AGENDA - NHS Stafford and Surrounds CCG

Enc 00

Stafford & Surrounds Clinical Commissioning Group Governing Body Meeting in Public

Beacon International Centre, Unit 26 Anson Court, Staffs Technology Park, Stafford, ST18 0GB

To be held on Tuesday 17th February 2015

14:00 – 16:30

AGENDA

12:30 – 14:00 Confidential Governing Body Meeting

FOLLOWED BY:

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

A=Approval R=Ratification D=Discussion I=Information

Enc Lead A/R/D/I

1. Welcome by the Chair Verbal AMH I

2. Apologies for Absence Verbal AMH I

3. Conflicts of Interests Declarations of Interest Register for Stafford & Surrounds Governing Body

Enc 01 AMH I

4.

Minutes of the last meeting: Minutes of Meeting 20/01/15 Matters Arising/Action List

Enc 02 Enc 03

AMH AMH

A A

5. Chairs Report Verbal AMH I

6. Chief Officers Report Enc 04 AD I

7. Quality and Safety Report Enc 05 VJ I

8. Performance Report – December 2014 Enc 06 LM I

9. Board Assurance Framework (BAF) Enc 07 SY D

10. Finance Report - December 2014 Enc 08 PS D/I

11. Primary Care Strategy Enc 09 LM A

12. IVF/ICIS Policy 2015 Enc 10 MH A

13. Stafford CCG Q2 Assurance letter Enc 11 AMH I

14.

Items for Information Finance, Performance & Contracting Minutes Communications & Engagement Committee

Minutes

Enc 12 Enc 13

AMH I

Enc 00

15. Any Other Business

Should GP pressure be a 'standing item' or not

Enc 14

AMH

D/A

16. Questions from the public: 16:00 – 16:30 Verbal

17.

Next Meeting – Organisational Development

Date: Tuesday 17th March 2015 Time: 14:00 – 17:00 Venue: Beacon International Centre, Unit 26 Anson Court, Staffordshire

Technology Park, Stafford, ST18 0GB

Acronyms

1. A&E Accident & Emergency 2. ALE Auditors Local Evaluation 3. AED Automated External Defibrillator 4. ADP Accelerated Development Programme 5. AHP Allied Health Professional 6. ALAN Adult Literacy and Numeracy 7. ALOS Average Length of Stay 8. ANNP Advanced Neonatal Nurse Practitioner 9. APMS Alternative Provider Medical Services 10. AQP Any Qualified Provider 11. AVS Acute Visiting Service 12. BCH Birmingham Children’s Hospital 13. BEN Birmingham East and North PCT 14. BNP Brain Natriuretic Peptide 15. CAG Commissioning Advisory Group 16. CAMHS Children and Adolescent Mental Health Service 17. CAS Clinical Assessment Service 18. CB Commissioning Board 19. CBSA Commissioning Business Support Agency 20. CC Cannock Chase 21. CCG Clinical Commissioning Group 22. CDiff Clostridium Difficile Infection 23. CEO Chief Executive Officer 24. CGA Comprehensive Geriatric Assessment 25. CHAI Commission for Health Auditing Inspection 26. CHI Commission for health Improvement 27. CHPP Children’s Health Promotion Programme 28. CIAMs Commissioning Investment Asset Management Strategy 29. CIG Clinical Informatics Group 30. CIP Cost Improvement Programme 31. CNST Clinical Negligence Scheme for Trusts 32. CoE Care of the Elderly 33. COPD Chronic Obstructive Pulmonary Disease 34. CPAG Clinical Policies Advisory Committee 35. CPN Community Psychiatrist Nurse 36. CQC Care Quality Commission 37. CQRM Care Quality Review Meetings 38. CQUIn Commissioning for Quality and Innovation 39. CQINS Cancer Quality Improvement Network System 40. CMT Contract Management Team 41. CRL Capital Resource Limit 42. CRT Crisis Response Team 43. CSIP Clinical Services Implementation Programme 44. CSU Commissioning Support Unit 45. CSW Clinical Support Worker 46. CWG Clinical Working Group 47. DC Day Care 48. DCC Direct Clinical Care 49. DES Direct Enhanced Service 50. DIPC Director of Infection Prevention & Control

