief Officer not capable of
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remedy or such breach is in the reasonable opinion of the GM Chief Officer capable of remedy and is not remedied to his reasonable satisfaction within such time period as he shall stipulate, acting reasonably,
then the GM Chief Officer (with advice and support from the GM HSCPB and/or the GM HSCPBE) may:
a) specify additional or amended requirements on the Locality and make the allocation of further Transformation Funding contingent on performance of those additional requirements; b) re-profile, pause, reduce or cease payment of some or all of further Transformation Funding; c) seek the recovery of some or all of the Transformation Funding; and/or d) terminate this Agreement by giving written notice to the Parties.
Before exercising any right under clause 10.2(a)-(d) inclusive, the GM Chief Officer shall have, at the least:
(iv) considered whether any alternative options are available that would address the outstanding performance issue(s); (v) taken reasonable steps to meet with the Locality to discuss the performance issue(s) and seek alternative options to address them; and (vi) discussed the matter with the GM HSCPB.
10.3 The CCG would only be required to repay to NHS England:
(i) any uncommitted Transformation Funding that it has not yet distributed to the Recipient; any Transformation Funding that the CCG has in turn been repaid by the Recipients.
11. Variations
11.1 This Agreement may be varied by the Parties at any time by agreement in writing in accordance with the Parties’ internal decision-making processes.
12. Confidentiality
12.1 The Parties agree to keep confidential all documents relating to or received from another Party under this Agreement that are labelled as confidential.
12.2 Clause 12.1 shall not apply to disclosure of information:
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(i) required by any applicable law; (ii) where a Party can demonstrate that such information is already generally available and in the public domain otherwise than as a result of a breach of Clause 12.1 (iii) which is already lawfully in the possession of the receiving party, prior to its disclosure by the disclosing party.
12.3 Where a Party receives a request to disclose information that another Party has designated as confidential, the receiving Party shall consult with the other Parties before deciding whether the information is subject to disclosure.
13. Dispute Resolution
13.1 Subject to Clause 13.2, if any dispute arises out of or in connection with this Agreement, the Parties must first attempt to settle the dispute in accordance with the procedures set out in Schedule 6.
13.2 A Party may seek an injunction in connection with any breach by another Party of its obligations under Clause 12.
14. General
14.1 Subject to clause 14.2, this Agreement is personal to the Parties and no Party shall, without the prior written consent of the other Parties, assign, transfer or vest, except by the operation of any statutory provision, the benefit of the Agreement to any other person.
14.2 The benefit and/or burden of this Agreement may be assigned or transferred by any Party to any successor of all or part of its functions, property, rights and liabilities.
14.3 The Parties agree that this Agreement shall not be interpreted as constituting a partnership between the Parties nor as constituting any agency between the Parties and the Parties agree that they shall not do cause or permit anything to be done which might lead any person to believe otherwise.
14.4 Any termination of this Agreement shall be without prejudice to any rights or remedies of the Parties in respect of any antecedent breach of this Agreement.
14.5 The termination of this Agreement shall not affect the coming into force or the continuation in force of any provision of this Agreement which is expressly or by implication intended to come into or continue in force on or after such termination or expiry.
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14.6 Unless otherwise stated all sums stated in this Agreement are inclusive of all applicable tax, including any VAT.
14.7 The construction, validity and performance of this Agreement shall be governed by the laws of England.
14.8 This Agreement may be entered into in any number of counterparts and by the parties to it on separate counterparts, each of which, when so executed and delivered shall be an original.
15. Signatures to Agreement
15.1 The CCG will be responsible and accountable for the delivery of the requirements as set out within this Agreement. However, Local Medical Committees and GP Provider/Federations are also requested to sign the Agreement to demonstrate their support in delivery.
Signatures
NHS England
Signed on behalf of NHS England
Name: Jon Rouse
Role: GM Chief Officer
Signature: ______
The Greater Manchester Health and Social Care Partnership Board
Signed on behalf of the Greater Manchester Health and Social Care Partnership Board
Name: Lord Peter Smith
Role: Chair
Signature:
Date:
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The Locality
Signed on behalf of the CCG
Name:
Role:
Signature:
Date:
Signed on behalf of the Local Medical Committee
Name:
Role:
Signature:
Date:
Signed on behalf of the GP Federation
Name:
Role:
Signature: ______
Date:
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Schedule 1 – Primary Care Reform Programme
SBP paper - Primary Care Reform 24-02-17 FINAL.pdf
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Schedule 1A – GM Primary Care Strategy
GM Partnership - Primary Care Strategy FINAL NOVEMBER 16.pdf
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Schedule 2 - The metrics and milestones for measuring performance
Improving Access
There should be appropriate access to meet the reasonable needs of the population during core hours and therefore all patients should have access to both routine and urgent primary care services during the hours 8am – 6.30pm, Monday to Friday. Reasonable needs6 are considered as: Attend a pre-bookable appointment Book / cancel appointments Collect a prescription Access urgent appointments / advice Ring for telephone advice Page 111 Page Access to diagnostics Access to medical records Any alternative arrangements are discussed with the PPG
Localities will need to provide assurance as to how they will ensure that the reasonable needs of the population are met in line with above.
2. The locality is clear as to how it is going to embed the primary care reform programme into the development of their LCO and neighbourhood model over the duration of the agreement in line with the ambitions set out in the Primary Care Reform Programme (schedule 1). This includes optimising this additional capacity in order target vulnerable and complex patients such as supporting nursing and care homes to provide more proactive care, targeted appointments for carers, linking in to integrated neighbourhood teams and the voluntary sector.
6 House of Commons Committee of Public Accounts. Access to General Practice: progress review Sixty-first Report of Session 2016-17 https://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/inquiries/parliament-2015/access-general- practice-16-17/
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Requirements Locality Response Trajectory – key milestones Outline Service Model Delivery of 7 day access FOR a 3 Extended Access Pilots have been operational in Salford during 16/17, neighbourhood, hub based model serving offering additional evening and weekend access to Primary Care services 30th September 2017 populations of circa 30k – 50k for approximately a fifth of the CCG registered population. These pilots will continue during 17/18 until the Salford Wide Extended Access Pilot (SWEAP) mobilises in Eccles. 14th August 2017 – Mobilisation in The CCG has commissioned Salford Primary Care Together (SPCT) to Swinton provide SWEAP from 5 Neighbourhood Hubs each serving a population of around 50k. SWEAP service commissioned to provide 1.5hours (after 2nd October 2017- 6.30pm) Monday to Friday and 6 hours (initially) across Saturday and Mobilisation in Eccles Sunday from each Neighbourhood Hub. & Irlam Page 112 Page In addition, extended access coverage for the care homes population has March 2018 – All 5 been incorporated into the contract with the provider of the Salford Care Neighbourhood Hubs Homes Practice from 17/18 onwards. mobilised Provision of 30mins per 1000 population SWEAP service commissioned to provide 49580 appointments (mixture of As above rising to 45mins/1000* population by GP, ANP, Nurse) per year = 9916hrs per year or 190.7hrs/week. 20/21 *It is envisaged this will incorporate a The additional extended access coverage provided by the Salford Care wider primary care team as part of Homes Practice equates to an additional 18 hours per week. neighbourhood delivery model In 2018/19 with SWEAP fully mobilised the total hours of extended access (208.7) will equate to 46.7mins/1000 population per week based on the current registered population of 268,375 (July 2017) The service operates for a minimum 1.5 SWEAP service commissioned to provide 1.5hours (after 6.30pm) As above hours (after 6.30pm) Monday to Friday Monday to Friday and 6 hours (initially) across Saturday and Sunday from and at least 4 hours on Saturday and at each Neighbourhood Hub. least 4 hours on Sunday. (Early morning appointments can also be provided via the Extended Access DES either on a hub arrangement or at an individual practice level.)
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Requirements Locality Response Trajectory – key milestones Provision of routine diagnostics (as per Routine diagnostic provision minimum requirements have been included As above commitment already agreed as part of in the service specification for SWEAP. Healthier Together),
Measurement All practices will consent to and Salford CCG has already engaged with a consultancy to develop tools to As required download a nationally automated tool to calculate the number of appointments and their utilisation. The CCG will measure appointment activity both in- explore the specifics of the nationally automated tool, but in principle will hours and during the additional hours to support its roll out across Salford practices as this is a key element of data enable improvements in matching required to enable us to commission the services that we require. capacity to times of high demand. Practices have been notified nationally of the new POMI tool and Salford will seek to use it.
Page 113 Page To provide information as part of a GM Salford CCG agrees in principle to gaining routine access to appropriate As required minimum data set to illustrate the impact, data sets to enhance performance and outcomes. Indeed we already outcomes and learning as a result of this gather a large set of KPIs to support our Salford Standard. additional funding. With regard to a data set, in principle there is no objection as long as it meets all the requirements under data protection law.
Raising patient and public awareness Ensure the service is advertised to SPCT as the provider is required to ensure that patients are aware of the 14th August 2017 – patients so that it is clear to patients how service and choices by producing and disseminating appropriate Mobilisation in they can access these appointments. marketing and publicity materials and providing information in a range of Swinton accessible formats on request. 2nd October 2017- The CCG can seek assurance on information available to patients relating Mobilisation in Eccles to extended access appointments through ‘mystery shopper’ exercises & Irlam which: visit practices March 2018 – All 5 telephone practices Neighbourhood Hubs review websites mobilised
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Requirements Locality Response Trajectory – key milestones There will be advice and direction on every GP practice website in each As above There is a link to the service on every GP Neighbourhood as that Neighbourhood mobilises. practice website and the CCG website. There is a mechanism for patients to Patients will be able to book both in-hours appointments and extended As above book an appointment in-hours and out of access appointment by contacting their GP practice. hours All practice receptionists are able to Practice receptionists will be able to offer and book extended access As above direct patients to the service and offer appointments on the same basis as core hour appointments. appointments to the additional hour’s service on the same basis as appointments in core hours. Patients should be offered a choice of Patients will be offered a choice of extended access appointments on an As above Page 114 Page evening or weekend appointments on an equal footing to core hours appointments. equal footing to core hours appointments. To have a single number which patients Patients will just have a single contact number for their GP Practice to As above can book appointments book appointments
Digital Patients will be able to access alternative Salford CCG will create a programme to offer practice support and TBA as part of the modes of consultation both in hours and technology to offer e-consultation options. At present a number of online consultation through the additional hours service practices offer telephone consultations, but further work is required to project plan which includes; develop online and web-ex consultations. We are actively seeking to Telephone consultations develop a number of these technologies with Salford Primary Care Online consultations Together, in particular in the new development planned for Salford Quays Web-ex consultations (where new practice. available) Addressing inequalities There is a plan to address the issues of SPCT are required to make every effort to ensure that all vulnerable March 2018 – All 5 inequalities in patients’ experience of groups have access to extended access services, putting reasonable Neighbourhood Hubs accessing general practice identified by adjustments and other assistance in where necessary for those with mobilised local evidence and actions protected characteristics. Access to appropriate language services must be available for patients who have additional language needs, eg patients
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Requirements Locality Response Trajectory – key milestones who do not speak English or who have sensory disabilities.
Extended access reporting mechanisms include appropriate, relevant and measurable KPIs to enable equality monitoring and monitoring of patient experience which would inform development of action plans. Effective access to wider whole system services There is active connection to other The service specification for SWEAP describes how in phase 2 of the Sept 2018 system services enabling patients to mobilisation that extended access will provide ring-fenced appointments receive the right care from the right for divert schemes (from 111, pathfinder ED, others) working alongside professional, including access to and existing OOHs (for urgent care) and any other available urgent care from other primary care and general services. practice services such as urgent care
Page 115 Page services The CCG will work with SPCT and practices through Neighbourhoods to develop primary care navigation and social prescribing will work with system partners to further develop models of integrated care. Local Care Organisation The locality will incorporate the service as Salford Primary Care Together are working in partnership with the March 2018 – All 5 part of the development of LCO. Integrated Care Organisation (Salford Royal NHS Foundation Trust) to Neighbourhood Hubs develop and implement Neighbourhood delivery models with which the mobilised extended access service will be linked. The service model is discussed and The service model and associated business case has been signed-off via NA signed off by the Health and Wellbeing the CCG Governance as follows: Board Informal PMG – 13th April 2016 Supported business case and procurement CCG Execs – 20th & 27th April 2016
External reviewer – May 2016
Commissioning Committee – 8th June 2016
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Requirements Locality Response Trajectory – key milestones Primary Care Commissioning Approved business case Committee – 11th July 2016
Commissioned Services Quality Approved pilot approach to Group – 21st July 2016 procurement
CCG Execs – 26th October 2016 Supported procurement process and timetable
Page 116 Page Primary Care Commissioning Received update on Committee – 28th November 2016 procurement process
Governing Body – 25th January 2017 Received update on procurement process, gave delegated authority to Chief Accountable Officer and Chief Finance Officer
Governing Body 17th March 2107 Inform of outcome of procurement process
The Health and Wellbeing Board does not form part of the formal governance route for this project, however, they are aware and supportive of the aspirations to commission extended access. Extended primary care access is a feature of the Salford Locality Plan, which is endorsed by the Health and Wellbeing Board. Extended primary care access has also been a topic of conversation at the Salford Adult and Health Scrutiny Panel, who recommend improved access to general practice.
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Requirements Locality Response Trajectory – key milestones Salford’s governance in relation to this Investment Agreement is provided in Schedule 7
Page 117 Page
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Training for reception and clerical staff
As part of the General Practice Forward View, a new five year £45 million fund has been created to contribute towards the costs for practices of training reception and clerical staff to undertake enhanced roles in active signposting and management of clinical correspondence. For GM, this equates to £2.3m over four years to fund both care navigation and/or workflow optimisation. It will be for localities to determine how this is best deployed locally. Further information around these roles is appended to the agreement (appendices one and two).
Requirements Locality Response Trajectory – key milestones The role of the care navigator is part of a The care navigator role will be developed as an integral part of multidisciplinary team the primary care team and will align to other workforce development activities as part of the implementation of the Primary Care Workforce Strategy and the emerging
Page 118 Page Neighbourhood Model of Care The role is connected to a practice/group of Training and development of the care navigator role will be To commence in practices and is part of the practice team rolled out on a neighbourhood by neighbourhood basis, so that 17/18 in 1 or 2 groups of practices can work together to enable an effective and neighbourhoods and efficient approach roll out in 18/19 The role(s) meets the competencies as set out in An accredited training provider will be identified to provide Provider to be HEE Competency Framework for Care Navigators training to meet the competencies as set out by HEE. We are identified by October - see currently reviewing the training offered by a number of providers. 17 https://hee.nhs.uk/sites/default/files/documents/Car e%20Navigation%20Competency%20Framework_ Final.pdf Essential - Signposting to local service; inputting data to directory and databases; supervised, e.g. GP receptionist Enhanced - Greater level independent working, enhanced communication skills, i.e. health coaching, e.g. care navigator Expert - Developing services; dealing with more complex cases; advanced communication skills;, mentoring other staff e.g. Navigator team leader
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Supporting GP workload – training of clerical staff to manage medical correspondence / Medical Assistants A member of clerical staff within the practice is provided with training and relevant protocols to support the GP in clinical administration tasks. These may include tasks such as READ coding, action incoming clinical correspondence in accordance with agreed protocols, ordering tests, chasing results and outpatient referrals, liaising with other providers and explaining care processes to patients.
Requirements Locality Response Trajectory – key milestones Ensure the practice has developed its own internal A standardised approach to training will be taken across Salford 3 administrators to be systems (which have been assured) including safe using one training provider to ensure that safe systems and trained in 17/18 to and appropriate protocols to guide staff; that there protocols are put in place. This will include training and provide support to one is a system of supervision and regular audits of protected time for a named GP, who will act as a supervisor and (or part of one) safety and effectiveness. This should include the ensure audits of safety and effectiveness are undertaken. neighbourhood opportunity to learn from other practice examples (c30,000 patients). The Salford Enhanced Training Practice, will also enable a Training to be rolled standardised approach to training and systems to be utilised. out across Salford
Page 119 Page from 18/19 To ensure there is a system for practice managers, SPCT neighbourhood provider boards can be used to share As above GPs and staff to hear from others who are already good practice and learn from practices who are implementing working in this way this new way of working, within and outside of Salford.
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GM Excellence Programme
Provide Locality input (provider and CCG Quality Lead) into the design and delivery of the operating model Continue to provide statutory duties to support General Practice Join up local intelligence in order to offer a pro-active approach to supporting General Practice Promote the GM Resilience Programme within the locality Facilitate neighbourhood resilience as part of new models of care
Requirements Locality Response Trajectory – key milestones Promote the GM Excellence Programme locally We will work in partnership with Salford Primary Care Together Ongoing (SPCT) and the LMC to ensure that all Salford practices are
Page 120 Page aware of the GM Excellence Programme and how to access it. We have already circulated information regarding the programme via the CCG’s Member Newsletter and SPCT were asked to support raising awareness. In conjunction with the GM Co-ordination and This support will be provided via Sam Glynn-Atkins and the As required Support Team, identify local delivery teams within CCG’s Service Improvement Team when requested by the GM respective localities, this could include: Co-ordination and Support Team. CQC outstanding practices GP Federations CCG Quality Improvement Leads LMC support
Ensure Locality representation on the GM Sam Glynn-Atkins is the Salford CCG rep and she will continue Salford representation Excellence Working Group who will oversee the to attend Group meetings. at each meeting GM programme
Establish a formal link between any local systems We will ensure that the CCG committees responsible for Ongoing of support and the GM Support and Development approving any new local systems of support (Primary Care hub to ensure the two systems complement rather Commissioning Committee and the Integrated Community than duplicate. Based Care Commissioning Group) consider any areas of duplication with the GM programme. Sam Glynn-Atkins will be
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Requirements Locality Response Trajectory – key milestones responsible for co-ordinating this and liaising with the GM Hub to resolve any potential issues. Identify provider and commissioner lead to meet CCG – Sam Glynn Atkins Quarterly meetings quarterly with the GP Excellence Team to discuss SPCT – Geraldine Hennighan the primary care dashboard for the locality / neighbourhood and identify areas for quality improvement and support. Demonstrate how the locality will build resilience The design and implementation of neighbourhood new models Pilot of the into new models of care at a neighbourhood / LCO of care are being actively progressed and resilience is a factor neighbourhood model over the duration of the programme that is central to this redesign. to commence before 31 March 2018 The neighbourhood model project initiation documents due in Autumn 17 will demonstrate how resilience will be built in to the
Page 121 Page model.
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Online Consultations Recent years have seen rapid development of a number of online consultation systems for patients to connect with their general practice. Using a mobile app or online portal, patients can contact the GP. This may be a follow-up or a new consultation. The e-consultation system may be largely passive, providing a means to pass on unstructured input from the patient, or include specific prompts in response to symptoms described. It may offer advice about self-care and signposting to other sources of help, as well as the option to send information to the GP for a response.
In early adopter practices, these systems are proving to be popular with patients of all ages. They free time for GPs, allowing them to spend more time managing complex needs. Some issues are resolved by the patient themselves, or by another member of the practice team. Others are managed by the GP entirely remotely, in about a third of the time of a traditional face to face consultation. Others still require a face to face consultation, and these are enhanced by the GP already knowing about the patient’s issue.
Page 122 Page Requirements Locality Response Trajectory – key milestones Please outline project description which should The project will cover 5 neighbourhoods and 45 practices. Complete survey include but not limited to: The content will review a number of methods of e- on current status Scope and content communications including but not limited to SMS 2 way for 9/17) Objective and benefits reminders, cancellations and surveys; email advice services; Project initiation Location and distribution (where appropriate) video consultations; telephone consultations. with all Wider stakeholders, their interest and plan for stakeholders. engagement The objective is to increase patients’ choice on methods to (9/17) access the practice advice, and increase effectiveness of use of Complete full If online consultation systems are currently practice time. Opportunities for remote monitoring of long term project plan deployed in practices, please list them here. conditions. The benefits will be in line with nationally indicated (10/17) to include benefits. at minimum:- -Assessment of Stakeholders: technical options and Patients are key stakeholders. Engagement is via practice procurement participation groups and a forum across Salford of PPGs. Work methods. is complete on feedback regarding Electronic prescribing -Assessment of services and this method has been useful. We also have a policies and good citizen’s panel and a number of special interest groups which we practice. can access to engage patients -Patient and
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SPCT, 45 practices, LMC representing the providers of the professional services. consultation and GMSS IM&T services- provider of the network and IT service for communications plan GPs in Salford. -Procurement and Salford City Council – partners in promoting digital engagement implementation amongst Salford citizens Go ONSalford) this will be via the -Benefits realisation digital programme of the locality plan.
Please describe how the plans for deploying online This objective fits with the locality plan IM&T enabler Communications consultations are aligned with other relevant STP, programme; the Salford CCG IM&T work plan; and the GM and across all locality plan commissioning, clinical and digital technology national digital roadmaps. programme owners strategies on IM&T enabler
Salford Locality IMT Strategy - August 2017V2.doc
Page 123 Page Please describe the procurement strategy, who will This detail is not yet available but will be worked up as part of As per above be leading, and timetable for completion, to the relevant phase of the project. We aspire to have a pilot include: underway by January 2018. Market assessment and plan for market engagement Procuring organisation Procurement Advisers (CSU, Health Informatics Service, NHS England Procurement Hub) where applicable Procurement route, (eg. Direct award, competition, framework, EU procurement procedure) Procurement plan – timetable Key commercials considerations (e.g. term and expiry, service levels and standards, quality and assurance, business continuity etc.) Provision of training in clinical skills to ensure SCCG are working with SPCT to coordinate training for all IT As per above. safety and productiveness of alternative systems and this will be included in that programme. Learning consultations from other pilots (within and without GM) will be sought out and taken into account.
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Promote the use of the practice website as the first Communications team for SCCG and SPCT together with As per above point of contact for patients Practices will work on this. Many practices already do this. To co-operate with the development of an app that SCCG have already engaged with Evergreen Life As per above will enable patients to access the local service and https://evergreen-life.co.uk/download/ who offer such an app. book appointments on line (it is anticipated that We are also looking at other options that suit patient need. there will be a national app available 18/19) Practices actively promote the use of system apps such as Patient Access (EMIS). The CCG will co-operate with any development that assists us in increasing choices for patients. System suppliers are also making their own access apps more flexible.
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Clinical Pharmacists in General Practice
This section has not been completed as Clinical Pharmacists are not included in the investment agreement for Salford CCG.
The CCG has already invested £1.2million in 22.55wte Clinical Pharmacists to work with general practice via the Neighbourhood Integrated Practice Pharmacists Service; this service is provided by Salford Royal Foundation Trust in partnership with Salford Primary Care Together.
Requirements Locality Response Trajectory – key milestones Expansion of the Clinical Pharmacist Programme This will be subject to an APMS contract between GM HSCP and the provider organisation for the duration of the 3 year funding. There is a clear implementation plan in place for NA the recruitment and placement of the Clinical Pharmacists.
Page 125 Page The Clinical Pharmacists are embedded within the NA neighbourhood delivery model. The provider engages with GM and other parts of NA the system in order to share learning and experience of the clinical pharmacist programme in order to optimise this role as part of the primary care workforce. Clinical Pharmacists participate in the GM network NA to provide peer support and shared learning. There is a clear governance and accountability NA process between the CCG and the provider for use of resources.
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Schedule 4 - National Requirements – Primary Care Contribution
This section is meant to understand the locality response to the primary care related national requirements aligned to the 9 ‘Must Do’s’ mandated in the in the NHS England Five Year Forward View / Planning Guidance 2017-19. Please provide a locality response as to how you are meeting these requirements and how the primary care reform programme will support the delivery against those. Where this is already detailed within your Operational Plan, please insert relevant section.
Ref Requirements Locality Response
3 Support general practice at scale, the expansion Please see Salford GP Forward View Plan 2017/18 of emerging new models of care such as MCPs, PACS and other provider forms and enable and GP Forward View Page 126 Page fund primary care to play its part in fully Plan 2017-18 FINAL.docx implementing the forthcoming Enhanced Care Homes Framework7 for improving health in care homes. In Salford, the implementation of the Enhanced Care Homes Framework will be via our existing APMS contract with the Salford Care Homes Practice which offers primary medical care for all patients residing in a Salford care home.
3 Ensure the sustainability of general practice in Please see Salford GP Forward View Plan 2017/18 your area by implementing the General Practice Forward View, including the plans for Practice Transformational Support, and the ten high impact changes. 3 Tackle workforce and workload issues, including Please see Salford GP Forward View Plan 2017/18 and embedded interim milestones that contribute towards CCG workforce strategy increasing the number of doctors working in general practice by 5,000 in 2020, co-funding an Salford CCG was engaged in the development of the GM workforce / extra 1,500 pharmacists to work in general workload capacity and demand tool. 4 Salford practices supported the practice by 2020, the expansion of Improving development and testing of the tool and it has now been rolled out to
7 NHS England – The framework for enhanced health in care homes https://www.england.nhs.uk/wp-content/uploads/2016/09/ehch-framework-v2.pdf
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Ref Requirements Locality Response
Access to Psychological Therapies (IAPT) in all practices. Salford Primary Care Together is using the tool to general practice with 3,000 more therapists in support neighbourhoods to develop workforce plans. primary care, and investment in training practice staff and stimulating the use of online consultation systems. Participate in the roll out of GM workforce / workload capacity and demand tool and share high level data. 4 Implement the Urgent and Emergency Care As requested by Jon Rouse, NHS Salford CCG is preparing a Review, ensuring a 24/7 integrated care service response to the requirement to ‘set out the approach your locality will for physical and mental health is implemented be taking to ensure delivery of a robust model if urgent primary care by March 2020 in each STP footprint, including a and the milestones for delivery’. This will be submitted by 30th August clinical hub that supports NHS 111, 999 and out- 2017.
Page 127 Page of-hours calls. It is the CCG’s vision to have an integrated primary care offer.
The 2 year pilot of extended access (SWEAP) is mobilising from 14th August 2017, with a plan to integrate this with GP Out of Hours towards the end of the 2 year pilot.
A&E streaming is planned to be in place at Salford Royal Foundation Trust by the end of September 2017.
The CCG and partners are in discussion regarding plans for an Urgent Treatment Centre or Single Point of Access in Salford.
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Schedule 5 GM Metrics
Additional metrics will be developed over time and in conjunction with the signatories to this agreement.
Additional Access
Confirmation that the extended access Directed Yes Enhanced Service is not included as part of the core requirement of 30mins/1000 population provision
Evidence available for the disposition of services The CCG monitors activity/demand across the system including A&E, GP OOH, NHS across the week – this could include evidence of 111 patient demand or activity of current 7 day services Page 128 Page or activity data from other services, i.e. A&E, WiC, OoH etc.
How is this allocated to deliver a minimum of Salford Wide Extended Access Pilot is commissioned to provide 49580 appointments 30mins /1000 weighted population per week? (mixture of GP, ANP, Nurse) per year = 9916hrs per year or 190.7hrs/week. This will be provided from 5 Neighbourhood Hubs in Salford with 38.1hrs/wk provided from each hub.
An additional 18 hours per week extended access coverage is provided by the Salford Care Homes Practice to the care homes population.
In 2018/19 with SWEAP fully mobilised the total hours of extended access (208.7) will equate to 46.7mins/1000 population per week based on the current registered population of 268,375 (July 2017).
Is there a communications strategy in place for Salford Primary Care Together are developing a communications plan to support the promoting new services for patients locally? Please mobilisation of extended access from Neighbourhood Hubs, the CCG has requested a attach copy of this.
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Evidence that practices are telling staff to promote Assurance on information available to patients relating to extended access appointments the new service? (please outline) can be sought through ‘mystery shopper’ exercises which: • visit practices • telephone practices
Has every practice updated their websites with new Practice websites will need to be updated by each practice in each Neighbourhood as access patient offer clearly outlining: that Neighbourhood mobilises. - modes of access - Appointment availability Assurances on information available to patients on websites relating to extended access - local evidence of publicity available appointments can be sought through review of websites. (please provide details)
Page 129 Page Evidence of the local assessment / impact analysis An equality impact assessment was undertaken as part of the business case for of inequalities? SWEAP.
SPCT are required to make every effort to ensure that all vulnerable groups have access to primary care services, putting reasonable adjustments and other assistance in where necessary for those with protected characteristics. Access to appropriate language services must be available for patients who have additional language needs, eg patients who do not speak English or who have sensory disabilities.
Reporting mechanisms include appropriate, relevant and measurable KPIs to enable equality monitoring.
Provision of quarterly monitoring utilisation of SPCT are required to provide both monthly and quarterly utilisation data which will be appointments and how this is responsive over time reviewed through the monthly contract meeting between the CCG and SPCT to meet patient needs?
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Can you confirm the service offer includes the Yes, patients will be able to book an appointment with a GP or relevant other healthcare ability for patients to have a face to face professional i.e. ANP, Nurse, HCA appointment with a GP in your locality if they wish?
Please can you outline the model in place to Patients will be able to contact their GP practice to book an extended access accommodate this. appointment with a GP.
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Workforce
A GM Primary Care Workforce Reference Group has been established with representation from primary care leads and workforce leads from across Greater Manchester. GM HSCP will work with localities to support workforce planning including providing baseline data information, identifying opportunities for recruitment and retention initiatives and working closely with Health Education England North to ensure a consistent offer to localities.
Planned annual increase in the number of doctors working in Planned annual increase in the number of other clinicians primary care working in primary care
i. Number for the overall increase ii. iii.If iv. i. Number for the overall increase ii. iii.If other (headcount or wte) Intended other Types (headcount or wte) Intended please list sources please of sources Page 131 Page for list in doctors for securing column planned securing that B. to work that increase in increase primary care 2017/18 2018/19 2019/2020 2020/21 2017/18 2018/19 2019/2020 2020/21
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Additional investment (CCG plans for £3ph non recurrent investment)
Year Planned spend Spend 2017/18 2018/19
Participation in GP Excellence Programme
Evidence of neighbourhood peer review system in place to review / discuss GM metrics Evidence of quality improvement initiatives as a result No of practices engaged with GM Excellence Programme Evidence of high level outcomes
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Training and upskilling staff – Care Navigators/Active Signposting/Workflow Optimisation Annual report of initiatives, outcomes in order to showcase and share learning
Online Consultations
Baseline 2017/18 2018/19 2019/20 Total
Number of practices offering online consultations to their patients Total number of patients covered by the offer of online consultations % of practices offering online consultations to their patients
% of patients covered by the offer of online consultations
Total number of patients using online consultation
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Ongoing monitoring and shared learning A rolling programme to monitor outcomes will be co-designed with localities in order to, illustrate the benefits of the primary care reform programme, to demonstrate increased investment in primary care as well as facilitate shared learning across the system.
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Schedule 6 - Dispute Resolution
This Investment Agreement will be subject to a dispute resolution agreed by Greater Manchester.
This dispute resolution process is still in development, will be inserted at such time the agreed version is available.
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Schedule 7 Locality Management and Governance Arrangements
Anthony Hassall (Chief Accountable Officer) will act as the Senior Responsible Officer for this programme of work and Anna Ganotis (Head of Service Improvement) will provide Programme Management.
Within the CCG’s governance structure, the Primary Care Commissioning Committee has been judged to be the most appropriate committee to make decisions in relation to the Primary Care Investment Agreement and to oversee delivery.
The Primary Care Commissioning Committee will report to the Locality Plan Programme Management Board to ensure consistency of approach with the other two programmes funded by GM Transformation Funding and alignment to Salford’s Locality Plan.
Salford Health and Wellbeing Board
Primary Care Locality Plan Programme Commissioning Management Board
Committee
Each workstream has its own governance arrangements as set out below:
Provision of 7 Day Access Delivery against the Salford Wide Extended Access Pilot is being managed via monthly Salford Primary Care Together Contract meetings.
Training Care Navigators and Medical Assistants Primary Care Workforce provides 6 monthly update reports to the CCG’s Integrated Community Based Care Commissioning Group.
Provision of Online Consultation Software The Online Consultation programme will report to the CCG’s IM&T Group.
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Appendices:
Appendix one outline of care navigator role Appendix two outline of workflow optimisation / medical assistants Appendix three NHS England Health Inequalities guidance
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Appendix one Care Navigation / Active Signposting
The Care Navigator role can enable GPs and nurses to focus more on managing complex care, including medical care, where Care Navigators provide continuity and spend longer less pressurised time with patients and carers.
What is care navigation and why is it important?
Care navigation is a simple, sustainable model of care that improves access to primary care and reduces GP pressures. By providing clear information about the range of services available both inside and outside of the GP practice, care navigation provides real choice to patients allowing them to go straight to the service that best meets their health and social care needs.
Care navigators’ can play a crucial role in helping people to get the right support, at the right time to help manage a wide range of needs. This may include support with long term conditions, help with finances and signposting to a range of statutory and voluntary sector services such as services within the practice, housing, debt management, benefits advice, the voluntary sector or varied community assets for those who feel isolated.
Age UK defines care navigation to include Personalisation support, Co-ordination and integration across health, social care and voluntary sectors.
Effective navigation is a key element of delivering coordinated, person-centred care Evidence suggests navigation services can enhance patient and carer experience, reduce unnecessary hospital readmissions and promote independent living at home.
The Care Navigator role can enable GPs and nurses to focus more on managing complex care, including medical care, where Care Navigators provide continuity and spend longer less pressurised time with patients and carers.
Who provides care navigation?
Navigator roles, job titles and day-to-day tasks vary depending on local context, including organisation function, peoples’ existing skills and local population need. For example ‘care coordinators’ and ‘care navigators’ may work in hospitals, focusing on discharging people safely from hospital to home, or as part of a general practice in a multidisciplinary team.
Titles include: Health and social navigator, Social prescriber / link worker, Community connector, Non- clinical navigators, Care coordinator, Locality navigator, Stroke navigator, Primary care navigators for dementia
People who provide care navigation build relationships, problem solve and help locate resources, serving as a link between community, health and social services. They advocate the needs of people; they are enabling and focused on recovery, to strengthen the work of the multidisciplinary team. A key purpose is to ensure patients experience seamless, joined up care and support.
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Currently there are a range of care navigation service models. Non-clinical staff who deliver care navigation in the UK tend to occupy a plethora of roles, work in many settings and have varying job titles and backgrounds such as reception staff, administrative staff, trained volunteers, staff with health or social care backgrounds.
There is no ‘one size fits all’ navigation service, with variations throughout the UK and internationally, people who provide care navigation build relationships, problem solve and help locate resources, serving as a link between community, health and social services. They advocate the needs of people; they are enabling and focused on recovery, to strengthen the work of the multidisciplinary team. A key purpose is to ensure patients experience seamless, joined up care and support.
A person providing in care navigation is usually based in a multi-disciplinary team, helps identify and signpost people to available services, acting as link workers. There is a variety of different approaches to solving local problems around coordinating and signposting patients.
There is a current lack of clarity, clear consensus and coherence in such navigation roles and the necessary skills, attributes and training requirements.
Competency Framework
Health Education England has produced a competency framework describing three different levels of competency for care navigation.
These core competencies are brought together in a tiered competency framework, recognising three successive levels; essential, enhanced and expert. This will help provide a coherent benchmark or set of standards for care navigation, to help ensure that relevant staff receive the necessary education, training and support to work effectively.
Three levels of competencies for care navigation:
Essential – At this level people may have no or minimal experience of working in a health/social- voluntary care setting; or some experience already working within administrative roles. Signposting to local service; inputting data to directory and databases; supervised e.g. GP Receptionist ward clerks, non-clinical navigator
Enhanced – At this level people will have some level of expertise, background in health/social care and/or voluntary sector and some experience of working with people with long term health/mental health needs. Some people may progress from the essential navigation level, or may enter at this level if competencies are already achieved. Greater level independent working, enhanced communication skills i.e. health coaching e.g. care navigators, locality navigators
Expert – At this level people will possess a greater depth and breadth of knowledge/
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experience of health/social care, enabling a greater ability to support person-centred care and wellbeing. Some may progress from the enhanced navigation level or enter at this level if competencies are already achieved. Individuals will have some experience in managerial aspects of healthcare, and will need to lead a team of others in navigation-roles.
At this level, individuals will mentor and supervise others in navigation-roles. Developing services; Dealing with more complex cases; advanced communication skills; mentoring other staff e.g. Navigator team leader, Discharge co-ordinator
Areas to consider prior to roll out of Care Navigators
Simply having services and trained people in place are not enough; there are a few areas to consider before training takes place: Each practice will need to be in a state of readiness where care navigators have knowledge of the community assets and local services available in order to effectively signpost and support patients. Therefore a mapping process resulting in a directory of local services will need to be in place. Each practice will have diverse community needs so there needs to be an understanding of the culture within each locality so that the needs of each locality are met. Each individual practice will have varied capacity within their workforce, which will determine how they cope with the change in role so there needs to be a capability assessment.
Care Navigation Models
There are various examples of care navigation models and training programmes in place, across the UK, which we can learn from:
West Wakefield Health & Wellbeing
Based in West Wakefield, this social enterprise was established to support primary care transformation, initially through the Prime Minister’s GP Access Fund and later as part of the new care models vanguard program.
They have developed and implemented a highly effective care navigation model that has helped to signpost over 9500 patients and saved over 1685 hours in GP time across Wakefield in just seven months. They have developed the country’s first Accredited Certificate in Care Navigation training programme for frontline staff.
Training includes interactive guided learning, flexible online sessions and consultancy to support the development of systems and processes. Each learner receives a certificate of achievement and access to a progression pathway giving frontline staff chance to build on their skills and competencies even further.
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Care co-navigator/health and social care navigators Waltham Forest and East London (WELC)
Navigators are part of an integrated care pioneer programme and embedded within a care coordination for high risk patients model (long term health conditions, older people for example)
Navigators work within an integrated team, including other key workers such as GP, lead nurse, social workers, acute trust geriatrician
Some of the key tasks of the navigator include:- supporting assessment and development of a personal care plan based on needs, together with relatives, patient, health and social workers
being a point of contact for patients to help coordinate care across primary secondary and community care
attending case conferences and multidisciplinary meetings
reaching out to providers for appointments and to clients to check the care plan is followed
supporting people to access services from a range of statutory and non-statutory sectors including arts, faith, voluntary, education.
being flexible, able to multi-task, prioritise jobs, cope with stress, deal with challenging clients.
Greenwich Care Navigators
Greenwich Coordinated Care is made up of partners including CCG, acute trusts, mental health trust and local Healthwatch
Care navigators were introduced to help co-ordinate multidisciplinary care planning, scanning and integrating different sectors including health, social and community sectors.
Navigators work to develop ‘I’ statements, personalised care plans which build upon a person’s goals, desires and needs.
Key elements of the job include: speaking with people over the phone to determine their individual needs, working closely with other agencies which may reach far and wide including housing, voluntary organisations, using a motivational interviewing style, acting as a main point of contact for the carer or client, take part in team meetings and being able to communicate confidently and assertively when necessary, to help champion the needs of a person. Education and training is in- house.
Camden Care Navigators, Age UK
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Navigators work as a team of six with a team manager, who oversees and supports the training and work of the navigators
Navigators focus on supporting people to access mainly community and voluntary sector services in Camden
Navigators have a wide range of background in health social care e.g. Macmillan nursing, substance misuse services.
They work across a network of services
A local directory is created and team members share information and knowledge – it is important to meet with one another to learn together and reflect on challenging cases
Key tasks include signposting people to services, provide advice, contribute to MDT meetings, help coordinate care people e.g. to attend appointments at the hospital
Receive referrals from GP, and may involve speaking to clients over the phone or arranging home access visits
They help set goals and develop individual personalised care plans
Important elements of the job include: understanding some basic medical terminology, knowledge of impact of long term conditions on health, mental health and capacity issues, confidence, excellent communication, presenting information at a meeting, persistence
Education and training is usually in house, where the team leader seeks available on- line and other courses.
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Appendix two
Workflow Optimisation / Medical Assistants Summary
What is medical assistant/workflow optimisation?
A member of clerical staff (although this can be other staff groups such as Physician Assistants, etc) in the practice is given additional training and relevant protocols in order to support the GP in clinical administration tasks. These may include tasks such as to read, code and action incoming clinical correspondence according to a standard protocol, ordering tests, chasing results and outpatient referrals, liaising with other providers and explaining care processes to patients. In some practices, the medical assistant works very closely with the GP, sitting alongside them during telephone clinics.
The aim is to reduce the number of letters requiring processing by a GP.
The benefits are: GPs typically save 30-60 minutes per day (e.g. mean of 45min in Brighton –see case study below) With training and a standard protocol, safety is very good (e.g. zero adverse events in 15,000 letters, Brighton – see case study below) Coding improves. Staff satisfaction improves: enhanced role and greater contribution to the practice.
Managing clinical correspondence is an enhancement to typical administrative tasks of handling correspondence, such as scanning, forwarding to GPs and filing. It requires the staff member to be skilled and confident to make decisions about how to code a letter and its contents in the patient record, how to use an approved protocol for deciding which letters need to be sent to a GP and with what level of urgency, and when to ask for help. Training should also support the practice in establishing its own internal systems including a safe and appropriate protocol to guide staff, a system of supervision (especially for the early stages of implementation) and regular audits of safety and effectiveness. Ideally a training experience should provide opportunities for practice managers, GPs and staff to hear from others who are already working in this way.
Other training needs for clerical and reception staff (for example, customer service, information governance, understanding Read or Snomed codes, safeguarding) remain the responsibility of the employer, and are not covered by this funding.
Areas to consider prior to training
Support for the practice to develop its own internal systems including a safe and appropriate protocol to guide staff, a system of supervision (especially for the early
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stages of implementation) and regular audits of safety and effectiveness. This should include the opportunity to learn from other practices’ examples. Create opportunities for practice managers, GPs and staff to hear from others who are already working in this way.
Examples of models/case studies from elsewhere
“Here”
Here is a not-for-profit social enterprise and primary care federation, bringing together GPs, clinicians, staff and other health partners to improve services and patient care.
Training for document management
Workflow Optimisation was an approach to document management developed as part of the Prime Minister’s GP Access Fund. It provides a proven framework giving practices the confidence to redirect the flow of clinical administration work within the practice – releasing GPs to spend a greater proportion of their time with their patients. Practices are assured that clinical administration will be handled safely and accurately.
The outcome is that up to 80% of the patient correspondence is completed without the GP, freeing up approximately 40 minutes of GP time each day. Patients and their clinicians can then make informed decisions about their health which allows people to move onto the next step in their health care journey safely and efficiently.
The Training Programme
The training programme consists of:
4-day training course for administrators. Administrators are trained to read, code and action incoming clinical correspondence safely and accurately. Administrators are trained on their practices own patients – ensuring that the training is as realistic as possible. Training courses are taught in small groups of up to 16 trainees with a maximum ratio of 4 trainees to every trainer. Half-day training course for GP Champions. GP Champions attend a half-day training course learning the key responsibilities of their role – the role is pivotal in ensuring the practice achieves a safe, sustainable and full implementation of Workflow Optimisation. The training includes; the principles and processes underpinning Workflow Optimisation, the role of auditing and feedback in ensuring clinical governance and assurance, the medication protocol and other key protocols. Follow-up visits to support implementation. Follow-up visits can be provided to support practices in implementing Workflow Optimisation, to provide a refresher on any aspects the practice remains unsure of and to troubleshoot any issues encountered by the practice.
In addition to the training programme, practices also benefit from:
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An e-learning platform Training resources (including manuals, policies, protocols etc). An online forum Remote support from the Workflow Optimisation team for the duration of the contract. Medical indemnity assurance for Workflow Optimisation as confirmed by the Medical Defence Union (MDU) and the Medical Protection Society (MPS). CPD accreditation for the GP Champion element of the training programme
Medical assistants processing letters, Brighton and Hove GP Access Fund
To reduce workload pressures and help practices improve access for patients, this GP Access Fund scheme developed a new standard protocol to allow clerical staff to play an active role in processing incoming clinical correspondence, rather than the GP having to deal with every letter.
The idea Members of the practice clerical team are trained to read, code and action incoming clinical correspondence according to a standard protocol. The protocol was developed by local GPs and refined through live testing in practice, using feedback about its safety and efficiency. A standard process has been developed for training staff in undertaking this new work. It has been found to be feasible for staff with no prior experience of general practice, as well as very experienced secretaries and clinical coders. It has been found to be important to include mentoring as well as information-giving in the training, and for a GP at the practice to meet regularly with staff in the early days.
Impact In the first 6 practices to trial this, this has saved an average of 45 minutes of each GPs time each day, with no significant events having occurred in the first 15,000 letters to be processed. GPs report being satisfied with the safety of the approach, the improved quality of coding and the release of their time. Clerical staff report that they are confident to run the new process and describe renewed job satisfaction. Some of the most experienced staff describe it as the best thing that has happened to their job.
Implementation tips In the abstract, GPs often have concerns about the feasibility and clinical safety of this approach. It is useful for them to speak to a GP from another practice who has done it, as well as to reflect on the number of times currently that they feel it was not appropriate for them to have received a letter. Standard protocols are a very useful starting point, but can be adapted by a practice to adjust to their own ways of working and preferences about workflows and thresholds for insisting a GP handles a letter.
Link(s) www.england.nhs.uk/ourwork/futurenhs/pm-ext-access/wave-one/pm-about/#pil5
AT Medics
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AT Medics is London’s largest primary care provider, serving 170,000 patients across 30 sites. The group provides innovative services and has a track record of innovation in training and improving quality and productivity.
Training for document management EZ DOC™ is a systemised approach to managing GP letters, safely enabling administrative staff to handle most of the letters traditionally forwarded to GP’s. EZ DOC™ focuses on managing incoming correspondence safely and efficiently, reducing the amount of time GPs spend on administration, and building resilience and a well-connected practice team. The benefits have been:
efficiency: an hour of GP administration time saved every day per GP safety: significant improvement in clinical safety cost saving: £11,000 worth of annual savings per practice per 1000 patients satisfaction: huge increase in clinical and administration staff satisfaction
The training programme EZ DOC™ was developed by GPs at AT Medics, and a standard training approach has been developed, which has successfully rolled out the approach in over 25 GP practices to date.
The approach combines face to face training with the EZ DOC web-tool which enables individual practice teams to easily access information, training, assessment to ensure proficiency, and regular audits to ensure accurate and safe document management. We also recognise the need to allow Federations and CCG’s the opportunity to localise systems and this is built into our approach.
The standard process for introducing EZ Doc includes:
Understanding current practice identifying your complete document workflow process Co-designing the new working model, with face-to-face workshops to develop a localised solution, based on the EZ Doc model Training – web training includes an assessment to ensure staff proficiency and perpetual learning Implementation – development of a guided strategy to ensure a sustained improvement and change, step by step Audit – measuring the effectiveness and accuracy of the new document management process, periodically
Clerical staff processing letters, Wincanton Health Centre The five GPs at this practice were feeling overwhelmed with burgeoning admin work, but found the solution was in working smarter, not harder.
The idea In autumn/winter 2015 Wincanton Health Centre in Somerset decided the long working hours and administrative demands for GPs had to be addressed. Practice GPs receive about 200 pieces of paperwork every day which need to be processed. With each GP holding a list
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size of more than 2,000 patients and demands ever increasing during the day, the paperwork was being pushed to the end of the day. The practice handed over more administrative duties to admin staff and provided training to help them take over more of the procedural tasks previously handled by the GPs. As new processes were implemented, practice GPs found they could hand over an increasing number of duties to their clerical colleagues.
GP Dr Fox says: “We started by identifying letters that we felt we never needed to see, such as ‘did not attend’ letters and diabetic retinopathy screening notifications. We put in place systems to make sure these were dealt with appropriately by a member of the admin staff. This was a small help but didn’t make a sufficient dent in the workload so we pushed the envelope further. We trained one of the admin staff to code diagnoses, procedures and values in the letters and set the computer system so that on viewing the letters the GPs could deal with actions that were required but not have to go to the trouble of doing the coding - another improvement but still not enough.
“Finally we took the plunge and decided that a lot of the work being done by the GPs could be done equally well and possibly better by a member of the admin staff. A senior member of the admin team would then go through the post and weed out the letters that needed to be seen by the GPs but send the remainder to the admin team for task completion, coding or simply for scanning if no action was required. The initial letter reading was checked by a second senior staff member to ensure there were checks in the system. The general rule of thumb is if there is any doubt then the letter should be presented to the GP.”
Impact The number of letters being sent to the GPs has dropped to about 10 to 20% of what was previously being received. GPs are now feeling more in control of their workload and regaining more of a sense of work-life balance. Working hours have been reduced – something that will be attractive whenever the practice next needs to go to GP recruitment.
Implementation tips Dr Fox says: “It has been a great process for us although it may not work for all as it does require an amount of trust being placed in the senior staff on behalf of the GPs. I am aware of GPs even in my area who feel uncomfortable with that but I would strongly encourage them to consider how certain processes within their practice can be handled differently.”
Link(s) [email protected] www.wincantonhealth.co.uk
Local HEE support
Health Education England North also intends to commission a training provider to upskill the workforce across the North Region. The training will provide 90 places across the Northwest as a pilot and education model. Training will begin by September with two cohorts in spring and autumn. There will be a 6-9 month program of work based learning. It will target existing staff.
54 Page 146 SALFORD’S HEALTH AND WELLBEING BOARD
FORWARD PLAN 2017/18
Date and time of For assurance (regular reporting) For discussion / decision For information meeting 20th June 2017 Q4 2016/17 implementation plan highlight Peoples’ story - film 2017/18 HWB Forward Plan Business meeting report CCG Operational Plan 2017/18 (9am – 11am) ANNUAL REVIEW of Locality Plan progress Salford Flu Vaccination Report against outcomes (2016-17) including finance Memorandum of understanding update – discussion to link outcomes and the between the Health & Social Care implementation plan highlight report – is our Partnership and the GM VCSE sector implementation plan starting to make a difference in terms of health outcomes and financial savings?
Population Health Plan proposition – update Page 147 Page
12th September 2017 Q1 2017/18 implementation plan highlight Peoples’ story - film (START WELL) 2017/18 HWB Forward Plan 10 October report and risk register Answer to question from Mental Business meeting START WELL – issue based ‘deep dive’ Health Forum on hoarding (2pm – 4pm) discussion with invited speakers Health Protection Annual Report Update on Living Wage Task group work Population Health Plan proposition – including CCG Annual Report 2016/17 update on how GM Population Health Plan will HWB Annual Review 2016/17 Agenda Item 13 impact in Salford (for approval) Health Watch Salford – Priorities for 2017/18 and Annual Report Suicide Prevention strategy Better Care Fund update
GM Primary Care Reform Investment Agreement (for approval)
29/09/2017 1 SALFORD’S HEALTH AND WELLBEING BOARD
FORWARD PLAN 2017/18
Date and time of For assurance (regular reporting) For discussion / decision For information meeting 3rd October GM PSR Strategic Self Assessment Development & shared Working meeting
14th November 2017 Q2 2017/18 implementation plan highlight Peoples’ story - film (LIVE WELL) 2017/18 HWB Forward Plan
Business 148 Page meeting report and risk register JSNA / Intelligence Newsletter (2pm - 4pm) 2017/18 Implementation Milestone Plan (for Health Protection Forum Update approval) CYPT Annual Report Locality Plan Workforce Strategy LIVE WELL – issue-based discussion with invited speakers o Physical Activity Strategic Framework - SCL 13th February 2018 Q3 2017/18 implementation plan highlight Peoples’ story - film (AGE WELL) 2017/18 and 2018/19 HWB Forward Business meeting report and risk register Plans (2pm – 4pm) AGE WELL – issue-based discussion with invited JSNA / Intelligence Newsletter speakers Health Protection Forum Update
To be re-scheduled: Discussion around collaboration – My City and My City Health
29/09/2017 2 SALFORD’S HEALTH AND WELLBEING BOARD
FORWARD PLAN 2017/18
PROPOSED DEVELOPMENT SESSIONS
Date and time of Purpose, Content and Output of sessions meeting 26th April 2017 Purpose: The role and purpose of the Board – induction for new members
Content: Peer learning and discussion focussing on the role of the partners around the table in the Board meetings and how representative members can take direct action, influence others, campaign, or communicate Board priorities.
Output: All Board members are clear of the role that they play in the business of the Health and Wellbeing Board, and how they can take an active part in the delivery of the Locality Plan outcomes.
3rd October 2017 Purpose: To discuss how the Board member organisations might engage in co-production
9.30 149 Page – 11.30am Content: A practical case study around the use of the My City Salford community portal
Output: information to inform a development plan for use of My City Salford to support improvements in Health and Wellbeing December 2017 Purpose:
Content:
Output:
March 2018 Purpose:
Content:
Output:
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Salford Council Health Protection Annual Report 2016/17
1.0 Purpose
The purpose of this document is to provide a clear overview of the current health protection situation within Salford highlighting any on-going challenges or issues. The document enables the Director of Public Health (DPH) to provide assurance to the Health and Wellbeing Board (HWBB) and Lead members that the health of the residents of Salford is being protected in a proactive and effective way.
1.1 Key points The Director of Public Health is able to provide assurance that the health of Salford’s residents is being protected; All of the groups that support and deliver health protection across the City are engaged in a process of continuous improvement; There are robust civil contingency mechanisms in place to protect Salford’s residents and ensure business continuity; The majority of Salford’s immunisation rates remain very high and childhood immunisations, in particular, are above the national average.
1.2 Recommendations Local System Governance: . To review the current systems and structures in order to maximise the health protection response in protecting Salford’s population; . To ensure the inclusion of environmental health within the health protection system to ensure a more complete offer to the population.
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Emergency planning and Major Incident Response: . To maintain current good performance to ensure enhanced preparedness; . To continue to participate in exercises to build capacity within the local emergency response.
Communicable diseases: . To maintain the excellent vaccination schedule performance to ensure herd immunity within Salford’s population; . To continue raising the profile of the ‘Flu Champion Programme’; . To develop improved links with primary care to enhance TB diagnosis and early diagnosis of HIV to improve outcomes for the most vulnerable citizens.
Screening Programmes: . Work collaboratively with Public Health England (PHE), primary care and key partners to identify opportunities to improve screening rates in communities of low uptake in Salford in order to reduce inequalities in uptake across the borough.
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2.0 Introduction
2.1 Health protection is an essential part of achieving and maintaining good public health. It involves strategic planning, emergency planning, surveillance and response to incidents and outbreaks. Health protection prevents and reduces the harm caused by communicable diseases and minimises the health impact from environmental hazards such as chemicals and radiation. It also includes the delivery of major programmes such as national immunisation and screening programmes and provision of services to diagnose and treat infectious diseases.
2.2 The Health and Social Care Act 2012 defines the health protection duty of Local Authorities (LAs). The Act states that Public Health teams, on behalf of Directors of Public Health, are responsible for the LA’s contribution to health protection matters including responses to incidents and emergencies. PHE is required to provide specialist support and have a complementary role to play. Both PHE and LA Public Health should work as a single unit when addressing health protection issues. NHS organisations including NHS England and Salford’s Clinical Commissioning Group (CCG) have a legal responsibility under the NHS Act 2006 to mobilise resources to manage incidents and emergencies. They also have a legal duty to co-operate with LA Public Health teams in delivering health protection national and local priorities. A summary of roles and responsibilities can be found in Appendix 1 at the end of this document.
2.3 The key roles necessary to provide effective health protection include: Planning and responding to incidents and emergencies; Carrying out surveillance of communicable and notifiable diseases; Reducing the negative impacts of communicable and non-communicable diseases including preventing infection and infectious diseases; Minimising the health impact of environmental hazards;
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Reducing premature mortality and morbidity by improving environmental sustainability.
Health protection arrangements in Salford 2.4 The Health Protection Team sits in the Local Authority in Salford under the Director of Public Health. The team works closely with other LA services – Environmental Health and Children’s Service – and they also work with key partners across the city, the CCG, Salford Royal Hospital and the Integrated Care Organisation. By having a multi-agency approach this allows a more in-depth examination of current practice and performance and offers the opportunity to raise any changes to procedures or protocol, raise concerns or to highlight good practice. 2.5 The Health Protection Forum (HPF) retains an overview of the work of these groups via membership of the groups and reporting arrangements.
2.6 Membership of the HPF comprises representation from the subgroups. Attendance at meetings of the HPF has been consistent; the agenda delivery has just recently been reviewed and restructured.
2.7 Public Health also receives national data in respect of the Public Health Outcomes Framework and performance reports from PHE.
2.8 Diagram of local Health Protection arrangements in Salford
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LA Health Protection Team/ Infection Control
GM IPC GM IPC Confederation Collaboration
Health Protection Forum Salford Urgent Salford Flu & Emergency group Care Delivery Board
Health Care Salford Health Acquired Economy Infections Resilience Group group (HERG)
Data Sources 2.9 The data included within this report are the most current available and cover the period July 2015 to December 2016. The data are taken from the Public Health Outcomes Framework Tool published by PHE. (http://www.phoutcomes.info/). PHE is currently in the process of reviewing a number of health protection related indicators. Further data will be available later this year.
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3.0 Emergency planning and major incident response
Background 3.1 Emergency planning and major incident response comprise actions that are taken to reduce the chances of emergencies occurring. If incidents do occur the response includes ensuring that the impact on residents and the environment is kept to a minimum. Emergency planning is guided by the Civil Contingencies Act 2004. The Act ensures that the organisations best placed to manage emergency response and recovery are at the heart of civil protection.
3.2 Salford has two multi-agency groups, a Health Economy Resilience Group (HERG) and a Salford Urgent & Emergency Care Delivery Board (UECDB). Both groups have a role in planning for potential emergencies and ensuring clear protocols and standard operating procedures are in place. The groups include representation from all the agencies including LA, CCG, Salford Royal Foundation Trust, NHS England (NHSE), PHE and Out Of Hours (OOH).
3.3 The groups utilise national and regional strategies to develop local action plans to ensure Salford is prepared for a range of emergencies. As part of the Public Health Outcomes Framework LAs are measured against whether they have a ‘comprehensive and agreed inter-agency plan for responding to health protection incidents and emergencies’. Salford does have this and is rated green against this measure.
Current situation 3.4 The unusually excessive rainfall over the 2015 Christmas period hit Greater Manchester (GM) and Lancashire on 26th December 2015 with rainfall totalling 100mm (average GM rainfall for the month 80mm). The weather was unexpected with the forecast pointing towards potential issues for Cumbria and Lancashire only. No Flood Warnings were issued by the Environment Agency for Salford and as a result, neither Salford City Council nor residents received any warnings about the
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flooding. 668 residential properties and 196 businesses were flooded. The debrief report in respect of the incident has led to a number of changes being made to local civil contingency arrangements such as updating and enhancing the list of vulnerable residents, a review of the civil contingencies rota, a review of the Emergency Management Plan and the Multi-Agency Flood Plan as well as updates to the Contacts and Capabilities Document within the Council. Subsequent work has included flood information packs being sent to affected households and work with the Environment Agency to increase uptake of the Flood Warning System. Nationally changes are currently being made to the Environment Agency’s reporting arrangements in order to produce more “live forecasting” information which should, in turn, enable services to respond to incidents more effectively.
3.5 Following the floods, Salford Resilience Forum and HERG participated in a major GM emergency planning exercise, Exercise Triton 2, which simulated the effects of a major dam breach in Oldham and its potential regional repercussions. The exercise was the largest of its type ever undertaken in GM.
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4.0 Communicable Diseases Background 4.1 Communicable diseases are diseases that you can "catch" from someone or something else. They are spread from person to person or from an animal to person. The spread often happens via airborne viruses or bacteria, but also through blood or other bodily fluids. Some people may use the words contagious or infectious when talking about communicable diseases.
Vaccine-preventable diseases 4.2 Vaccines are preventative, that is, they only protect the individual before they get an infectious disease. When an individual is vaccinated, the processes in the immune system are stimulated to mimic the body’s natural immunity. These processes occur without causing the damage that an infection usually causes.
4.3 Vaccines provide immunity by stimulating the immune system to produce antibodies to fight a particular infection or prevent the effects of a toxin. These antibodies stay in the body and provide long-term protection. Antibodies fight a particular infection or toxin by identifying a matching antigen. Antigens are a pattern or structure found on the microorganism or toxin, and the antigen is a complementary match for the antibody that will be produced.
4.4 If an individual has not been vaccinated against a disease and they have contact with it, they will usually acquire some natural active immunity through exposure to antigens of the microorganism or toxin. However, there are risks associated with contracting an infection as some infections can leave individuals with long-term complications, or worse, cause death. Artificial active immunity occurs through vaccination or inoculation.
4.5 If enough of a population is vaccinated, herd immunity is attained. Herd immunity in a population prevents outbreaks of an infection. This is due to the inability of
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the disease to infect vaccinated individuals and through the inability for unvaccinated individuals to come into contact with the disease due to its decreased prevalence. It is important to maintain herd immunity as some people are unable to have vaccinations. Individuals who may not be able to have a vaccine include those who are immune-compromised, individuals with allergies to the components of vaccines, and very young children.
The Immunisation Schedule 4.6 The Immunisation Schedule of childhood vaccinations has been designed to provide early protection against infections that are most dangerous for the very young. Older people are also urged to protect themselves from a number of infections that pose risks for this population.
Measles, mumps and rubella (MMR) 4.7 This is a safe and effective combined vaccine that protects against three separate illnesses in a single injection. The full course of MMR vaccination requires two doses. Measles, mumps and rubella are common, highly infectious, conditions that can have serious, potentially fatal, complications, including meningitis, swelling of the brain (encephalitis), and deafness. They can also lead to complications in pregnancy that affect the unborn baby and can lead to miscarriage. Since the MMR vaccine was introduced in 1988, it has become rare for children in the UK to develop these serious conditions. However, outbreaks happen and cases of measles, in particular, have been rising in recent years.
Current situation 4.8 Salford’s vaccination coverage for MMR (one dose) has remained stable from 2010/11 to 2015/16 with uptake rates of between 97.3% and 98.6% being achieved. For this first dose, the vaccination coverage in Salford has consistently remained higher than both the North West and England uptake. Salford’s coverage for two doses of MMR has reduced slightly (but not significantly) in the 2015/16
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data release (see below) but still remains higher than both the North West and England.
Human Papilloma Virus (HPV) 4.9 The Human Papilloma Virus (HPV) is the name given to a family of viruses. The HPV virus is very common and is easily spread by sexual activity; as much as half the population will be infected at some time in their life. Different types of HPV are classed as either high risk or low risk, depending on the conditions they can cause. For instance, some types of HPV can cause warts or verrucas. Other types are associated with cervical, penile and anal cancer. In fact, in 99% of cases, cervical cancer occurs as a result of a history of infection with high-risk types of HPV. Often, infection with the HPV causes no symptoms.
NHS England, under their national responsibilities outlined in the NHS Public Health Functions Agreement, is responsible for the commissioning of the HPV vaccination programme. The HPV vaccine protects against the two high-risk HPV types that
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cause over 70% of cervical cancers. Vaccination coverage is the best indicator of the level of protection a population will have against vaccine-preventable communicable diseases. In the UK, all 12-13-year-old girls (school year 8) are offered HPV vaccination through the national HPV immunisation programme. This consists of two injections into the upper arm spaced at least six, and not more than 24 months apart.
4.10 HPV vaccination has a target of 90% coverage. Salford’s coverage for HPV in females aged 12-13 years has fallen slightly between 2011/12 and 2013/14 with coverage ranging from 84.0% to 81.1%. This is lower than the England and North West coverage which in 2013/14 was 86.7% and 88.9% respectively. Salford falls short of the national target figure, principally due to the number of girls in the Orthodox Jewish population (which make up approximately 10% of the cohort) who may refuse the vaccine on religious grounds or for other reasons not known to services. However, if the Orthodox Jewish population is excluded the coverage target was achieved in 2011/12, 2012/13 and 2013/14. Some individuals do seek vaccination at an older age before they become sexually active.
Meningococcal Disease 4.11 Meningococcal disease can affect all age groups, but the rates of disease are highest in children under five years of age, with the peak in babies under one year of age. There is also a second peak in cases in young people aged between 15 and
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19. Babies are routinely offered the Men C vaccine as part of the childhood vaccination programme at 3 months of age. A second dose of Men C is offered at 12 months in a combined vaccine with Haemophilus influenzae type b (Hib). Teenagers and first-time university students are offered Men C vaccination in a combined Men ACWY vaccine.
4.12 A new vaccine to prevent meningitis has been offered to all babies as part of the routine NHS childhood vaccination programme since 1st September 2015. The Men B vaccine will be offered to babies aged 2 months, followed by a second dose at 4 months, and a booster at 12 months. There was a temporary catch-up programme for babies who are due their 3- and 4-month vaccinations in September 2015, to protect them when they are most at risk from infection. The Men B vaccine will protect babies against infection by meningococcal group B bacteria, which can cause meningitis and septicaemia (blood poisoning), which are serious and potentially fatal illnesses.
Current situation 4.13 Salford has an excellent coverage of the Men C vaccination with 96.1% of 1-year- olds receiving the vaccination in 2012/13. This uptake is better than the North West and the England average. In 2012/13 the rates increased significantly from the previous year 2011/12 (94.8 to 96.1).
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Pneumococcal Infections 4.14 The pneumococcal vaccine protects against pneumococcal infections. Pneumococcal infections are caused by the bacterium Streptococcus pneumoniae and can lead to pneumonia, septicaemia (a kind of blood poisoning) and meningitis. A pneumococcal infection can affect anyone. However, some people need the pneumococcal vaccination because they are at higher risk of complications. These include: All children under the age of two; Adults aged 65 or over; Children and adults with certain long-term health conditions, such as a serious heart or kidney condition.
4.15 Babies receive the pneumococcal vaccine as three separate injections, at 2 months, 4 months and 12-13 months. People over 65 only need a single pneumococcal vaccination, which will protect for life. It is not given annually like the flu jab. People with a long-term health condition may need just a single one-off pneumococcal vaccination or five-yearly vaccination depending on their underlying health problem.
4.16 There are two different types of pneumococcal vaccine: Pneumococcal conjugate vaccine (PCV) – this is given to all children under two years old as part of the NHS childhood vaccination programme; Pneumococcal polysaccharide vaccine (PPV) – this is given to people aged 65 and over, and to people at high risk due to long-term health conditions.
Current situation 4.17 The PCV coverage in Salford is 95.6% (2015/16); this is higher than the North West and England average. Coverage in both Salford, England and the North West has remained relatively stable in recent years.
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4.18 The PPV coverage in Salford is 66.6% (2015/16); this is lower than the North West and England average. However, there has been a slight increase in uptake in the last 3 years from 2012/13 to 2015/16. Coverage in both England and the North West has remained stable in recent years.
Shingles 4.19 Shingles is also known as herpes zoster and is a painful skin rash caused by the reactivation of the chickenpox virus (varicella-zoster virus) in people who have previously had chickenpox. It begins with a burning sensation in the skin, followed by a rash of very painful fluid-filled blisters that can then burst and turn into sores before healing. The shingles vaccine is given as a single injection for people aged 70 and 78 or 79 (as a catch up). Unlike the flu jab, individuals only need to have the vaccination once and it can be administered at any time of the year. The shingles vaccine is expected to reduce individuals’ risk of getting shingles in the future but some people may still contract the disease. In these cases, the
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symptoms are likely to be milder and the illness shorter. Shingles can be very painful and uncomfortable. Some people are left with pain lasting for years after the initial rash has healed and shingles is fatal for around 1 in 1,000 people aged 70 years and over who develop it.
Current situation 4.20 Salford’s routine shingles vaccine uptake for 70-year-olds was 32.4% for the nine months September 2015 – May 2016. In comparison, that of England was 51.0%. That represents a gap of 19 percentage point between Salford and the England average. The catch-up vaccination coverage for 78-year-olds was also lower than the England average: 31.1% against 51.1%. For both Salford and England, the vaccination coverage at 70 years has reduced in 2015/16 when compared to 2013/14, while the catch up for those aged 78 years has now stabilized after initially increasing significantly.
Shingles vaccination coverage Sept 2013-Aug 2014 Sept 2014-May 2015 Sept 2015-May 2016 Salford England Salford England Salford England Routine 70 years 40.7 61.8 40.7 52.8 32.4 51.0 Catch up 78 years 0.7 1.0 30.9 52.5 31.1 51.1
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5.0 Other Vaccine-Preventable diseases
Seasonal flu and flu vaccination 5.1 Influenza (flu) is a viral infection affecting the lungs and airways. The symptoms can appear very quickly and include a headache, fever, cough, sore throat and/or aching muscles and joints. In small numbers of cases, flu can lead to complications including bacterial pneumonia, which can be life threatening especially in older people and those with certain underlying health conditions. Flu occurs most often in winter in the UK and peaks between January and March.
5.2 The seasonal influenza virus does not necessarily cause high mortality, but for people who are over 65 years of age and who are already sick, it may speed up their death. For some people with long-term conditions, under the age of 65 years, the risk of mortality from seasonal influenza can be far higher than the average population.
5.3 To protect those vulnerable individuals from seasonal flu each year there is a national flu vaccination programme. All the individuals that fall within at-risk groups are identified and offered the flu vaccination through their GPs although increasingly these individuals are also able to access vaccination via workplaces and pharmacies.
5.4 In the 2016/17 flu season, the flu vaccine was offered to all two-, three- and four- year-old children, to all children of school years 1, 2 and 3.
5.5 Salford Council does not have direct responsibility for delivering the seasonal flu immunisation programme to school-aged children; responsibility now lies with NHS England Greater Manchester, supported by co-commissioner Salford Clinical Commissioning Group. In 2016/17 the schools programme was delivered by the provider IntraHealth to children in school years 1, 2 and 3. The Public Health team in the LA supports the agency responsible for delivery of the seasonal influenza
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immunisation programme. We help to promote the vaccination through the ‘Flu Champion Programme’ engaging all front-line staff across the Local Authority and other agencies to promote the vaccination to our eligible population at every given opportunity. The Health Improvement service also supports flu vaccination promotion.
Current situation 5.6 Within Salford the eligible group which has the highest uptake of flu vaccine is the over 65s. Uptake in this group has increased in the last two years, peaking at 81.1% in 2016/17; GPs provided 73.5% of the vaccinations and the rest of the vaccinations were provided by pharmacies or other health care providers. Uptake of the flu vaccination in Salford’s under-65s at risk was 52.2%. This includes vaccinations delivered by the GP, pharmacies and other health care providers. Performance is above the England average of 48.7%. In 2016/17 there was a huge increase in the number of vaccinations delivered by providers other than the GP, such as pharmacies and district nurses, increasing from 3.3 % to 7.6%.
5.7 Two-, three- and four-year-old child uptake of the flu vaccination in 2016/2017 was 30.7% reported as a combined total. This is a slight decrease in uptake from the previous season where 31% of two-, three- and four-year-olds were vaccinated by primary care. Next flu season the four-year-olds will be offered the vaccination via the school based programme delivered by IntraHealth. A minimum uptake of 40% has been shown to be achievable in both primary care and school-based programmes. The expected uptake levels are between 40-65% . This includes uptake in the school-based programme.
5.8 How Salford CCG ranked against other CCGs:
Salford uptake rank for 2 year olds flu vaccination 2013/14 2014/15 2015/16 2016/17 National rank: out of 211 CCGs N/A 119 142 153 GM rank: out of 12 CCGs 12 6 11 8
Salford uptake rank for 3 year olds flu vaccination
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2013/14 2014/15 2015/16 2016/17 National rank: out of 211 CCGs N/A 129 165 170
GM rank: out of 12 CCGs 12 8 11 10
Salford uptake rank for 4 year olds flu vaccination 2013/14 2014/15 2015/16 2016/17 National rank: out of 211 CCGs N/A 98 125 144 GM rank: out of 12 CCGs N/A 5 8 7
*CCGs are ranked by rate of uptake with the CCG ranked 1st having the highest uptake.
5.9 Salford has remained in the lower half of the Greater Manchester Authorities for two-, three- and four-year-olds flu vaccination coverage over the last three years; when compared nationally, Salford’s uptake is similar to the England average. 5.10 Flu vaccine uptake is variable between GP practices. This variation is independent of practice level deprivation and indicates an inequality in the protection of groups of vulnerable patients against seasonal influenza. This variation in influenza vaccine uptake also represents variation in the protection of the health of different GP practice populations. We know that uptake in the Jewish population is low due to cultural beliefs around vaccinations. There are a number of interventions in place to try and increase the uptake amongst this group with support from the Rabbi.
5.11 Seasonal flu presents a varied picture due to the occurrence of a variety of other viral infections that can cause flu-like symptoms. This can mask the threat that influenza presents to vulnerable people with a much greater risk of complications. It also undermines individuals’ sense of urgency in accessing seasonal flu vaccination which is a safe and effective method to protect people at high risk from flu.
5.12 This coming flu season, winter 17/18, there are some changes around the delivery of the flu vaccination. GPs will be commissioned to deliver the vaccination to over 18s in the eligible groups and children aged 2 and 3. IntraHealth is commissioned by NHS England to deliver the school based programme to children in reception and school years 1, 2, 3 and 4.
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5.13 Salford Care Home Practice is a GP practice that solely oversees the care of Salford residents who reside in care homes. All residents are encouraged to register with Salford Care Home Practice once moving into a home. Having all care home residents registered with one practice enables an efficient flu vaccination programme with the achievement of high uptake rates. The management of a flu outbreak is also easier because the Community Infection Prevention and Control Team and PHE only have to liaise with the one practice.
Tuberculosis 5.14 Tuberculosis (TB) is a vaccine-preventable infectious disease, caused by bacteria belonging to the Mycobacterium tuberculosis complex. TB usually causes disease in the lungs (pulmonary), but can also affect other parts of the body (extrapulmonary). Between 2013 and 2015, there were 19,491 TB cases reported in England, an incidence of 12.0 cases per 100,000 of the population. Those most at risk are migrant populations and vulnerable groups, particularly the homeless. The UK currently has the second highest rate of TB among Western European countries.
5.15 The most effective way to prevent TB is through vaccination. The BCG vaccination is recommended on the NHS for babies, children and adults under the age of 35 considered at risk of catching TB. It is not given to anyone over the age of 35 as there is no evidence it has any effect in this age group. The BCG vaccination is recommended for all older children and adults at risk of TB including older children with an increased risk of TB who were not vaccinated against TB when they were babies, anyone under 16 who has come from an area where TB is widespread or anyone under 16 who has been in close contact with someone who has pulmonary TB (TB infection of the lung). In addition, the BCG vaccination is recommended for people between the ages of 16 and 35 who are at occupational risk of exposure to TB.
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Current situation Number of new cases of Tuberculosis in Salford 5.16 Based on three year averages between 2013 and 2015, the number of new cases per year in Salford residents was 88. This gives a rate of 12.1 cases per 100,000 population.
5.17 From 2008/10 the rate peaked at 14.4 per 100,000; from thereon it decreased over the following 3 years from 2009/11 to 2011/13. Since then there has been a small increase in cases. The England average has reduced and the gap between England and Salford has closed with rates currently at 12.0 and 12.1 respectively (2013/15).
5.18 In addition, there is a strong association between TB and social deprivation, and Salford has a higher than average proportion of deprived residents when comparing areas nationally.
Treatment completion 5.19 Treatment completion is a vital aspect of tackling TB as a health protection issue. It is essential to ensure that those with TB become free of the disease so that they are no longer carriers and therefore cannot pass on the disease. In addition, it reduces the risk of Multi-Drug Resistant TB (MDR TB) which if developed can be extremely problematic as there are no effective treatments. MDR TB results in individuals being unable to clear the bacteria, which in turn leads to on-going
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health issues and makes them a wider risk to the public as they will be a constant carrier.
5.20 The percentage of treatment completion in Salford has been rising over the years. Latest data for 2014 shows 100% completion rate.
5.21 Overall, TB treatment completion in Salford is higher than the England average of 84.4%. However, the year on year variation is more apparent because local numbers are small.
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6.0 Sexually Transmitted Infections
6.1 Sexual health is an issue that concerns the majority of the population. The World Health Organization (WHO) defines sexual health along these main parameters: Enjoyment of sexual relations without exploitation, oppression or abuse; Safe pregnancy and childbirth, and avoidance of unintended pregnancies; Absence and avoidance of sexually transmitted infections, including HIV.
6.2 To ensure these parameters can be achieved, comprehensive and high-quality sexual healthcare services, health promotion campaigns, and educational opportunities (especially for young people) is required. In addition, good surveillance of trends in key measures of sexual health such as rates of sexually transmitted infections should be used to measure this. Under the Public Health Outcomes Framework the main areas of focus for sexual health are HIV and Chlamydia.
HIV 6.3 HIV is a virus which attacks the immune system and weakens the ability to fight infections and disease. It is most commonly caught through unprotected sex. It can also be passed on by sharing infected needles and other injecting equipment, and from an HIV-positive mother to her child during pregnancy, birth and breastfeeding. Around one in every 360 people in the UK has HIV, but the two groups with highest rates of HIV are gay and bisexual men and Black African heterosexuals, where the rates are approximately one in 17 and one in 18 respectively.
6.4 Salford has the third highest prevalence of diagnosed HIV cases (aged 15-59) outside of Greater London which has been rising year on year since 2010. The prevalence rate in Salford in 2015 was 4.95 per 1000, significantly higher than the England average (2.26).
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When the overall prevalence in Salford is compared to the new diagnosis rate (diagram below) it shows that although new diagnoses remain fairly static, the overall prevalence continues to rise. This can be somewhat attributed to the increased life expectancy of individuals with HIV but also suggests that people that have previously been diagnosed with HIV have moved to the city.
6.5 The uptake of eligible new episodes in men who have sex with men (MSM) where HIV testing was accepted as a proportion of those where an HIV test was offered was 88.5% in 2015, down slightly from 2014, but relatively typical over the course of the trend and is similar to rates in the North West and England for this indicator and has been for several years.
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6.6 Late diagnosis for HIV is associated with increased morbidity and mortality (i.e. poorer health outcomes) and therefore early diagnosis is a priority. As such, HIV late diagnosis has been made an indicator on the Public Health Outcome Framework. The measurement used is the percentage of adults (aged 15 and older) diagnosed with a CD4 cell count less than 350 per mmᶾ within 91 days of diagnosis. Using 3-year rolling averages the percentage of HIV late diagnosis has decreased slightly since 2010-12. However, due to the low numbers this change is not statistically significant and could be due to natural variance or chance. It is hoped that this indicator will improve locally following the introduction of home and point of care testing in recent years.
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Chlamydia 6.7 Chlamydia is one of the most common sexually transmitted infections (STIs) in the UK. The infection is passed on from one person to another through unprotected sex (i.e. sex without a condom). In 2012, 206,912 people tested positive for Chlamydia in England; 64% of people diagnosed with Chlamydia were under 25 years old.
Current situation 6.8 In 2015, the Chlamydia detection rate per 100,000 young people aged 15-24 years in Salford was 2,613 (compared to 1,887 per 100,000 in England) up from 2,368 in 2014 (a non-statistically significant increase). The increase was in line with the picture nationally.
6.9 A new Integrated Sexual Health Service commenced July 1st 2016, across Salford and Bolton, and includes Chlamydia screening with national targets set as key performance indicators. The service specification also includes: Screening Initiation sites – GPs, Pharmacies, maternity, TOP; Self-sampling sites – pharmacies; Postal kits via telephone/website ordering; Click & Collect from identified pharmacies (in close proximity to university and colleges); Refresher training to all sites.
6.10 In addition, Chlamydia screening forms part of the Salford Standard Quality Contract for Primary Care. The electronic form for primary care Chlamydia screening tests has also been modified and re-launched which has enabled more accurate data submission.
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Other STIs Syphilis, Gonorrhoea, Genital Herpes and Genital Warts 6.11 These diseases comprise a series of other bacterial and viral infections which are predominantly passed through sexual contact. They have a range of signs, symptoms and complications and are more common in young adults. For all communicably acquired conditions it is important to both identify and treat the infections in a timely manner to prevent further onward transmission.
Current situation 6.12 Salford’s syphilis diagnosis rate has risen significantly since 2013.
6.13 Between 2009 and 2015 the rate of gonorrhoea diagnosis increased year on year in Salford which matches regional and national trends.
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6.14 Rates of genital herpes have fluctuated slightly between 2009 and 2015 but show similarities to the national trend.
6.15 The diagnosis rate of genital warts has remained consistent in Salford over recent years. During this time it has generally been higher than both the North West and England but has mirrored the trend over time. It is expected there will be further reductions in genital warts in future as the impact of the HPV vaccine is realised.
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7.0 Healthcare-Associated Infections (HCAIs)
7.1 Healthcare-associated infections (HCAIs) can develop either as a direct result of healthcare interventions such as medical or surgical treatment or from being in contact with a healthcare setting. The term HCAI covers a wide range of infections. The most well-known include those caused by methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. difficile).
7.2 HCAIs pose a serious risk to patients, staff and visitors. They can incur significant costs for the NHS and cause significant morbidity to those infected. As a result, infection prevention and control is a key priority for the NHS. Infection prevention and control is fundamental to improving the safety and quality of care provided to patients.
Current situation 7.3 The number of cases of MRSA in Salford has stayed relatively stable since 2013/14 with 3 cases per year, 4 in 2015/16.
7.4 The number of C.difficile cases in Salford increased slightly in 2015/16 to 73, up from 65 in 2014/15. A root cause analysis (RCA) was carried out on all cases to identify learning needs for primary and secondary care. Unpublished local data
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shows a reduction in cases in 2016/17, 58 in total. Out of the 58 cases RCAs deemed only 2 cases as avoidable due to inappropriate prescribing.
7.5 The number of E.coli cases in Salford increased in 2015/16 compared to the previous year. We had more cases than the Greater Manchester average and the England average.
8.0 Screening Programmes
8.1 Screening is a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any
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complications arising from the disease or condition. In England there is a range of screening programmes including antenatal and newborn screening; breast, cervical and bowel cancer; abdominal aortic aneurysm (AAA); and diabetic retinopathy. Screening can lead to a reduction in late diagnosis and preventable deaths.
8.2 To maximise the benefits of a screening programme it is important that as many of the eligible population take up the screening as possible (ideally 100%). Screening rates can be affected by a number of factors including socioeconomic group, ethnicity, knowledge and service provision.
8.3 Screening programmes are commissioned nationally by NHS England (NHSE).
Current situation Antenatal and Newborn Screening 8.4 Antenatal and newborn screening comprises: screening for infectious diseases in pregnancy (HIV, syphilis and hepatitis B), screening for sickle cell and thalassaemia, and screening of newborn infants for a number of rare but serious diseases via blood spot testing as well as hearing and physical examinations.
8.5 The data for the screening of infectious diseases in pregnancy and sickle cell and thalassaemia is only available at a regional level. For 2015/16 the North West rate is slightly below the England average but is still over 97% coverage for all three diseases.
8.6 The newborn blood spot and hearing screening rates for Salford exceed both the North West and England average.
Breast cancer screening 8.7 The data shows the percentage of residents in the population eligible for breast screening who were screened adequately within the last 3 years. In Salford and in
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the North West this has reduced slightly from 2013. This is in line with the pattern observed nationally.
NHS Breast screening programme coverage: Women screened adequately within the previous 3 years As on 31 March 2013 As on 31 March 2014 As on 31 March 2015 As on 31 March 2016 Number Coverage Number Coverage Number Coverage Number Coverage screened (%) screened (%) screened (%) screened (%) Women aged 53-70 Salford 14,549 68.7 14,733 68.8 14,190 65.2 13,346 60.3 North 563,602 74.5 563,412 73.4 566,094 72.6 571,608 72.2 West England 4,248,035 76.3 4,282,034 75.9 4,327,589 75.4 4,399,968 75.5
Cervical cancer screening 8.8 The data shows the percentage of women in the population eligible for cervical screening who were screened adequately in the last 3.5 years (women aged 25-49) and 5.5 years (50-64) on 31st March. The overall trend of cervical screening coverage in Salford for women aged 25-64 (see table below) has been decreasing over the past 4 years from 2012/13 to 2015/16; that is a reflection of the pattern observed across England over the same period of time. That pattern is more clearly identified among women aged 25-49, than those aged 50-64 where the behaviour of the trend appears to be rather random.