51. DN District Nurse 52. DoH Department of Health 53. DoLs Deprivation of Liberty Standards 54. DPD Dental Practice Division 55. DPP Developing Patient Partnerships 56. DQF Data Quality Facilitator 57. DRS Dental Reference Service 58. DTC Delayed Transfer of Care 59. EAU Emergency Admissions Unit 60. ECDL European Computer Driving Licence 61. ECIST Emergency Care Intensive Support Team 62. EDD Expected Discharge Date 63. EDS Euality Delivery System 64. EL Elective 65. EMS Escalation Management System 66. ENT Ear Nose Throat 67. EPO Emergency Planning Officers 68. ESR Electronic Staff Record 69. EWISS Emotional Well Being in Stafford & Surrounds 70. EWTD European Working Time Directive 71. FE Frail Elderly 72. FIG Financial Improvement Group 73. FIMS Financial Information Management System 74. FIT Funding Individual Treatment – now FET 75. FET Funding Exceptional Treatment 76. FFT Friends and Family Test 77. FNOF Fractured Neck of Femur 78. FOI Freedom of Information 79. F&P Finance and Performance 80. FPC Finance Performance & Contract Committee 81. GAAP Generally Accepted Accounting Principles 82. GDC General Dental Council 83. GDS General Dental Services 84. GMS General Medical Services (Practice) 85. GPWSI GP with special interest 86. GSF Gold Standard Framework 87. HALO Hospital Ambulance Liaison Officer 88. HCC Healthcare Commission 89. HCIA Healthcare Acquired Infection 90. HEFCE Higher Education Funding Council for England 91. HEFT Heart of England Foundation Trust 92. HIS Health Informatics Service 93. HPA Health Protection Agency 94. HPS Health promoting Schools 95. HPSS Health promoting Schools Scheme 96. HRG4 Healthcare Resource Group 4 97. HROD Human Resources Organisational Development 98. HSJ Health Service Journal 99. ICG Infection Control Group 100. IFR Independent Funding Request 101. IFRS International Financial Reporting Systems

102. IG Information Governance 103. IP Inpatients 104. IM&T Information Management and Technology 105. IPC Infection Prevention & Control 106. IPR Individual Performance Review 107. IQT Improving Quality Team 108. ISA Intermediate Support Assistant 109. ITT Invite to Tender 110. IV Intravenous Therapy 111. IWL Improving Working Lives 112. JCI Joint Clinical Investigation 113. JCU Joint Commissioning Unit (SCC) 114. JSNA Joint Strategic Needs Assessment 115. JSP Joint Staff Partnership 116. KPI’S Key Performance Indicators 117. LAA Local Area Agreement 118. LCCB Local Collaborative Commissioning Boards 119. LCP Liverpool Care Pathway 120. LDP Local Delivery Plan 121. LES Local Enhanced Service 122. LETB Local Education and Training Board 123. LH Local Hospital 124. LHE Local Health Economy 125. LIN Local Intelligence Network 126. LINks Local Involvement Networks 127. LMC Local Medical Council 128. LMS Local Medical Services 129. LOC Local ophthalmic Committee 130. LSC Learning Skills Council 131. LSP Local Strategic Partnership 132. LTB Local Transition Board 133. LTC Long Term Conditions 134. LTFM Long Term Financial Model 135. MAU Medical Assessment Unit 136. MAT Maternity 137. MDT Multidisciplinary Team 138. MFCA Multi Factorial Comprehensive Assessment 139. MHRA Medicines & Healthcare products Regulatory Agency 140. MICOT Minor Injuries Community Outreach Team 141. MLU Midwife-led Unit 142. MORI (Market & Opinion Research International) 143. MOI Memorandum of Information 144. MPIG Medical Practice Income Guarantee 145. MRSA Meticillin-Resistant Staphylococcus Aureusis Infection 146. MSFT Mid Staffordshire NHS Foundation Trust 147. MSK Musculoskeletal 148. MUR Medicine Use Review 149. NCAS National Clinical Assessment Service 150. NCB National Commissioning Board 151. NCT National Childbirth Trust 152. NEDs None Executive Directors