8.9 Changes to the test for cervical screening will increase the specificity of the test and should ensure increased uptake. The newly integrated sexual health service for Salford and Bolton is not required to undertake cervical screening for women attending for a planned cervical screen as part of the National Cervical Screening Programme i.e. where a patient receives an invite letter to attend for her 3/5 yearly cervical screen and attends the integrated sexual and reproductive health services only for this reason. In such instances, clients should be referred to their GP/the provider detailed on their invite letter. The only exception to this is where there is a specific contract is put in place between the provider and NHS England to fund cervical screening as part of the National Cervical Screening Programme as per National Specification 25 (link below). In this circumstance, the planned cervical screen may be provided alongside any sexual health services.
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The sexual health service will, however, offer appropriate ‘opportunistic’ cervical screens – that is, if a woman attends for a sexual health appointment and the attending clinician, either through asking the patient or through reference to patient records, identifies that the woman’s scheduled cervical screen as part of the National Cervical Screening Programme is overdue. https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/02/serv- spec-25.pdf
NHS Cervical Screening Programme Coverage: Split by age group 2012/13 2013/14 2014/15 2015/16 Women aged 25-49 (less than 3.5 years since last adequate test) Salford 67.5 67.1 67.1 66.3 North West 70.8 70.8 70.8 70.2 England 71.4 71.9 71.2 70.2 Women aged 50-64 (less than 5.5 yrs since last adequate test) Salford 74.5 73.3 74.8 74.0 North West 75.9 77.8 77.0 76.6 England 77.4 77.0 78.4 78.0 Women aged 25-64 (less than 3.3/5.5 yrs since last adequate test) Salford 75.4 74.3 69.2 68.4 North West 77.7 73.0 72.8 72.3 England 78.2 77.8 73.5 72.7
Bowel cancer screening 8.10 The bowel cancer screening uptake between October 2014 and September 2015 was lower in Salford than in both the North West and England. However, the positivity rate was higher in Salford (1.81%) than the North West average (1.76%),
32 Page 182 and similar to that of England (1.86%). Evidence suggests areas with low uptake tend to have higher positivity. Possible explanations suggested for this include that lower uptake is more common in more deprived areas, and positive screens are more likely in deprived groups.
Uptake and positivity rates by Greater Manchester CCGs: October 2014 to September 2015 Uptake rates (minimum standard 52%, aspirational target 55%) CCG Oct-Dec Jan-Mar Apr-Jun Jul- Oct 14-Sep 15 14 15 15 Sep 15 (cumulative rate) Bolton 55.55% 55.93% 52.82% 52.53% 54.04% Bury 56.63% 54.32% 55.37% 55.88% 55.62% Central Manchester 38.52% 39.70% 40.35% 37.83% 39.06% Heywood, Midd & 53.72% 53.57% 52.98% 53.01% 53.27% Roch North Manchester 42.31% 43.44% 41.75% 43.01% 42.60% Oldham 52.39% 53.53% 51.98% 54.32% 53.12% Salford 49.81% 53.27% 48.58% 49.99% 50.36% South Manchester 42.18% 46.40% 43.27% 43.69% 43.83% Stockport 53.73% 55.80% 56.33% 56.48% 55.61% Tameside & Glossop 50.29% 53.87% 51.80% 52.50% 52.09% Trafford 54.28% 57.70% 55.43% 55.89% 55.79% Wigan Borough 55.80% 57.63% 52.03% 54.45% 54.88%
Greater Manchester 51.83% 53.81% 51.53% 52.30% 52.34% North West 55.16% 55.94% 55.11% 52.73% 54.65% England 57.21% 58.86% 57.57% 54.65% 57.03%
Positivity rates (expected standard 2%) Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct 14-Sep 15 14 15 15 15 (cumulative rate) Bolton 2.01% 1.58% 1.98% 1.59% 1.77% Bury 1.56% 2.48% 1.51% 1.71% 1.77% Central Manchester 2.98% 2.69% 3.14% 3.23% 3.01% Heywood, Midd & 2.52% 1.67% 1.97% 1.86% 2.00% Roch North Manchester 2.67% 2.28% 2.59% 3.15% 2.72% Oldham 2.13% 1.60% 2.02% 1.59% 1.82% Salford 1.95% 1.76% 1.68% 1.85% 1.81% South Manchester 2.14% 2.09% 2.76% 1.22% 2.03% Stockport 1.89% 1.32% 1.39% 1.55% 1.54% Tameside & Glossop 2.01% 1.74% 1.61% 2.01% 1.83% Trafford 1.83% 1.87% 1.58% 1.36% 1.65% Wigan Borough 1.93% 1.53% 1.51% 1.72% 1.66%
Greater Manchester 2.02% 1.73% 1.83% 1.73% 1.82%
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North West 1.90% 1.71% 1.77% 1.67% 1.76% England 1.87% 1.68% 1.82% 2.07% 1.86% Data source: Salford CCG
8.11 Going forward there is an expectation that screening rates will increase. Early indications show that the new bowel cancer screening test (to be rolled out nationally from September 2016) is more acceptable to the eligible population than its predecessor, increasing uptake by around 10%. Of particular note is that this increase appears to be in the traditionally ‘hard to reach’ population.
Abdominal aortic aneurysm (AAA) screening 8.12 Coverage is a key measure for the screening programme as it provides an indication of the accessibility of the service and that men are aware of the importance of screening. Programmes should aim to increase the coverage of screening so that those not accepting have done so because of informed choice not lack of access to the service or from lack of information in an appropriate format. The AAA screening coverage rate in Salford for 2015/16 was 72.2%, which has slipped below the North West (76.6%) and national (79.9%) averages.
Diabetic retinopathy screening 8.13 The data shows the number of patients offered screening who attended a digital screening encounter during the reporting period. In 2010/11 the screening rate in
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Salford (81.9%) was higher than both the North West (80.5%) and England (79.2%). However, that performance has significantly decreased in the following two years below both the North West and England average. In 2012/13 75.6% of people who were offered diabetic retinopathy screening received it, compared to 75.2% in 2011/12. That represents a slight increase of 0.4 percentage point from 2011/12 to 2012/13.
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9.0 Assurance Summary
There is appropriate and robust scrutiny of the health protection issues covered by the sub-groups of the Health Protection Forum; however, the forum itself needs to be reviewed in order that any concerns, escalation or plaudits can be raised appropriately; Emergency planning and incident response offer robust support and protection for Salford’s residents; Vaccination schedule rates are pleasingly high and offer herd immunity to Salford’s population; Flu vaccination rates have increased amongst our eligible adult population. Children’s uptake has remained stable. However, there has been a very large increase of uptake in the acute trust. TB remains an issue as, although patients are appropriately managed, a more cohesive and concerted preventative approach to diagnosis would improve outcomes for the at-risk population; Sexually transmitted infections are identified and managed appropriately and the newly-commissioned integrated services for Salford and Bolton are committed to improving performance in these areas; Healthcare-acquired infections in hospital settings are reducing and are aggressively managed; Management of outbreaks in care homes remains a priority; Although screening rates are mainly lower than the North West and the national averages, there are opportunities to improve them via interventions in primary care; There are training and delivery needs for some staff and communities; Financial savings and efficiencies may pose a threat to performance in the future.
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9.1 Many of the recommendations within this report remain the same or similar to previous years as they relate to the high performance levels of many aspects of health protection in Salford.
9.2 There are a large number of services and partners that contribute to ensuring the protection of Salford’s population and they should be congratulated on their work and ongoing cycle of improvement.
9.3 In conclusion, this document offers assurance that Salford’s population is being protected in a proactive way to improve their health.
With thanks to Bolton Council Public Health team for the format and some content of this Health Protection Annual report
37 Page 187 Appendix 1: Local Health Protection System Responsibilities
Organisation Responsibilities Preparation and Response NHS England Has responsibility for managing the Preparation NHS response to an incident, Planning and securing the health services needed to protect the ensuring that relevant NHS public’s health; resources are mobilised and With regards to planning and preparedness, obtaining appropriate directed as necessary. advice including from persons with a broad range of professional Ensuring that their contracted expertise in the protection or improvement of public health. providers will deliver an Participating in arrangements for exercising and testing plans to appropriate clinical response to respond to outbreaks/incidents. any incident that threatens the public’s health. Response Mobilising NHS resources in response to incidents and outbreaks; Page 188 Page Participating (as required) in Outbreak/Incident Management Teams to help inform decisions about the appropriate level of NHS response from providers and working alongside the CCG to agree the resources needed to be released; Co-ordinating the primary care response to the incident with the Area Team Pharmacy Advisor (as required); Supporting CCGs to coordinate any response required by Community Trusts and/or Acute Trusts.
Public Health England Provide the specialist health Preparation: protection response to public Providing advice to local NHS providers and commissioners regarding health outbreaks/incidents. any preparation that they might need to undertake to ensure an Lead the epidemiological effective and timely response when a public health outbreak/incident investigation. occurs; Have the responsibility to declare a Supporting local authorities to understand and respond to potential health protection incident, major threats; or otherwise. Collection, analysis, interpretation of surveillance data; Providing expert advice on hazards that pose a risk to the public’s
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Appendix 1: Local Health Protection System Responsibilities
health and effective interventions to prevent and respond accordingly; Coordinating an out-of-hours rota for the delivery of specialist health protection advice by qualified personnel; Participating in arrangements for exercising and testing plans to respond to outbreaks/incidents; Providing access to regional and national PHE expertise as required; Advising on the requirement for prophylactic treatment and immunisation for all health protection incidents; Keeping the DPH informed about significant health protection issues and actions being taken to overcome them; Providing the local authority with information to support the Joint Strategic Needs Assessment and Joint Health and Wellbeing Board strategies as required; Page 189 Page Supporting local authorities to develop a trained and knowledgeable workforce in the area of health protection.
Response Leading the Public Health response to declared Major Incidents; receiving and investigating notifications (with partners); Initiating immediate control measures when required; providing expert epidemiological advice through field epidemiology teams to support incident/outbreak investigation (both in the response and recovery phases); Sharing information concerning incidents/outbreaks with the local authority through the Director of Public Health; Chairing the ‘Outbreak/Incident Management Team’ and keeping health protection risks under review throughout the incident; communicating to partners when an Outbreak/Incident Management Team is established; Providing updates until the outbreak/incident is declared over;
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Appendix 1: Local Health Protection System Responsibilities
Coordinating public communications/media response in collaboration with the local authority, CCG and NHS England
Local Authority Via DPH the LA has overall Preparation responsibility for the strategic Preparing for and leading the local authority’s response to incidents oversight of an incident impacting that present a threat to the public’s health; providing information, on population’s health. Ensures advice, challenge and advocacy; that an appropriate response is put Chairing the Salford Health Protection Forum to ensure that the health in place by NHSE and PHE protection system is meeting the needs of its local authority population supported by the CCG. and that risks identified are adequately mitigated against and control Must be assured that the local arrangements are in place; health protection system is robust Coordinating the Joint Strategic Needs Assessment to support the Page 190 Page enough to respond appropriately understanding of local health protection risks; to protect the local population’s Reporting local health protection arrangements and escalating health health and that risks are identified, protection risks to the Health and Wellbeing Board; mitigated against and adequately Ensuring that relevant commissioned services (including providers of controlled. sexual health services, drug and alcohol services and school health services) can provide an appropriate response to any incident that threatens the public’s health and that business continuity plans are in place; Participating in arrangements for exercising and testing plans to respond to outbreaks/incidents.
Response Collaborating with PHE to lead the PH response to a major incident; Participating (as required) in Outbreak/Incident Management Teams, to help inform decisions about the appropriate level of NHS response from providers AND working alongside PHE and the CCG to agree and source through agreed plans the resources needed to be released; Reducing the risk of healthcare-associated infection in the community
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Appendix 1: Local Health Protection System Responsibilities
through surveillance, audit and training; Briefing Local Authority colleagues and elected members regarding health protection incidents/outbreaks; Mobilising local authority resources required to support an incident (e.g. Services Trading Standards).
Salford CCG To ensure through contractual Preparation arrangements with providers that Ensuring provider organisations commissioned by the CCG are able to healthcare resources are made respond adequately to health protection incidents/outbreaks where available to respond to health screening, diagnosis, treatment or vaccination might be required; protection incidents or outbreaks. Disseminating information as required by PHE or the local authority regarding the prevention of/response to, health protection incidents/
Page 191 Page outbreaks across the local system of health care; With regards to planning and preparedness, obtain appropriate advice from persons with the professional expertise in the protection or improvement of public health; Participating in arrangements for exercising and testing plans to respond to outbreaks/incidents. Response Participating (as required) in Outbreak/Incident Management Teams to help inform decisions about the appropriate level of NHS response from providers and any CCG resources needed to be released; Providing (if requested by NHS England), clinical support for the prescribing and administration of medication
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Salford Health and Wellbeing Board
Title of report Creating a real Living Wage City Date 10 October, 2017 Contact Chris Dabbs (Greater Manchester Chamber of Commerce) Officer Alison Page (Salford CVS)
1. Executive Summary
Why is this report being brought to the In the Locality Plan for Salford, the Board? - Relevance of this report to the partners on the Health and Wellbeing priorities of the Joint Health and Board commit to: Wellbeing Strategy, the Joint Strategic securing for the people of our city a Needs Assessment or integrated working good education and decent jobs system and wider enablers, including social value maximising adoption of the real Living Wage and the best possible working conditions for our workforce across the city working towards: introducing the real Living Wage; becoming accredited Living Wage Employers; incorporating the real Living Wage within procurement working with partners to ensure that jobs being created in Salford have the highest employment standards, such as working towards or paying the real Living Wage Health and Wellbeing Board’s duties or Improve health and well-being across responsibilities in this area the city and remove health inequalities. Social Justice and tackling inequality - everyone should get a fair chance to succeed in Salford. Prevention and early intervention throughout life - we will stop problems occurring in the first place wherever we can. (Board terms of reference). Key questions for the Health and Key points to note: Wellbeing Board to address - what action Seven of the 13 members of the Health is needed from the Board and its and Wellbeing Board are accredited members? Living Wage Employers, plus most of the Salford Strategic Housing
Page 193 1 Partnership. Two other Health and Wellbeing Board members are committed to accreditation by the end of 2017. Discussions are ongoing with the other three Board members. There are also two other larger and at least eight smaller health and care providers in Salford that are accredited. Work has started to promote the business case for the real Living Wage to all employers in every sector in Salford. Initial information and advice has been obtained about effective practice in incorporating the real Living Wage within procurement of services, works and goods. A meeting is being arrange to discuss the real Living Wage at Greater Manchester level with the Greater Manchester Health and Social Care Partnership. Greater Manchester Combined Authority is committed to accreditation by November 2017.
Actions recommended: 1. To note the progress made on the real Living Wage, with more than half of the Board’s members now being accredited Living Wage Employers, and more committed to becoming so before the end of 2017. 2. To request the Living Wage Task and Finish Group continues its work on the actions agreed in March 2017. 3. To request the Salford Social Value Alliance to monitor progress with the real Living Wage in Salford, and report to the Health and Wellbeing Board on progress in spring 2018. What requirement is there for internal or Publish the Health and Wellbeing Board’s external communication around this progress on the real Living Wage and issue? publicise the actions it has agreed.
Page 194 2 2. Introduction
2.1 Fair Society, Healthy Lives
Fair Society, Healthy Lives (The Marmot Review, 2010) recognises that: 1. Reducing health inequalities is a matter of fairness and social justice. 2. There is a social gradient in health – the lower a person’s social position, the worse his or her health. Action should focus on reducing the gradient in health. 3. Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health. 4. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. 5. Action taken to reduce health inequalities will benefit society in many ways. It will have economic benefits in reducing losses from illness associated with health inequalities. 6. Reducing health inequalities will require action on six policy objectives, including: to ensure a healthy standard of living for all. As a priority, this requires a minimum income for healthy living for people of all ages.
2.2 Economic performance and inequality
The Greater Manchester Economic Forecasting Model suggests that Greater Manchester is set to see both output and employment growth over the next decade. A forecast 2.8% per year annual growth rate in Gross Value Added (GVA) between 2014 and 2024 (in line with the UK figure and above the North West annual rise of 2.6%) will take the overall size of the economy to £72 billion by the end of the period, with an additional 111,000 jobs (8%). This exceeds projected growth in the working age population (2.4%).
Poverty in Greater Manchester: In 2013-2014, 620,000 people in Greater Manchester were in poverty. More than half (390,000) were working age adults, 180,000 were children, and 50,000 were over pension age. According to the Indices of Multiple Deprivation, 21% of Greater Manchester’s Lower Super Output Areas (LSOAs) are in the top 10% most deprived in England in 2015. The highest proportions are in Manchester, Salford, Rochdale and Oldham. 41 LSOAs are very highly deprived, ranking in the top 1% nationally. The largest clusters of these are in north and east Manchester, Oldham and Salford.
Changing geography and disparity of growth and deprivation:
There is a picture of improvements in the centre of the city region coupled with little change or deterioration in outer areas.
Over half (54%) of the neighbourhoods in suburban areas of Greater Manchester saw an increase in economic deprivation compared to 32% of neighbourhoods in urban areas between 2001 and 2009.
Page 195 3 The overall improvement on the Indices of Multiple Deprivation seen in Greater Manchester has largely been driven by Manchester, with a reduction from 72% of its neighbourhoods in the top fifth in 2004 to 59% in 2015. Salford has also seen reductions as has Trafford, with both these areas also seeing increases in the proportions of least deprived neighbourhoods. This is also the pattern for Wigan.
There are persistent differences between social and demographic groups in their access to the labour market: Particular groups tend to have consistently lower employment rates, including disabled people, carers, people from some black and minority ethnic communities (especially those with Pakistani or Bangladeshi heritage), younger people and older people. This situation may be worse in Greater Manchester than the UK average. Limited access to employment translates to some extent into higher poverty risks for many of these groups.
When they do obtain employment, such groups are more likely than others to be paid below the real Living Wage.
2.3 Living Wage
The real Living Wage is an hourly rate set independently and updated annually. It is calculated by the Resolution Foundation and overseen by the Living Wage Commission, based on the best available evidence about living standards in London and the UK. This is based on detailed research of what households need in order to have a minimum acceptable standard of living.
The UK Living Wage is set annually by the Living Wage Foundation and is £8.45 per hour (outside London) from 31 October, 2016. The new Living Wage rate will be announced on 6 November, 2017, for implementation within six months. Employers choose to pay the real Living Wage on a voluntary basis and can become accredited by the Living Wage Foundation.
Distinct from the real Living Wage, the ‘national living wage’ for all workers aged over 25 was introduced by the Government in April 2016. This is effectively a premium on top of the National Minimum Wage rate, while the current National Minimum Wage for those under the age of 25 still applies.
The rates from 1 April, 2017, are: £7.50 per hour - 25 years old and over £7.05 per hour - 21-24 years old £5.60 per hour - 18-20 years old £4.05 per hour - 16-17 years old £3.50 per hour - apprentices under 19, or 19 or over who are in the first year of apprenticeship
The Low Pay Commission has a remit to review annually the ‘national living wage’, as well as the minimum wage, and to recommend any increases. The rate changes every April. The Government has asked the Commission to ensure that the ‘national living wage’ reaches 60% of median earnings by 2020. That would be likely to take it above £9.00 per hour.
Page 196 4 For the purposes of this report, the ‘real Living Wage’ means the Living Wage as calculated for and overseen by the Living Wage Foundation.
2.4 Living Wage in Salford
Intelligence Analysis at Salford City Council (July 2017) found from the 2015 Annual Survey of Hours and Earnings (and other data sources), it was estimated that in 2015, the proportion of the workforce that earned below and above the real Living Wage was:
Salford United Kingdom below real Living Wage 39.2% (44,600) 29.8% (8 million) above real Living Wage 60.8% (69,300) 70.2% (19 million)
This means that nearly 1/3 more of Salford’s workforce was not earning the real Living Wage in 2015, compared to the national average. This is fairly self-explanatory given that Salford has a younger and more deprived population, and that nationally 86% of under-23s earned less than the real Living Wage in 2015. In particular, Salford has nearly double the amount of the most deprived 16-28-year-olds than the average local authority, and virtually all of these earn less than the real Living Wage.
The updated Annual Survey of Hours and Earnings suggests that nationally the number earning below the real Living Wage fell to 25% in 2016, probably largely due to inflation. It is inevitable that in Salford wages will have increased for the vast majority even if only by a small fraction for some, and so we might expect that the proportion earning below the real Living Wage has also fallen, but we are not yet in a position to judge whether Salford has kept up with the national pace.
Within Greater Manchester, Salford has taken the lead on the real Living Wage, with the then City Mayor signalling in 2013 the intention for Salford to end poverty pay and to become a real Living Wage City. This commitment has been continued by the current City Mayor, having previously chaired Salford’s Living Wage Partners Group.
There are now more than 20 organisations based in Salford – in the public, private and social sectors – that are Living Wage Employers accredited with the Living Wage Foundation, with a significant additional number going through accreditation and/or already paying the real Living Wage to their employees.
3. Key issues for the Board to consider
3.1 Living Wage: Stating the Case
Research by the Greater Manchester Chamber of Commerce to review the available evidence surrounding the business case for paying the real Living Wage (The Living Wage: Stating the Case, November 2016) found that: Across all the available evidence, three main areas in which paying higher wages can have a significant beneficial impact are evident: productivity; ease of recruitment; and staff retention. The evidence is almost entirely supportive of the idea that paying higher wages can improve production and quality, although the long-term nature of the benefits
Page 197 5 make them harder to quantify against the immediate cost increase. Wider beneficial economic spill-over effects have been observed following pay increases in select cases. Organisations in traditionally low-paid, low-skilled and high staff-turnover sectors such as retail, health and social care, bars and restaurants, etc., will likely face relatively larger wage bill increases and have less scope to absorb such increases than sectors such as IT, banking, finance and construction. Sector also determines how prices are likely absorbed. Some sectors have scope to increase prices, whilst others may have to remove inefficiencies or reduce the number of staff or hours worked. Paying the real Living Wage means an increased wage bill for those organisations with low-paid workers, and due to the vast differences between business models the real Living Wage may not be practical for many organisations, so no blanket statement of endorsement can be made. If, after careful consideration, a particular organisation has adequate scope for paying higher wages, the evidence overwhelmingly suggests it is beneficial to do so.
3.2 Health Inequalities and the real Living Wage
Health Inequalities and the Living Wage (health equity briefing 6, UCL Institute of Health Equity, September 2014), commissioned by Public Health England, found that the evidence shows that insufficient income is associated with worse outcomes across virtually all domains of health, including long-term health and life expectancy. It is associated with a greater risk of limiting illness and poor mental health including maternal depression. Children who live in poverty are more likely to be born early and small, suffer chronic diseases such as asthma, and face greater risk of mortality in early and later life.
The negative health effects of living on a low income can be caused by material factors (the inability to afford the items necessary for a healthy life) and/or psychosocial factors (such as ‘status anxiety’).
The Institute for Health Equity concluded that adopting the real Living Wage has been shown to improve psychological health and well-being among employees and increase life expectancy. It is also associated with significant improvements in self- rated health, depression, alcohol consumption, activity-limiting illnesses and a fall in mortality.
As major employers, statutory agencies can lead by example by paying at least the real Living Wage to all directly employed staff and, where appropriate, to all sub- contracted staff. As major purchasers, statutory agencies can also help to implement the real Living Wage through procurement from their suppliers, including through innovative application of the Public Services (Social Value) Act 2012.
3.3 Salford Health and Wellbeing Board position – 2015
At its meeting on 21 July, 2015, Salford’s Health and Wellbeing Board resolved to:
1. endorse the evidence about the [real] Living Wage produced by the Institute for Health Equity; and support the principle that adopting the [real] Living Wage improves health and well-being
Page 198 6 2. acknowledge the [real] Living Wage and its benefits within the Board’s strategy and locality plan 3. (each member) consider working towards: introducing the [real] Living Wage; becoming an accredited Living Wage Employer; and incorporating the [real] Living Wage within its procurement whilst acknowledging the constraints of national pay bargaining and review bodies 4. receive a report on member responses in respect of the issues in (3) above at a future meeting of the Board
3.4 Locality Plan for Salford
Amongst the outcomes stated in the Locality Plan for Salford are: Start Well: I am a young person who will achieve their potential in life, with great learning, and employment opportunities. Start Well: I am as good a parent as I can be. Live Well: I lead a happy, fulfilling and purposeful life. Age Well: I am an older person who is looking after my health and delaying the need for care.
At all stages of the life course, therefore, local people would benefit from the application of the real Living Wage.
Within the Locality Plan for Salford, the partner agencies state that “Our commitment is to ensure our residents can take advantage of the new opportunities in Salford, to secure for the people of our city a good education and decent jobs, whilst the City undergoes real growth, continues to attract ongoing investment, development and regeneration. We know that these are all key determinants affecting the health and wellbeing of our residents.”
The Locality Plan states that its implementation plan “seeks to make the required savings and efficiencies across the health and social care budget … through a number of system and wider enablers, including … Social Value:” Economic Growth and Employment – including an acknowledgement by Salford’s Health and Wellbeing Board of the wellbeing and health impacts of paying the real Living Wage.
Under Enabling Transformation, the Locality Plan identifies within its enabling programme to streamline back office support across public sector organisations this transformation priority: Explore introduction of the real Living Wage; becoming an accredited Living Wage Employer; and incorporating the real Living Wage within its procurement.
Similarly, under its enabling workforce programme - to enable a suitably skilled workforce and working conditions in order to achieve transformation and new ways of working - the Locality Plan identifies for an emerging workforce and organisational development strategy for various organisations across the city this key strand: Employment conditions: We will utilise evidence about the real Living Wage produced by the Institute for Health Equity in work to maximise adoption of the real Living Wage and the best possible working conditions for our workforce across the city, in order to improve health and well-being.
Page 199 7 The programme to deliver this workforce priority is described as: Whilst acknowledging the constraints of national pay bargaining and review bodies, each member of the Health and Wellbeing Board will work towards: introducing the real Living Wage; becoming an accredited Living Wage Employer; and incorporating the real Living Wage within its procurement
Furthermore, with regard to Prevention, the Locality Plan for Salford identifies within the programme on wider determinants of health and wellbeing to work with partners to reduce the harmful impact of the social, environmental and economic conditions in which people live on their health and wellbeing this transformation priority: To recognise the importance of ensuring that the jobs that are being created have the highest employment standards, such as working towards or paying the real Living Wage.
Two high-level assumptions stated as being used to construct the Salford Locality financial plan is: Assumed cost pressures in council expenditure for pay inflation and specific amounts added for implications of implementing the real Living Wage. The NHS provider position assumes average tariff increases of 0.5% each year over the next 5 years with pay and price increases of 2.5% each year.
3.5 Survey of progress - 2016
To assess the responses of members of Salford’s Health and Wellbeing Board in respect of the three key issues agreed at the Board’s meeting in July 2015, a survey of all member organisations was run in August-October 2016. There was a 100% response rate from the nine member organisations at that time.
The survey results were reported to the Health and Wellbeing Board in November 2016. In brief, the key findings of the survey were: 7 of the Board’s 9 member organisations stated that they paid all staff at least the real Living Wage. (This includes both directly employed and sub-contracted staff). 4 of the Board’s 9 member organisations were accredited Living Wage Employers. 4 of the Board’s 9 member organisations stated that they always or sometimes incorporated the real Living Wage in their procurement: 3 always did so for services and works, and 1 for goods. 5 member organisations never did so.
3.6 Salford Health and Wellbeing Board position – 2016
In line with the Locality Plan for Salford and in light of the survey results, on 15 November, 2016, the Health and Wellbeing Board agreed, in principle, to:
1. support the principle that adopting the [real] Living Wage reduces inequalities and improves health and well-being at all stages of the life course 2. support efforts to encourage all employers in Salford (in statutory, commercial or social sectors) to pay all staff at least the [real] Living Wage, by promoting the business case for the [real] Living Wage and leading by example 3. work towards becoming a [real] Living Wage health and well-being system, using evidence about the business and health cases for the [real] Living Wage to encourage and support all member organisations to pay all staff (both directly employed and sub-contracted) the [real] Living Wage, and to become accredited
Page 200 8 Living Wage Employers, within workforce and organisational development strategies 4. commit that contracts when started or renewed will be at the [real] Living Wage rate, supported by development of collective guidance and shared experience of incorporating the [real] Living Wage within procurement of services, goods and works, and by financial plans incorporating any implications, drawing on the most effective practice within and outside Salford 5. promote through the Greater Manchester Health and Social Care Partnership the implementation of the [real] Living Wage in both employment and procurement 6. request the Salford Social Value Alliance to monitoring progress with the [real] Living Wage in Salford, and report to the Health and Wellbeing Board on progress in autumn 2017
Note: For clarity, within these actions, the ‘real Living Wage’ means the Living Wage as calculated for and overseen by the Living Wage Foundation.
The Board also agreed to set up a Living Wage task and finish group to: explore the enablers and barriers to the actions above how these might be used and overcome, and within what timescale
3.7 Salford Health and Wellbeing Board position – 2017
The Health and Wellbeing Board reviewed progress in March 2017 and, in line with the Locality Plan for Salford, agreed to:
1. support the principle that adopting the real Living Wage reduces inequalities and improves health and well-being at all stages of the life course 2. work towards Salford becoming a real Living Wage health and well-being system, using evidence about the business and health cases for the real Living Wage to encourage and support all member organisations on the Health and Wellbeing Board to: pay all staff (both directly employed and sub-contracted) the real Living Wage become accredited Living Wage Employers with the Living Wage Foundation by 2021 at the latest 3. support efforts to encourage all employers in Salford (in statutory, commercial or social sectors) to pay all staff at least the real Living Wage, by leading by example and also promoting the business case for the real Living Wage in other sectors of the local economy, including the wider health and social care system in Salford 4. develop collective guidance and shared experience of incorporating the real Living Wage within procurement of services, works and goods, drawing on the most effective practice within and outside Salford, with the aim that contracts when started or renewed in the future will be at the real Living Wage rate 5. promote through the Greater Manchester Health and Social Care Partnership the implementation of the real Living Wage in both employment and procurement 6. request the Salford Social Value Alliance to monitor progress with the real Living Wage in Salford, and report to the Health and Wellbeing Board on progress in autumn 2017
3.8 Progress on implementing the real Living Wage
Page 201 9 Since the previous report to the Health and Wellbeing Board in March, the Living Wage Task and Finish Group has convened twice in May and July to make progress on the actions above.
Salford becoming a real Living Wage health and well-being system by 2021.
Following a change in the constitution of the Health and Wellbeing Board, there have been 13 member organisations since 1 April, 2017. The current positions reported for each of them are:
Accredited Living Greater Manchester Chamber of Commerce Wage Employers Greater Manchester Mental Health NHS Foundation Trust Healthwatch Salford Salford City Council Salford Clinical Commissioning Group Salford CVS University of Salford
Both Healthwatch Salford (June 2017) and Salford Clinical Commissioning Group (August 2017) have become accredited since the previous report to the Board. The Clinical Commissioning Group is also exploring how the real Living Wage could be incorporated into its contracts for commissioned services.
This means that, for the first time, a majority (53.8%) of Health and Wellbeing Board members are accredited Living Wage Employers.
Furthermore, while Salford Strategic Housing Partnership itself is not an employer, some (but far from all) social housing providers are accredited Living Wage Employers: City West Housing Trust (and ForWorks); Salix Homes (which was the first accredited Living Wage Employer in Greater Manchester, in June 2012); Symphony Housing Group; Windsor Albion Co-operative; and Your Housing Group.
Two other Health and Wellbeing Board members are committed to accreditation: GMFRS now comes under the Greater Manchester Combined Authority, which is committed to accreditation by November 2017.
Greater Manchester Fire The Co-Chairs of the Salford Health and Wellbeing and Rescue Service Board and the Chair of the Salford Social Value Alliance sent a joint letter on 23 August, 2017, to the Mayor of Greater Manchester to urge that both the GM Combined Authority and GM Police should become accredited Living Wage employers. In process of completing the application process, with Salford Primary Care the aim of completing and signing the licence by mid- Together October 2017.
This should mean that, by the end of 2017, at least 10 out of the 13 members (76.9%) of the Health and Wellbeing Board will effectively be accredited Living Wage Employers.
The current position of the other three Board members is: Page 202 10 Initial high level scoping at Greater Manchester level, with more to be done with NHS employers and other Greater Manchester Health associated bodies. The Chief Operating Officer has and Social Care expressed particular interest, and is keen to work with Partnership Salford to learn from its experience for the rest of Greater Manchester. Salford Clinical Commissioning Group is arranging a meeting to discuss this further. While the Office of the Police and Crime Commissioner of Greater Manchester is accredited, GM Police is not. GM Police has, however, implemented the real Living Wage for its staff, with the exception of contractors. Greater Manchester Police The Co-Chairs of the Salford Health and Wellbeing Board and the Chair of the Salford Social Value Alliance sent a joint letter on 23 August, 2017, to the Mayor of Greater Manchester to urge that both the GM Combined Authority and GM Police should become accredited Living Wage employers. Salford Royal NHS Foundation Trust does not presently pay all its staff at least the real Living Wage, although there is interest in doing so.
A meeting was held on 27 June, 2017, with the Deputy Director of Human Resources at Salford Royal NHS Foundation Trust. The real Living Wage is a financial challenge for the Trust, particularly as from April 2017, the boards of Salford Royal NHS Foundation Trust and Pennine Acute Hospitals NHS Trust delegated their delegated their functions to a Group ‘Committees in Common’. While the two trusts remain separate statutory bodies, the Group Salford Royal NHS Committees in Common effectively manages both Foundation Trust trusts. This covers some 18,000 employees (Bury and Rochdale, North Manchester, Oldham and Salford Royal).
There have also been constructive conversations between Salford Clinical Commissioning Group and the Trust, which is interested in the experience of other NHS trusts that have become accredited. The Trust has costed the implementation of the real Living Wage and committed to assess the key drivers, key barriers and practical implications. It has also begun to include the real Living Wage in its sub-contracts. The Trust is preparing a wider paper on social value, which will include thinking on the real Living Wage.
The Board may also wish to note the position with regard to larger provider organisations in Salford: Aspire for intelligent Care and Support - accredited Living Wage Employer
Page 203 11 Oaklands Hospital (owned by Ramsay Health Care UK) - not accredited; Salford Clinical Commissioning Group contacted the new General Manager in July, with a meeting about the real Living Wage to take place on 5 October. Salford Community Leisure - does not presently pay all its staff at least the real Living Wage Salford Health Matters – accredited Living Wage Employer
There are also at least eight smaller providers operating in Salford that are accredited Living Wage Employers: 42nd Street; Being There; Gaddum Centre; Helping Hands; LGBT Foundation; Pathways CIC; Social adVentures; and Unlimited Potential.
Promoting the business case for the real Living Wage to all employers in Salford.
In addition to the agencies mentioned in the section above, there is already a range of other organisations based in Salford from all sectors that are accredited Living Wage Employers, including: Anchor Removals ltd.; Broughton Trust; Church Action on Poverty; Helping Hands; Salford Academy Trust; and Salford Unemployed & Community Resource Centre.
There are other accredited Living Wage Employers with branches in Salford, including Barclays Bank, Lloyds Bank, Nationwide Building Society and Santander UK.
The Salford Social Value Alliance has agreed to link work on the real Living Wage within the forthcoming 10% Better campaign in Salford. This includes a target of 10% more companies paying the real Living Wage, which would mean 1,570 more people being paid at this rate in Salford.
Statutory sector: Beyond the ongoing work through the Health and Wellbeing Board, it has been agreed to link the work of the Living Wage Task and Finish Group with the plans and activities of Salford’s Skills and Work Board.
Voluntary and community sector: Salford CVS will hold an event to promote the real Living Wage during Living Wage Week (5-11 November, 2017).
Commercial sector: It has been agreed to seek to work through both the Business Group Salford and the Greater Manchester Chamber of Commerce in appropriate communications and events to promote the real Living Wage.
It should also be noted that, in Our people; our place: the Greater Manchester Strategy (July 2017), the Greater Manchester Combined Authority stated that “consistent with our priority to create good jobs in Greater Manchester, we will encourage businesses to provide working conditions that contribute to employee health and well-being, building on healthy workplace principles, as well as embodying corporate social responsibility within business practices”, including paying the real Living Wage.
Real Living Wage within procurement of services, works and goods.
Initial information and advice has been obtained from the Living Wage Foundation about effective practice in incorporating the real Living Wage within procurement of
Page 204 12 services, works and goods. This includes exemplar practice from the commercial sector.
Promotion of the real Living Wage through the Greater Manchester Health and Social Care Partnership.
There has been initial high level scoping at Greater Manchester level, with more to be done with NHS employers and other associated bodies. The Chief Operating Officer of the Greater Manchester Health and Social Care Partnership has expressed particular interest, and is keen to work with Salford to learn from its experience for the rest of Greater Manchester. A meeting is being arranged through Salford Clinical Commissioning Group to discuss this further.
4. Recommendations for action
In line with the Locality Plan for Salford, the Health and Wellbeing Board agrees to:
1. To note the progress made on the real Living Wage, with more than half of the Board’s members now being accredited Living Wage Employers, and more committed to becoming so before the end of 2017.
2. To request the Living Wage Task and Finish Group continues its work on the actions agreed in March 2017.
3. To request the Salford Social Value Alliance to monitor progress with the real Living Wage in Salford, and report to the Health and Wellbeing Board on progress in spring 2018.
Note: For clarity, within these recommendations, the ‘real Living Wage’ means the Living Wage as calculated for and overseen by the Living Wage Foundation.
5. Contextual information
BACKGROUND DOCUMENTS: Association of Chartered Certified Accountants (2017), The Living Wage: core principles and global perspectives – http://www.accaglobal.com/content/dam/ACCA_Global/Technical/sus/pi-living- wage-core-principles.pdf Bloomer E. (2014), Health Inequalities and the Living Wage (health equity evidence review 6, UCL Institute of Health Equity) - www.instituteofhealthequity.org/projects/health-inequalities-and-the-living-wage Bloomer E. (2014), Health Inequalities and the Living Wage (health equity briefing 6, UCL Institute of Health Equity) - www.instituteofhealthequity.org/projects/health- inequalities-and-the-living-wage Centre for Research in Social Policy (2014), Uprating the out-of-London Living Wage (Loughborough University) - www.lboro.ac.uk/research/crsp/mis/thelivingwage/ Coulson A. and Bonner J. (2014), Living Wage Employers: evidence of UK business cases (University of Strathclyde) - http://www.livingwage.org.uk/sites/default/files/BAR_LivingWageReport%20croppe d%2021%2001.pdf
Page 205 13 D’Arcy C. and Finch D. (2016), Calculating a Living Wage for London and the rest of the UK (Resolution Foundation) - http://www.resolutionfoundation.org/wp- content/uploads/2016/10/Living-wage-calculations.pdf Davies A. (2016), The Living Wage: Stating the Case (Greater Manchester Chamber of Commerce) – http://www.gmchamber.co.uk/system/attachments/1538/original.pdf Heery E, Nash D. and Hann D. (2017), The Living Wage Employer Experience (Cardiff Business School) – https://www.cardiff.ac.uk/__data/assets/pdf_file/0008/722429/The-Living-Wage- Employer-Experience-Report.pdf Lawton K. and Pennycook M. (2013), Beyond the Bottom Line: The Challenges and Opportunities of a Living Wage (IPPR and Resolution Foundation) - http://www.resolutionfoundation.org/wp- content/uploads/2014/08/Beyond_the_Bottom_Line_-_FINAL.pdf Living Wage Commission (2016), Closing the Gap. A Living Wage that means families don’t go short - http://www.livingwage.org.uk/sites/default/files/Closing the gap - final report of the Living Wage Commission.pdf London Economics (2009), An independent study of the business benefits of implementing a Living Wage policy in London – www.london.gov.uk/mayor/economic_unit/docs/living-wage-benefits-report.pdf Marmot M. et al. (2010), Fair Society, Healthy Lives: strategic review of health inequalities in England post-2010 - www.instituteofhealthequity.org/projects/fair- society-healthy-lives-the-marmot-review Robinson B. et al. (2015), The Living Wage: an economic impact assessment (KPMG) - https://www.kpmg.com/UK/en/IssuesAndInsights/ArticlesPublications/Documents/ PDF/Issues%20and%20Insights/kpmg-living-wage-report-2015.pdf
STRATEGIC DRIVERS AND EVIDENCE OF NEED: Locality Plan for Salford (2016) – http://www.salfordccg.nhs.uk/salford-locality-plan Lupton R., Rafferty A. and Hughes C. (2016), Inclusive Growth: opportunities and challenges for Greater Manchester, Manchester: Inclusive Growth Analysis Unit, University of Manchester Salford City Mayor's Charter for Employment Standards - http://www.visitsalford.info/locate/citymayorsemploymentcharter.htm Salford City Partnership (2017) – No One Left Behind: tackling poverty in Salford – https://www.salford.gov.uk/media/390192/no-one-left-behind-tackling-poverty-in- salford.pdf
THIS REPORT CONTENT HAS ALSO BEEN CONSIDERED BY: Salford Social Value Alliance - core group
EQUALITY IMPACT ASSESSMENT AND IMPLICATIONS: There has not been a community impact assessment completed locally.
ASSESSMENT OF RISK: There are costs to employers of implementation of the Living Wage, primarily associated with increased wage bills, though these will vary by sector and employer. Page 206 14 It does, however, lower staff turnover and absenteeism, increase productivity, improve organisational reputation and raise staff motivation and morale, with associated cost savings for employers.
LEGAL IMPLICATIONS: None.
FINANCIAL IMPLICATIONS: There are costs to employers of implementation of the Living Wage, primarily associated with increased wage bills, though these will vary by sector and employer. It does, however, lower staff turnover and absenteeism, increase productivity, improve organisational reputation and raise staff motivation and morale, with associated cost savings for employers.
PROCUREMENT IMPLICATIONS: There are implications in incorporating the Living Wage within procurement, wherever legal, including through application of the Public Services (Social Value) Act 2012. Legal advice has been obtained by Salford City Council on these.
HR IMPLICATIONS: Adopting the Living Wage for all employees should lower staff turnover and absenteeism, increase productivity, improve organisational reputation and raise staff motivation and morale.
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Annual Report and Accounts 2016/17
Page 209
Contents
Foreword ...... 2 PERFORMANCE REPORT ...... 3 Performance Overview ...... 4 Performance Analysis ...... 17 ACCOUNTABILITY REPORT ...... 27 Corporate Governance Report ...... 28 Members Report ...... 28 Statement of Accountable Officer’s Responsibilities ...... 31 Governance Statement ...... 33 Appendix A - Attendance at Governing Body Meetings and Prime Committees in 2016/17 ...... 44 REMUNERATION AND STAFF REPORT ...... 46 Remuneration Report ...... 47 Staff Report ...... 54 Parliamentary Accountability and Audit Report ...... 57 ANNUAL ACCOUNTS 2016/17 ...... 58
1 Page 210 Foreword
NHS Salford Clinical Commissioning Group (CCG) is the organisation that decides how to spend the NHS budget on the majority of health services for 247,000 people living in Salford. This includes the care and treatment you receive in hospital, maternity services, community and mental health services. We also have delegated responsibility for commissioning general practice services.
Established under the Health and Social Care Act 2012 as a statutory body, every GP from the city’s 45 practices is a Member of Salford CCG. As a CCG, we work hard to understand what is happening in Salford’s communities in order to commission the right services for the public.
To do this, the vast majority of decisions about how we use the public’s money is made by those clinicians who are closest to the people they look after – GPs and their practice staff. We work in partnership with health and social care partners (e.g. local hospitals, local authorities, the community and voluntary sector) and our Governing Body is made up of eight representatives of general practice from across Salford along with a chief accountable officer, chief finance officer, registered nurse, secondary care specialist and three lay members.
Salford is a growing city. Billions of pounds are being invested creating thousands of new jobs and homes.
Yet Salford is a city of contrasts. Although there are diverse levels of affluence within the city, Salford is ranked as one of the most deprived local authority areas in England with life expectancy lower than the England average. Even within the city itself, people living in poorer areas live up to 14 years less than those in our richer neighbourhoods.
We’re also an ageing city. As more people call Salford ‘home’, more of us are living longer and often with complicated health conditions. This means more people need more help and support to stay well.
Our vision is for Salford CCG to commission (buy) high quality services to enable our population to live longer, healthier lives.
Our Annual Report tells the story of what Salford CCG did towards achieving this during 2016/17 and details all the information we are required to provide to the public. I hope you enjoy reading it and, if you have any comments on the information within it, please do let us know using the contact details at the end of the report.
Dr Tom Tasker Chair
Page 211 2 PERFORMANCE REPORT
Anthony Hassall, Chief Accountable Officer 26 May 2017
Page 212 3 Performance Overview An overview from our Chief Accountable Officer
This report aims to provide a fair and balanced review of how NHS Salford Clinical Commissioning Group (CCG) discharged its statutory functions during the financial year of 2016/17. It summarises our business, development, activity and performance during the year and cross-references other sections of the Annual Report for further details where relevant. Twelve months ago, when preparing our 2015/16 annual report, we reflected on what had been a historic year for Salford CCG – and indeed the rest of Greater Manchester – as we embarked on an unprecedented journey as the first region to have devolved responsibility for our £6 billion annual health and social care budget.
2016/17 proved to be just as eventful as we entered a new financial year as a member of the Greater Manchester Health and Social Care Partnership - the body made up of 37 NHS organisations and councils from across the region which is overseeing devolution. With Salford leading on several pieces of work across GM, we are ensuring Salford has a strong voice at the Greater Manchester table.
There have been a number of significant and exciting milestones through our determination to turn the Salford Locality Plan, into a reality for our Members and the people of Salford.
Salford CCG became the first – and only - CCG in Greater Manchester to be rated ‘outstanding’ against the CCG Assurance Framework. Combined with Salford Royal NHS Foundation Trust’s previous ‘outstanding’ rating from the Care Quality Commission for 2015/16, it makes Salford one of only two places in England with a CCG and acute provider trust to have the highest accolade. This is an enormous achievement and one we’re extremely proud of. It is a result of the commitment and hard work by our Members and staff and has cemented Salford’s reputation as one of the leading healthcare economies in the UK.
However, we are not complacent. Despite this rating, we know that our population experiences some of the worst health needs in England with high levels of chronic disease and low life expectancy. We are working hard – but we know there is much, much more to do. This annual report will give a flavour of the work we are progressing, but it can only touch the surface of the work we continue to deliver in partnership across Salford.
In the summer, we had the historic launch of Salford’s Integrated Care Organisation (ICO). This was a huge piece of work to turn our vision for an integrated care model in Salford into a reality with joint governance arrangements to manage a pooled health and social care budget with GPs and local councillors making decisions together. The pooled budget and ICO mean we can begin to work hard on the full and proper integration of care across different organisations and professional groups, so that patients feel the real benefit of the NHS, social care and the voluntary sector working more closely together. We also became the first locality to secure £18.2m from the Greater Manchester’s Transformation Fund over a three year period. This money will aid the development of new projects and ways of working to encourage healthier lifestyles and reduce the number of avoidable hospital admissions. There is so much more to do, but we have made an important and pioneering step in Salford – one which many other parts of the UK are looking at with interest.
Page 213 4 These achievements are only possible due to the strong partnership commissioning arrangements with Salford City Council, our most important strategic partner. We already have a long history of partnership working and, in 2016/17, we have developed this even further with GPs and local councillors, as well as other clinicians and key management leaders across the system, making decisions together about how to spend our significant funding for adult health and social care together. To ensure we make the best decisions for the people of Salford we have worked hard together this year to develop further our already good relationships, also working together on wider issues such as tackling poverty and responding to our city’s changing population. We are determined to grasp opportunities work together more to improve wellbeing and health and care services for our entire population in the future. Throughout 2016/17 we continued to build on our partnerships as a member of the North West Sector Partnership (NWSP) with Bolton and Wigan. The NWSP presents an exciting opportunity to build stronger relationships with our NHS neighbours who commission and provide acute hospital services for local people. This will enable us to continue to provide high quality patient care, whilst maximising the skills, talents, and experience of our staff. This will mean there will be a change to the way services are delivered – but change which is discussed with local people and led by clinicians. We know that this will mean that we will need to work hard with partners in other sectors, such as public transport, but we are determined to do this to keep services safe, of the best quality and – as far as possible – local. 2016 also saw the launch of Salford Primary Care Together (SPCT), a GP provider organisation where GP practices across Salford have agreed to work more closely with one another to provide most health services for patients together. It is through SPCT that I am looking forward to continuing to strengthen our engagement with primary care to ensure that we do our utmost for the people of Salford.
As the landscape shifts in health and social care with more emphasis on prevention and people living longer and healthier lives, this year we have had a fundamental shift in our engagement moving from consultation to co-production. Having engaged with 5,000 citizens on a range of topics, the CCG received national recognition for our work winning Best Engagement at the AHCM awards.
Finally, we welcomed Dr Tom Tasker as our new Chair following the retirement of Dr Hamish Stedman. Tom was our clinical lead for mental health and neighbourhood clinical lead for Irlam and Eccles. Hamish provided statesmanlike leadership to the CCG and across Greater Manchester since we were established and left us with a strong legacy. I am delighted to have Tom, whose particular passion for improving mental health services for the people of Salford has driven forward the mental health agenda, step into the role to lead us.
Anthony Hassall, Chief Accountable Officer
Page 214 5 Our vision and aims
Our vision is for Salford CCG to commission (buy) high quality services to enable our population to live longer, healthier lives. To achieve this, we have four aims kept at the forefront of our decision-making to provide the best possible care for our patients.
These are: 1. Prevent ill health 2. Reduce health inequalities 3. Improve healthcare quality 4. Improve health and wellbeing outcomes
To achieve these four aims, Salford CCG had five strategic work programmes in 2016/17: Quality Community Based Care Integrated Care In Hospital Care Long Term Conditions and Mental Health
This is supported by an additional internal work programme of Effective Organisation.
Our priorities for 2016/17
Ensure strong alignment and engagement with all our stakeholders and in particular our members, local partners and population.
Deliver on our 2016/17 objectives and deliverables of the Salford CCG operational plan, including all national requirement within the NHS Mandate and planning guidance – in particular, ensuring strong primary care in the further development of community based and integrated care.
Drive the further development of integrated commissioning with Salford City Council and, as appropriate, a North West sector approach to delivery of acute services where single service configuration meet the needs of the population and particularly in the context of planning for Healthier Together implementation.
Contribute in a leading way to the development and deployment of Greater Manchester devolution, ensuring all key stakeholders are involved and consulted.
Key risks
Our Governance Statement discloses strategic, commercial, operational and financial risks which may significantly affect Salford CCG’s strategies and development. Our policy for managing principal risks is available via www.salfordccg.nhs.uk/policies-and-procedures.
Page 215 6 Performance summary
Quality
What does this mean? Engaging with our Members, population and providers to reduce variation in the standards of care and secure continuous improvement.
The CCG has been working on implementing a Quality and Safety strategy, available via www.salfordccg.nhs.uk/publications, over the past three years with agreed action plans refreshed on an annual basis. During 2016/17, we have maintained a strong emphasis on a system-wide approach to safety and safety improvement through our Safer Salford programme. The programme focuses on reducing avoidable harm in health and care with a particular emphasis on communication handover between services and professionals and medication safety.
Scrutiny of the quality of care is written into provider contracts and provider quality assurance includes a number of processes to collate and triangulate information gathered from regular inspections and quality walk rounds from within the system and by external bodies such as; CQC, NHS England and Monitor. Salford is one of three areas that took part in a new national CQC pilot, 'Quality of Care in a Place'. This is really about increasing that level of openness even further by building a picture of what the whole quality of care is like for people living in a particular area – including how well services are co-ordinated and working together.
During 2016/17, Safer Salford achieved the following:
Safer leadership – 26 leaders from partner organisations in Salford are undertaking a development programme to understand the principles around making safety visible Safer culture – safety cultures surveys have been piloted in different parts of the system to gain an overview of the safety culture within Salford. These will be evaluated and then rolled out over the next few months Safer intelligence - measures are currently being developed around falls, medicines safety and we are exploring other opportunities to capture data that enables us to track safety improvement Safer care homes – nine care homes have started an improvement collaborative Safer handover – data has been evaluated to define the themes and an improvement event to include GPs and consultants is planned for May 2017 Safer Medicines – an integrated medicines safety group has been established and information on various improvement projects has been collated. The interface between these projects, innovation projects relating to medicines safety and various medicines related CQUINs is being mapped to ensure a consistent and integrated approach to safety improvement.
More information on Safer Salford is available via http://safersalford.org/ Page 216 7 What else did we achieve in 2016/17?
Further developed the quality assurance processes as outlined within the Quality and Safety Strategy using information from a variety of sources to highlight areas of good practice and where quality and safety improvements to commissioned services were required Began to implement the actions within our patient experience strategy and research and innovation strategy, both available via www.salfordccg.nhs.uk/publications Established a multidisciplinary health economy Clostridium Difficile Review Group which makes sure learning and actions are identified and implemented for both primary and secondary care reducing the incidence of infections A summary of the impact of the Quality and Safety strategy was reported to the CCG’s Governing Body in March 2017 and available via www.salfordccg.nhs.uk/governing- body-minutes
Salford CCG’s Innovation Fund
Innovation is increasingly held up by senior healthcare leaders and NHS England as the vital solution to meeting many of the challenges in health and social care; a view shared by Salford CCG.
In fact the scale of transformation necessary to deliver the ambition outlined in Salford’s locality plan is a considerable challenge that requires widespread innovation, enhanced use of technology and a commitment to research; and Salford is uniquely placed within Greater Manchester to be a test bed for innovation and research.
In 2016/17 we streamlined our innovation process and have designated calls throughout the year for applications. Examples of projects funded include:
The Guardian Angel Project: A digital platform to enable Salford residents at risk of falls to live more safely in their own homes Salford Active Walk: A behavioural change app which provides evidence-led motivational reward programmes to promote physical activity Improving Pharmacy Communications in Transition of Care: An integrated electronic pharmacy referral platform to improve medicines optimisation, reduce wastage and avoid hospital readmissions Salford CTZN app for Young People: An app to help young people in Salford to improve self-confidence, self-esteem and encourage strong mental wellbeing.
Page 217 8 Community-based care
What does this mean? Supporting and investing in primary and community-based care services to increase integration and the provision outside hospital.
In Salford, our GP practices have been building the foundations for neighbourhood working for several years. This means we have a good basis to build on our capacity and deliver more specialist services in the community.
Investment is planned to scale up community-based services including GPs, community pharmacists, opticians and community services so we can increase the care provided outside of hospital. High quality premises, improved technology and an increased and sustainable workforce are essential.
Building on the strengths ofSalford primary Primary care, its Care value Together in the eyes of the public and the wider health and social care workforce will mean general practice’s place will be at the The CCG’sheart of ambition local communities is for general and practice networks to operateof services on .a larger scale, on a federated basis, and work in a more integrated way with other services.
With the vision of Healthy Neighbourhoods, Happy Staff, Salford Primary Care Together launched in October 2016 after over 18 months’ planning by GPs and stakeholders.
This included a pledge by all the city’s 45 GP practices to support Salford Primary Care Together in their work to deliver collaborative working within neighbourhoods across primary care.
Since being established, Salford Primary Care Together has celebrated a number of fantastic achievements, including:
Recruiting key Board members and the senior leadership teams for each of the five neighbourhoods Securing new premises at Orbit House, Eccles, to share with Integrated Care Organisation colleagues, bringing together the leadership of the health and social care system Winning Innovation Fund investment to create a Diagnostics Unit in Ordsall & Claremont and an Advance Paramedic Acute Home Visiting Service in Walkden & Little Hulton Being selected to provide the Salford Wide Extended Access Pilot, which will improve access to primary care for all patients living in Salford Collaborating with Salford Royal on work to re-design urgent care
Although just a snapshot, these achievements provide Salford Primary Care Together with a strong platform on which to head into the next financial year full of enthusiasm and determination for all our plans for 2017/18.
Page 218 9 What else did the CCG achieve in 2016/17?
Developed a primary care workforce strategy and development plan, available via www.salfordccg.nhs.uk/publications Developed a new primary care staffing model and tested within four GP practices before rolling out across Salford Evaluated year one of advanced practitioner programme. A more thorough evaluation will be undertaken at the end of the two-year programme Secured funding for 24 apprenticeships within primary care, an increase of 13 learners since August 2016 Commissioned the Neighbourhood Integrated Practice Pharmacists in Salford (NIPPS) service providing a designated named pharmacist for each practice Created an online training calendar, www.salfordccg.nhs.uk/education-and-events, for GPs, practice nurses and other clinical/non-clinical staff to support delivery of the Salford Standard Continued commissioning three extended access pilots at Eccles, St Andrews and Salford Health Matters and will do so throughout 2017/18 until the Salford-wide service is delivered by Salford Primary Care Together Established a primary care commissioning committee to ensure effective delegated commissioning Completed a new service specification for the Salford Community Children’s Nursing Team (CCNT) Implemented a new assessment pathway for Children and Young People’s Continuing Healthcare (CHC) Reviewed the healthy start vitamins scheme, which is continuing and we are exploring the option for Greater Manchester provision The re-procured MSK and urology Clinical Assessment and Treatment Services (CATs) opened at Pendleton Gateway Reviewed and updated the Salford Royal Podiatry Service Specification Continued to work on a solution to the pressures on primary medical services due to the significant population growth in Ordsall. Plans are now in place to re-procure The Heights Medical Practice contract, which expires September 2017
The Salford Standard
The CCG has a clear responsibility to improve and develop the quality of primary medical care, reduce variation of standards and support our Members to improve health outcomes across Salford. The Salford Standard has been developed in alignment with the CCG’s five year strategy to describe the level of care patients should expect from a GP practice in Salford. The ‘Standard’ is a vital component in the steps being taken to impact on the growing pressures of local health and care services.
All GP practices in Salford have signed up to deliver the requirements of the Salford Standard and they all made progress towards implementing it in 2016/17.
Full details of the Salford Standard are available via www.salfordccg.nhs.uk/salford-standard
Page 219 10 Integrated care
What does this mean? Helping people keep their independence and quality of life through integrating health and social care services.
Salford CCG has a long history of working with partners Salford Royal, Salford City Council, Greater Manchester Mental Health NHS Foundation Trust and general practice, as Salford Together, to transform the health and wellbeing of the people of Salford.
Partners initially focused on integrating commissioning and services for older people and implementing a preventative model of care with the aim of improving experience, improving quality and outcomes and reducing costs. During 2016/17 work has continued to embed these changes whilst developing an integrated model of care for all adults in Salford with the same aims, focused on a neighbourhood population health model.
Salford recognises that it is a forward thinking economy and as such has established new governance arrangements for the integrated care system, reflecting the shared ambition in our Locality Plan to improve the health outcomes of residents of the city, while also moving towards financial sustainability of health and care services. Established during 2016/17, the Integrated Health and Care Commissioning Joint Committee has responsibility for the adult health and social care pooled budget and brings GPs and councillors together to contribute to, and make, decisions with regards to health and social care matters.
We also:
Worked with partners to create one of England’s first Integrated Care Organisations (ICOs) bringing together adult social care with community and acute mental and physical health. This brings council and health staff together to deliver more personalised services for residents in a streamlined system to keep patients out of hospital and to receive care closer to home. Supported the development of a new model of delivery for general practice to work within the integrated care system in Salford, creating Salford Primary Care Together Secured £18.2m investment from Greater Manchester’s Transformation Fund over a three year period to support our work to improve population health in line with Salford’s Locality Plan. Continued to work with partners to implement our integrated adult model and discuss further models of integration such as Accountable Care
More information on Salford Together is available via www.salfordtogether.com
Page 220 11 What else did we achieve in 2016/17?
Agreed plan with health partners and develop objectives for Integrated Place, neighbourhood working and implement CCG elements of neighbourhood working plan Worked with the King’s Fund for an independent review of how the CCG and Salford City Council can expand on integrated commissioning governance and structure Carried out reviews on services within the adult pooled budget including community continence service, community dietetics service, speech and language therapy, carers support service and occupational therapy equipment service Reviewed the need for a specialist sensory adult social care team and review procedures and role of the extra care team Performance management to monitor the outcomes of the integrated care system now in place, including a dashboard of KPIs for commissioners Started work on incorporating mental health and social care data into Salford Integrated Care Record A new Housing Strategy and draft Carers’ Strategy have been developed Reviewed the financial policy and process regarding support available to individual carers through Direct Payments and Carers Personal Budgets Started work on developing a CCG policy and approach to Personalised Health Budgets, which will be finalised in 2017/18 Completed implementing a second year of funding to deliver the Third Sector Fund, granting a total £1 million divided between a wide range of initiatives and delivered by voluntary organisations, community groups, social enterprises and schools, to encourage people to live healthier lifestyles and improve access to services
In Hospital Care Programme
What does this mean? Deliver improvements in patient outcomes and efficiency through systems that assure high quality and reliable care at lower cost
The main provider of acute health services in Salford, Salford Royal NHS Foundation Trust (SRFT), is an ‘outstanding’ organisation (CQC 2015/16) working with us towards Salford being the safest and most productive health and social care system in England. As part of the Integrated Care Programme and development of an ICO, we will fully integrate health and care services within Salford with more acute care delivered in the community.
Under Healthier Together, Salford Royal has been designated one of four high acuity sites in Greater Manchester and the main centre for major trauma patients. As the North West Sector Partnership (NWSP), Salford Royal, Bolton NHS Foundation and Wrightington, Wigan and Leigh NHS Foundation trusts are working together to create ‘single shared services’ for our combined populations for complex surgery and urgent care. Building on this, the NWSP – which includes the three CCGs - are exploring ways of joining up more surgical, medical and clinical support services – subject to public engagement.
Salford Royal and WWL are also working together as an acute care collaboration vanguard to lead the design of a healthcare group, the Salford and Wigan Foundation Train. Currently decisions are made on a hospital-by-hospital basis but the healthcare group model will mean that decisions about the best way to use resources can be made in response to the needs of the local population as a whole. The trusts will work to standard clinical,
Page 221 12 operational and workforce processes, removing any variation in the way patients are treated across the different trusts. If the concept works, it is our ambition to extend this approach to other hospitals allowing crucial decisions to be made at pace, delivering benefits quicker and more efficiently.
What did we achieve in 2016/17?
Established the governance arrangements for the NW Sector CCG meeting and sub- groups, in addition to the NW Sector Partnership Board; agreed a definition on a clinical model for high risk general surgery; completed baseline audits of workforce and clinical standards; and submitted initial draft of financial model to the GM team Following a mandate from the NW Sector Partnership Board, we are supporting the development of a North West Sector response to the delivery of dermatology services, including links to GM workforce programme. Working on a GM mandate to develop a revised community-based delivery model for neurology outpatients Worked with Greater Manchester partners to ensure a safe, robust breast surgery service continues to be available for Salford patients Evaluated the 2015/16 winter resilience plans and used learning to develop and implement robust 2016/17 plan, for example a GP working within A&E to see people appropriate for primary care to treat freeing up capacity within the department Participated in the ongoing Greater Manchester 24/7 Urgent Primary Care Review Received regular updates that SRFT are progressing towards implementing 7 day service standard and 10 clinical standards, with four key standards due to be implemented by March 2018 Reviewed Manchester Orthopaedic Service; urgent paediatric admissions in the PANDA unit at Salford Royal Hospital; and the Take Home Tuck Up innovation scheme Established the governance structure and working groups to look at dermatology and neurology across Greater Manchester Work to make sure there was sufficient capacity in the system to manage the transfer of becoming the responsible commissioner for bariatric surgery from April 2017 Successfully applied to become a Maternity Pioneer in partnership with Bolton and Wigan CCGs to test ways of improving choice and personalisation for women accessing maternity services Procured a new maternity provider for a Freestanding Midwifery-led Unit (FMU) and began relocating antenatal and postnatal clinics into the community, e.g. Walkden Gateway Adopted Greater Manchester standard cancer referral forms to all Salford GP clinical systems to refer patients with suspected cancer Agreed improved pathways to cancer diagnostics with Salford Royal with the aim to make sure there is sufficient capacity to meet demand and reduce waiting times
Page 222 13 Long Term Conditions Programme
What does this mean? Achieve a more personalised and patient centred approach to caring for people with long term conditions, providing care closer to home.
A long term condition is a health condition which currently has no cure but can be managed with drugs and other treatments and support. Examples of a long term conditions are diabetes, respiratory disease such as chronic obstructive pulmonary disease (COPD) and heart conditions such as heart failure. One in three people in Salford currently have one or more long term condition (just over 76,000) and this is predicted to rise to one in two over the next 25 years.
Over the next five years we aim to make improvements in the prevention, early diagnosis and treatment of conditions which cause the most ill health and reduced quality of life. For Salford this includes Diabetes, Cancer, Cardiovascular Disease, Kidney Disease, Dementia, Liver Disease, Lung Disease (COPD and asthma). We also aim to improve the care people receive at the end of their life.
In 2016/17 we achieved the following:
Agreed a business case for an INR Self-Testing project (point of care testing for patients taking warfarin). Project is expected to start April 2017 Agreed business cases for a children and families bereavement facilitator, cancer health and wellbeing programme, Care Homes End of Life Care Facilitators and Dying Matters initiative Reviewed the Chronic Airways Support Team (CAST) service Developed and implemented the Community Diabetes Service Specification Expanded Cancer CANmove service to take referrals for all cancer groups Implemented recommendations of local Cancer needs assessment Completed the Asthma Needs Assessment Ongoing development of new models of care for out of hospital provision (e.g. remodelling of end to end pathways and outpatient clinics to a more integrated approach to care and treatment) Completed a second year as a National Diabetes Prevention Programme (NDPP) demonstrator site and achieved accreditation to continue delivering this service for a third year
Page 223 14 Mental Health Programme
What does this mean? To make sure all Salford residents have access to high quality, compassionate, world class mental health services
Every year, one in four British adults experience at least one diagnosable mental health problem. In Salford, this number is higher than other parts of the UK with around 36,000 adults and 6,000 children estimated to have some kind of mental wellbeing need.
Our Integrated Mental Health Commissioning Strategy 2013-2018 invests around £45m each year on mental health service provision. While it does mainly focus on adults, it looks at the issues concerning the mental health of young people who are making the transition to adulthood and adult services. Along with this, we have an Emotional Health and Wellbeing Strategy for Children and Young People (2013- 2015), developed by the Children and Young People’s Emotional Health and Wellbeing Partnership.
Salford has long-standing and effective joint commissioning arrangements across the CCG and Salford City Council, which ensures an integrated approach to commissioning across the city. Health and social care services can be expected to be operating in a stringent financial climate over time and there will be an ongoing need for efficiencies in health and social care services through the NHS Quality, Innovation, Productivity and Prevention (QIPP) programme and the reduction in funding for councils.
Despite the ongoing financial constraints, mental health services are, and will continue to be, a key priority in Salford. We are committed to protecting effective services and developing new services with an increased focus on building resilience for communities and individuals, together with prevention and early intervention, to meet the rising demand with the resources available.
During 2016/17, we:
Carried out significant engagement with commissioners across Greater Manchester (GM) regarding the development of a GM mental health strategy, KPIs and CQUINs; and strategic initiatives regarding mental health. Salford commissioners took a key role in progressing work at a GM level regarding criminal justice, crisis and suicide Drafted the Salford Suicide Prevention Strategy Overseen the successful transition of mental health services into the ICO with specifications reviewed and written; and governance arrangements revised Made sure the access standards to the Early Intervention in Psychosis service were exceeded every month Successfully rolled out the IAPT Shared Point of Access which contributed to a year end position where all IAPT targets (Recovery, Access, 6 week wait and 12 week wait) were met and exceeded Excellent performance in Dementia Diagnosis and Care Planning Review as a result of both the investment (£1.5m) made by the CCG in Salford's Memory Clinic in 2014, and the ongoing quality assurance of the performance of Greater Manchester Mental Health Trust. The level of dementia diagnosis in Salford is a direct consequence of the performance of GPs successfully identifying, screening and referring patients to the Memory Clinic Agreed a Dementia Standard as part of the Salford Standard Page 224 15 Reviewed the Dementia Support Service commissioned from Age UK Salford Co-designed a new dementia booklet with the Dementia Champions Group Developed Dementia Management Guidelines to make sure best practice dementia care and support is provided across Salford Royal Developed new referral pathways and joint working between SRFT and GMMH meaning patients receive benefits of timely assessment and treatment for dementia coordinated across two hospital providers Continued to implement the Children and Young People’s CAMHS Transformation Plan and refreshed the plan, available via http://www.salfordccg.nhs.uk/camhs Established a community eating disorder service (CEDS) for children aged up to 18 years and started work on developing an Integrated First Response team, both in conjunction with Manchester CCGs Completed phase one of the National CAMHS School Link pilot and extended the scheme to an additional 23 schools
Greater Manchester health and social care devolution – one year on
On 01 April 2016, a new era began as the Greater Manchester Health and Social Care Partnership took charge of the £6 billion budget and spending decisions in Greater Manchester (GM).
The first year of operation was scoping how we will deliver our vision, putting in place plans to begin to address our issues - not as single organisations, but as a partnership of 37 under appropriate new governance structures.
A wide range of communication and engagement has ensured that the public, staff and other stakeholders are informed and involved in our work to develop and agree a range of strategies to address our biggest challenges.
More information is available via www.gmhsc.org.uk, but during our first year, as the partnership, we have:
Signed historic Transformation Fund deals to deliver plans to change the way we do things locally Created GM frameworks for assurance and performance Established an Urgent and Emergency Care Taskforce and an extra £5m of funding to support local system resilience over winter Published our Primary Care Reform Plan, Population Health Plan and Cancer Plan Set out our Social Care Transformation Plan to improve adult social care - focusing on workforce, easing the problems of the funding gap (£176m in social care by 2020/21), and an aging population Presented plans for urgent and emergency care reform in GM, including ways of using data better to predict demand and using apps and websites to show in real time where people can get help Agreed a range of Memorandums of Understanding to clarify partnerships. For example, between GM and Sport England, the pharmaceutical industry and voluntary and community sector Page 225 16 Performance Analysis
Performance measures
The CCG has an integrated approach to performance reporting which includes patient access, quality, service performance, financial performance and risk elements. Dashboards provide a clear line of sight on progress against the CCG’s six strategic objectives.
Monthly quality and outcome and performance and contract meetings with key providers ensure robust scrutiny of performance gaps and the development of effective recovery plans to address these. The CCG Executive Team and Governing Body reviews progress against the entirety of the Operational Plan on a bi-monthly basis and publishes these reports through the Salford CCG website. The newly established Integrated Health and Care Commissioning Joint Committee also meet bi-monthly to review the progress being made towards an integrated care system, with updates on decisions included within the published CCG Governing Body papers.
In 2016/17 the Salford CCG and health and social care system has: Delivered referral to treatment time performance (<18 weeks) in every month and achieved all cancer wait times with the exception of 2 week waits for breast symptoms (where cancer was not initially suspected) Invested additional winter monies in a broad range of hospital and out of hospital schemes Established an Integrated Health and Care Commissioning Joint Committee, which has responsibility for overseeing the delivery of our health and social care services to adults Continued to develop the ‘Salford Standard’ for primary (general practice) care to ensure standardisation in the quality of care across the city Delivered diagnosis rates for dementia in primary care amongst the highest in the UK Improved waiting times for access to psychological therapies for our patients
During the year the CCG has worked with a number of providers on areas of challenging performance. For every NHS constitutional standard measure not on track, the CCG develops an improvement plan with the appropriate provider. During 2016/17 there are three key areas needing improvement; 4hr A&E target and diagnostic test waiting times and ambulance transportation and response times.
Full recovery plans and the complete CCG performance dashboard covering each of the strategic programmes can be found here: www.salfordccg.nhs.uk/governing-body-minutes
The CCG is also subject to external assurance by NHS England. The 2016/17 year-end assessment for Salford CCG will be available on www.nhs.uk/service- search/performance/search from July 2017.
Page 226 17 Report of the Chief Finance Officer
Summary Financial Performance 2016-17
The CCG has four statutory financial duties against which it is measured:
Revenue resource use does not exceed the amount specified in Directions- ie cannot overspend on revenue budget
Revenue administration resource use does not exceed the amount specified in Directions- ie cannot overspend on running costs
Capital resource use does not exceed the amount specified in Directions- ie cannot overspend on capital allocation
Better Payments Practice Policy- ie prompt payment of invoices
In 2016-17, Salford CCG achieved all of its statutory financial duties and this reflects the strong financial management within the organisation.
The financial statements of the CCG are detailed on annual accounts pages 2 to 32. The performance against each of the statutory targets is summarised as follows:
Revenue resource use: The CCG has a legal duty to maintain spending within its resource limit i.e. total budget. There are two separate limits against which the CCG is measured: revenue and cash. In 2016-17 the CCG met both requirements. The CCG reported a £15.6m under spend (surplus) against its revenue budget (resource limit) of £439m. The CCG planned to achieve a surplus of £11.6m and therefore exceeded the planned surplus by £4m. As set out in the 2016/17 NHS Planning Guidance, CCGs were required to hold a 1 percent reserve uncommitted from the start of the year, created by setting aside the monies that CCGs were otherwise required to spend non-recurrently. This was intended to be released for investment in Five Year Forward View transformation priorities to the extent that evidence emerged of risks not arising or being effectively mitigated through other means.
In the event, the national position across the provider sector has been such that NHS England has been unable to allow CCGs’ 1% non-recurrent monies to be spent. Therefore, to comply with this requirement, NHS Salford has released its 1% reserve to the bottom line, resulting in an additional surplus for the year of £4m. This additional surplus has been offset against other national cost pressures from the current financial year and will be carried forward for drawdown in future years.
The cash book balance at the end of the year was £0.1m which was within the £0.4m limit approved by NHS England.
Revenue administration resource use: Salford CCG has been allocated a running costs allowance of £5.52m. In 2016-17, the CCG’s running cost expenditure was £5.49m and so has remained within the allowable expenditure limit.
Page 227 18 Capital resource use: The CCG received no capital allocation in 2016-17 and has incurred no capital expenditure.
Better Payment Practice Code: In line with other public sector bodies, NHS organisations are required to pay invoices within 30 days or within the agreed payment terms, whichever is the sooner. This is known as the Better Payment Practice Code. CCGs are required to ensure that at least 95% of invoices are dealt with in line with this code. In 2016-17 the CCG exceeded this target:
NHS invoices 100% by invoice value and 99.9% by invoice number. Non NHS invoices 99.6% by value and 98.9% by number. Overall 99.9% by value and 99.2% by number
How did Salford CCG spend its allocation of £439m in 2016-17?
During 2016-17 the CCG achieved a surplus of £15.6m and spent £423m on the achievement of its objectives in a variety of services, as identified in figure one below:
Salford CCG - Allocation of Total Expenditure 2016-17 - £423m
Other £17m Running Costs £5m Continuing Care £8m Primary Care £48m
Prescribing £42m
Acute £222m
Community Health £36m
Mental Health £44m
By far the biggest area of spend relates to Acute services which equates to £222m, which is 52% of the total CCG spend. Acute services relate to hospital spend (accident and emergency attendances, inpatient admissions, diagnostics and outpatients) as well as ambulance services.
Whilst the majority of acute care is commissioned from Salford Royal NHS Foundation Trust (SRFT), other NHS and non NHS providers are also used. The services we buy from these providers are shown in figure two below:
Page 228 19 Salford CCG - Purchase of Acute Services 2016-17 - £222m
Other £34m
NW Ambulance £9m South Manchester FT £4m
Oaklands £9m Pennine Acute NHST £6m Salford Royal FT £115m
Bolton FT £15m
Central Manchester FT £30m
Looking forward into 2017-18
On 27 September 2016, NHS England published “NHS Operational Planning and Contracting Guidance 2017-19”. This document explains how the NHS operational planning and contracting processes will now change to support Sustainability and Transformation Plans (STPs) and the ‘financial reset’. It reaffirms national priorities and sets out the financial and business rules for both 2017/18 and 2018/19.
This guidance also contained CCG funding allocations for the forthcoming year. CCGs’ funding allocations are based on a national funding formula, which includes weightings for the age profile of populations and the deprivation of localities, for example. There have been some amendments to the business rules with regards to the funding which has to be retained as uncommitted, and period of time over which accumulated surpluses may be drawn down. These issues have impacted adversely upon the CCG’s five year financial plan.
The CCG has been permitted to carry forward the surplus that was delivered in 2016-17 (£15.6m). There are rules set at a national level that determines the amount that can be used in any given year and the timescales that this funding can be drawn down. Salford CCG intends to use this surplus over the next 5 years to invest in service transformation. An amount of £2.5m will be used in 2017-18.
Page 229 20 Salford CCG plans to make use of recurrent growth funding and the non-recurrent surplus over the next 5 years to achieve better outcomes for the population of Salford. Some of the investments planned for 2017-18 are as follows:
The CCG is investing £1.3m in the Salford wide extended access scheme which will increase evening and weekend access to primary care
Continued investment in mental health services with an additional £0.6m to fund additional investment in eating disorder services
An investment of £1m recurrently in health and wellbeing services commissioned from the voluntary sector
The CCG continues to invest £2m recurrently in the Innovation Fund, and this is planned to increase by £0.5m from 2018/19.
Non recurrent funds have been set aside for children’s services joint reviews and the implementation costs of the new Freestanding Maternity Unit provider.
It is evident that Salford CCG will have some funds available to invest over the next five years. The challenge for Salford CCG is to target this funding to make significant inroads into addressing those areas where there are poor health outcomes in Salford.
Steve Dixon Chief Finance Officer
Page 230 21 In Hospital Care Programme Page 231 Page
22 Sustainable development
In May 2015, the Governing Body approved Salford CCG’s ‘Sustainable Development Management Plan’, available via www.salfordccg.nhs.uk/policies- and-procedures, and Social Value Pledge.
The CCG’s Social Value Pledge 2016-17 was: Sponsoring the Salford Poverty Truth Commission to explore ways to reduce poverty and create local prosperity (achieved) Implementing the Salford Living Wage as an employer and commissioner (achieved as a direct employer) Continuing to use social value within commissioning and contract evaluation and continue to invest in health and wellbeing initiatives in local communities (achieved) Exploring opportunities to develop high quality apprenticeships with partners (begun as planned); and, improve staff health and wellbeing through a ‘One You’ health improvement programme (achieved). Exploring options to reduce the environmental impact of travel to meetings and continue to pursue paperless working (achieved in part – more to be done)
During 2016/17, we made the following progress: Extensive public, patient and partner engagement on the development of the Salford Locality Plan, including the aims for co-production and social value Launch of the Salford Poverty Truth Commission, www.salfordpovertytruth.org.uk, with Joseph Rowntree Foundation including CCG innovation funding and CCG Chair representation as a public life commissioner The Third Sector Fund (innovation investment) contributing to addressing the health priorities for Salford identified through the Health and Wellbeing Board. More than 100 voluntary organisations, community groups, social enterprises and schools have and continue to benefit from the Third Sector Fund Trained staff to include social value in tender selection criteria and explore how to encourage through existing contracts Achieved ‘highly commended’ status in the 2016 national social value awards Social value aims and monitoring included within the service specification template and tender evaluation process Default black and white and duplex printing (forecast £9k saving year on year including paperless committees) All committees moved to paperless reducing paper use and waste by up to 10,000 sheets per meeting (enabling around a £4K annual saving on printing and paper costs) The CCG’s rubbish is now all sorted off site, and as much as possible is recycled
Page 232 23 Patient and public involvement
Salford CCG is committed to putting the voice of patients and the public at the heart of its commissioning. Our bi-monthly Governing Body meetings are held in public and we rotate the meetings around the CCG’s five neighbourhoods using community venues. This allows each meeting to focus on the developments in specific neighbourhoods of Salford. We maintain our long standing “public comments and questions” section at the beginning of all our public Governing Body meetings, at which we often get a range of queries from the public in relation to general matters or things on the meeting agenda. The formal part of our Governing Body always begins with a patient story, either shared by the people concerns, by way of a video or read by a member of staff.
Each year the CCG publishes an engagement report which outlines the engagement work and the difference the feedback from patients has made, available via www.salfordccg.nhs.uk/publications.
As the landscape shifts in health and social care with more emphasis on prevention and people living longer and healthier lives, this year we have had a fundamental shift in our engagement moving from consultation to co-production. Conversations with communities take an asset based approach, enabling us to develop solutions together and asking not just what we can do for citizens but what citizens can do for themselves.
The integration of the health and social care engagement teams has been fundamental to co-production, it has enabled the CCG to have a wider reach into communities of interest and vulnerable groups bringing the existing forums together to create a ‘wheel of engagement’ (available via www.salfordccg.nhs.uk/publications) with a continuous cycle of discussion on key topics. This includes a Citizen Panel of over 2,500 citizens (1% of the population) and forums for mental health, learning difficulties, black and ethnic minorities, physical and sensory impairments, older people, people with dementia and young people. This year, we have engaged with over 5,000 citizens on a range of topics including suicide prevention, mental health, integrated care, maternity and community services.
Two key achievements this year have been our engagement with young people through the Spiralling Minds workshop and the co-produced Dementia Event. The mental health workshops were received by all senior schools in Salford including pupil referral units and secure units reaching over 2,300 young people. The co-produced Embracing the Dementia Challenge event involved dementia patients, carers, commissioners, providers and students jointly creating an engagement and celebration event that was livestreamed and covered on social media, reaching over 800,000 people.
Both the above received national recognition at the AHCM Awards, gaining Best Engagement 2016 and Commended Engagement 2016.
Our Start Well, Live Well, Age Well Plan (Locality Plan) is now firmly embedded across all key partners and continues to be delivered jointly with the City Council,
Page 233 24 Healthwatch, providers and the voluntary sector. The newly formed Citizen Advisory Panel support us to communicate and engage with the community to achieve the aims of the plan. This year’s themes for engagement and discussion have been developed by the citizen members and include self-responsibility, people powered health and supporting others.
Reducing inequality
It is a core requirement of Salford CCG to demonstrate how we embed equality, diversity and human rights across all work streams. This involves identifying, reporting and setting objectives on health inequality outcomes against each of the nine protected characteristic groups in our planning and decision making processes.
We achieve this by ensuring we engage with local community groups to identify key barriers to accessing services and on proposed key changes in healthcare to identify any potential adverse impacts for them. Through this consultation process, we place the patient voice at the heart of this process which will helps us to shape fair, accessible services that take account of individual needs.
Our fourth Annual Equality Publication, published January 2017 and available via www.salfordccg.nhs.uk/equalitydiversity, shows our commitment to promoting equality and reducing health inequalities and sets out the way we fulfil our responsibilities arising from the Equality Act 2010. The report sets out what we have done in key areas as well as the challenges we know we need to address to achieve our equality objectives:
1) Improve health and narrow the gaps in access, experience and outcomes 2) Improve collection and use of data/evidence for all protected groups 3) Communicate and engage with all protected groups 4) Develop equality and diversity competent and well supported staff 5) Develop leadership, corporate commitment and governance arrangements for equality and diversity
We are pleased with the progress in our equality assurance with health care providers and contract management, governance arrangements for reviewing equalities and, in particular, getting closer and engaging with our local communities.
The report also gives an overview of our role and aims, and our current understanding of Salford’s diverse population and health challenges. It recognises our legal responsibilities in demonstrating ‘due regard’ to the Public Sector Equality Duty and what we are doing to achieve it, as well as progress against our Equality Objectives and commissioning for inclusion.
We are increasingly assured that the organisations providing the services we commission can effectively collect and analyse data to improve service provision and achieve better health outcomes for vulnerable groups in Salford.
Page 234 25 The report highlights examples of work we have undertaken to take account of the needs of our vulnerable communities, looks at our plans to improve the way we commission services and identifies future areas for development. It shows our approach to inclusion, with examples of work we have undertaken to take account of the needs of our vulnerable communities, rather than an exhaustive list of all our achievements.
This publication reflects our open and transparent approach to inclusion and to local vulnerable protected groups, and is available in other formats on request.
Page 235 26 ACCOUNTABILITY REPORT
Anthony Hassall, Chief Accountable Officer 26 May 2017
Page 236 27 Corporate Governance Report
Members Report
NHS Salford CCG’s Constitution is available on our website www.salfordccg.nhs.uk/salford-ccg-constitution. The Constitution was made between the Members of NHS Salford CCG and has been effective since 1 April 2013, when the Governing Body established the organisation. All GPs in Salford have confirmed agreement to, and signed the NHS Salford CCG Constitution.
Member profiles
Section 3.1 of NHS Salford CCG’s Constitution provides full details of the Membership of the organisation. The Constitution has periodically been updated to reflect a number of national and local changes. The appropriate process has been followed to make these changes culminating in NHS England approval.
Member practices
Information regarding the eligibility for Membership and arrangements for leaving the CCG is provided in Section 3 of the CCG’s Constitution. In addition, Section 8.4 provides detail regarding the methods the CCG uses to engage with its Member Practices.
Composition of Governing Body
Governing Body Dr Hamish Stedman, Chair (until July 2016) Dr Tom Tasker, Chair (from August 2016) Anthony Hassall, Chief Accountable Officer Steve Dixon, Chief Finance Officer Dr Paul Bishop, Strategic Partnerships and Planning Clinical Lead (until Oct 2016) Dr Tom Regan, Strategic Partnerships and Planning Clinical Lead (from Feb 2017) Dr Jeremy Tankel, Clinical Lead for Quality and Safety Dr Jenny Walton, Neighbourhood Clinical Lead for Swinton (until Jan 2017) Dr Ben Williams, Neighbourhood Clinical Lead for Swinton (from Feb 2017) Dr Tom Tasker, Neighbourhood Clinical Lead for Eccles, Irlam and Cadishead (until May 2016) Dr Clare Gibbons, Neighbourhood Clinical Lead for Eccles, Irlam and Cadishead (from Jun 2016 until Dec 2016) Dr Aisha Awan, Neighbourhood Clinical Lead for Broughton (from Jun 2016 until Dec 2016) Dr Owain Thomas, Neighbourhood Clinical Lead for Ordsall and Claremont (until Sept 2016) Dr David McKelvey, Neighbourhood Clinical Lead for Ordsall and Claremont (from Jan 2017) Dr Nick Browne, Neighbourhood Clinical Lead for Little Hulton and Walkden (from Jun 2016)
Page 237 28 Brian Wroe, Lay Member for Engagement Edward Vitalis (Vice chair), Lay Member for Finance and Governance Paul Newman, Lay Member for Commercial Alison Kelly, Governing Body Nurse (from July 2016) Dr Mansel Haeney, Governing Body Secondary Care Clinician (until March 2017)
Ex Officio Governing Body Members:
Cllr Tracy Kelly, Salford City Council Executive Lead Member – Health and Wellbeing Charlotte Ramsden, Salford City Council Strategic Director – Children’s and Adult Services David Herne, Salford City Council Director of Public Health
Committee(s), including Audit Committee
Audit Committee
Edward Vitalis, Lay Member for Finance and Governance (Chair) Dr Jeremy Tankel, Clinical Lead for Quality and Safety Alison Kelly, Governing Body Nurse (from July 2016)
Details of the membership of the Remuneration Committee is included in the Remuneration Report, and details of and membership of all other Governing Body Committees are included in the Governance Statement.
Register of Interests
NHS Salford CCG has a policy which is in line with statutory guidance on managing conflicts of interest for CCGs. The register of interests is available via www.salfordccg.nhs.uk/publications Personal data related incidents
There have been no personal data related incidents reports formally reported to the information commissioner’s office.
Statement of Disclosure to Auditors
Each individual who is a member of the CCG at the time the Members’ Report is approved confirms:
so far as the member is aware, there is no relevant audit information of which the CCG’s auditor is unaware that would be relevant for the purposes of their audit report
the member has taken all the steps that they ought to have taken in order to make him or herself aware of any relevant audit information and to establish that the CCG’s auditor is aware of it.
Page 238 29 Modern Slavery Act
Salford CCG fully supports the Government’s objectives to eradicate modern slavery and human trafficking but does not met the requirements for producing an annual Slavery and Human Trafficking Statement as set out in the Modern Slavery Act 2015.
In addition, the CCG was actively involved in developing Multi Agency Modern Day Slavery policies and procedures (now shared across GM). Modern Day Slavery is included within relevant CCG Policies or appropriate links included to the multi agency polices/ procedures. This includes the GP Safeguarding Policy.
The CCG arranged and coordinated Multi Agency Modern Day Slavery training across Salford on behalf of the Safeguarding Adult/ Children’s Board.
Assurance from providers is sought via the CCG Safeguarding Team using the Greater Manchester Safeguarding standards as part of contractual arrangements.
Page 239 30 Statement of Accountable Officer's Responsibilities
The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed Mr Anthony Hassall to be the Accountable Officer of Salford CCG.
The responsibilities of an Accountable Officer are set out under the National Health Service Act 2006 (as amended), Managing Public Money and in the Clinical Commissioning Group Accountable Officer Appointment Letter. They include responsibilities for: • The propriety and regularity of the public finances for which the Accountable Officer is answerable, • For keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction), • For safeguarding the Clinical Commissioning Group's assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities). • The relevant responsibilities of accounting officers under Managing Public Money, . • Ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with Section 14Q of the National Health Service Act 2006 (as amended)) and with a view to securing continuous improvement in the quality of services (in accordance with Section14R of the National Health Service Act 2006 (as amended)), • Ensuring that the CCG complies with its financial duties under Sections 223H to 223J of the National Health Service Act 2006 (as amended).
Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its net expenditure, changes in taxpayers' equity and cash flows for the financial year.
In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Group Accounting Manual issued by the Department of Health and in particular to: • Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; • Make judgements and estimates on a reasonable basis; • State whether applicable accounting standards as set out in the Group Accounting Manual issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements; and, • Prepare the financial statements on a going concern basis.
Page 240
31 To the best of my knowledge and belief, I have properly discharged the responsibilities set out under the National Health Service Act 2006 (as amended), Managing Public Money and in my Clinical Commissioning Group Accountable Officer Appointment Letter.
I also confirm that: • as far as I am aware, there is no relevant audit information of which the CCG's auditors are unaware, and that as Accountable Officer, I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that the CCG's auditors are aware of that information. • that the annual report and accounts as a whole is fair, balanced and understandable and that I take personal responsibility for the annual report and accounts and the judgments required for determining that it is fair, balanced and understandable
Chief Accountable Officer
26 May 2017
Page 241
32 Governance Statement
Introduction and context
NHS Salford Clinical Commissioning Group (CCG) is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended).
The clinical commissioning group’s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG’s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population.
As at 1 April 2016, the clinical commissioning group is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006.
Scope of responsibility
As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out under the National Health Service Act 2006 (as amended) and in my Clinical Commissioning Group Accountable Officer Appointment Letter.
I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group as set out in this governance statement.
Governance arrangements and effectiveness
The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it exercises its functions effectively, efficiently and economically and complies with such generally accepted principles of good governance as are relevant to it.
The Governing Body
NHS Salford CCG’s Governing Body has approved the vision, values and overall strategic direction of the organisation and authorises any matters that amend the CCG’s Constitution, including Terms of Reference for the Governing Body, its
Page 242 33 committees, the Membership of those committees, the overarching scheme of reservation and delegation and the standing orders and prime financial policies. NHS Salford CCG’s Constitution permits that the Governing Body must not comprise less than 6 Members and that the Chair will be a GP. In addition, five representatives of Member Practices (covering the various neighbourhoods) coupled with two other GPs or primary care health professionals, one registered nurse (with a lead role on assurance for safeguarding and quality) and one secondary care specialist doctor (with a lead role on assurance associated with clinical matters including clinical systems and research and development) make up its clinical Membership.
Furthermore, three lay Members (one of whom will be the Deputy Chair) respectively lead on audit, remuneration and conflict of interest matters; patient and public participation matters; and commercial issues. Finally, the Accountable Officer and the Chief Finance Officer complete the composition of the Governing Body.
To add value to its work, NHS Salford CCG routinely extends an invitation to Salford City Council’s Director of Public Health, its Strategic Director for Community, Health and Social Care and its Lead Member for Adult Services, Health and Wellbeing.
Committees of the Governing Body
To support the successful delivery of its functions and activities, NHS Salford CCG has established several Prime Committees, each accountable to the Governing Body. In 2015/16, the CCG undertook a review of all Prime Committees with regards to their effectiveness. As a consequence, improvements and amendments to the organisation’s Constitution were made in 2016/17.
The majority of Governing Body Members have undertaken an appraisal during 2016/17, and routine, informal Governing Body developmental sessions serve to facilitate the transfer of knowledge and aid aspects of each Member’s personal development. The main body of the Annual Report provides comprehensive highlights of the work led by NHS Salford CCG’s committees and sub-committees.
Audit Committee
The Audit Committee provides the Governing Body with an independent and objective view of the CCG’s financial systems, financial information and compliance with laws, regulations and directions governing the group in so far as they relate to finance. In addition, NHS Salford CCG’s Governing Body has conferred/delegated the following functions, connected with the Governing Body’s main function to its Audit Committee: To review the implementation and ongoing quality of integrated governance, risk management and internal control, across the whole of NHS Salford CCG’s activities (both clinical and non-clinical); and Act as the arbiter for any issues which may arise from conflicts of interest in relation of the awarding of contracts, in particular to primary care providers and/or primary care independent contractors. The Committee directed that a number of reviews be undertaken, prioritised on a combination of risk rating and organisational impact. Assurance was obtained on the areas included in the Head of Internal Audit Opinion below.
Page 243 34 Remuneration Committee
The Remuneration Committee makes decisions on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the organisation and on determinations about allowances under any pension scheme that the CCG may establish as an alternative to the NHS pension scheme.
Commissioning Committee
The Commissioning Committee oversees commissioning activities including service developments, Quality, Innovation, Prevention and Productivity (QIPP) plans investments/disinvestments, quality assurance and contract management.
Primary Care Commissioning Committee
The Primary Care Commissioning Committee oversees commissioning activities associated with the commissioning of Primary Care. These commissioning activities include GMS, PMS and APMS contracts, newly designed enhances services; design of local incentive schemes; decision making on whether to establish new GP practices in an area; approving practice mergers; and making decisions on ‘discretionary’ payment.
Executive Team
The Executive Team is responsible for compliance with statutory and regulatory duties, operational delivery of all CCG functions and performance management of the objectives of the organisation. It is also specifically responsible for the functions of health, safety and risk, information management and technology (IM&T) including information governance, equality and diversity and health economy resilience.
Integrated Adult Health and Social Care Commissioning Joint Committee (joint commissioning arrangement with Salford City Council)
The Integrated Adult Health and Care Commissioning Joint Committee, has commissioning responsibilities, as well as overseeing commissioning activities associated with the Adult Health and Care Pool, including the Integrated Care Organisation. These commissioning activities include service strategy, service design, the Annual Programme Plan and market management. The Integrated Adult Health and Care Commissioning Joint Committee also manages system performance and agrees the Service and Financial Plan (which is the Commissioning Plan for the Integrated Care System and the Integrated Care Organisation).
Appendix A provides summary detail of attendance at meetings throughout 2016/17. Terms of Reference for each Prime Committee are available within the constitution on our website www.salfordccg.nhs.uk/publications
Page 244 35 Joint Arrangements
NHS Salford CCG is one of 12 (now 10 as NHS North, South and Central Manchester CCGs have merged) Member CCGs of the Greater Manchester Association of CCGs, a collaborative body which acts as a single commissioning voice within Greater Manchester and a vehicle for joint working. NHS Salford CCG’s Clinical Chair and Chief Officer represent the CCG’s interests at the Association Governing Group (AGG), the Association’s most senior decision-making body. The CCG also has representatives on the AGG’s sub-committees, including Heads of Commissioning and Chief Finance Officers. Through the GM Association of CCGs, Member CCGs are able to share best practice, access peer support and work collaboratively on a wider footprint to achieve the best possible health outcomes for their patients.
NHS Salford CCG has also entered into joint arrangements with Salford City Council and other Salford based organisations as follows: Salford Safeguarding Adults Board; Salford Safeguarding Children’s Board; Alliance Board for Integrated Care; Integrated Health and Wellbeing Commissioning Board; Salford Health and Wellbeing Board; Integrated Care Advisory Board; and the Greater Manchester Health and Social Care Partnership.
Terms of Reference for each committee highlighted above coupled with detailed attendance records are available upon request.
UK Corporate Governance Code
NHS Bodies are not required to comply with the UK Code of Corporate Governance. However, compliance is considered to be good practice. This Governance Statement is intended to demonstrate NHS Salford CCG’s compliance with the principles set out in the code.
For the financial year ended 31 March 2017, and up to the date of signing this statement, the CCG has complied with the provisions set out in the Code, and equally applied the principles laid out therein.
Discharge of Statutory Functions
In light of recommendations of the 1983 Harris Review, the clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the clinical commissioning group’s statutory duties.
Page 245 36 Risk management arrangements and effectiveness
NHS Salford CCG’s Risk Management Strategy underpins a Risk Management Framework as part of its wider governance arrangements. The Framework illustrates how our strategic programmes, key work programmes and activities are aligned and explains the method by which risks are assessed, scored, monitored and reported.
Our strategic programmes and key deliverables (objectives) are the primary focus for risk identification and horizon scanning. Strategic risks are recorded in our strategic risk register which is held in the integrated performance and risk system, Covalent. Operational risks are captured in specific programme/project risk registers across the organisation.
All risks across the organisation are aligned to objectives and so the CCG does not operate a process of escalation/de-escalation. If a risk is no longer considered to be relevant to a strategic objective, it can be moved to an operational risk register provided that the risk would have an impact on the achievement of objectives at that level i.e. for a programme/project. In turn, a programme/project risks could be moved to the strategic risk register provided that the assessment could demonstrate a risk to the achievement of one or more of our strategic objectives. This process is closely managed by the Senior Planning and Performance Manager, the CCG’s risk practitioner.
Details on the CCG’s Risk appetite, risk assessment process, risk ownership and accountability and training and reporting arrangements can be found in the CCG’s latest Risk Management Strategy.
NHS Salford CCG reported one programme risk in relation to Information Governance in 2016/17 as follows:
A breach of Information Governance or data security processes may result in the release of Patient Confidential Data, Patient Identifiable Data, confidential corporate data or other highly sensitive information.
The risk was identified in 2015/16 but was carried over in to 2016/17. The risk has strong existing controls and assurances with no gaps identified in the controls. The CCG is comfortable with the level of risk which has been rated as low (green) and therefore tolerates the risk.
The CCG did not identify any risks to compliance with the CCG’s licence in 2016/17.
NHS Salford CCG reported one strategic risk to its internal controls in 2016/17 as follows: Commissioning decisions are influenced by conflicts of interest and do not represent the best solutions for the people of Salford.
Page 246 37 Existing controls are in place and assurances have been provided. Gaps in assurances were identified in 2015/16 and further controls were applied as part of the risk treatment plan. This risk was carried forward in to 2016/17 but remains low (green).
In 2016/17, NHS Salford CCG reported one strategic risk in relation to organisational performance as follows:
If pressures in the health and social care system are not effectively monitored and managed then we may fail to achieve national performance targets. This may result in patient harm, negative media attention (reputational damage), reduced patient confidence and could cause further pressures in the wider health system.
The risk was identified in 2015/16 and carried over to the 2016/17 Strategic Risk Register due to ongoing pressures in the system. Existing controls and assurances are in place. Gaps in assurance were identified in 2015/16 and further controls were applied as part of the risk treatment plan. This risk remains high (red).
In addition to the risk above, the Governing Body receives an integrated planning, performance and risk report at every meeting which details the latest performance breaches including plans for recovery.
Other sources of assurance
Internal Control Framework A system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically.
The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness.
The committee and reporting structures of NHS Salford CCG provide the basis of the framework and process that maintains, monitors and reviews the effectiveness of the system of internal control and risk management. The governance structure and sub committees comprise of a mix of senior managers, clinical professionals, independent contractors and internal audit representation to provide an effective balance between the Membership, executive and audit functions and furthermore to ensure that decision making is effectively triangulated.
The Governing Body’s role is to provide active leadership of the CCG within a framework of prudent and effective controls that enable risk to be managed. Consequently, the Governing Body’s Risk Assurance Framework itself provides the Governing Body with high level assurance of the progress of achievement of the CCG's aims, objectives and priorities within a robust risk based framework. In addition, the Governing Body also receives regular reports offering internal assurances on financial, organisational and quality performance.
Page 247 38 The Audit Committee specifically advises the Governing Body on the effectiveness of the system of internal control by the review of the internal audit report, external audit report and the Risk Assurance Framework. Any significant control issues are routinely reported to the Governing Body by the Audit Committee.
Annual audit of conflicts of interest management The revised statutory guidance on managing conflicts of interest for CCGs (published June 2016) requires CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to undertake this task, NHS England has published a template audit framework.
The CCG has carried out our annual internal audit of conflicts of interest. Following the review, internal audit has assigned compliance levels to each area as follows:
Scope Area Compliance Level RAG rating
1. Governance Arrangements Partially Compliant
2. Declarations of interests and gifts and Partially Compliant hospitality
3. Register of interests, gifts and Partially Compliant hospitality and procurement decisions
4. Decision making processes and contract Fully Compliant monitoring
5. Reporting concerns and identifying and Fully Compliant managing breaches / non compliance In the majority of cases (21 out of the 26 requirements set by NHS England), the CCG is compliant with legal requirements and statutory guidance in relation to the management of conflicts of interest and gifts and hospitality.
Data Quality Data provided to the Membership and the Governing Body to inform decision making has a high degree of provenance. It is obtained from trusted sources: NHS data sets; National Institute for Health and Care Excellence (NICE); the Joint Strategic Needs Assessment (JSNA) etc., and from trusted advisers: Greater Manchester Shared Services (GMSS); the National Health Service Litigation Authority (NHSLA); the National Health Service Business Services Authority (NHSBSA) etc.
The Audit Committee and Internal Audit team play pivotal roles in assuring and challenging, where relevant, the data and assumptions made from that data in reports destined for the Governing Body and other decision making committees or sub groups of the Governing Body. Information Governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is
Page 248 39 supported by an information governance toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. The CCG has submitted a satisfactory level of compliance with the IG Toolkit. The full details of our compliance with the assessment will be presented to the Governing Body to be held on 24 May 2017, and will be available on our website from that date.
We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. We have established an information governance management framework and are developing / have developed information governance processes and procedures in line with the information governance toolkit. We have ensured all staff undertake annual information governance training and have implemented a staff information governance handbook to ensure staff are aware of their information governance roles and responsibilities.
There are processes in place for incident reporting and investigation of serious incidents. We are developing information risk assessment and management procedures and a programme will be established to fully embed an information risk culture throughout the organisation against identified risks. Business Critical Models No significant internal control issues have been identified in this respect as the CCG uses only those quality assurance models prescribed by NHS England.
Third party assurances NHS Salford CCG has received third party assurance from GMSS through the Director of Audit Annual Report 2016/17, the link to which is www.salfordccg.nhs/publications. This report confirms the governance, risk management and internal control arrangements operated by GMSS. In addition, significant assurance opinions are provided in respect of key financial systems and people services controls upon which NHS Salford CCG relies. In the early part of the year GMSS received Service Auditor Reports via NHS England's Internal Auditors and progress has continued to be made in completing the actions arising from these.
Control Issues
No significant control issues currently facing the CCG were identified via the Month 9 Governance Statement return.
Review of economy, efficiency & effectiveness of the use of resources
The Governing Body and its committees and sub committees receive proposals that are based upon evidenced based commissioning intentions. A wide variety of data sources are used to inform the development of our commissioning intentions, but chief amongst these is the Joint Strategic Needs Assessment. Summary business cases are also provided for each commissioning intention drafted that comprises an
Page 249 40 assessment of the cost benefit analysis of the proposal and an appropriate risk assessment.
The Audit Committee provides the assurance overview for the effective use of resources, and the Internal Audit Team have an annual work programme that complements that role and focuses upon all work areas covered by the CCG.
While CCGs have a responsibility to promote comprehensive healthcare within the resources available, this does not mean an obligation to provide every treatment. As a commissioning organisation, NHS Salford CCG strives to take into account the resources available to it and the competing demands on those resources.
The GMSS Effective Use of Resources (EUR) team works closely with NHS Salford CCG to facilitate and support making those judgments at an individual patient level known as Individual Funding Requests (IFRs). GMSS’s EUR team combine regional best practice and benchmarking with local knowledge gained from a strong client relationship and deep knowledge and expertise. A regional overview improves consistency across boundaries, leading to an improved patient experience.
Salford CCG was rated 'outstanding' for 2015/16 and commended in areas such as strong and robust leadership, involving and engaging patients and the public and getting best value for money. It is the only CCG in Greater Manchester rated 'outstanding' and the only CCG nationally to achieve 'outstanding' in three out of the five components of the framework.
The Quality of Leadership indicator assesses the quality of the CCG’s leadership, the quality of its plans, how the CCG works with its partners, and the governance arrangements that the CCG has in place to ensure it acts with probity, for example in managing conflicts of interest. As at Quarter 2 2016/17, Salford CCG was rated ‘green star’ and the year end results for the Quality of leadership Indicator will be available from July 2017 at www.nhs.uk/service-search/scorecard/results/1175.
Delegation of functions
GMSS undertake a number of functions on behalf of the CCG including finance. There are no other significant delegated functions that are not already covered elsewhere in the governance statement.
Counter fraud arrangements
The CCG has made the following arrangements regarding its managing of counter- fraud: An Accredited Counter Fraud Specialist is contracted from TIAA to undertake counter fraud work proportionate to identified risks. The CCG’s Audit Committee receives a report against each of the Standards for Commissioners at least annually. There is the commitment to provide executive support and direction for a proportionate proactive work plan should this report identify any risks to the organisation.
Page 250 41 A member of the Executive Board is proactively and demonstrably responsible for tackling fraud, bribery, and corruption.
Head of Internal Audit Opinion
Following completion of the planned audit work for the financial year for the clinical commissioning group, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the clinical commissioning group’s system of risk management, governance and internal control. The Head of Internal Audit concluded that:
Significant Assurance, can be given that that there is a generally sound system of internal control designed to meet the organisation’s objectives, and that controls are generally being applied consistently.
During the year, Internal Audit issued the following audit reports: Area of Audit Level of Assurance Given Annual Governance Statement Advisory Assurance Framework Opinion Significant Healthcare Overseas Visitors Significant Healthcare Associated Infections Significant Financial Control Environment self- N/A assessments Information Governance Significant Assurance on Quality of Services Significant Commissioned incl Francis follow up Medicines Management Significant GP Plans – Salford Standard Limited Follow Up of Internal Audit Significant progress evidenced in Recommendations implementing the recommendations
Review of the effectiveness of governance, risk management and internal control
My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their annual audit letter and other reports.
Page 251 42 Our assurance framework provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principles objectives have been reviewed.
I have been advised on the implications of the result of this review by: The governing body The audit committee Internal audit Other explicit review/assurance mechanisms.
The role and conclusions of each were that the committee and reporting structures of NHS Salford CCG provide the framework and process that maintain, monitor and review the effectiveness of the system of internal control and risk management. The governance structure and subcommittees comprise of a mix of senior managers, clinical professionals, independent contractors and internal audit representation.
The Governing Body’s role is to provide active leadership of the CCG within a framework of prudent and effective controls that enable risk to be managed. High risks are reported to each meeting of the Governing Body where gaps in controls and assurances are identified and remedial actions agreed. The Governing Body also receives regular reports giving internal assurances on financial, organisational and quality performance.
The Audit Committee is pivotal in advising the Governing Body on the effectiveness of the system of internal control by the review of the internal audit report, external audit report and the Risk Assurance Framework. Any significant control issues are reported to the Governing Body by the Audit Committee.
Conclusion
No significant issues have occurred during 2016/17 which would have a significant impact upon the organisation. My review confirms that NHS Salford CCG has a generally sound system of internal control that supports the achievement of its policies, aims and objectives.
Anthony Hassall Chief Accountable Officer 26 May 2017
Page 252 43 Appendix A - Attendance at Governing Body Meetings and Prime Committees in 2016/17
Meeting Dates for 2016/17
Members Team Executive Executive Committee Committee Committee Committee Health and Social Care Management Primary Care Remuneration Commissioning Commissioning Commissioning Commissioning Commissioning Integrated Adult Governing Body Joint Committee Joint Audit Committee Audit Dr Hamish Stedman (left the - organisation on 31/07/2016) 3/4 - - 2/2 0/7 11/15 Dr Tom Tasker 8/9 - - - 1/1 11/17 21/29 Anthony Hassall 9/9 2/6 - 4/6 - 6/17 39/44 Steve Dixon 9/9 6/6 - 6/6 - 12/17 35/44 Dr Paul Bishop (left the - Governing Body on 31/10/2016) 3/5 0/4 - - 7/11 22/27 - Dr Jeremy Tankel 5/9 5/6 3/5 - 13/17 - Dr Clare Gibbons (joined the - - Governing Body on 01/06/2016 and left on 31/12/2016) 4/4 5/5 - - 8/9 Dr Aisha Awan (joined the - - Governing Body on 01/06/2016 and left on 31/12/2016) 3/4 3/5 - - 9/9 Dr Owain Thomas (stepped - - down from the Governing Body on 30/09/2016) 2/5 2/3 - - 9/9 Dr Nick Browne (joined the - - Governing Body on 01/06/2016) 4/6 6/6 - - 11/13 Dr Jenny Walton (stepped - - down from the Governing Body on 31/01/2017) 4/8 2/5 2/2 - 12/15 Dr David McKelvey (joined - - the Governing Body on 01/01/2017) 2/2 1/1 - - 4/4 Dr Tom Regan (joined the - Governing Body on 01/02/2017) 1/1 1/1 - - 1/2 - Dr Ben Williams (joined the - - Governing Body on 01/02/2017) 1/1 1/1 - - 2/2 Alison Kelly (joined the - - organisation on 01/07/2016) 5/6 - 1/2 1/1 - - - Dr Mansel Haeney 7/9 - - 2/3 -
Page 253 44 6/6 - Brian Wroe 8/9 - - 3/3 - - ‐ Edward Vitalis 7/9 - 5/5 3/3 - 1/6 ‐ Paul Newman 5/9 - - 2/3 - Karen Proctor 7/9* 4/6* - 6/6 - 12/17 32/44 Francine Thorpe 7/9* 4/6* - - - 13/17 35/44 Hannah Dobrowolska 7/9* - - - - - 38/44 Jennifer McGovern - 6/6* - - - - 36/44 NB Ex Officio Governing Body Members including the Director of Public Health are invited to attend meetings but may not vote and therefore attendance is not listed in the table above
KEY: * - In attendance
Page 254 45 REMUNERATION AND STAFF REPORT
Anthony Hassall, Chief Accountable Officer 26 May 2017
Page 255 46 Remuneration Report
Remuneration Committee
For the period from 1 April 2016 to 31 March 2017, details of the membership of the Remuneration Committee were as follows:
Edward Vitalis - Chair – Governance Dr Mansel Haeney - Secondary Care Consultant Paul Newman - Lay Member – Commercial Brian Wroe - Lay Member – Engagement Alison Kelly - Governing Body Nurse (from July 2016)
The Remuneration Committee follows national guidance issued by the Department of Health to determine the remuneration and terms and conditions of senior managers using the national Very Senior Managers pay framework (VSM). The Remuneration Committee is also responsible for the remuneration of the clinical members. Summary detail of attendance at meetings throughout 2016/17 is provided as an appendix to the Governance Statement.
The performance of VSMs is assessed through the CCG’s Personal Development Review system in line with NHS policy. Remuneration is not performance related. Termination of contracts, and any relevant payments, are calculated on an individual basis, taking into account circumstances of termination, notice periods, length of service and salary. All calculations are in line with statutory and NHS terms and conditions.
Policy on the remuneration of senior managers
The policy on the remuneration of directors for the current and future years is in line with the CCG’s Approved Standing Orders.
Remuneration of Very Senior Managers
There are no senior managers earning in excess of £142,500.
Page 256 47 Senior manager remuneration (including salary and pension entitlements)
Senior managers for the purposes of the remuneration report are the members of the Governing Body plus the executive directors of the CCG.
2016/17 (a) (b) (c) (d) (e) (f) Salary Expense Performance pay Long term All pension-related TOTAL (bands of payments and bonuses performance pay benefits (a to e) Name and Title £5,000) (taxable) (bands of £5,000) and bonuses (bands of £2,500) (bands of to nearest £100 (bands of £5,000) £5,000)
£000 £ £000 £000 £000 £000 Hamish Stedman, 45-50 45-50 Chair Anthony Hassall Chief 115-120 50-52.5 165-170
Page 257 Page Accountable Officer Steve Dixon Chief 105-110 62.5-65 170-175 Finance Officer Karen Proctor Director 80-85 62.5-65 145-150 of Commissioning Francine Thorpe 85-90 112.5-115 200-205 Director of Quality and Innovation Hannah Dobrowolska 55-60 32.5-35 90-95 Director of Corporate Services Paul Bishop Lead for 85-90 85-90 Strategic Partnership and Planning Jeremy Tankel Clinical 55-60 55-60 Lead for Quality & Safety Girish Patel 25-30 25-30 Neighbourhood Lead Owain Thomas 40-45 40-42.5 80-85 Neighbourhood Lead Tom Tasker 85-90 35-37.5 120-125 Neighbourhood Lead /Chair
48 2016/17 (a) (b) (c) (d) (e) (f) Salary Expense Performance pay Long term All pension-related TOTAL (bands of payments and bonuses performance pay benefits (a to e) Name and Title £5,000) (taxable) (bands of £5,000) and bonuses (bands of £2,500) (bands of to nearest £100 (bands of £5,000) £5,000)
£000 £ £000 £000 £000 £000 Jenny Walton 75-80 75-80 Neighbourhood Lead Aisha Awan 20-25 20-25 Neighbourhood Lead Nicholas Browne 20-25 167.5-170 190-195 Neighbourhood Lead Alison Kelly Governing 5-10 5-10 Body Nurse Page 258 Page David McKelvey 5-10 20-22.5 25-30 Neighbourhood Lead Claire Gibbons Lead 15-20 37.5-40 55-60 for Eccles, Irlam & Cadishead Mansel Haeney 10-15 10-15 Secondary Care Clinician Ben Williams 0-5 0-5
Brian Wroe Lay 5-10 5-10 Member Edward Vitalis Lay 10-15 10-15 Member Paul Newman Lay 5-10 5-10 Member
49 2015/16 (a) (b) (c) (d) (e) (f) Salary Expense Performance pay Long term All pension-related TOTAL (bands of payments and bonuses performance pay benefits (a to e) Name and Title £5,000) (taxable) (bands of £5,000) and bonuses (bands of £2,500) (bands of to nearest £100 (bands of £5,000) £5,000)
£000 £ £000 £000 £000 £000 Hamish Stedman Chair 130-135 130-135 Anthony Hassall Chief 75-80 57.5-60 135-140 Accountable Officer Steve Dixon Chief 100-105 15-17.5 115-120 Finance Officer Alan Campbell Chief 40-45 40-45 Accountable Officer Karen Proctor Director 75-80 15-17.5 95-100 of Commissioning
Page 259 Page Francine Thorpe 75-80 22.5-25 100-105 Director of Quality & Innovation Hannah Dobrowolska 60-65 15-17.5 75-80 Director of Corporate Services Paul Bishop Clinical 85-90 17.5-20 105-110 Lead for Strategic Partnership & Planning Jeremy Tankel Clinical 60-65 2.5-5 65-70 Lead for Quality & Safety Babar Farooq 35-40 35-40 Neighbourhood Lead Girish Patel 75-80 75-80 Neighbourhood Lead Owain Thomas 55-60 0-2.5 55-60 Neighbourhood Lead Tom Tasker 80-85 20-22.5 100-105 Neighbourhood Lead Jenny Walton 75-80* 75-80* Neighbourhood Lead Clare Todd Governing 5-10 5-10 Body Nurse
50 2015/16 (a) (b) (c) (d) (e) (f) Salary Expense Performance pay Long term All pension-related TOTAL (bands of payments and bonuses performance pay benefits (a to e) Name and Title £5,000) (taxable) (bands of £5,000) and bonuses (bands of £2,500) (bands of to nearest £100 (bands of £5,000) £5,000)
£000 £ £000 £000 £000 £000 Mansel Haeney 10-15 10-15 Governing Body Secondary Care Clinician Brian Wroe Lay 5-10 5-10 Member Edward Vitalis Lay 10-15 10-15 Member Page 260 Page Paul Newman Lay 5-10 5-10 Member *Note – disclosure corrected for Jenny Walton’s 2015/16 salary
51 Pension benefits as at 31 March 2017
Name and Title (a) (b) (c) (d) (e) (f) (g) (h) Real increase Real increase in Total accrued Lump sum at Cash Equivalent Real Increase in Cash Equivalent Employers in pension at pension lump pension at pension age Transfer Value at Cash Equivalent Transfer Value at Contribution to pension age sum at pension pension age at 31 related to 1 April 2016 Transfer Value 31 March 2017 partnership pension (bands of age March 2017 accrued pension £2,500) (bands of £2,500) (bands of £5,000) at 31 March 2017 (bands of £5,000)
£000 £000 £000 £000 £000 £000 £000 £000 Anthony Hassall 2.5-5 2.5-5 25-30 70-75 332 44 377 Chief Accountable Officer Steve Dixon 2.5-5 2.5-5 30-35 75-80 399 55 454 Chief Finance Officer
Page 261 Page Karen Proctor 2.5-5 5-7.5 25-30 65-70 345 57 403 Director of Commissioning Francine Thorpe 5-7.5 15-17.5 35-40 115-120 712 140 852 Director of Quality & Innovation Hannah 0-2.5 0-2.5 15-20 50-55 234 41 275 Dobrowolska Director of Corporate Services Paul Bishop 0-2.5 0-2.5 20-25 55-60 289 8 304 Owain Thomas 0-2.5 0 10-15 25-30 138 14 168 Tom Tasker 0-2.5 0-2.5 20-25 50-55 298 14 312 Aisha Awan 0 0 5-10 20-25 123 0 104 Clare Gibbons 0-2.5 2.5-5 10-15 35-40 158 32 213 Nicholas Browne 7.5-10 20-22.5 10-15 35-40 60 118 202 David McKelvey 0-2.5 2.5-5 5-10 25-30 98 21 183 Ben Williams 0-2.5 0-2.5 0.5 0.5 18 1 26
52 Cash equivalent transfer values
A cash equivalent transfer value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s) pension payable from the scheme.
A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies.
The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.
Real increase in CETV
This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.
Compensation on early retirement of for loss of office
None
Payments to past members
None
Pay multiples
Reporting bodies are required to disclose the relationship between the remuneration of the highest paid director in their organisation and the median remuneration of the organisation's workforce. The annualised full-time equivalent remuneration of the highest paid member of the Salford Clinical Commissioning Group in the financial year 2016-17 was £155k-160k (2015-16 £165k-£167.5k) This is 3.8 times (2015-16,4.2x) the median remuneration of the workforce, which was £41k (2015-16 £40k). In 2016-17, no employees (2015-16, nil) received remuneration in excess of the highest paid member of the governing body. Remuneration for 2016-17 ranged from £15k to £158k (2015-16, £17k - £166k). Total remuneration includes salary, non-consolidated performance related pay and benefits in kind. It does not include severance payments, employer pension contributions and the cash equivalent transfer value of pensions.
Page 262 53 Staff Report (subject to audit)
Number of senior managers
Executive Team As at 31 March 2017:
Payscale Payscale Description No. WCOP Chief Operating Officer 1 XN11 Non Review Body Band 8 - Range 1 D WVSM Very Senior Managers 3 WWCL Chair 1 Total 6
Governing Body As at 31 March 2017:
Payscale Payscale Description No. WWCL Governing Body Secondary Care 1 Clinician * WWLM Governing Body Lay Member 3 WWNL Governing Body Neighbourhood 8 Lead Total 12 * = Governing Body Nurse not included here as seconded from Countess of Chester NHS Foundation Trust
Staff numbers and costs
Employee Number of Employees Costs Status Permanent 138 £4,787,218
Fixed Term 21 £586,466 Temporary Total 159 £5,373,684
Page 263 54 Staff composition
At the end of the 2016/17 financial year, Salford CCG staff comprised:
Employee Group Male Female Total Executive Team 3 3 6 Governing Body * 11 1 12 Other Clinical Leads 10 14 24 All other employees 24 93 117 Total 48 111 159 * = Statistics drawn from NHS Electronic Staff Records (ESR) 2017
Sickness absence data
Salford CCG’s average sickness absence rate over the year 2016/17 was 2.9 per cent (2.6% for the same period of 2015/16) compared with an average score of 3.3 per cent for all North West CCG’s for the period Jan 2016 – Dec 2016 , as issued by Health and Social Care Information Centre.
Staff policies
Staff policies are available on the intranet and on request.
Expenditure on consultancy
The CCG has incurred £197k in consultancy expenditure for 2016/17. This was for specific projects as follows: - Governance work to support the delivery of the Integrated care Organisation, within the wider Integrated Care System - Development of Salford Primary Care Together as the GP Federation for Salford - Work commissioned on behalf of Health Education England on primary care workforce development - Consultant midwife input to the Freestanding Midwife Led Unit review
Page 264 55 Off-payroll engagements
Table 1: Off-payroll engagements longer than 6 months
For all off-payroll engagements as at 31 March 2017, for more than £220 per day and that last longer than six months: Number Number of existing engagements as of 31 March 2017 2 Of which, the number that have existed: for less than one year at the time of reporting 0 for between one and two years at the time of reporting 0 for between 2 and 3 years at the time of reporting 2 for between 3 and 4 years at the time of reporting 0 for 4 or more years at the time of reporting 0
The CCG confirms that all existing off-payroll engagements have at some point been subject to a risk based assessment as to whether assurance is required that the individual is paying the right amount of tax and, where necessary, that assurance has been sought.
Table 2: New off-payroll engagements
For all new off-payroll engagements between 01 April 2016 and 31 March 2017, for more than £220 per day and that last longer than six months:
Number Number of new engagements, or those that reached six months in 0 duration, between 1 April 2016 and 31 March 2017 Number of new engagements which include contractual clauses giving Salford CCG the right to request assurance in relation to income tax and 0 National Insurance obligations Number for whom assurance has been requested 0 Of which: assurance has been received 0 assurance has not been received 0 engagements terminated as a result of assurance not being received. 0
Page 265 56 Table 3: Off-payroll engagements / senior official engagements
For any off-payroll engagements of Board members and / or senior officials with significant financial responsibility, between 01 April 2016 and 31 March 2017.
Number of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the 0 financial year Total no. of individuals on payroll and off-payroll that have been deemed “board members, and/or, senior officials with significant 0 financial responsibility”, during the financial year. This figure should include both on payroll and off-payroll engagements.
Exit packages, including special (non-contractual) payments
There have been no exit packages paid during 2016/17 (2015/16 Nil).
Parliamentary Accountability and Audit Report
NHS Salford CCG is not required to produce a Parliamentary Accountability and Audit Report. Disclosures on remote contingent liabilities, losses and special payments, gifts, and fees and charges are included as notes in the Financial Statements of this report at page 32 of the annual accounts. An audit certificate and report is also included in this Annual Report at page 59.
Anthony Hassall Chief Accountable Officer 26 May 2017
Page 266 57 ANNUAL ACCOUNTS 2016/17
Page 267 INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE GOVERNING BODY OF NHS SALFORD CCG
We have audited the financial statements of NHS Salford CCG for the year ended 31 March 2017 under the Local Audit and Accountability Act 2014 (the "Act"). The financial statements comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, as interpreted and adapted by the Department of Health Group Accounting Manual 2016/17 (the “2016/17 GAM”) and the requirements of the Health and Social Care Act 2012.
We have also audited the information in the Accountability Report that is subject to audit, being: the single total figure of remuneration for senior managers; CETV disclosures for each senior manager; the analysis of staff numbers and costs; and the fair pay (pay multiples) disclosures.
This report is made solely to the members of the Governing Body of NHS Salford CCG, as a body, in accordance with Part 5 of the Act and as set out in paragraph 43 of the Statement of Responsibilities of Auditors and Audited Bodies published by Public Sector Audit Appointments Limited. Our audit work has been undertaken so that we might state to the members of the Governing Body of the CCG those matters we are required to state to them in an auditor's report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the CCG and the members of the Governing Body of the CCG, as a body, for our audit work, for this report, or for the opinions we have formed.
Respective responsibilities of the Accountable Officer and auditor
As explained more fully in the Statement of Accountable Officer’s Responsibilities, the Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view and is also responsible for ensuring the regularity of expenditure and income. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law, the Code of Audit Practice published by the National Audit Office on behalf of the Comptroller and Auditor General (the “Code of Audit Practice”) and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. We are also responsible for giving an opinion on the regularity of expenditure and income in accordance with the Code of Audit Practice as required by the Act.
As explained in the Governance Statement the Accountable Officer is responsible for the arrangements to secure economy, efficiency and effectiveness in the use of the CCG's resources. We are required under Section 21 (1)(c) of the Act to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources and to report by exception where we are not satisfied.
We are not required to consider, nor have we considered, whether all aspects of the CCG's arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. Page 268 Scope of the audit of the financial statements
An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the Accountable Officer; and the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the Performance Report and the Accountability Report to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.
In addition, we are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.
Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources
We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criteria issued by the Comptroller and Auditor General in November 2016, as to whether the CCG had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined these criteria as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2017, and to report by exception where we are not satisfied.
We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary.
Opinion on financial statements
In our opinion: the financial statements give a true and fair view of the financial position of NHS Salford CCG as at 31 March 2017 and of its expenditure and income for the year then ended; and the financial statements have been prepared properly in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the Department of Health Group Accounting Manual 2016/17 and the requirements of the Health and Social Care Act 2012.
Opinion on regularity
In our opinion, in all material respects the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions in the financial statements conform to the authorities which govern them.
Page 269 Opinion on other matters
In our opinion: the parts of the Accountability Report to be audited have been properly prepared in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the Department of Health Group Accounting Manual 2016/17 and the requirements of the Health and Social Care Act 2012; and the other information published together with the audited financial statements in the Performance Report and the Accountability Report for the financial year for which the financial statements are prepared is consistent with the audited financial statements.
Matters on which we are required to report by exception
We are required to report to you if: in our opinion the Governance Statement does not comply with the guidance issued by the NHS Commissioning Board; or we have referred a matter to the Secretary of State under section 30 of the Act because we had reason to believe that the CCG, or an officer of the CCG, was about to make, or had made, a decision which involved or would involve the body incurring unlawful expenditure, or was about to take, or had begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency; or we have reported a matter in the public interest under section 24 of the Act in the course of, or at the conclusion of the audit; or we have made a written recommendation to the CCG under section 24 of the Act in the course of, or at the conclusion of the audit; or we have not been able to satisfy ourselves that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2017.
We have nothing to report in respect of the above matters.
Certificate
We certify that we have completed the audit of the financial statements of NHS Salford CCG in accordance with the requirements of the Act and the Code of Audit Practice.
Michael Thomas
Mike Thomas for and on behalf of Grant Thornton UK LLP, Appointed Auditor
4 Hardman Square Spinningfields Manchester M3 3EB
26th May 2017
Page 270 FOREWORD TO THE ACCOUNTS
NHS Salford CCG
The clinical commissioning group was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006.
These accounts for the year ended 31 March 2017 have been prepared by Salford Clinical Commissioning Group under section 17 of schedule 1A of the National Health Service Act 2006 (as amended) in the form which the Secretary of State has, with the approval of the Treasury, directed.
The National Health Service Act 2006 (as amended) requires Clinical Commissioning Groups to prepare their Annual Report and Annual Accounts in accordance with Directions issued by NHS England.
Page 271 Salford CCG - Annual Accounts 2016-17
CONTENTS Page Number
The Primary Statements:
Statement of Comprehensive Net Expenditure for the year ended 31st March 2017 1 Statement of Financial Position as at 31st March 2017 2 Statement of Changes in Taxpayers' Equity for the year ended 31st March 2017 3 Statement of Cash Flows for the year ended 31st March 2017 4
Notes to the Financial Statements Accounting policies 5-10 Other operating revenue 11 Revenue 11 Employee benefits and staff numbers 12-14 Operating expenses 15 Better payment practice code 16 Operating leases 17 Intangible non-current assets 18-19 Trade and other receivables 20 Other financial assets 21 Cash and cash equivalents 22 Trade and other payables 23 Provisions 24 Contingencies 25 Commitments 26 Financial instruments 26-27 Operating segments 28 Pooled budgets 28 Related party transactions 29-30 Events after the end of the reporting period 31 Financial performance targets 31 Losses and Special Payments 32
Page 272 Salford CCG - Annual Accounts 2016-17
Statement of Comprehensive Net Expenditure for the year ended 31 March 2017 2016-17 2015-16 Note £'000 £'000
Income from sale of goods and services 2 (657) (359) Other operating income 2 (255) (496) Total operating income (912) (855)
Staff costs 4 6,798 5,719 Purchase of goods and services 5 416,473 367,133 Depreciation and impairment charges 50 0 Provision expense 5 (202) 251 Other Operating Expenditure 5 1,079 1,390 Total operating expenditure 424,149 374,492
Net Operating Expenditure 423,237 373,637
Finance income Finance expense 00 Net expenditure for the year 423,237 373,637 Net Gain/(Loss) on Transfer by Absorption 00 Total Net Expenditure for the year 423,237 373,637 Other Comprehensive Expenditure Items which will not be reclassified to net operating costs Net (gain)/loss on revaluation of PPE 00 Net (gain)/loss on revaluation of Intangibles (540) 0 Net (gain)/loss on revaluation of Financial Assets 00 Actuarial (gain)/loss in pension schemes 00 Impairments and reversals taken to Revaluation Reserve 00 Items that may be reclassified to Net Operating Costs Net gain/loss on revaluation of available for sale financial assets 00 Reclassification adjustment on disposal of available for sale financial assets 00 Sub total (540) 0
Comprehensive Expenditure for the year ended 31 March 2017 422,697 373,637
The notes on pages 5 to 32 form part of this statement
Page 273 page1 Salford CCG - Annual Accounts 2016-17
Statement of Financial Position as at 31 March 2017 2016-17 2015-16
Note £'000 £'000 Non-current assets: Property, plant and equipment 00 Intangible assets 00 Investment property 00 Trade and other receivables 00 Other financial assets 11 540 0 Total non-current assets 540 0 Current assets: Inventories 00 Trade and other receivables 10 10,215 8,379 Other financial assets 00 Other current assets 00 Cash and cash equivalents 12 60 96 Total current assets 10,275 8,475
Non-current assets held for sale 0 0
Total current assets 10,275 8,475
Total assets 10,815 8,475
Current liabilities Trade and other payables 13 (22,007) (15,874) Other financial liabilities 00 Other liabilities 00 Borrowings 00 Provisions 14 (151) (572) Total current liabilities (22,158) (16,446)
Non-Current Assets plus/less Net Current Assets/Liabilities (11,343) (7,971)
Non-current liabilities Trade and other payables 00 Other financial liabilities 00 Other liabilities 00 Borrowings 00 Provisions 00 Total non-current liabilities 0 0
Assets less Liabilities (11,343) (7,971)
Financed by Taxpayers’ Equity General fund (11,343) (7,971) Revaluation reserve 00 Other reserves 00 Charitable Reserves 00 Total taxpayers' equity: (11,343) (7,971)
The notes on pages 5 to 32 form part of this statement
The financial statements on pages 1 to 4 were approved and authorised for issue by the Governing Body on 24th May 2017 an
Anthony Hassall Chief Accountable Officer
Page 274 page2 Salford CCG - Annual Accounts 2016-17
Statement of Changes In Taxpayers Equity for the year ended 31 March 2017 Revaluation Other Total General fund reserve reserves reserves £'000 £'000 £'000 £'000 Changes in taxpayers’ equity for 2016-17
Balance at 01 April 2016 (7,971) 0 0 (7,971) Transfer between reserves in respect of assets transferred from closed NHS bodies 000 0 Adjusted NHS Clinical Commissioning Group balance at 31 March 2017 (7,971) 0 0 (7,971)
Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2016-17 Net operating expenditure for the financial year (423,236) (423,236)
Net gain/(loss) on revaluation of property, plant and equipment 0 0 Net gain/(loss) on revaluation of intangible assets 540 540 Net gain/(loss) on revaluation of financial assets 00 Total revaluations against revaluation reserve 0 540 0 540
Net gain (loss) on available for sale financial assets 0 0 0 0 Net gain (loss) on revaluation of assets held for sale 0 0 0 0 Impairments and reversals 0000 Net actuarial gain (loss) on pensions 0 0 0 0 Movements in other reserves 0000 Transfers between reserves 540 (540) 0 0 Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0 Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0 Transfers by absorption to (from) other bodies 0 0 0 0 Reserves eliminated on dissolution 0000 Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (422,696) 0 0 (422,696)
Net funding 419,324 0 0 419,324 Balance at 31 March 2017 (11,343) 0 0 (11,343)
Revaluation Other Total General fund reserve reserves reserves £'000 £'000 £'000 £'000 Changes in taxpayers’ equity for 2015-16
Balance at 01 April 2015 (14,235) 0 0 (14,235) Transfer of assets and liabilities from closed NHS bodies as a result of the 1 April 2013 transition 0000 Adjusted NHS Clinical Commissioning Group balance at 31 March 2016 (14,235) 0 0 (14,235)
Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2015-16 Net operating costs for the financial year (373,637) (373,637)
Net gain/(loss) on revaluation of property, plant and equipment 0 0 Net gain/(loss) on revaluation of intangible assets 00 Net gain/(loss) on revaluation of financial assets 00 Total revaluations against revaluation reserve 0000
Net gain (loss) on available for sale financial assets 0 0 0 0 Net gain (loss) on revaluation of assets held for sale 0 0 0 0 Impairments and reversals 0000 Net actuarial gain (loss) on pensions 0 0 0 0 Movements in other reserves 0000 Transfers between reserves 0000 Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0 Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0 Transfers by absorption to (from) other bodies 0 0 0 0 Reserves eliminated on dissolution 0000 Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (373,637) 0 0 (373,637) Net funding 379,901 0 0 379,901 Balance at 31 March 2016 (7,971) 0 0 (7,971)
The notes on pages 5 to 32 form part of this statement
Pagepage3 275 Salford CCG - Annual Accounts 2016-17
Statement of Cash Flows for the year ended 31 March 2017 2016-17 2015-16 Note £'000 £'000 Cash Flows from Operating Activities Net operating expenditure for the financial year 5 (423,236) (373,637) Depreciation and amortisation 00 Impairments and reversals 00 Movement due to transfer by Modified Absorption 00 Other gains (losses) on foreign exchange 00 Donated assets received credited to revenue but non-cash 00 Government granted assets received credited to revenue but non-cash 0 0 Interest paid 00 Release of PFI deferred credit 00 Other Gains & Losses 00 Finance Costs 00 Unwinding of Discounts 00 (Increase)/decrease in inventories 00 (Increase)/decrease in trade & other receivables 10 (1,836) (5,529) (Increase)/decrease in other current assets 00 Increase/(decrease) in trade & other payables 13 6,133 (765) Increase/(decrease) in other current liabilities 00 Provisions utilised 14 (219) (266) Increase/(decrease) in provisions 14 (202) 251 Net Cash Inflow (Outflow) from Operating Activities (419,360) (379,946)
Cash Flows from Investing Activities Interest received 00 (Payments) for property, plant and equipment 00 (Payments) for intangible assets 00 (Payments) for investments with the Department of Health 00 (Payments) for other financial assets (540) 0 (Payments) for financial assets (LIFT) 00 Proceeds from disposal of assets held for sale: property, plant and equipment 540 0 Proceeds from disposal of assets held for sale: intangible assets 00 Proceeds from disposal of investments with the Department of Health 0 0 Proceeds from disposal of other financial assets 00 Proceeds from disposal of financial assets (LIFT) 00 Loans made in respect of LIFT 00 Loans repaid in respect of LIFT 00 Rental revenue 00 Net Cash Inflow (Outflow) from Investing Activities 0 0
Net Cash Inflow (Outflow) before Financing (419,360) (379,946)
Cash Flows from Financing Activities Grant in Aid Funding Received 419,324 379,903 Other loans received 00 Other loans repaid 00 Capital element of payments in respect of finance leases and on Statement of Financial Position PFI and LIFT 0 0 Capital grants and other capital receipts 00 Capital receipts surrendered 00 Net Cash Inflow (Outflow) from Financing Activities 419,324 379,903
Net Increase (Decrease) in Cash & Cash Equivalents 12 (36) (43)
Cash & Cash Equivalents at the Beginning of the Financial Year 12 96 140
Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies 0 0
Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 12 60 97
The notes on pages 5 to 32 form part of this statement
Pagepage4 276 Salford CCG - Annual Accounts 2016-17
Notes to the financial statements 1 Accounting Policies
NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the Group Accounting Manual issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Group Accounting Manual 2016-17 issued by the Department of Health. The accounting policies contained in the Group Accounting Manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical commissioning group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the clinical commissioning group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts. 1.1 Going Concern These accounts have been prepared on the going concern basis (despite the issue of a report to the Secretary of State for Health under Section 30 of the Local Audit and Accountability Act 2014). Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents. Where a clinical commissioning group ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided the financial statements are prepared on the going concern basis. 1.2 Accounting Convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities. 1.3 Acquisitions & Discontinued Operations
Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another. 1.4 Movement of Assets within the Department of Health Group Transfers as part of reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs. Other transfers of assets and liabilities within the Department of Health Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries. 1.5 Pooled Budgets Where the clinical commissioning group has entered into a pooled budget arrangement under Section 75 of the National Health Service Act 2006 the clinical commissioning group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement. If the clinical commissioning group is in a “jointly controlled operation”, the clinical commissioning group recognises: · The assets the clinical commissioning group controls; · The liabilities the clinical commissioning group incurs; · The expenses the clinical commissioning group incurs; and, · The clinical commissioning group’s share of the income from the pooled budget activities. If the clinical commissioning group is involved in a “jointly controlled assets” arrangement, in addition to the above, the clinical commissioning group recognises: · The clinical commissioning group’s share of the jointly controlled assets (classified according to the nature of the assets); · The clinical commissioning group’s share of any liabilities incurred jointly; and, · The clinical commissioning group’s share of the expenses jointly incurred. 1.6 Critical Accounting Judgements & Key Sources of Estimation Uncertainty In the application of the clinical commissioning group’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods. 1.6.1 Critical Judgements in Applying Accounting Policies
The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements:
- The calculation of running costs has been undertaken in accordance with NHS England national guidance and definitions. However the application of the rules for each organisation involves an application of professional judgement to particular circumstances
- The assessment of the pooled budget as a joint arrangement, resulting in accounting for the clinical commissioning group's share of transactions on a net basis. 1.6.2 Key Sources of Estimation Uncertainty The following are the key estimations that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements: · Due to the NHS England deadline for the submission of the accounts, actual information is not available for the full 12 months for some material expenditure such as prescribing expenditure and secondary care incomplete spells of treatment. The CCG therefore estimates one or two months of expenditure in some areas using historical information, in year trends and any other available information sources. · Amounts included in provisions include an element of uncertainty around both the amount and timing of the likely liability occurring. They are also frequently, but not necessarily, one-off or unusual items for which there are fewer comparisons.
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Notes to the financial statements · Amounts included in provisions include an element of uncertainty around both the amount and timing of the likely liability occurring. They are also frequently, but not necessarily, one-off or unusual items for which there are fewer comparisons. The CCG currently provides for termination costs in respect of the merger of Trafford Healthcare NHS Trust (now demised) with Central Manchester Foundation Trust, where future redundancy and restructuring costs are estimated but not yet certain. 1.7 Revenue Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable. Where income is received for a specific activity that is to be delivered in the following year, that income is deferred. 1.8 Employee Benefits 1.8.1 Short-term Employee Benefits Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken. The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period. 1.8.2 Retirement Benefit Costs
Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the clinical commissioning group commits itself to the retirement, regardless of the method of payment. Some employees are members of the Local Government Superannuation Scheme, which is a defined benefit pension scheme. The scheme assets and liabilities attributable to those employees can be identified and are recognised in the clinical commissioning group’s accounts. The assets are measured at fair value and the liabilities at the present value of the future obligations. The increase in the liability arising from pensionable service earned during the year is recognised within operating expenses. The expected gain during the year from scheme assets is recognised within finance income. The interest cost during the year arising from the unwinding of the discount on the scheme liabilities is recognised within finance costs. Actuarial gains and losses during the year are recognised in the General Reserve and reported as an item of other comprehensive net expenditure. 1.9 Other Expenses Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable. Expenses and liabilities in respect of grants are recognised when the clinical commissioning group has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met. 1.10 Property, Plant & Equipment 1.10.1 Recognition Property, plant and equipment is capitalised if: · It is held for use in delivering services or for administrative purposes; · It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group; · It is expected to be used for more than one financial year; · The cost of the item can be measured reliably; and, · The item has a cost of at least £5,000; or, · Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or, · Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost. Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives. 1.10.2 Valuation All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at valuation. Land and buildings used for the clinical commissioning group’s services or for administrative purposes are stated in the statement of financial position at their re-valued amounts, being the fair value at the date of revaluation less any impairment. Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows: · Land and non-specialised buildings – market value for existing use; and, · Specialised buildings – depreciated replacement cost. HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued. Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are re-valued and depreciation commences when they are brought into use. Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from current value in existing use. An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Net Expenditure. 1.10.3 Subsequent Expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses.
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Notes to the financial statements 1.11 Intangible Assets 1.11.1 Recognition Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the clinical commissioning group’s business or which arise from contractual or other legal rights. They are recognised only: · When it is probable that future economic benefits will flow to, or service potential be provided to, the clinical commissioning group; · Where the cost of the asset can be measured reliably; and, · Where the cost is at least £5,000. Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised but is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated: · The technical feasibility of completing the intangible asset so that it will be available for use; · The intention to complete the intangible asset and use it; · The ability to sell or use the intangible asset; · How the intangible asset will generate probable future economic benefits or service potential; · The availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it; · The ability to measure reliably the expenditure attributable to the intangible asset during its development. 1.11.2 Measurement The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred. Following initial recognition, intangible assets are carried at current value in existing use by reference to an active market, or, where no active market exists, at the lower of depreciated replacement cost or the value in use where the asset is income generating . Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances. 1.12 Depreciation, Amortisation & Impairments Freehold land, properties under construction, and assets held for sale are not depreciated. Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the clinical commissioning group expects to obtain economic benefits or service potential from the asset. This is specific to the clinical commissioning group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are At each reporting period end, the clinical commissioning group checks whether there is any indication that any of its tangible or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve. 1.13 Leases Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases.
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Notes to the financial statements 1.13.1 The Clinical Commissioning Group as Lessee Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the clinical commissioning group’s surplus/deficit. Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term. Contingent rentals are recognised as an expense in the period in which they are incurred. Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases. 1.13.2 The Clinical Commissioning Group as Lessor Amounts due from lessees under finance leases are recorded as receivables at the amount of the clinical commissioning group’s net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of return on the clinical commissioning group’s net investment outstanding in respect of the leases. Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-line basis over the lease term. 1.14 Cash & Cash Equivalents Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value. In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the clinical commissioning group’s cash management. 1.15 Provisions
Provisions are recognised when the clinical commissioning group has a present legal or constructive obligation as a result of a past event, it is probable that the clinical commissioning group will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate as follows: · Timing of cash flows (0 to 5 years inclusive): Minus 2.70% (previously: minus 1.55%) · Timing of cash flows (6 to 10 years inclusive): Minus 1.95% (previously: minus 1.%) · Timing of cash flows (over 10 years): Minus 0.80% (previously: minus 0.80%)
When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.
A restructuring provision is recognised when the clinical commissioning group has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of the entity. 1.16 Clinical Negligence Costs
The NHS Litigation Authority operates a risk pooling scheme under which the clinical commissioning group pays an annual contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with the clinical commissioning group. 1.17 Non-clinical Risk Pooling The clinical commissioning group participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the clinical commissioning group pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due. 1.18 Continuing healthcare risk pooling In 2014-15 a risk pool scheme was been introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. Under the scheme CCGs contribute annually to a pooled fund, which is used to settle the claims. 1.19 Contingencies A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non- occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote. A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group. A contingent asset is disclosed where an inflow of economic benefits is probable. Where the time value of money is material, contingencies are disclosed at their present value.
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Notes to the financial statements 1.20 Financial Assets Financial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred. Financial assets are classified into the following categories: · Financial assets at fair value through profit and loss; · Held to maturity investments; · Available for sale financial assets; and, · Loans and receivables.
The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition. 1.20.1 Financial Assets at Fair Value Through Profit and Loss Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial assets at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in calculating the clinical commissioning group’s surplus or deficit for the year. The net gain or loss incorporates any interest earned on the financial asset. 1.20.2 Held to Maturity Assets Held to maturity investments are non-derivative financial assets with fixed or determinable payments and fixed maturity, and there is a positive intention and ability to hold to maturity. After initial recognition, they are held at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. 1.20.3 Available For Sale Financial Assets Available for sale financial assets are non-derivative financial assets that are designated as available for sale or that do not fall within any of the other three financial asset classifications. They are measured at fair value with changes in value taken to the revaluation reserve, with the exception of impairment losses. Accumulated gains or losses are recycled to surplus/deficit on de-recognition. 1.20.4 Loans & Receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques.
The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset. At the end of the reporting period, the clinical commissioning group assesses whether any financial assets, other than those held at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset. For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables. If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised. 1.21 Financial Liabilities Financial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de- recognised when the liability has been discharged, that is, the liability has been paid or has expired. 1.21.1 Financial Guarantee Contract Liabilities Financial guarantee contract liabilities are subsequently measured at the higher of: · The premium received (or imputed) for entering into the guarantee less cumulative amortisation; and, · The amount of the obligation under the contract, as determined in accordance with IAS 37: Provisions, Contingent Liabilities and Contingent Assets. 1.21.2 Financial Liabilities at Fair Value Through Profit and Loss Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial liabilities at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in the clinical commissioning group’s surplus/deficit. The net gain or loss incorporates any interest payable on the financial liability. 1.21.3 Other Financial Liabilities After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method. 1.22 Value Added Tax Most of the activities of the clinical commissioning group are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.
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Notes to the financial statements 1.23 Losses & Special Payments
Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the clinical commissioning group not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure). 1.24 Subsidiaries
Material entities over which the clinical commissioning group has the power to exercise control so as to obtain economic or other benefits are classified as subsidiaries and are consolidated. Their income and expenses; gains and losses; assets, liabilities and reserves; and cash flows are consolidated in full into the appropriate financial statement lines. Appropriate adjustments are made on consolidation where the subsidiary’s accounting policies are not aligned with the clinical commissioning group or where the subsidiary’s accounting date is not co-terminus. Subsidiaries that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less costs to sell’.
1.25 Associates
Material entities over which the clinical commissioning group has the power to exercise significant influence so as to obtain economic or other benefits are classified as associates and are recognised in the clinical commissioning group’s accounts using the equity method. The investment is recognised initially at cost and is adjusted subsequently to reflect the clinical commissioning group’s share of the entity’s profit/loss and other gains/losses. It is also reduced when any distribution is received by the clinical commissioning group from the entity. Joint ventures that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less costs to sell’. Associated companies are entities over which the CCG has significant influence, but not control, generally accompanied by a shareholding giving rise to voting rights of 20% and above but not exceeding 50%. Investments in associated companies are accounted for in the financial statements using the equity method of accounting less impairment losses, if any. Investments in associated companies are initially recognised at cost. The cost of an acquisition is measured at the fair value of the assets given, equity instruments issued or liabilities incurred or assumed at the date of exchange, plus costs directly attributable to the acquisition. In applying the equity method of accounting, the CCG’s share of its associated companies’ post-acquisition profits or losses are recognised in profit or loss and its share of post-acquisition other comprehensive income is recognised in other comprehensive income. These post-acquisition movements and distributions received from the associated companies are adjusted against the carrying amount of the investment.
1.26 Joint Ventures Material entities over which the clinical commissioning group has joint control with one or more other parties so as to obtain economic or other benefits are classified as joint ventures. Joint ventures are accounted for using the equity method. Joint ventures that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less costs to sell’. 1.27 Joint Operations Joint operations are activities undertaken by the clinical commissioning group in conjunction with one or more other parties but which are not performed through a separate entity. The clinical commissioning group records its share of the income and expenditure; gains and losses; assets and liabilities; and cash flows. 1.28 Research & Development
Research and development expenditure is charged in the year in which it is incurred, except insofar as development expenditure relates to a clearly defined project and the benefits of it can reasonably be regarded as assured. Expenditure so deferred is limited to the value of future benefits expected and is amortised through the Statement of Comprehensive Net Expenditure on a systematic basis over the period expected to benefit from the project. It should be re-valued on the basis of current cost. The amortisation is calculated on the same basis as depreciation. 1.29 Accounting Standards That Have Been Issued But Have Not Yet Been Adopted The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2016-17, all of which are subject to consultation: · IFRS 9: Financial Instruments ( application from 1 January 2018) · IFRS 14: Regulatory Deferral Accounts ( not applicable to DH groups bodies) · IFRS 15: Revenue for Contract with Customers (application from 1 January 2018)
The application of the Standards as revised would not have a material impact on the accounts for 2016-17, were they applied in that year.
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2 Other Operating Revenue 2016-17 2016-17 2016-17 2015-16 Total Admin Programme Total £'000 £'000 £'000 £'000
Recoveries in respect of employee benefits 0 0 0 0 Patient transport services 0 0 0 0 Prescription fees and charges 0 0 0 0 Dental fees and charges 0 0 0 0 Education, training and research 72 72 0 12 Charitable and other contributions to revenue expenditure: NHS 0 0 0 0 Charitable and other contributions to revenue expenditure: non-NHS 0 0 0 0 Receipt of donations for capital acquisitions: NHS Charity 0 0 0 0 Receipt of Government grants for capital acquisitions 0 0 0 0 Non-patient care services to other bodies 585 372 213 347 Continuing Health Care risk pool contributions 0 0 0 0 Income generation 0 0 0 0 Rental revenue from finance leases 0 0 0 0 Rental revenue from operating leases 0 0 0 0 Other revenue 255 75 180 496 Total other operating revenue 912 519 393 855
3 Revenue 2016-17 2016-17 2016-17 2015-16 Total Admin Programme Total £'000 £'000 £'000 £'000 From rendering of services 912 519 393 855 From sale of goods 0 0 0 0 Total 912 519 393 855
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4. Employee benefits and staff numbers
4.1.1 Employee benefits 2016-17 Total
Permanent Total Employees Other £'000 £'000 £'000 Employee Benefits Salaries and wages 5,656 5,386 270 Social security costs 533 533 0 Employer Contributions to NHS Pension scheme 609 609 0 Other pension costs 0 0 0 Other post-employment benefits 0 0 0 Other employment benefits 0 0 0 Termination benefits 0 0 0 Gross employee benefits expenditure 6,798 6,528 270
Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 Total - Net admin employee benefits including capitalised costs 6,798 6,528 270
Page 284 Page Less: Employee costs capitalised 0 0 0 Net employee benefits excluding capitalised costs 6,798 6,528 270
4.1.1 Employee benefits 2015-16 Total
Permanent Total Employees Other £'000 £'000 £'000 Employee Benefits Salaries and wages 4,827 4,447 380 Social security costs 357 357 0 Employer Contributions to NHS Pension scheme 534 534 0 Other pension costs 0 0 0 Other post-employment benefits 0 0 0 Other employment benefits 0 0 0 Termination benefits 0 0 0 Gross employee benefits expenditure 5,719 5,339 380
Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 Total - Net admin employee benefits including capitalised costs 5,719 5,339 380
Less: Employee costs capitalised 0 0 0 Net employee benefits excluding capitalised costs 5,719 5,339 380
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4.2 Average number of people employed 2016-17 2015-16 Permanently Total employed Other Total Number Number Number Number
Total 124 120 4 107
Of the above: Number of whole time equivalent people engaged on capital projects 0 0 0 0
4.3 Staff sickness absence and ill health retirements 2016-17 2015-16 Number Number Total Days Lost 818 1,115 Total Staff Years 119 157 Average working Days Lost 77
2016-17 2015-16 Number Number Number of persons retired early on ill health grounds 0 0
£'000 £'000 Total additional Pensions liabilities accrued in the year 0 0
Ill health retirement costs are met by the NHS Pension Scheme
4.4 Exit packages agreed in the financial year
No exit packages were agreed in 2016-17 or 2015-16
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4.5 Pension costs
Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/Pensions.
The Scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The Scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities.
Therefore, the Scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting
The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows:
4.5.1 Full actuarial (funding) valuation
The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2012 and covered the period from 1 April 2008 to that date. Details can be found on the pension scheme website at www.nhsbsa.nhs.uk/pensions.
For 2016-17, employers’ contributions of £609,000 were payable to the NHS Pensions Scheme (2015-16: £534,000) at the rate of 14.3% of pensionable pay. The scheme’s actuary reviews employer contributions, usually every four years and now based on HMT Valuation Directions, following a full scheme valuation. The latest review used data from 31 March 2012 and was published on the Government website on 9 June 2014. These costs are included in the NHS
Pagepage14 286 Salford CCG - Annual Accounts 2016-17
5. Operating expenses 2016-17 2016-17 2016-17 2015-16 Total Admin Programme Total £'000 £'000 £'000 £'000 Gross employee benefits Employee benefits excluding governing body members 6,202 3,316 2,886 5,157 Executive governing body members 596 596 0 562 Total gross employee benefits 6,798 3,912 2,886 5,719
Other costs Services from other CCGs and NHS England 1,110 670 440 1,705 Services from foundation trusts 250,194 91 250,103 239,436 Services from other NHS trusts 16,791 38 16,753 16,260 Services from other WGA bodies 10 1 0 Purchase of healthcare from non-NHS bodies 58,579 0 58,579 53,473 Chair and Non Executive Members 424 424 0 472 Supplies and services – clinical 18 0 18 (11) Supplies and services – general 652 17 635 4,199 Consultancy services 265 25 240 45 Establishment 1,015 293 722 1,706 Transport 211 6 205 673 Premises 2,835 308 2,527 2,496 Impairments and reversals of receivables 0 0 0 0 Inventories written down and consumed 00 0 0 Depreciation 00 0 0 Amortisation 00 0 0 Impairments and reversals of property, plant and equipment 0 0 0 0 Impairments and reversals of intangible assets 0 0 0 0 Impairments and reversals of financial assets · Assets carried at amortised cost 00 0 0 · Assets carried at cost 00 0 0 · Available for sale financial assets 0 0 0 0 Impairments and reversals of non-current assets held for sale 0 0 0 0 Impairments and reversals of investment properties 0 0 0 0 Audit fees 68 68 0 68 Other non statutory audit expenditure · Internal audit services 00 0 0 · Other services 00 0 0 General dental services and personal dental services 0 0 0 0 Prescribing costs 41,950 0 41,950 41,175 Pharmaceutical services 150 0 150 130 General ophthalmic services 49 0 49 17 GPMS/APMS and PCTMS 42,031 0 42,031 4,813 Other professional fees excl. audit 114 36 78 79 Grants to Other bodies 124 0 124 0 Clinical negligence 00 0 0 Research and development (excluding staff costs) 333 0 333 582 Education and training 214 122 92 303 Change in discount rate 00 0 0 Provisions (202) 2 (204) 251 Funding to group bodies 00 0 CHC Risk Pool contributions 226 0 226 565 Other expenditure 197 2 196 336 Total other costs 417,351 2,102 415,249 368,774
Total operating expenses 424,149 6,014 418,136 374,492
Pagepage15 287 Salford CCG - Annual Accounts 2016-17
6.1 Better Payment Practice Code
Measure of compliance 2016-17 2016-17 2015-16 2015-16 Number £'000 Number £'000 Non-NHS Payables Total Non-NHS Trade invoices paid in the Year 7,163 107,472 6,830 123,410 Total Non-NHS Trade Invoices paid within target 7,085 107,131 6,769 123,229 Percentage of Non-NHS Trade invoices paid within target 98.91% 99.68% 99.11% 99.85%
NHS Payables Total NHS Trade Invoices Paid in the Year 2,855 343,506 2,577 242,343 Total NHS Trade Invoices Paid within target 2,854 343,505 2,577 242,343 Percentage of NHS Trade Invoices paid within target 99.96% 100.00% 100.00% 100.00%
6.2 The Late Payment of Commercial Debts (Interest) Act 1998 2016-17 2015-16 £'000 £'000
Amounts included in finance costs from claims made under this legislation 0 0 Compensation paid to cover debt recovery costs under this legislation 0 0 Total 00
Pagepage16 288 Salford CCG - Annual Accounts 2016-17
7. Operating Leases
7.1 As lessee 7.1.1 Payments recognised as an Expense 2016-17 2015-16 Land Buildings Other Total Land Buildings Other Total £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Payments recognised as an expense Minimum lease payments 0 2,862 57 2,919 0 2,430 45 2,475 Contingent rents 0 0 0 0 0000 Sub-lease payments 0 0 0 0 0000 Total 0 2,862 57 2,919 0 2,430 45 2,475
Whilst our arrangements with Community Health Partnership's Limited and NHS Property Services Limited fall within the definition of operating leases, rental charge for future years has not yet been agreed . Consequently this note does not include future minimum lease payments for the arrangements only
7.1.2 Future minimum lease payments 2016-17 2015-16 Land Buildings Other Total Land Buildings Other Total £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Payable: No later than one year 0 0 0 0 0031 31 Between one and five years 0 0 0 0 002 2 After five years 0 0 0 0 002 2 Total 0000003535
7.2 As lessor 7.2.1 Rental revenue 2016-17 2015-16 £'000 £'000 Recognised as income Rent 00 Contingent rents 00 Total 00
7.2.2 Future minimum rental value 2016-17 2015-16 £'000 £'000 Receivable: No later than one year 00 Between one and five years 00 After five years 00 Total 00
Pagepage17 289 Salford CCG - Annual Accounts 2016-17
8 Intangible non-current assets Computer Development Computer Software: Expenditure Software: Internally Licences & (internally 2016-17 Purchased Generated Trademarks Patents generated) Total £'000 £'000 £'000 £'000 £'000 £'000 Cost or valuation at 01 April 2016 0 0 0 0 599 599
Additions purchased 0 0 0 0 0 0 Additions internally generated 0 0 0 0 0 0 Additions donated 00 00 00 Additions government granted 0 0 0 0 0 0 Additions leased 00 00 00 Reclassifications 00 00 00 Reclassified as held for sale and reversals 0 0 0 0 0 0 Disposals other than by sale 0 0 0 0 (540) (540) Upward revaluation gains 0 0 0 0 540 540 Impairments charged 0 0 0 0 0 0 Reversal of impairments 0 0 0 0 0 0 Transfer (to)/from other public sector body 0 0 0 0 0 0 Cumulative amortisation adjustment following revaluation 0 0 0 0 0 0 Cost / Valuation At 31 March 2017 0 0 0 0 599 599
Amortisation 01 April 2016 0 0 0 0 599 599
Reclassifications 00 00 00 Reclassified as held for sale and reversals 0 0 0 0 0 0 Disposals other than by sale 0 0 0 0 0 0 Upward revaluation gains 0 0 0 0 0 0 Impairments charged 0 0 0 0 0 0 Reversal of impairments 0 0 0 0 0 0 Charged during the year 0 0 0 0 0 0 Transfer (to) from other public sector body 0 0 0 0 0 0 Cumulative amortisation adjustment following revaluation 0 0 0 0 0 0 Amortisation At 31 March 2017 0 0 0 0 599 599
Net Book Value at 31 March 2017 0 0 0 0 0 0
Purchased 00 00 00 Donated 00 00 00 Government Granted 0 0 0 0 0 0 Total at 31 March 2017 0 0 0 0 0 0
Revaluation Reserve Balance for intangible assets Computer Development Computer Software: Expenditure Software: Internally Licences & (internally Purchased Generated Trademarks Patents generated) Total £'000 £'000 £'000 £'000 £'000 £'000 Balance at 01 April 2016 00 00 00
Revaluation gains 00 00 00 Impairments 00 00 00 Release to general fund 0 0 0 0 0 0 Other movements 00 00 00 Balance at 31 March 2017 0 0 0 0 0 0
Pagepage18 290 Salford CCG - Annual Accounts 2016-17
8.2 Cost or valuation of fully amortised assets
The cost or valuation of fully depreciated assets still in use was as follows: 2016-17 2015-16 £'000 £'000 Computer software: purchased 00 Computer software: internally generated 0 0 Licences & trademarks 00 Patents 00 Development expenditure (internally generated) 0 599 Total 0 599
8.3 Economic lives Minimum Maximum Life (Years) Life (Years) Computer software: purchased 0 0 Computer software: internally generated 0 0 Licences & trademarks 0 0 Patents 00 Development expenditure (internally generated) 0 0
Pagepage19 291 Salford CCG - Annual Accounts 2016-17
9 Trade and other receivables Current Non-current Current Non-current 2016-17 2016-17 2015-16 2015-16 £'000 £'000 £'000 £'000
NHS receivables: Revenue 408 0 290 0 NHS receivables: Capital 0 0 0 0 NHS prepayments 460 0 773 0 NHS accrued income 984 0 24 0 Non-NHS and Other WGA receivables: Revenue 7,305 0 7,004 0 Non-NHS and Other WGA receivables: Capital 0 0 0 0 Non-NHS and Other WGA prepayments 875 0 234 0 Non-NHS and Other WGA accrued income 217 0 29 0 Provision for the impairment of receivables 0 0 0 0 VAT (36) 0 25 0
Private finance initiative and other public private partnership arrangement prepayments and accrued income 0000 Interest receivables 0 0 0 0 Finance lease receivables 0 0 0 0 Operating lease receivables 0 0 0 0 Other receivables and accruals 2 0 0 0 Total Trade & other receivables 10,215 0 8,379 0
Total current and non current 10,215 8,379
Included above: Prepaid pensions contributions 0 0
9.1 Receivables past their due date but not impaired 2016-17 2015-16 £'000 £'000
By up to three months 589 73 By three to six months 30 By more than six months 00 Total 592 73
The great majority of trade is with bodies funded directly by NHS England. As NHS England is funded by Government to provide funding to clinical commissioning groups to commission services, no credit scoring of them is considered necessary.
9.2 Provision for impairment of receivables 2016-17 2015-16 £'000 £'000
Balance at 01 April 2016 00
Amounts written off during the year 0 0 Amounts recovered during the year 0 0 (Increase) decrease in receivables impaired 0 0 Transfer (to) from other public sector body 0 0 Balance at 31 March 2017 0 0
No receivables have been impaired in the financial year and due to the nature, counterparty and profile of debt there are no provisions made for future impairment.
2016-17 2015-16 £'000 £'000 Receivables are provided against at the following rates: NHS debt 00
Pagepage20 292 Salford CCG - Annual Accounts 2016-17
10 Other financial assets
10.1 Non-current 2016-17 2015-16 £'000 £'000 Balance at 01 April 2016 00
Additions 540 0 Revaluation 00 Impairments 0 0 Impairment reversals 0 0 Transferred from non-current financial assets 0 0 Disposals 00 Transfer (to)/from other public sector body 0 0 Balance at 31 March 2017 540 0
North West eHealth was set up in 2008 to develop links between academia and the NHS in the area of health informatics and develop new research using anonymised patient records to support improving healthcare. Its customers are pharmaceutical companies and technology partners as well as the NHS and government. The original founders of this collaboration were the University of Manchester, Salford Royal Foundation Trust and Salford PCT. Salford PCT made annual contributions for research costs from 2008 until its demise on 31 March 2013. It accounted for these contributions as an intangible asset (development expenditure), and amortised these over its expected life. The net book value transferred to the CCG on 1 April 2013 was £599k and was amortised to nil value by 31 March 2015. The CCG has made no contributions since it was formed.
On 1 November 2016, the business of North West eHealth was transferred to a company limited by shares, North West eHealth Limited, the three shareholders being University of Manchester, Salford Royal FT and Salford CCG on a 40:40:20 basis. The share capital of the company will comprise both ordinary shares and preference shares.
The cumulative value of the intellectual property at 1 November 2016 was assessed by management as having a value of £2.7m based on a methodology approved by KPMG. This takes account of current cost plus the value of future income to be generated, discounted back to net present value. The company has issued preference shares to the three organisations to reflect the opening intellectual property value, and Salford CCG’s shares have a value of £540k, being 20% of £2.7m. As the CCG’s Chief Finance Officer is a director of North West eHealth Limited, under International Accounting Standard 28 - Investments in Associates and Joint Ventures (2011), the CCG has significant influence over its investment (but not control) and the company should be regarded as an associate of the CCG. North West eHealth Limited has been trading for five months by 31 March 2017, and as its year end is 31 December 2017, statutory accounts have not yet been produced. The investment is therefore shown at cost of £540,000.
Pagepage21 293 Salford CCG - Annual Accounts 2016-17
11 Cash and cash equivalents
2016-17 2015-16 £'000 £'000 Balance at 01 April 2016 96 140 Net change in year (37) (44) Balance at 31 March 2017 60 96
Made up of: Cash with the Government Banking Service 60 96 Cash with Commercial banks 0 0 Cash in hand 00 Current investments 00 Cash and cash equivalents as in statement of financial position 60 96
Bank overdraft: Government Banking Service 0 0 Bank overdraft: Commercial banks 0 0 Total bank overdrafts 0 0
Balance at 31 March 2017 60 96
Patients’ money held by the clinical commissioning group, not included above 00
Pagepage22 294 Salford CCG - Annual Accounts 2016-17
Current Non-current Current Non-current 12 Trade and other payables 2016-17 2016-17 2015-16 2015-16 £'000 £'000 £'000 £'000
Interest payable 0 0 0 0 NHS payables: revenue 1,031 0 2,752 0 NHS payables: capital 0 0 0 0 NHS accruals 283 0 1,243 0 NHS deferred income 0 0 0 0 Non-NHS and Other WGA payables: Revenue 1,870 0 1,222 0 Non-NHS and Other WGA payables: Capital 0 0 0 0 Non-NHS and Other WGA accruals 10,353 0 10,289 0 Non-NHS and Other WGA deferred income 5,783 0 61 0 Social security costs 83 0 62 0 VAT 00 00 Tax 78 0 76 0 Payments received on account 0 0 0 0 Other payables and accruals 2,528 0 169 0 Total Trade & Other Payables 22,007 0 15,874 0
Total current and non-current 22,007 15,874
Other payables include £448k outstanding pension contributions at 31 March 2017 (£88k : 2015/16)
Pagepage23 295 Salford CCG - Annual Accounts 2016-17
13 Provisions Current Non-current Current Non-current 2016-17 2016-17 2015-16 2015-16 £'000 £'000 £'000 £'000 Pensions relating to former directors 0 0 0 0 Pensions relating to other staff 0 0 0 0 Restructuring 0 0 0 0 Redundancy 0 0 0 0 Agenda for change 0 0 0 0 Equal pay 0 0 0 0 Legal claims 0 0 0 0 Continuing care 0 0 0 0 Other 151 0 572 0 Total 151 0 572 0
Total current and non-current 151 572
Pensions Relating to Pensions Former Relating to Agenda for Continuing Directors Other Staff Restructuring Redundancy Change Equal Pay Legal Claims Care Other Total Page 296 Page £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000
Balance at 01 April 2016 0 0 0 0 0 0 0 0 572 572
Arising during the year 0 0 0 0 0 0 0 0 115 115 Utilised during the year 0 0 0 0 0 0 0 0 (219) (219) Reversed unused 0 0 0 0 0 0 0 0 (317) (317) Unwinding of discount 0 0 0 0 0 0 0 0 0 0 Change in discount rate 0 0 0 0 0 0 0 0 0 0 Transfer (to) from other public sector body 0 0 0 0 0 0 0 0 0 0 Transfer (to) from other public sector body under absorption 0 0 0 0 0 0 0 0 0 0 Balance at 31 March 2017 0 0 0 0 0 0 0 0 151 151
Expected timing of cash flows: Within one year 0 0 0 0 0 0 0 0 151 151 Between one and five years 0 0 0 0 0 0 0 0 0 0 After five years 0 0 0 0 0 0 0 0 0 0 Balance at 31 March 2017 0 0 0 0 0 0 0 0 151 151
Included in other provisions are amounts which may become due in respect of the cost of overseas visitors totalling £96k
Pension payments are made quarterly and amounts are known. The pension provision is based on life expectancy. Legal claims are calculated from the number of claims currently lodged with the NHS Litigation Authority and the probabilities provided by them.
page24 Salford CCG - Annual Accounts 2016-17
14 Contingencies 2016-17 2015-16 £'000 £'000 Contingent liabilities Equal Pay 00 NHS Litigation Authority Legal Claims 00 Employment Tribunal 00 NHSLA employee liability claim 55 Redundancy 00 Continuing Healthcare 00 Amounts recoverable against contingent liabilities 00 Net value of contingent liabilities 55
Contingent assets
Amounts payable against contingent assets 00 Net value of contingent assets 00
Pagepage25 297 Salford CCG - Annual Accounts 2016-17
15 Commitments
15.2 Other financial commitments
The NHS Clinical Commissioning Group has entered into no non-cancellable contracts (which are not leases, private finance initiative contracts or other service concession arrangements)
16 Financial instruments
16.1 Financial risk management
Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities.
Because NHS Clinical Commissioning Group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities.
Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS Clinical Commissioning Group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS Clinical Commissioning Group and internal auditors.
16.1.1 Currency risk
The NHS Clinical Commissioning Group is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The NHS Clinical Commissioning Group has no overseas operations. The NHS Clinical Commissioning Group and therefore has low exposure to currency rate fluctuations.
16.1.2 Interest rate risk
The Clinical Commissioning Group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The clinical commissioning group therefore has low exposure to interest rate fluctuations.
16.1.3 Credit risk
Because the majority of the NHS Clinical Commissioning Group and revenue comes parliamentary funding, NHS Clinical Commissioning Group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.
16.1.4 Liquidity risk
NHS Clinical Commissioning Group is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The NHS Clinical Commissioning Group draws down cash to cover expenditure, as the need arises. The NHS Clinical Commissioning Group is not, therefore, exposed to significant liquidity risks.
Pagepage26 298 Salford CCG - Annual Accounts 2016-17
16 Financial instruments cont'd
16.2 Financial assets
At ‘fair value through profit and Loans and Available for loss’ Receivables Sale Total 2016-17 2016-17 2016-17 2016-17 £'000 £'000 £'000 £'000
Embedded derivatives 00 00 Receivables: · NHS 0 1,392 0 1,392 · Non-NHS 0 7,522 0 7,522 Cash at bank and in hand 0 60 0 60 Other financial assets 0 542 0 542 Total at 31 March 2017 0 9,516 0 9,516
At ‘fair value through profit and Loans and Available for loss’ Receivables Sale Total 2015-16 2015-16 2015-16 2015-16 £'000 £'000 £'000 £'000
Embedded derivatives 00 00 Receivables: · NHS 0 314 0 314 · Non-NHS 0 7,033 0 7,033 Cash at bank and in hand 0 96 0 96 Other financial assets 00 00 Total at 31 March 2016 0 7,443 0 7,443
16.3 Financial liabilities
At ‘fair value through profit and loss’ Other Total 2016-17 2016-17 2016-17 £'000 £'000 £'000
Embedded derivatives 00 0 Payables: · NHS 0 1,313 1,313 · Non-NHS 0 14,750 14,750 Private finance initiative, LIFT and finance lease obligations 0 0 0 Other borrowings 00 0 Other financial liabilities 00 0 Total at 31 March 2017 0 16,064 16,064
At ‘fair value through profit and loss’ Other Total 2015-16 2015-16 2015-16 £'000 £'000 £'000
Embedded derivatives 00 0 Payables: · NHS 0 3,995 3,995 · Non-NHS 0 11,680 11,680 Private finance initiative, LIFT and finance lease obligations 0 0 0 Other borrowings 00 0 Other financial liabilities 00 0 Total at 31 March 2016 0 15,675 15,675
Pagepage27 299 Salford CCG - Annual Accounts 2016-17
17 Operating segments
The Clinical Commissioning Group consider they have only one segment: commissioning of healthcare services.
18 Pooled budgets
As of the 1st April 2016 Salford CCG now only has one pooled budget with Salford City Council. This is due to the expansion of the Older Peoples pooled budget to include all Adult Service across Salford CCG and Salford City Council.
As a result of the Older Peoples pool expansion the previous Learning Difficulties pooled budget has now been incorporated into the new Integrated Care Pooled budget.
Salford CCG are the hosts of the new Integrated Care Adult Pooled Budget which commenced from 1st April 2016. The memorandum account for the integrated Care Adult pooled budget is:
2016-17 2015-16 CCG % Contribution 71% 71%
The CCG shares of the income and expenditure handled by the pooled budget in the financial year were:
2016-17 2015-16 £'000 £'000 Income 167,510 92,231 Expenditure (167,724) (89,910)
In 2016/17 the CCG contributed £2.9m in underspend from the older peoples pool that ceased on 31st March 2015 into the Integrated Care Pool Budget. The total expenditure of the new Integrated Care Adult Pool budget in 2016/17 was £237.4m of which Salford City Council contribute £69.7m
Pagepage28 300 Salford CCG - Annual Accounts 2016-17
19 Related party transactions 2016/17 Details of related party transactions with individuals are as follows:
The wife and sister in law of Dr Hamish Stedman, chair of Salford CCG until 31.07.2016, are employed by Salford Royal FT. Dr Paul Bishop was the Clinical Lead for Strategic Partnerships and Planning until 01.11.2016. He is a Director of Salford Primary Care Together and Silverdale Medical Practice. His partner is a Nurse at University Hospitals South Manchester Mr Steve Dixon is Chief Finance Officer and a Director of North West e-Health Limited. David Herne is the Director of Public Health at Salford City Council Dr Aisha Aiwan was Neighbourhood Clinical Lead from 01.06.2016 until 31.12.2016, whose brother is a partner at Gill Medical Centre, Swinton. Mr Anthony Hassall and Dr Tom Tasker were Directors of Manchester Academic Health Science Centre until 31st March 2017. The practice of Dr Tasker, St Andrew's Medical Centre, has a GMS contract with NHS England (Greater Manchester Area Team). The practices of Drs Paul Bishop (until 01.11.2016), Ben Williams (from 01.02.2017), Nicholas Browne (from 1.6.16) and Tom Tasker (Chair from 01.08.2016) are all members of Salford Primary Care Together. Salford Primary Care Together is the GP provider company and was known as Salix Ltd until 1 November 2016.
Payments have been made to the practices of Governing Body members in relation to Locally Commissioned Services, as follows:
Receipts Amounts Amounts from owed to due from Payments to Related Related Related Related Party Party Party Party £'000 £'000 £'000 £'000
Organisation Governing Body Member SALFORD PRIMARY CARE TOGETHER Dr Bishop (until 01.11.2016), Dr 70 0 170 0 Williams (from 01.02.2017), Dr Tasker.
SALIX LIMITED (until October 2016) Dr Browne, Dr Tankel, Dr 259 0 0 0 Tasker and Dr Choudry
SILVERDALE MEDICAL PRACTICE Dr Bishop (until 01.11.2016) 378 0 1 0
Dr Aswan (from 01.06.2016 to GILL MEDICAL CENTRE 31.12.2016) 174 0 0 0
ST ANDREWS MEDICAL CENTRE Dr Tasker 98 0 0 0
NORTH WEST E HEALTH LIMITED Mr Dixon 0 0 540 (648)
MAHSC Dr Tasker, Mr Hassall 0 0 188 0
The Department of Health is regarded as a related party as it is the parent body of Salford CCG. During the year the clinical commissioning group has had a significant number of material transactions with entities for which the Department is regarded a related party.
In addition, the clinical commissioning group has had a number of material transactions with other government departments and other central and local government bodies.
SALFORD CITY COUNCIL 27,518 (76,536) 11,060 (6,256)
NHS ENGLAND NHS PENSIONS NORTH WEST AMBULANCE SERVICE NHS TRUST
ROYAL BOLTON HOSPITAL NHS FOUNDATION TRUST CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST GREATER MANCHESTER MENTAL HEALTH NHS FOUNDATION TRUST SALFORD ROYAL NHS FOUNDATION TRUST
Pagepage29 301 Salford CCG - Annual Accounts 2016-17
19 Related party transactions 2015/16
Details of related party transactions with individuals are as follows: The wife and sister in law of Dr Hamish Stedman, chair of Salford CCG, are employed by Salford Royal FT. Dr Paul Bishop is the Clinical Lead for Strategic Partnerships and Planning, his spouse is a Consultant at Central Manchester UH FT Mrs Claire Vaughan is the Head of Medicines Management and her spouse is employed by Greater Manchester West FT. David Herne is the Director of Public Health at Salford City Council Drs Paul Bishop, Hamish Stedman, Tom Tasker, and Owain Thomas are all members of the GP provider, Salix Health Ltd.
Payments have been made to the practices of Governing Body members in relation to Locally Commissioned Services, as follows:
Payments Receipts Amounts Amounts to Related from owed to due from Party Related Related Related Party Party Party
£000 £000 £000 £000
Practice Governing Body Member The Lakes Medical Centre Dr Stedman, Dr Walton 115 Blackfriars Medical Practice Dr Farooq 60 Mosslands Medical Practice Dr Johnson 114 The Sides Medical Centre Dr Patel 169 Drs Budden, Sutherland, Tasker & Tyrrell Dr Tasker 84 Langworthy Medical Practice Dr Thomas 163 Lowry Medical Practice Dr Bishop 248 Clarendon Medical Practice Dr Tankel 121
CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST GREATER MANCHESTER WEST MENTAL HEALTH NHS FOUNDATION TRUST NHS ENGLAND GREATER MANCHESTER SHARED SERVICES NORTH WEST AMBULANCE SERVICE NHS TRUST PENNINE ACUTE HOSPITALS NHS TRUST ROYAL BOLTON HOSPITAL NHS FOUNDATION TRUST SALFORD ROYAL NHS FOUNDATION TRUST UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FOUNDATION TRUST WARRINGTON & HALTON HOSPITALS NHS FOUNDATION TRUST WRIGHTINGTON WIGAN & LEIGH NHS FOUNDATION TRUST SALIX HEALTH LTD 230 0 0 0
The Department of Health is regarded as a related party as it is the parent body of Salford CCG. During the year the clinical commissioning group has had a significant number of material transactions with entities for which the Department is regarded a related party. In addition, the clinical commissioning group has had a number of material transactions with other government departments and other central and local government bodies.
SALFORD CITY COUNCIL 55,957 (29,363) 17 (6,999)
Pagepage30 302 Salford CCG - Annual Accounts 2016-17
20 Events after the end of the reporting period
None to report.
21 Financial performance targets
NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended). NHS Clinical Commissioning Group performance against those duties was as follows:
2016-17 2016-17 2015-16 2015-16 Target Performance Target Performance Expenditure not to exceed income 439,764 424,149 390,070 374,492 Capital resource use does not exceed the amount specified in Directions 0000 Revenue resource use does not exceed the amount specified in Directions 438,855 423,236 389,215 373,637 Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0000 Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 0000 Revenue administration resource use does not exceed the amount specified in Directions 5,520 5,493 5,879 5,469 Page 303 Page
page31 22 Losses and special payments
There were no losses or special payments for 2016-17 or 2015-16.
Page 304 page32 Salford CCG - Annual Accounts 2016-17
4. Employee benefits and staff numbers
4.1.1 Employee benefits 2016-17 Total Admin Programme
Permanent Permanent Permanent Total Employees Other Total Employees Other Total Employees Other £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Employee Benefits Salaries and wages 5,656 5,386 270 3,226 3,190 36 2,430 2,196 234 Social security costs 533 533 0 321 321 0 211 211 0 Employer Contributions to NHS Pension scheme 609 609 0 364 364 0 245 245 0 Other pension costs 0 0 0 0 0 0 0 0 0 Other post-employment benefits 0 0 0 0 0 0 0 0 0 Other employment benefits 0 0 0 0 0 0 0 0 0 Termination benefits 0 0 0 0 0 0 0 0 0 Gross employee benefits expenditure 6,798 6,528 270 3,911 3,875 36 2,886 2,653 234
Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 0 0 0 0 0 0 Total - Net admin employee benefits including capitalised costs 6,798 6,528 270 3,911 3,875 36 2,886 2,653 234
Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0 Net employee benefits excluding capitalised costs 6,798 6,528 270 3,911 3,875 36 2,886 2,653 234
Page 305 Page 4.1.1 Employee benefits 2015-16 Total Admin Programme
Permanent Permanent Permanent Total Employees Other Total Employees Other Total Employees Other £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Employee Benefits Salaries and wages 4,827 4,447 380 2,808 2,704 104 2,019 1,743 276 Social security costs 357 357 0 221 221 0 137 137 0 Employer Contributions to NHS Pension scheme 534 534 0 326 326 0 209 209 0 Other pension costs 0 0 0 0 0 0 0 0 0 Other post-employment benefits 0 0 0 0 0 0 0 0 0 Other employment benefits 0 0 0 0 0 0 0 0 0 Termination benefits 0 0 0 0 0 0 0 0 0 Gross employee benefits expenditure 5,719 5,339 380 3,354 3,250 104 2,364 2,088 276
Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 0 0 0 0 0 0 Total - Net admin employee benefits including capitalised costs 5,719 5,339 380 3,354 3,250 104 2,364 2,088 276
Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0 Net employee benefits excluding capitalised costs 5,719 5,339 380 3,354 3,250 104 2,364 2,088 276
page33 This page is intentionally left blank SALFORD’S HEALTH AND WELLBEING BOARD – ANNUAL REVIEW OF 2016/17
Salford’s Health and Wellbeing Board Annual Review 2016/17
August 2017
V14 21/9/17 pm 1 Page 307
Contents:
1. Forward ...... 3 2. Executive Summary ...... 4-7 3. Background ...... 8-12 4. What has the Health and Wellbeing Board done in 2016/17? ...... 13-18 5. Delivering the Locality Plan ...... 19 6. So What? – achievements of Salford’s Health and Wellbeing Board ………………...…20 7. Next Steps …………………...... 20
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FOREWORD
Paul Dennett, City Mayor
I was honoured to be Chair of Salford’s Health and Wellbeing Board in my first year as City Mayor of Salford City Council. I am continually enthused by the collaboration and co- operation of partners who have maintained the pioneering reform of health and social care services in our city.
In 2016/17 Board members continued their demonstration of empowering partnership working, enabling Salford to remain at the forefront of innovative practice for the provision of health and social care. Our Locality Plan was assessed by the Greater Manchester Devolution Team as the most well developed in Greater Manchester and rated as ‘A well- structured plan, which refers extensively to existing Vanguard programmes and links well across to the GM strategy and transformation themes’ (April 2016).
Cllr Tracy Kelly Dr Tom Tasker (Lead Member for (Chair of Salford’s Adult Services, Clinical Health and Commissioning Wellbeing) – Vice Group) – Vice Chair, Chair.
We are both pleased to report the Board’s successes in 2016/17, which show the strength and depth of partnership co-operation and integration in tackling some of the most serious and enduring health inequalities in the country. This has instinctively consisted of working with other partners, such as the voluntary community and social enterprise (VCSE) sector and blue light services.
In the light of the breadth of our Locality Plan, we have been pleased to welcome representation from Salford’s Housing Partnership, Primary Care, Salford University and an additional VCSE representative.
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EXECUTIVE SUMMARY
Salford’s Health and Wellbeing Board’s Annual Review of 2016/17 contains a summary of the business, achievements and progress made towards the Board’s three main responsibilities in its fourth year of statutory operation. The report is intended for Board members and stakeholder organisations for assurance purposes, and contains evidence to show whether the Board is achieving what it set out to do and is meeting its statutory responsibilities.
Key responsibilities of the Health and Wellbeing Board are: Assurance, Strategy, and Informing and Influencing.
The Board’s ambition is – to improve life expectancy in Salford so that the gap between Salford and the UK average is reduced, and to improve health and wellbeing at every stage of life.
Board highlights during 2016/17 have included:
Salford’s Locality Plan for the city being assessed as one of the best in the city region. Overseeing the contributions of key Salford-based health and social care partners – Salford Royal, Salford CCG, GM Mental Health and the council – to launch our
integrated care organisation through DRAFT Salford Together; a new integrated holistic model of care for older people in the City. The Board maintaining its research and intelligence understanding of the needs of the residents of Salford with analysis of the requirements of specific groups as part of the Joint Strategic Needs Assessment, i.e. cancer patients. Undertaking focused on-going public health communications and engagement (using a wide range of techniques and methods) with Salford citizens, of our Locality Plan’s three themes: o Start Well – making use of the national ‘Change 4 Life’ campaign resources, delivering the messages to young people and parents in Salford, o Live Well – making use of the national ‘One You’ campaign resources, delivering the messages to the general adult population in Salford, o Age Well – making use of the national ‘Stay Well this Winter’ (SWtW) campaign resources, delivering the messages to the over 65’s and carers (family, friends and/ or paid for). Salford Suicide Prevention Strategy. Alongside the other ten Greater Manchester local authorities and the central Devolution Team (Chief Officer is Jon Rouse), taking control of an estimated budget of £6 billion each year from 1st April 2016. The latest on GM Health and Social Care can be viewed here: https://www.greatermanchester-ca.gov.uk/info/20008/health_and_social_care.
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Holding six business meetings that: o approved a number of reports, protocols and guidance, i.e. the H&WB’s Communication, Engagement and Social Marketing Approach 2016-2019 Future Engagement Strategy (which supports the delivery of the Salford Locality Plan), o discussed a number of reports, protocols and guidance, i.e. hospital group work with Wigan update, o assured a number of reports, protocols and guidance, i.e. Health Protection Forum update, o received a range of reports, protocols and guidance for information, i.e. Salford Healthwatch priorities for 2016/17.
Holding three strategy meetings, each one focusing upon a separate matter, these being: o to discuss the Care Quality Commissions ‘Quality in a place’ inspection report and Salford Locality Plan implementation planning, o to discuss prevention in the Salford Locality Plan and the development of a scaleable proposition for delivering work around prevention, o to discuss governance and accountability for performance reporting arrangements relating to the Locality Plan.
DRAFT
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Nationally, the Health Profiles published by Public Health England show how Salford compares with the rest of the country. Our baseline taken from our first year of statutory operation is:
Salford Health Profile 2012:
DRAFT
Salford Health Profile 2017: Salford is one of the 20% most deprived districts/ unitary authorities in England and about 27% (12,700) of children live in low income families. Life expectancy in Salford is increasing year on year but is still lower that the England average. Whilst the health of people in Salford is generally worse than the England average against a basket of indicators, the general trend even against ‘red’ indicators is improvement, although progress is still required:
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DRAFT
Conclusion
This wide range of activity and achievements demonstrate how the Board and its partners are making a positive difference for the people of Salford, by maintaining and evolving: our understanding of the varied characteristics of need and assets across many sectors of the local community, a practical and relevant approach to future health and wellbeing in Salford, and making in-year improvements, even against ‘red’ indicators, of a basket of health indicators.
Furthermore, new quarterly themed focus Board meetings will operate from the 1st April 2017. Over the next few years, the Board will continue to oversee and deliver a more community-based integrated health and social care system in and for Salford.
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BACKGROUND This report contains a review of the fourth year of operation of Salford’s statutory Health and Wellbeing Board. It is intended for assurance – used by the Board and its partner organisations to understand whether it is achieving its purpose … making sure that Locality Plan outcomes and transformation objectives are being delivered for the people of Salford … and to inform the planning of the Board’s business and work plan for 2017/18.
The scope of this report includes the activities and discussions of the Health and Wellbeing Board and its sub-groups when carrying out Board business. Findings included can be directly attributable to the actions of the Board and its members.
Whilst chaired by the directly elected City Mayor of Salford at the time, currently Paul Dennett; Board meetings are more usually led and chaired by either the Local Authority Elected representative (Lead Member for Health and Adult Services, Cllr Tracey Kelly) or the representative of Salford CCG (Chair of the Governing Body, Dr. Tom Tasker). The Board brings together a wide range of partners from the City Council, Clinical Commissioning Group (CCG), Health Watch, community and voluntary sector, local providers and employers, as well as NHS England, Greater Manchester Police, and Fire and Rescue Services. The following review will explain the purpose and responsibilities of the Health and Wellbeing Board, who is involved, how it is organised, what it has done during 2016/17 and how it has started to have an impact on the wellbeing and health of the citizens of Salford. Links are provided to more information about the Board and its work.
What is Salford’s Health and Wellbeing Board? Health and Wellbeing Boards are a key element of the Health and Social Care Act (2012) and they are a means to deliver improved strategic co-ordination across the NHS, social DRAFT care, children’s services and public health. The Boards must assess the needs and assets of the local population, produce a strategy that addresses these needs and builds on any assets, influence commissioning plans of organisations and promote joint commissioning and integrated provision.
In Salford, the Board ‘will be a strong, effective partnership to improve commissioning and delivery of services through an intelligence-led, and evidence based approach. There will be a clear focus on reducing health inequalities and an emphasis on prevention, early intervention and the wider determinants of health. The focus will be on continuous improvement, whole systems approaches, joint accountability, strong leadership, transparent decision-making and outcomes’.
Key responsibilities – the Health and Wellbeing Board should: understand and use health and wellbeing needs, inequalities, risks and assets locally (via on-going continuous analysis frameworks) (Assurance), to determine priorities for local action (focusing collective efforts and resources on an agreed set of priorities and outcomes) (Strategy), and promote integration and partnership in addressing these priorities and delivering services (holding organisations accountable for their contribution to outcomes in the Locality Plan and encourage integrated commissioning and pooling of resources where applicable) (Informing and Influencing).
The Board has an ambition: to improve life expectancy in Salford so that the gap between Salford and the UK average is reduced and to improve health and wellbeing at every stage of life.
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Vision – the Board’s vision for wellbeing and health in Salford is: “Salford people will start, live and age well – people in Salford will get the best start in life, will go on to have a fulfilling and productive adulthood, will be able to manage their health well into their older age and die in a dignified manner in a setting of their choosing. People across Salford will experience health on a parallel with the current “best” in Greater Manchester, and the gaps between communities will be narrower than they have ever been before”.
Our vision is therefore supported by the following high level strategic principles: Salford will have the safest, most productive health, care and wellbeing system in England, with consistently high quality service standards and outcomes. our local citizens will help to shape and be fully engaged in this system, but they will also recognise the vital role they have in sustaining it by maintaining their own health, supporting neighbours and friends, and contributing to the local economy. across Salford, partners will come together across the public, private, faith, voluntary and community sectors to create a fully integrated offer, local accountability and an accompanying reduction in the acute health and care sector to reflect this shift.
In Salford, the Board’s priorities come from the Locality Plan and are: Starting well – children will have the best start in life and continue to develop well during their early years, Living Well – citizens will achieve and maintain a sense of wellbeing by leading a healthy lifestyle supported by resilient communities, Aging Well – older people will maintain wellbeing and can access high quality health and care, using it appropriately. DRAFT
The Board has agreed a number of delivery principles, which underpin the way that it intends to achieve its vision and ambition through transformation and reform: ensure care and services in Salford are financially and operationally sustainable, allocating resources to achieve the best outcomes deliver services are high quality, safe and effective integrate activity wherever possible in planning, commissioning, and delivery put outcomes for people at the heart of the way we work and the care we provide maximise the use of effective digital technology ensure Salford learns and develops, using data and intelligence sourced from across the public, private and voluntary sectors share leadership and responsibility across all sectors and stakeholders to achieve the best results for Salford people enable care and support to be accessed as close to home as possible focus on prevention and early intervention ensure the transformation of care delivers benefits in the short, medium and long term work closely with the people of Salford to shape what it looks like
In addition, the Board has agreed a number of values, which underpin the way that it intends to achieve its vision and ambition: valuing the assets the people of Salford bring , supporting strong and vibrant neighbourhoods that promote health and wellbeing, social justice and tackling inequality, health and wellbeing will be everyone’s responsibility,
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partnership and integration of provision, prevention and early intervention throughout life, and quality, innovation and evidence-based.
Who is involved in the Board? Salford’s Health and Wellbeing Board has the following members: Salford City Mayor (Chair) Salford City Council Executive Lead Member for Health and Wellbeing (Deputy Chair) Chair of Salford CCG (Deputy Chair) Salford City Council Strategic Director – Children’s Services and Adult Services Salford City Council Director of Public Health Salford Healthwatch representative Additional five elected representatives from Salford City Council Salford CCG Chief Accountable Officer Greater Manchester Health and Social Care Partnership Team representative Greater Manchester Chamber of Commerce representative Salford Voluntary and Community Sector representative (Salford CVS) Greater Manchester Police representative Greater Manchester Fire and Rescue Service representative Salford Royal Foundation Trust representative Greater Manchester West Trust representative
Selection for membership on the board has been based on the following key principles: statutory requirement to participate
DRAFT significant commissioning or delivery role in the local economy significant capacity to impact on a key area of the Board’s outcome frameworks as detailed in the Locality Plan legitimate ability to represent a wider community of interest i.e. not self appointed delegated authority and accountability within the organisations represented
During 2016/17 Board membership has been stable in terms of the organisations represented.
Governance Figure 1 During 2016/17 and as part of its governance arrangements, the Board has operated a number of sub-groups as shown in the following diagram. The Board delegates responsibilities to the sub-groups to oversee some of its work, including publishing the Joint Strategic Needs Assessment (JSNA), delivering the priorities of the Locality Plan, assurance around health protection, joining up commissioning between the Council and CCG and ensuring effective communication and engagement with the Board’s stakeholders. Many of these groups have their own governance arrangements and terms of reference, particularly where they take decisions or have responsibility for budgets within the health and social care system.
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On 24th January 2017, the Board agreed a revised terms of reference, covering its statutory responsibilities, role/ purpose and values/ principles, specifically altering its meetings (from 1st April 2017) from every 6-8 weeks to quarterly with a themed focus at each.
This revised terms of reference also led to a new arrangement of sub-groups, with specific responsibilities assigned to reflect delivery of our Locality Plan.
DRAFT Reporting overview City Council Salford Health and Wellbeing Board Cabinet, Voluntary Scrutiny Sector Leaders and other partners Locality outcomes dashboard, progress summary, Implementation Plan highlight reports Locality Leaders Locality Plan Programme GM Portfolio Board Group (informal) Management Board Locality Delivery Framework – dashboard, milestone plan, progress reporting, risk registers KEY
Prevention Better Care Enabling Group / role in development
Prevention and Better Health Integrated Integrated 3x Acute Intelligence and Board (proposed) Adult Health Care Sector Performance group Group in place and Care Advisory Programme Commissioning Board Boards Communication and Joint Engagement group Children and Young People’s Committee Trust (Start Well) (ICJC) Workforce IMT Strategy Strategy Group Safer Salford Board Group
Estates Social Value Strategy Alliance Locality Plan Group
Healthwatch and user / public engagement forums Officer Reference group (proposed)
The Board is formally part of the Constitution of Salford City Council, under section 102 of the Local Government Act 1972 – however, the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 will apply. It is accountable to the Council’s Cabinet and ultimately the City Mayor, with quarterly progress updates provided.
From April 1st 2017 the proposed Locality Plan Programme Management Group will be a sub-group of the Board which has oversight of delivery of the many work streams in the Locality Plan, reporting back to the Board on progress and performance.
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JOINT STRATEGIC NEEDS ASSESSMENT, HEALTH AND WELLBEING STRATEGY, INTEGRATED WORKING The Board has a group of wider stakeholders ranging from the Children and Young Salford Safeguarding Salford Adult People’s Trust Children’s Board Safeguarding Board people of Salford, through the other Boards and partnerships operating Salford Clinical Salford City Council Commissioning Group in the City, local employers, service Salford CVS (Voluntary Salford Royal FT and Community providers and regulatory bodies. Salford Health Sector) Greater Manchester The Board engages with these wider and Wellbeing Health Watch Salford West FT Board stakeholders through its sub-groups, NHS England GM Chamber of through the Board meetings in public Commerce GM Fire and Rescue GM Police Service which includes an opportunity for questions, and by putting in place a Community Safety Strategic Housing Skills and Work Partnership Partnership Board communication and engagement strategy. The diagram below shows BENEFIT FOR THE CITIZENS OF SALFORD how the Health and Wellbeing Board works with other Boards and partnerships to collect intelligence for the Joint Strategic Needs Assessment, deliver programmes for the Locality Plan and work towards the integration of delivery. Joint work programmes already exist with the Children and Young People’s Trust (around Best Start in Life), Community Safety Partnership (reducing the impacts of violence and alcohol abuse on wellbeing), Skills and Work Board (Workforce Resilience and Wellbeing), Strategic Housing Partnership (Housing and Health programme), and the Salford Safeguarding Children Board (endorsement of the Safeguarding Children Compact).
Case study: Salford Health and Social Care Transformation
In March 2016, the Greater Manchester Health andDRAFT Social Care Partnership was awarded £450 million ‘Transformation Fund’, to help the region achieve the fastest and greatest improvement to its health and wellbeing through the process of devolution – Salford and Stockport were given vanguard delivery status. The money is earmarked to provide patients with better access to GPs, pharmacies and community care, improve mental health services and reduce the length of time patients are spending in hospitals through the setting up of Local Care Organisations.
Salford was awarded £18million over three years following an independent application process, which assessed the region’s health and social care plans. This money will be used to improve health and social care services for adults across the city, for example actively encouraging GP practices to work more closely together on effective patient care and some practices will be able to stay open longer.
This funding has also facilitated the transfer of social care staff from Salford City Council to Salford Royal Foundation Trust, forming the new Integrated Care Organisation, Salford Together.
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WHAT HAS THE HEALTH AND WELLBEING BOARD DONE IN 2016/17?
The following section provides examples of the work of the Health and Wellbeing Board and its sub-groups which have taken place between April 2016 and March 2017. These listed activities are further illustrated by a series of case studies. The activities are listed under the three main objectives of the Board, to: understand and use health and wellbeing needs, inequalities, risks and assets locally (Joint Strategic Needs Assessment), determine priorities for local action (Locality Plan), and promote integration and partnership in addressing these priorities and delivering services (Integrated and Partnership Working and Governance).
Joint Strategic Needs Assessment – the Health and Wellbeing Board has: reviewed and published the Salford Pharmacy Needs Assessment, a statutory document that is refreshed every three years (28th March 2017), published a JSNA cancer update with the aim to inform future local strategy and actions to improve cancer outcomes in Salford and to reduce inequalities, details of its hospital group work with Wigan and Salford being identified as a pilot area for the call for evidence for the GM Integrated Societal Review re: capturing evidence of activities which are building ‘social capital’ in communities (19th July 2016), published a Salford Inter Board Protocol with Salford Partnership (15th November 2016), and issued a new Intelligence Newsletter – focusing upon its JSNA future work streams and support available for Salford’s LGBT community (28th March 2017).
Delivering the Locality Plan – the Health andDRAFT Wellbeing Board has: undertaken focused on-going public health communications and engagement (using a wide range of techniques and methods) with Salford citizens, against the Locality Plan’s three themes: Start Well, Live Well and Age Well (see case study below for details), approved a number of reports, protocols and guidance, including: the H&WB’s Communication, Engagement and Social Marketing Approach 2016-2019 Future Engagement Strategy (which supports the delivery of the Salford Locality Plan) (17th May 2016) and the Salford Locality Plan update and governance proposal re: proposed changes to the Health and Wellbeing Board Terms of Reference and the establishment of a new Locality Plan Programme Board (15th November 2016), discussed a number of reports, protocols and guidance, including: o Acute care hospital transformation update and cold weather planning (24th January 2017), o Prevention proposition draft proposal and CAMHS transformation update (28th March 2017), o Living Well prevention briefing and partner responses to implementing the Living Wage update (20th September 2016), assured a number of reports, protocols and guidance, including: o BCF Final submission (17th May 2016), o Health Protection Forum update (20th September 2016), o Locality Plan Highlight report (24th January 2017), o Health Protection Forum update and Locality Plan Highlight report (28th March 2017),
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received a range of reports, protocols and guidance for information, including: Salford Healthwatch priorities for 2016/17, Salford CCG Operational Plan 2016/17 and Social Value in Health and Care update (17th May 2016), and held a strategy meeting focusing upon prevention in the Salford Locality Plan and the development of a scaleable proposition for delivering work around prevention (14th July 2016).
Case study: JSNA Cancer Update As people are living longer, more people are getting conditions such as cancer. More people are however surviving for longer with cancer. Early diagnosis and treatment is key to continuing to improve cancer outcomes and survival.
Cancer profiles have been produced to aid understanding of cancer outcomes in Salford and to help identify areas for improvement. The cancer profiles provide comparative information for GP practice populations in Salford. Cancer incidence (new cases), mortality (death rates), screening uptake and urgent referral measures are included and adjusted for the demographics of the practice population.
All measures show variability across practice populations. For example breast screening uptake ranges from 41% to 83% (Q2 2013/14) and bowel screening uptake from 27% to 63% (2013). There is three fold variation in new cancer cases and cancer death rates.
DRAFT
Each Salford GP practice has been asked to review their cancer profile and develop a practice action plan to help improve outcomes. Improving the outcomes presented within the profile however requires collaborative action from both communities and the wider public sector. Many organisations can ‘Make Every Contact Count’ to support cancer prevention messages and promote screening.
The practice profile therefore provides a starting point for practices to reflect on local information and identify possible reasons for the picture given to enable tailored and specific local action. A Salford needs assessment for cancer will be published later in the year which will include further information at a Salford level.
Integrated and Partnership Working – the Health and Wellbeing Board has: alongside the other ten Greater Manchester local authorities and the central Devolution Team (Chief Officer is Jon Rouse) taken control of an estimated budget of
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£6 billion each year from 1st April 2016 (the latest on GM Health and Social Care can be viewed here: https://www.greatermanchester- ca.gov.uk/info/20008/health_and_social_care, overseen the contributions of key Salford-based health and social care partners – Salford Royal, Salford CCG, GM Mental Health and the council – in the launching on 4th July 2016 through Salford Together of a new integrated holistic model of care for older people in the City, approved a number of reports, protocols and guidance, including: a Salford Suicide Prevention Strategy statement of principle and pledge for Board members to consider and for their organisations to sign-up to (19th July 2017) and the Inter Board Safeguarding Protocol on behalf of Salford Partnership (by the Salford Community Safety Partnership) (24th January 2017), discussed a number of reports, protocols and guidance, including: Salford Integrated Care Organisation briefing and update on Communications and Engagement “Future Engagement Strategy” (17th May 2016), and held a strategy meeting focusing upon the Care Quality Commissions ‘Quality in a place’ inspection report and Salford Locality Plan implementation planning (21st June 2016).
DRAFT
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Case study: Focused public health communications and engagement with Salford citizens using the Locality Plan’s three themes A wide range of focused techniques and methods of public health communications and engagement with Salford citizens, using the Locality Plan’s three themes have been undertaken: o Start Well – making use of the national ‘Change 4 Life’ campaign resources, delivering messages to young people and parents in Salford, including: . a direct letter posted out to approximately 200 community and sporting clubs asking them to sign up to campaign, . a mail out to all primary schools in Salford in September 2016 coinciding with ‘back to school’, highlighting what a healthy lunch box should look like, . commissioning the Health Improvement Service to deliver Crucial Crew in November 2016 on behalf of Salford CCG, focusing on young people being Sugar Smart in their food and drink choices (approximately1,600 Salford children and 100 teachers were engaged with from 44 schools), . Salford Youth Centres removing all sugar drinks from sale in their buildings for one month (aligned to ‘Change 4 Life’ activity – impact being evaluated), o Live Well – making use of the national ‘One You’ campaign resources, delivering messages to the general adult population in Salford, including: . the citywide ‘One You Fest’ that took place between 10th – 21st October 2016, whereby staff from the CCG and SCC provided taster sessions on different health and wellbeing activities to encourage co-workers to improve their own physical and mental health (impact being evaluated), . runners in the September 2016 Salford 10k from the Health and Wellbeing team all ran wearing t-shirts branded with the ‘One You’ logo to illustrate how the campaign links in to both physical and mental health – this was also tied in with the ‘#22 too many’ campaign which promoted the city’s Suicide Prevention Strategy, DRAFT . a 12 month project, branded under ‘One You’, to give 3 families (identified by our Health Improvement Service who are desperate to get fitter and children marked as obese but who can’t afford gym membership, etc) a SCL package which gives them free gym membership, regular personal training, water sports packages, swimming lessons for the kids and activity sessions in exchange for them agreeing to be filmed over the 12 months (quarterly by the project team and by themselves on a smartphone/ tablet in 30 second snippets) talking about their journey to get more active and how it’s made a difference to themselves and their children (to be shown over social media), o Age Well – making use of the national ‘Stay Well this Winter’ (SWtW) campaign resources, delivering messages to the over 65’s and carers (family, friends and/ or paid for), including: . public engagement with over 65’s about flu undertaken at a variety of places, including Critchley House, that found many older people were more keen to keep themselves healthy for the sake of their grandchildren than for their own benefit and that they wanted to see posters/ leaflets that meant something to them personally and celebrated the efforts of all who turned up to get their flu jab – in response a localised 1 minute long film advert to support the flu campaign to the over 65’s using pester power of grandchildren to get their jabs was created, to be shown at events and public gatherings, on the MEN website and on You Tube (100+ older people at an Older Person’s event, including an interactive myth buster session, 1,126 views on You Tube and approximately 1,000 on MEN website), . clinicians from each neighbourhood in Salford have been photographed to be on the ‘SWtW’ posters being shown across the city, so that the public are seeing a familiar and more trusting face when they look at our posters, . we have been working more closely with local businesses and places of interest who come into contact with older people to disseminate the SWtW booklet and display the posters, rather than just relying on displaying them in GP practices, . we have created short films of our engagement officer, who specialises in working with the deaf community, delivering thePage flu jab 322 message via BSL. 16
Case study: Salford Together Integrated Care Programme Highlights
Salford Together is a partnership which includes Salford City Council (SCC), NHS Salford Clinical Commissioning Group (SCCG), Salford Royal NHS Foundation Trust (SRFT), Salford Primary Care Together (Salford’s GP practices) and Greater Manchester Mental Health NHS Foundation Trust. The programme received Vanguard money from NHS England, to test new models of care, through integrating acute and primary care.
A key step (unique in the country) was the integration of adult social care services into the NHS. On 1st July 2016, SRFT became the lead provider of adult social care in Salford, with approximately 400 staff transferring from Salford City Council to SRFT. This created a new division of about 2000 staff, within SRFT called Salford Health and Care Division.
Taking the learning from the Integrated Care Programme for Older People, Salford Together has been developing a number of tests of change and new services which will deliver improved outcomes and experiences for Salford people and deliver savings for the health and care economy.
The programme hosted The Times newspaper in late 2016, reporting on the benefits of integration. http://www.salfordtogether.com/2017/01/the-times-investigation-linking-health-with- social-care-can-offer-a-lifeline-to-the-frail/
Neighbourhood multi-disciplinary groups (MDGs) continue to develop and are being extended to support adults of all ages, with a range of conditions. MDGs are groups of health care workers and social care professionals who unite as a DRAFTteam to ensure the planning and implementation of person-centred care and its delivery for individuals who require support.
A new urgent care service is delivering intensive, short-term health and social care to people in the community, who would previously have been admitted to hospital. People have told us that they prefer to remain in their own homes, or in the community, rather than go into hospital and it is generally cheaper too, with people needing less ongoing support.
Small but significant steps have been taken to improve access to services through the health and social care contact team. These include the creation of a single number and the continued learning and relationship building between staff (customer care and practitioners) from adult social care and health care.
The large number of workstreams has recently been rationalized into four areas: developing neighbourhood health and social care teams, improving access to GP and community services, urgent care services at home or in the community, improving care pathways – delivering more health services and support at home.
Governance – the Health and Wellbeing Board has: met on nine occasions during the year, this included: o 3 strategy discussion meetings, each one focusing upon a separate matter, these being: o to discuss the Care Quality Commissions ‘Quality in a place’ inspection report and Salford Locality Plan implementation planning (21st June 2016),
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o to discuss prevention in the Salford Locality Plan and the development of a scaleable proposition for delivering work around prevention (14th July 2016), o to discuss governance and accountability for performance reporting arrangements relating to the Locality Plan (18th October 2016). o 6 business meetings, which are held in public and were attended by local community and voluntary groups and providers and sometimes members of the public, that approved a number of reports, protocols and guidance, including: o a Memorandum of Understanding between the Salford Health and Wellbeing Board, Salford Healthwatch and Salford Scrutiny Panel in respect of their different roles and how they can work together (20th September 2016), o the Inter Board Safeguarding Protocol on behalf of Salford Partnership (by the Salford Community Safety Partnership) (24th January 2017), o the Salford Pharmacy Needs Assessment a statutory document and is refreshed every three years (28th March 2017). reviewed and agreed, on 24th January 2017, a revised terms of reference, covering its statutory responsibilities, role/ purpose and values/ principles, specifically altering its meetings from 1st April 2017 from every 6-8 weeks to quarterly with a themed focus at each, approved a number of reports, protocols and guidance, including: a Memorandum of Understanding between the Salford Health and Wellbeing Board, Salford Healthwatch and Salford Scrutiny Panel in respect of their different roles and how they can work together (20th September 2016), received a range of reports, protocols and guidance for information, including: o Annual Report of Salford Healthwatch and the 0-25 Years Programme (19th July 2016), o Adult Social Care User survey, Housing and Health update, Working Together – DRAFT the role of GM F&RS in supporting Locality Plans, Salford CCG Annual report and Salford HWB Annual Review 2015/16 (20th September 2016), o Achieve Drug and Alcohol Service Performance Report, Safeguarding Adults Annual Report, Affordable warmth campaign and Safeguarding Children Board Annual Report (15th November 2016), o Social Value work update and GM Taking Charge 6 month review (24th January 2017).
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DELIVERING SALFORD’S LOCALITY PLAN
The key role of the Health and Wellbeing Board in 2016/17 was to lead delivery on and of the Salford Locality Plan. The Board ensured that all partners had oversight of decisions whilst holding to account those partners and agencies with responsibility for service delivery and progressing transformation thereby embedding what would be required for on-going and future change.
What worked? This was achieved through partnership: leadership – the Board led the process, the success of the plan relies upon strong leaders across all sectors and organisations to make it happen, a strengths based approach was used, so that the delivery of the plan will make use of existing community and local assets. The Locality Plan promotes good practice so that we make use of what works, partnership in delivery – the Board looked to build upon existing programmes, services, relationships and joint working through the plan, strong enablers have supported the plan such as the focus on IT and voluntary and community sector leadership. Other key enablers include social value (building Health and Wellbeing outcomes into wider activity), financial planning and workforce development have all contributed to the foundations of the plan, the plan is also grounded in intelligence about Salford. The development of the plan made use of the latest data, projections and intelligence from engagement so that we value the opinions of patients and public alongside the data. An ongoing part of the development of this Locality Plan has been engagement of stakeholders – partners,
service users, patients and wider citizens,DRAFT and a focus on reform – the plan encourages really innovative approaches to doing things differently.
What could be improved? Our focus on risk and its management Ensuring that financial performance is understood in the light of health and wellbeing outcomes Ensuring that resources are distributed in the most effective way across the Board’s partnership to maximise results.
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SO WHAT? – Conclusions on how the work of the Health and Wellbeing Board and its members is starting to make a difference for the people of Salford. The activities and case studies described in this report show the coverage of the work of the Board in 2016/17, of which the following demonstrate how it and its members are starting to make a difference: the Joint Strategic Needs Assessment and theme updates, continue to help all partners to have an improved understanding of the characteristics of needs and assets across many sectors of the local community, thereby assisting with the planning of future services, resource allocation and programming across the partnership, the Locality Plan, based upon solid foundations of intelligence about the city and neighbourhoods, maintains a practical and relevant approach to future health and wellbeing in Salford, and whilst the health of people in Salford is generally worse than the England average against a basket of indicators, the general trend even against ‘red’ indicators is improvement.
NEXT STEPS … for Salford’s Health and Wellbeing Board
Over the next year, the Board needs to continue to oversee and deliver an integrated health and social care system in and for Salford that: has more community/ neighbourhood-based health services that are nearer to users homes (whether as a patient or carer), has more people accessing and using primary care facilities/ services, has a wider range of test and health checks available for citizens, contributes towards and supports better quality housing and good job opportunities, and encourages a wide-spread of care and support providers, including voluntary and community sector and social enterprise organisations, in addition to – or sometimes instead of – NHS services.
The Health and Wellbeing Board’s role in this will be: Quarterly ‘deep dives’ around performance and the three pillars of our Locality Plan – Figure 1 Start Well, Live Well and Age Well. Approving key system leadership pieces of work which transform the arrangements for health and social care in Salford, ensuring integration. Ensuring strong partner engagement across the major transformational pieces of work. Remaining focussed on people’s health and wellbeing in Salford Maintaining a leading role in the GM Health and Social Care ‘Taking Charge’ and working with other partners from across GM to deliver this.
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Contents
Healthwatch Salford Annual Report 2016/17 ...... 1
Message from our Chair ...... 3
Message from our Chief Executive ...... 3
Your views on health and care ...... 4
Helping you find the answer ...... 6
Making a difference together ...... 8
Our plans for next year ...... 16
Our people ...... 19
Our finances ...... 23
Contact us ...... 25
Healthwatch Salford aims to ensure that local people are at the heart of the planning and delivery of health and social care services in Salford. We are continuously working to bring together local people and health and social care organisations to ensure that people in Salford are influencing decisions about their health and wellbeing. We do this by: • Providing people with information, advice and support about local health services. • Listening to the views and experiences of local people about the way health and care services are provided and commissioned. • Passing information and recommendations to Healthwatch England and The Care Quality Commission.
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Message from our Chair
“The past year has been an important one for Healthwatch Salford. We have held our first AGM with our members, become fully independent and moved to new offices. We have a sound financial base and this has allowed us to recruit extra staff. This means we can engage more with local people, find out about their experiences and expectations, and ensure they are heard clearly by health and care providers in Salford.” Phil Morgan ++++++
Message from
our Chief
Executive
“It has been an exciting year for Healthwatch Salford. We have made The most significant change is local, with significant changes as an organisation in the establishment of the Salford Together moving towards complete independence Integrated Care Transformation and relocating. This also coincides with Programme. The other significant change is changes to the health and social care on Devolution and relating to the Greater landscape which pose challenges for how Manchester Health and Social Care Healthwatch Salford operates effectively. Partnership.” Delana Lawson Page 329 Healthwatch Salford 3
.
Your views on health and care
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Listening to local people’s views SETTING OUR PRIORITIES In 2016 there were some substantial changes happening under Greater Manchester Devolution and Salford’s Locality Plan. Put simply, it is a long-term plan about how Salford people should be able to start, live and age well across their lifetime in Salford and the contributions we should all make to achieving this. Every year Healthwatch Salford goes out into the community and asks the people of Salford what they think we should be working on to make Salford people’s health and wellbeing better. By listening and sharing ideas we work together with public services, the private and voluntary sectors to make sure that decision makers and service providers shape health and social care provision around people’s experiences. Healthwatch Salford staff and volunteers developed surveys, published articles in newsletters and on the website, utilised social media, ran discussion groups and held many face-to-face interviews. Organising this amount of activity, and visiting seldom heard groups, ensured that many different people could share their views in lots of ways, including those who often struggled to have their voices heard. Generated by nearly 3,000 interactions, we got direct feedback from 491 local people. From these, our main priority areas this year were: • Mental health; • Intermediate care; • Wider health determinants; • Access to primary care.
Little Salfordian enjoying a HWS event Page 331 Healthwatch Salford 5
Helping you find the answer
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How we have helped the community access the care they need During this period we had 60 signposting cases who we helped to find the right answer and have their voices heard. Topics raised included: standard of, or problems with, clinical care; appointments, registration and catchment areas; delays in treatment; information and communication; costs, funding and commissioning; staff attitudes; prescriptions; care environment; and The new Healthwatch Salford feedback aftercare. system – coming soon Accessing our Signposting Service You said: You told us that you wanted to access signposting, information and advice when you need it in an easy and accessible way. You felt that having community based access to quality information and advice services was important. We will: • Make sure our own information and signposting service can be accessed through more community venues. • Increase our visibility with the public of Salford and be more present in the streets, shopping centres, community centres and at events. • Develop a new online feedback centre (pictured) for people to personally feedback to us their concerns and views. This new system will simplify how we ask for views. • Further improve our systems for Bridge Street feeding back to people what happens because of the views they give us.
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Making a difference together
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MENTAL HEALTH the project. They developed a questionnaire to ask other young people Mental Health Strategy and about their experiences of using wellbeing Influence and mental health services.
As mental health and access to decent The questionnaire was taken to schools, quality services came out as a priority for groups and places in the community and local people, we have taken the lead for lesson plans and activity sheets were mental health within the Greater developed to help younger children answer Manchester Healthwatch Network. We have the questions. ensured that engagement work on mental health undertaken across Greater From this work 411 responses were Manchester has been fed into the Greater analysed and used to develop key findings Manchester Health and Social Care and recommendations. Partnership. The results of the project have been We have also been working closely with presented to the Children and Young Greater Manchester Mental Health People’s Trust Board and the project has Foundation Trust on the development of been commended by Healthwatch England their Quality Accounts. We are pleased to in their award scheme. note that this has been reflected in their prioritising of patient experiences and the focus on improving access to psychological services for those with long term conditions.
The findings are reflected in the work of the refreshed Child and Adolescent Mental Health Services (CAMHS) Transformation Plan and their 0-25 Integration programme. We are pleased to note the emphasis the strategy has on increasing the capacity in schools to provide support around emotional health and wellbeing.
Blackleach Country Park, Walkden
Young People’s Engagement Co-design Healthwatch Salford and the Young Carers’ Service worked with children and young people to carry out an engagement project for mental health. A group of young people aged between 14 and 18 years were brought together and involved in planning Page 335 Healthwatch Salford 9
Forest Bank own wellbeing in their own homes in the The introduction of the Care Act 2015 community and make decisions about their means that local authorities in England are own care and lives. responsible for the assessment and meeting the eligible care and support needs for Strategically we are contributing and prisoners located in their area. feeding views into the Population Health Plan. HM Prison Forest Bank is a Category B Male Local Prison. Healthwatch has worked with Independent Living – Homecare Redesign 8 prisoners and the healthcare assistants to As part of Salford Together’s Home Care deliver training to become Prisoner Redesign project we held staff engagement Wellbeing Representatives. sessions and assisted with facilitating service-user and staff co-design workshops. The training programme was designed to The aim was to ensure that the experiences enable prisoners to co-design a peer of both patients, carers and front-line staff support service within the prison by which are at the heart of the Salford homecare they could signpost and gather the system and feature prominently in service experiences of other prisoners. modelling and commissioning.
Whilst it has been challenging to get the People told us that they felt it important forum off the ground, we have found that that people are assisted to be healthy and our increased exposure has meant that we maintain independent living skills within have prisoners and their families frequently their own homes. Both staff and users said contacting us for information about that there was a need for significant different health conditions and their rights. improvement in the consistency and quality of homecare service provision. We are planning to deliver another Well- being Representative training course later this year.
Information gathered will be themed by Healthwatch independently with issues or areas of best practice being pulled out and discussed with partners.
PREVENTION, VOICE AND INDEPENDENCE
Health Promotion Prevention of illness was also a priority locally and for Healthwatch Salford. Local people told us that they felt it was important that people are supported to avoid admission to hospital, maintain their The Crescent Page 336 Healthwatch Salford 10
Healthwatch Salford will ensure these views are fully considered in the transformation and commissioning of homecare services.
“Something I go on about is ensuring the market place is fit for purpose and this can only be achieved by communicating. The recent Homecare engagement work undertaken by Healthwatch Salford is a good example of this as it included representatives from all organisations involved in Homecare.” Sam Cook, Penderels Trust
Helping People with Dementia Have Their Local art in East Salford Say
In early 2016 we, as part of the New Roots Working Together to develop Patient Network, held a Dementia Discovery Day Participation Groups with 79 people attending, with 10 people Healthwatch Salford supported the living with dementia, 25 carers and 34 development of a paper outlining a professionals. Since then we have been framework for Salford Primary Care working with members of the community Together to engage patients effectively in with dementia to look at how the wishes of its transformation and improvement those living with dementia fit with the journey. agendas around the Locality Plan implementation, age friendly cities and More specifically the paper described the dementia friendly cities work. current position and work undertaken in
the development of G.P. Patient This work has also been presented by a Participation Groups and it focuses on three person living with dementia in their own levels: - words to the Institute for Dementia during • GP Practice Level; their ‘It takes a village: Dementia United’ • Neighbourhood Level; seminar. • City Wide;
It also made recommendations and We have met with commissioners and leads suggestions for a way forward for patient at Dementia United, Salford City Council participation and engagement. and Salford Clinical Commissioning Group to integrate local people’s recommendations into the strategic work around the Locality
Plan, Dementia Friendly Cities and Age
Friendly Cities. This work will help people live and age well here in Salford.
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INFLUENCE AND STRATEGY Care Quality Commission Public Engagement Strategy Healthwatch Salford and CQC Working The CQC are developing their next Public Together Engagement Strategy. Since August 2016, they have been speaking with people about You Said what their new strategy should look like. You told us that you want to make sure that health and social care services are We have had a series of conversations and accountable and listen to the people using webinars with the CQC and Healthwatch them. England about the development of the next CQC Public Engagement Strategy. We Did We have made sure that your views are fed Healthwatch Salford recruited 3 people into scrutiny and safeguarding locally from our membership to take part in the through developed working protocols with national campaign but also fed in the views The Health and Well Being Board, as well as of 30 service-users of mental health the Adult and Children Scrutiny Boards. services in Salford. Because of our input we have helped the CQC to outline These protocols set out a working opportunities for innovative ways of relationship so that we can highlight what working and challenges that they will tackle people have said and challenge decisions as a priority. Their experiences and that are made, when appropriate. involvement have also influenced where the CQC inspect in 2017 and added to the We worked with Healthwatch England, the findings of their State of Care report. Care Quality Commission (CQC) and the National Institute of Health and Care Excellence (NICE) to make sure that your voices are heard nationally as part of inspections, special reviews, guidance and policies.
A successful workshop was held in Salford, attended by local CQC inspectorate managers and Healthwatch Salford staff and volunteers. The aims were to learn more about each other and the current focus of work; review and develop more Bridgewater Canal integrated working and exchange information and share recent concerns and Key actions for the CQC suggested at the findings across health and social care in the webinar by us were: area. • Better information sharing between CQC and Healthwatch (both nationally and locally) through strategy development,
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shared workplans and working towards a and people or organisations supporting shared CiviCRM (database) system. carers across the country. • Accessible Information: BSL, Braille, simple language, easy read, interpreters. In 2017, we will be following up on how the • Use of technology: thinking about National Carer’s Strategy is being different digital techniques like sending developed based on your views and sharing videos, tagging on social media and skype. any updates with carers in Salford to check People also talked about other methods that you think it will work. We will also be that should be used due to digital exclusion working in partnership with Salford Carers’ and literacy levels. Centre to look at how we build feedback gathering into the activities of carers across the city over the next year so that they can influence the next Carers’ Strategy.
How we have worked on the Health & Wellbeing Board (HWbB) During the Locality-Plan-linked priority setting last year, people told us that they wanted help to maintain their own health and wellbeing within conducive environments. Whilst much of this agenda is outside of the remit of Healthwatch Salford The Packet House, Worsley
Department of Health Carers’ Strategy The Department of Health are creating a new national Carers’ Strategy. When we spoke to adult carers last year in Salford they said that help maintaining their physical health, managing long term conditions, coping with stress and anxiety, maintaining social networks and activities, and financial restraints caused by their caring role were their key issues. we have ensured that we are a key partner in the development of the Salford Healthwatch Salford shared the views and Population Health Plan. experiences of 96 carers that we spoke to with the Department of Health as part of SERVICE REVIEWS their call for evidence around the development of the national strategy. National Audit Office Review on Learning Disabilities Local Support They are looking at this information along Last year the National Audit Office with views they have gathered from carers conducted a review to see how the NHS in England and local authorities seek to Page 339 Healthwatch Salford 13
improve the lives of the 129,000 people environment. We also wanted to ask the aged 18 to 64 who use local authority patients what they thought would improve learning disability support services. They the service and about a new pager system also checked to see how the Transforming that NWAS was considering introducing. Care programme was working nationally.
Healthwatch Salford met with them in Salford to feedback the views of local people about the positive and negative things we have been told about: • Provision of support • Healthcare • Day-to-day activities • Carers’ relationship with local authorities • Accommodation • Employment and Volunteering. As a result, their report makes recommendations about where improvements to local strategy and services can be made. St. John’s Cathedral, Chapel Street
We asked some of our volunteers to accompany staff to carry out some work looking at the waiting areas at Salford Royal used by patients waiting for NWAS non-emergency patient transport.
They carried out a questionnaire in the outpatient waiting area over two days at Christina, our intern, gaining some various times to tie in with the clinic times valuable experience at a HWS event at Salford Royal. They did an observation access audit and interviewed 20 patients. MYSTERY SHOP – SALFORD ROYAL Key themes emerged around: Waiting Areas used by Patients for Non- • Accessible information Emergency Transport • Good staff practice We agreed to support North West • Return waiting times Ambulance Service (NWAS) with gathering • Booking and communications patient experience from waiting areas amongst departments around location, accessibility, facilities and
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The key themes were fed back to the as mystery shoppers to attend and report Patient Transport Service Tripartite back to us around the quality of the food. Meeting, which reviews performance and is attended by one of our volunteers. The dietary needs were: • Texture-modified for Speech and Subsequently, improvements have been Language Therapy made to help the discharge lounge process, • Allergen Free including introducing pagers to alert • Low Fibre patients of when their transport has arrived • Low Potassium and a simple sticker that will inform staff • Kosher that the patient is in receipt of non- • Caribbean and West Indian emergency patient transport services and • Halal hence they can help the patient appropriately wherever around the In total 8 volunteers attended 7 food hospital. tasting session and reported back to us that they were satisfied with the appearance, Food Nutrition and Patient Choice taste, smell and texture of the meals In May, Salford Royal invited members who prepared by Apetito. One volunteer said had recently been a patient at Salford that they were “surprised by the amount of Royal to provide their thoughts on a new choice and selection of vegetables”. supplier for the inpatient catering service. Following the full tender process, which The catering staff were prepared and well included evaluations of suppliers’ food, informed to answer questions about premises and an assessment of their nutritional content, food sourcing, storage approach to sustainability, traceability, and preparation. food safety and nutritional quality, Apetito was selected.
During July, 5 members of the public got in touch with us to raise their concerns about the change in provider. Recognising the huge role that nutrition plays in recovery and maintaining health, we spoke to Salford Royal who were aware of the concerns and had responded promptly by arranging a series of public tasting session throughout August to September, offering an opportunity to taste the food and ask Food glorious food at SRFT according to our questions of Apetito and the catering volunteers teams.
We asked some of our volunteers with different dietary needs and requests to go
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Our plans for next year
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What next? In terms of issue groups (13 of them) the following rated highest – appointments and Our Plans for Next Year assessments; waiting, delays and
registration; information, communication, Priorities test results and medical records; service We co-designed this year’s survey with our design, integration, access and levels of volunteers and focused on a shorter survey service; catchment areas and to allow people to tell their full stories commissioning; staff attitudes; standards of about using and accessing local health and clinical care, staff training, pay and social care services. conditions. We will be working in different
ways on these issues. We booked visits and stalls to engage people at 33 locations across Salford. We MOVING FORWARD talked to hundreds of people, raising the profile of our work, with many then going Our Business Plan and Priorities for 2017- on to complete our survey. 18
During this period, we’re committed to The survey was also promoted through the achieving several priorities: website, posted out through our distribution lists and social media, which 1. Organisational development and included over 70 Facebook groups and sustainability: Our Healthwatch Salford Twitter. Board
• Role Requests were made to promote it through The role of the Board and its effectiveness strategic partnerships such as Salford CVS will continue to be strengthened through VOCAL forum and the Health & Wellbeing the development of an assessment process Board. The locations attended included for Board members and more opportunities community events, Gateways, GP practices. for self-evaluation. We will also explore the
potential for peer Board assessment from We had 220 individual respondents to the Directors of other Healthwatch. survey, with several key themes emerging. • Conduct In terms of location of care delivery, The Code of Conduct will be refreshed. We hospitals rated highest with 81 comments, want it to be crystal clear as to what makes 65 related to GPs and 24 concerned services an exemplary Board Member and what is delivered in the community. These were the individual commitment and the three highest. In terms of ‘reason for contribution that we expect from Directors. care’ - there was more of a spread. A&E, The attendance and punctuality of mobility, cardiology, dementia, individual Board Members will also be dermatology, diabetes, childcare, mental monitored and reported at the next AGM. health, cancer, oral, podiatry, • Policies pulmonary/respiratory, sensory and social We will develop a full suite of care all figuring highly. (53 headings in the organisational policies which reflect the ‘reason for care’ category). values of HWS as an independent
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organisation. All policies will be ratified by 3.Increased Profile and Community the Board with an ongoing schedule of Engagement review. • Volunteers • Finance We will increase both the numbers of those As we are now a registered charity we are volunteering and opportunities to be obliged to follow guidance for fiscal involved in our work in diverse ways. management from the Charities Commission We will further develop ways to get and Companies House. To this end we have feedback from people about the experience appointed our own independent auditors. of volunteering with us and improve our We commit to do everything we can to volunteering programme accordingly. work with our Auditors to ensure that our accounts are available on time for our • Profile and Visibility company members to view and digest We commit to taking every opportunity we before the AGM. can, and will encourage members and staff, to ‘spread the word’ and seize every We have developed our finance policy and opportunity to increase membership. We will ensure that systems are in place to will look creatively at how we can make it ensure that money is managed effectively more attractive to be a member and how and with transparency. We want our we can be more engaging throughout the partners to be assured that there is year with existing members. effective fiscal management and scrutiny. We will produce fresh marketing materials 2. Strategic Engagement and take other opportunities to enhance The Board will review annually, all strategic the profile of Healthwatch Salford. engagement to ensure that it is in line with To facilitate accessibility, our Annual our priorities and statutory functions. This report will also be produced in Easy Read will mean ensuring that our presence is version. conducive to addressing issues which have been raised with us through our • Feedback and Priorities engagement activities. We will increase our visibility with the public of Salford and be more present in More mutually beneficial arrangements will the streets, shopping centres, community be developed further with Salford Adults centres and at events. Over-view and Scrutiny Committee and Salford Adults Safeguarding Board. We will develop a new online feedback Concerns have been raised about the centre for people to personally feedback to quality of care received within care homes. us their concerns and views. This new We commit to conducting Enter and Views system will simplify how we ask for views based on the feedback we have received. and will further improve our systems for feeding back to people what happens because of the views they give us.
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Our people
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OUR VOLUNTEERS equipped to tackle the challenges that we face when we face them together. It is Volunteer involvement about us coming together to celebrate the Our volunteers are one of the keys to our work we have done to help people have a success. They’re our ‘eyes and ears’ talking voice in health and social care. to people and finding out what matters most to the people of Salford about their All volunteers got certificates highlighting health and care services. their achievements and contribution over the past year to Healthwatch activities. 4 Since we formed we have trained over 50 volunteers won awards under Salford CVS’s people in the skills they need to listen and Volunteer Award for giving 100 hours or reflect local people’s views. more to Healthwatch in the past year and 1 was awarded for giving over 500 hours. This year, we had 20 volunteers give over 900 hours of their time to make sure that Our work would not be possible without the experiences of people were heard by them so we’d like to say a huge Thank You those who design, commission and deliver to all our volunteers! health and social care in Salford. What our volunteers say
“The NHS keeps me healthy. Volunteering with Healthwatch helps me return the favour! Peter Baimbridge (June 2017)
Delana and Sean at the Volunteers’ Big Lunch
During April 2016 to March 2017, our volunteers have listened to you at 48 community events and in 8 health and social care services; and reported your views at over 50 decision making meetings Peter and have worked on a range of projects within Healthwatch Salford.
As part of Volunteers Week in June we celebrated with our volunteers at our Big Lunch at Worsley Old Hall. The Big Lunch reflects our belief that we are better Page 346 Healthwatch Salford 20
“The reason I am volunteering is to empower the people of Salford to have a voice in their healthcare and a positive influence on our future of healthcare” Natalie Hunt (June 2017)
Natalie
“As a citizen of Salford, I’ve had to access health and social care on different occasions – I’d like to see things done differently; and to bring change you have to involve yourself in change” Andy Green (June 2017)
+++++++++++++++++++++++++++++++++++++
A Big Thanks to Unlimited Potential Healthwatch Salford was brought into the world by Unlimited Potential, the Salford social enterprise that was commissioned to do so by Salford City Council. Before we left at start of December they gave us a great send-off……and we miss them all.
Anyone for cake?
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Our Board Our Staff
Left to right from top: Phil Morgan (Chair), Jackie Tait (Vice-chair), J Ahmed; Faith Mann, Jackie Leigh, Antoinette Doyle, Michelle Duncalf. Left to right from top: Delana Lawson (Chief Officer), John Geoghegan (Information & Signposting Officer), Ruth Malkin (Engagement Officer), Safia Griffin (Engagement Officer), Kathryn Cheetham (Engagement Officer accepting a commendation from Healthwatch England on our behalf).
Thank you to Tracey Williamson and
Bernice Seworde who left us. All your hard work is appreciated.
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Our finances
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Healthwatch Finances 2016 - 2017
Income £
Funding received from local authority to deliver local 158,388 Healthwatch statutory activities
Additional income 38,003
Total income 196,391
Expenditure
Operational costs 7,232
Office costs 4,525
Staffing costs 83,097
Healthwatch Steward 20,248
Premises 836
Total expenditure 115,938
Balance brought forward 80,453
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Contact us
www.healthwatchsalford.co.uk Heathwatch Salford t: 0330 355 0300 The Old Town Hall e:[email protected] 5 Irwell Place tw: @HWSalford Eccles fb: facebook.com/TellHealthwatchSalford/ Salford M30 0FN
Healthwatch Salford is a private limited company, registered in England and Wales. Company number 9563358. Registered Office: The Old Town Hall, 5 Irwell Place, Eccles, Salford M30 0FN. Healthwatch Salford is registered with the Charity Commission as a charity; Registered Charity Number 1171170.
We will be making this annual report publicly available on 30 June 2017 by publishing it on our website and sharing it with Healthwatch England, CQC, NHS England, Salford NHS Clinical Commissioning Groups, Overview and Scrutiny Committee/s, and Salford City Council.
We confirm that we are using the Healthwatch Trademark (which covers the logo and Healthwatch brand) when undertaking work on our statutory activities as covered by the licence agreement.
If you require this report in an alternative format please contact us at the address above.
© Copyright Healthwatch Salford 2017
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This page is intentionally left blank Item no. 13i
Salford Health and Wellbeing Board
Title of report Better Care Fund Update Date 10th October 2017 Contact Officer Karen Proctor, Director of Commissioning, Salford CCG
1. Executive Summary
Why is this report being brought to the Oversight of the Better Care Fund (BCF) local Board? - Relevance of this report to the plan is a Health and Wellbeing Board priorities of the Joint Health and Wellbeing responsibility. Strategy, the Joint Strategic Needs Assessment or integrated working Health and Wellbeing Board’s duties or BCF planning guidance identifies Health and responsibilities in this area Wellbeing Boards as responsible for approval of annual plans. In Salford this has been delegated to the Integrated Care Joint Commissioning Committee (ICJC). Key questions for the Health and Wellbeing The update is provided for information. Board to address - what action is needed from the Board and its members? What requirement is there for internal or Communication with stakeholders is required external communication around this issue? to develop the plan and this has been completed.
The Better Care Fund has been in place since 2014/15 as a national framework to support health and social care integration. There is a requirement for local areas to provide annual BCF plans to the national BCF team, using templates provided. The plans cover integration schemes, spend, metrics and national conditions.
Salford’s BCF planning template has been approved by the Adults Integrated Care Joint Commissioning Committee and was submitted to the national BCF team on the 11th September 17.
The Greater Manchester (GM) Health and Social Care Partnership has agreed with the national BCF team that an additional supporting narrative plan is not required from GM localities. This is because Taking Charge and the ten locality plans demonstrate a level of integration that goes beyond the BCF’s intent.
All previous Salford BCF Plans received full assurance.
The Health and Wellbeing Board is requested to note the submission of Salford’s BCF planning template and that the outcome of the assurance process will be provided during October 2017.
Page 353 1 1. Introduction
1.1 The BCF is a statutory policy to facilitate integration through providing health and social care funding for local areas to support integration. The BCF provides a framework for joint health and social care planning and commissioning bringing together ring-fenced budgets from CCGs allocations and the Disabled Facilities Grant (DFG).
1.2 The BCF is not a new allocation. It has been available since April 2014 and incorporated into Salford’s Adults pooled budget (previously older people’s pooled budget). As such it is already committed within the pooled budget commissioning plans (the Service and Financial Plan). For 2017/18 to 2019/20 it includes additional funding paid directly to local government for adult social care services. The latter is termed the Improved BCF (iBCF).
1.3 The Better Care Fund Planning Guidance 2017/18 to 2018/19 was published on the 3rd July 2017. A summary of the main points from the Planning Guidance was provided to the Health and Wellbeing Board by e-mail on the 28th July 2017. The planning guidance requires a planning template and a more detailed narrative plan to be prepared.
1.4 Greater Manchester Health and Social Care Partnership (GMHSCP) has agreed with the national BCF team that supporting narrative plans are not required from GM localities; given that the GM Plan (Taking Charge) and the 10 locality plans demonstrate a level of integration that goes beyond the BCF’s intent. A BCF planning template however remains a requirement.
2. BCF Planning Template
2.1 The BCF planning template aims to collect the following planning information for each locality: Funding contributions and breakdowns Schemes and associated spend Metrics and quarterly trajectories for 2017/18 and 2018/19 Whether national conditions are met
2.2 As, in Salford, the Better Care Fund forms part of the larger pooled budget for adult services the financial sections in the planning template includes all contributions to the adult pooled budget (not just the funding associated with the BCF) and the planned spend on all services/schemes within the adult pooled budget.
2.3 The BCF planning template requires localities to submit trajectories for the four key metrics below for a two year period (2017/18 to 2018/19). Non-elective admissions (General and Acute) (quarterly); Admissions to residential and care homes (annual); Effectiveness of reablement (annual); and Delayed transfers of care (quarterly);
2.4 Proposed trajectories for the metrics in Salford have been included in the planning template; these trajectories are in line with targets set for these measures in other plans such as the Locality Plan, the Greater Manchester Transformation Fund Investment Agreement and Urgent Care Improvement Plan. In addition, the non- elective admissions trajectory is consistent with contract plans with Trusts.
Page 354 2 2.5 The submission confirms, as required, that the following national conditions detailed in the BCF Planning Guidance are on track to be met through delivery of the plan in 17-19: Plans to be jointly agreed NHS contribution to adult social care is maintained in line with inflation Agreement to invest in NHS commissioned out of hospital services Managing transfers of care
2.6 The guidance says that the Health and Wellbeing Board should approve the plan. In Salford, this has previously been delegated to the Integrated Care Alliance Board, prior to April 2016 and Integrated Care Joint Commissioning Committee (ICJC) since April 2016. Following discussion at various groups, ICJC approved the planning template for 2017 -19 in September 2017. The template can be provided to Health and Wellbeing Board members upon request.
3. Assurance and monitoring
3.1 BCF plans will be assured and moderated regionally via NHSE Director of Commissioning Operation Teams and regional local government leads. Plans will either, be approved, approved with conditions or not approved and areas will be notified by letter of the outcome from the 6th October 2017. For plans which are not approved support will be provided to achieve a compliant plan for resubmission by the end of October 2017.
3.2 Key lines of enquiry to support both development and assurance of plans are published. Once plans are approved allocations will be authorised.
3.3 In Salford, the annual BCF Plans have always been fully assured. The last one was produced in March 2016 for the 2016/17 year.
3.4 Quarterly monitoring of the information within the BCF planning template has been required in previous years however dates for monitoring submissions for this year have not yet been confirmed.
4. Graduation
4.1 Greater Manchester has applied to graduate from the BCF planning process on the 19th May, which may reduce the planning and reporting requirements. There were 17 first wave Expressions of Interest to graduate from the BCF. The short-list (who will go through graduation panels in the Autumn), is being finalised.
4.2 The GMHSCP were informed in August that there was no outcome from the national bodies on the Better Care Fund graduation application yet and therefore GM localities would still be required to submit the BCF planning template (without a supporting narrative plan) for the 11th September 2017.
4.3 The outcome of BCF graduation and the BCF monitoring requirements will be shared with the Health and Wellbeing Board, when this is known.
Page 355 3 5. Recommendations
5.1 The Health and Wellbeing Board is requested to note the submission of Salford’s BCF planning template and that the outcome of the assurance process will be provided during October 2017.
6. Contextual information
BACKGROUND DOCUMENTS:
STRATEGIC DRIVERS AND EVIDENCE OF NEED: Salford’s Service and Financial Plan for adults 2016/17 to 2020/21, Salford’s Locality Plan - Start Well, Live Well, Age Well, http://www.salfordccg.nhs.uk/salford-locality-plan NHS England, Better Care Fund Planning Guidance, 2017-19. https://www.england.nhs.uk/wp-content/uploads/2017/07/integration-better-care- fund-planning-requirements.pdf
THIS REPORT CONTENT HAS ALSO BEEN CONSIDERED BY: Integrated Care Joint Committee – 12th July and 13th September 17 Advisory Board for Integrated Care - 18th July and 5th September 17 Locality Plan Programme Board – 8th August 17 Service and Finance Group – 1st August 17 Urgent and Emergency Care Board – 28th July 17
EQUALITY IMPACT ASSESSMENT AND IMPLICATIONS: N/A
ASSESSMENT OF RISK: Pooled budget risk management is overseen by ICJC.
LEGAL IMPLICATIONS: N/A
FINANCIAL IMPLICATIONS: The Better Care Fund forms part of the pooled budget for adult services
PROCUREMENT IMPLICATIONS: N/A
HR IMPLICATIONS: N/A.
Page 356 4 Locality Workforce Strategy Deep Page 357 Page Dive
SRO: Sam Betts PM: Sue Louth; Catherine Sharples
29/9/17 Context
• Workforce is a critical enabler for transformation Page 358 Page • Public sector workforce = c10,500 staff (2016) • ‘Hidden workforce’ - Unpaid carers and volunteers • Increased demand for services means the workforce needs to be planned, trained and supported differently
Workforce challenges
• Difficulty in recruiting/ retaining people with the rights skill • The opportunities provided for learning and
Page 359 Page development are seen as limited in some sectors • The ability to gather and understand workforce data for some sectors • Need for a cultural and behavioural shift for all the parts of the workforce to a place-based approach • Widening participation - how can we support local residents into employment?
Milestones
Workforce visioning workshop June 2016 First draft strategy August 2016 Workforce transformation group established September 2016
Page 360 Page Realignment of strategy to emerging GM strategy April 2017
GM workshop with other localities April 2017 Refining of strategy in line with locality transformation July 2017 programmes Engagement workshop September 2017 Development of action plans September – October 2017 Establish task and finish groups (delivery) November 2017 Final draft shared with partners and members November 2017 Sign off by HWBB February 2018 Engagement
• Core workforce transformation group – SCCG, SCC, SRFT, GMMH – Workforce and service leads
Page 361 Page – Employment representatives • Wider reference group – Carers – VCSE sector – Fire – Police – Education
Links to GM workforce strategy
• Talent development and leadership – Joint leadership & development programmes – Salford Exchange Network
Page 362 Page • Grow our own – Enable more apprenticeships across health & care – Career engagement hub • Employment brand and offer – Charter for employment standards – How can we attract people to work in Salford? • Filling difficult gaps – Identification of key workforce shortages – Joined up approach to recruitment across partners Emerging priorities
• Employee engagement is key • Workforce development programme required
Page 363 Page for all parts of the workforce, including unpaid workforce • Leadership and management development • Culture of ‘place’ High Level Actions
• Engagement and communication plan • Develop digital capability across all parts of Page 364 Page the workforce • Maximise opportunities of apprenticeships / identify opportunities across integrated care system • Joint leadership programme – all levels • Shadowing/job swaps Challenges
• Capacity within the system to prioritise strategic workforce development
Page 365 Page • No ring-fenced funding for workforce transformation
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Salford Health and Wellbeing Board
Title of report Children and Families Act – Implementation of SEND reforms Date 21st September 2017 Contact Officer Cathy Starbuck / Geoff Catterall
1. Executive Summary
Why is this report being brought to The three year implementation phase following the the introduction of the Children and Families Act will end Board? - Relevance of this report to in March 2018. the priorities of the Joint Health and This is to update the Board about the achievements Wellbeing to date and to describe what is left to do to influence Strategy, the Joint Strategic Needs the cultural changes across health, social care and Assessment or integrated working education which were intended by the legislation.
Health and Wellbeing Board’s duties Section 27 of the Act requires local authorities to or responsibilities in this area keep the education, training and social care provision made for disabled children or young people and those with SEN under review. The process of keeping education, training and social care under review should be integrated with the Joint Strategic Needs Assessment undertaken by the Health and Wellbeing Board. In turn the Health and Wellbeing Board has strategic influence over local commissioning decisions and is responsible for the Joint Strategic Needs Assessment that analyses the health and social care needs of the local community.
Section 25 of the Act places a duty on local authorities to promote integration between educational and training provision, health care provision and social care provision. This duty mirrors the duty placed on CCGs by the Health and Social Care Act 2012. The NHS Mandate also makes clear that NHS England, CCGs and Health and Wellbeing Boards must promote the integration of services if this will improve services and/or reduce inequality. Key questions for the Health and To note progress made, consider the challenges and Wellbeing consider how the Board’s responsibilities and duties Board to address – what action is in this area can influence improving outcomes for needed from the Board and its children and young people aged 0-25 across Salford members? who have special educational needs and/or disabilities. What requirement is there for This is managed by the Children and Families Board. internal or external communication around this issue?
Page 367 2. Introduction
Duties regarding provision of support for children and young people with special educational needs and/or disabilities (SEND) are contained in the Children and Families Act 2014 (the Act), and regulations made under the Act. The duties are amplified in the statutory guidance ‘Special educational needs and disability code of practice: 0 to 25 years’ (the Code of Practice) published jointly by the Department for Education (DfE) and the Department of Health (DoH). These duties came into force in September 2014.
The Act expects significant changes in the way that services and support for SEND are delivered and the outcomes that are achieved. Approaches have to be outcome focussed and aspiration driven. This has been a key culture change away from the needs driven approaches used previously. Maintaining momentum of the culture change around service delivery is critical as other pressures emerge (budgetary, increased demand and meeting statutory deadlines).
Sometime between now and 2019, Ofsted and CQC will undertake an inspection to evaluate how well Salford carries out its statutory duties and how well it supports children and young people with SEND to achieve the best possible outcomes including educational, being able to live independently, secure meaningful employment and be well prepared for their adult lives. A key element of inspection will be how well the area knows its strengths and weaknesses.
3. Key issues for the Board to consider
Completion of Education Health & Care Plans within the 20 week statutory time frame remains a challenge. A dip in performance during 2016 to below 10% has been scrutinised in detail by an Accountability Group comprising senior colleagues across all agencies. Whilst the performance has improved considerably (currently above 50%) the current work is focussing on the key obstacles which include The capacity of and timeliness in advice from health partners Increased demand and complexity of need Timeliness in responses from the education settings when being consulted over whether being named in a Plan. Capacity in SEN teams Quality assurance
Transfer of Statements of SEN to EHC Plans has to be completed by March 2018. Of the 1450 Statements in Salford, only 120 remain to be transferred and all of these are in process. Every transfer involves a re-assessment and the production of outcome focused plans with families at the centre of choice and control. Salford’s performance in this area bucks the national trend where it is proving a challenge to complete the transfers on time.
Effective co-production and engagement with parents is evident in Salford, both strategically and at an individual planning level. Salford Parent Voice is represented at the Children and Families Board. The Local Authority and Salford Parent Voice meet to consider the joint returns to the DfE on local progress in implementing the reforms.
Page 368 Joint commissioning arrangements are supporting the expectation that partners are working together to monitor how outcomes in education, health and care are being improved as a result of the provision they make. The Joint Commissioning Statement weaves the arrangements together with the needs analysis and planning around provision. There are strong and effective working relationships between the CCG and LA at a strategic and clinical level.
There is a duty on the local authority to host a Local Offer of all provision available within the area for children and young people with SEND and their families. It also acts as a conduit for families to feed into the joint commissioning process. Following the successful work to ensure the offer meets all legal obligations, the next stages are to encourage more input via it into joint commissioning and to continue to work with users to ensure it meets their needs and to make it the ‘go to’ place. Those that use it are strong supporters.
Personal budgets in EHC Plans are an area for development. Nationally, this has proved to be a challenge. There are some good local examples merging such as a young person at college with a personal budget to provide mentoring support for work experience and access to leisure/vocational opportunities and to enable easier access to transport.
Transition: for young people with SEND and their families the change from children’s to adults’ services can feel confusing and difficult. Working in partnership with families and young people to plan transition from aged 14 is key to success. For those with an EHC Plan, transition will become integral to the planning and review of the EHCP through the critical years. The Children and Families Board welcome the recently published NICE guidance – ‘Building Independence through Planning for Transition’ as an effective toolkit for practitioners.
At any one time 12% of the 0-25 population will have an identified additional need but do not require a full EHC assessment to have their support in place. There is good knowledge of this population and excellent working arrangements between partners. Work is being undertaken around the robustness of identification in terms of the ‘primary need’ by schools in their census. Moderate learning needs are the largest cohort but many of whom will have a diagnosis, for example, of autism and which does not translate into the school data. Learning Support Services are working with schools on this and effective provision mapping, co-production and moderation activity.
The Children and Families Board have developed a more outcome focused data monitoring scorecard which provides a more effective self view.
Shaping our City – 0-25 transformation work includes SEND as well as trialling new and innovative ways of working with families putting them in control and choice of solutions to improve outcomes.
The forthcoming inspection will cover the local area and potentially all services that contribute to the 0-25 SEND offer. There has been much work to prepare for the inspection, including development of a self evaluation framework, CCG audit, setting up of key focus groups and an up to date analysis of data (comparative national data sets have now been published).
Page 369 4. Recommendations for action
For the Board to assure itself of progress in implementing the SEND reforms and to be assured of the effectiveness of the local area in meeting the needs of the 0-25 population with SEND.
5. Contextual Information
Please refer to previous reports to the Board.
BACKGROUND DOCUMENTS:
SEN CODE OF PRACTICE JULY 2015 CHILDREN AND FAMILIES ACT 2014 CARE ACT 2014 NICE Guidance ‘Building Independence through Planning for Transition’ 2017
STRATEGIC DRIVERS AND EVIDENCE OF NEED:
The duties and activities reported are statutory under the above legislation.
THIS REPORT CONTENT HAS ALSO BEEN CONSIDERED BY:
Children and Families Board
EQUALITY IMPACT ASSESSMENT AND IMPLICATIONS: Not applicable for this update.
ASSESSMENT OF RISK:
A risk register is regularly reviewed by the Children and Families Board
LEGAL IMPLICATIONS:
Families have recourse to Tribunal and Judicial review on decisions made by the Local Authority under this legislation.
FINANCIAL IMPLICATIONS: Beth Mitchell x 3205
Funding in this area is provided from three sources, the core budgets, DSG and the SEN grant.
Page 370 The core funding will be managed as part of the overall Children’s budget, there is currently enough budget but this may be subject to savings in future years. The DSG funding will be managed as part of the overall funding provision for High Needs children, and the SEN grant is closely monitored on a monthly basis to ensure all costs are covered.
PROCUREMENT IMPLICATIONS: N/A
HR IMPLICATIONS: N/A
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