153. NEL Non-Elective 154. NES National Enhanced Service 155. NICE National Institute for Clinical Excellence 156. NHSU NHS University 157. NHQAC Nursing Home Quality Assurance Group 158. NRPSI National Register of Public Service Interpreters 159. NTDA NHS Trust Development Authority 160. OBD Occupied Bed Days 161. OOH Out of Hours, also Out of Hospital 162. OP (D) Outpatients (Department) 163. OT Occupational Therapist 164. PA Programmed Activities 165. PAED Paediatrics 166. PALS Patient Advice and Liaison Service 167. PASS Professional Advice and Support Service 168. PAU Paediatric Assessment Unit 169. PBC Practice Based Commissioning 170. PBR Payment By Results 171. PC Planned Care 172. PCR Patient Charge Revenue 173. PCT Primary Care Trust 174. PCTDS PCT Dental Service 175. PEAT Patient Environment Action Team 176. PEC Professional Executive Committee 177. PRF Patient Report Form 178. PiP Partners in Paediatrics 179. PIP Productivity Improvement Programme 180. PIS Prescribing Incentive Scheme 181. PLCV Procedures of Limited Clinical Value 182. PLT Protected Learning Time 183. PMO Programme Management Office 184. PMS Personal Medical Services 185. POPP Partnerships for Older People Projects 186. PPG Patient Participation Group 187. PPI Patient and Public Involvement 188. PPI

(prescribing) Proton Pump Inhibitors

189. PPV Post Payment Verification 190. PQQ Pre Qualifying Questionnaire 191. PRISM Personnel Resource Information System for

Management 192. PROMs Patient Related Outcome Measures 193. PT Physical Therapist 194. PTL Patient Target List 195. PU Pressure Ulcer 196. PWSI Pharmacist with Special Interest 197. QIA Quality Impact Assessment 198. QIF Quality Improvement Framework 199. QIL Quality Improvement Lead 200. QIP Quality Improvement Lead 201. QIPP Quality, innovation, productivity and prevention.

202. QOF Quality and Outcomes Framework 203. QSG Quality Surveillance Group 204. QSISM Quality and Safeguarding Information Sharing Group 205. RAG Responsible Authorities Group 206. RAG Red Amber Green 207. RCA Root Cause Analysis 208. RIA Risk Impact Assessment 209. RRL Revenue Resource Limit 210. RTT Referral to Treatment 211. RWHT Royal Wolverhampton Hospital Trust 212. SALT Speech & Language Therapist 213. SARC Sexual Assaults Referrals Centre 214. SCC Staffordshire County Council 215. SCG Strategic Commissioning Group 216. SCR Strategic Change Reserve 217. SCIO Staffordshire Consortium of Infrastructure Organisations 218. SCBU Special Care Baby Unit 219. SCWP Social Care Workforce Planning 220. SDB Service Delivery Board 221. SHA Strategic Health Authority 222. SI Serious Incident 223. SIB Service Improvement Board 224. SIC Statement of Internal Control 225. SLAM Service Level Agreement Model 226. SPA Supporting Programmed Activities 227. SPEC Strategic Public Engagement Committee 228. SSHLF South Staffordshire Health Libraries Federation 229. SSOTP Staffordshire & Stoke on Trent Partnership Trust 230. SSPAU Short Stay Paediatric Assessment Unit 231. SSSHCFT South Staffs & Shropshire Healthcare Foundation Trust 232. SUI Serious Untoward Incident 233. SUS Secondary User Services 234. TSA Trust Special Administrator 235. TV Team Tissue Viability Team 236. UCC Urgent Care Centre 237. UDA Units of Dental Activity 238. UHB University Hospital Birmingham 239. UHNS University Hospital North Staffordshire 240. UOA Units of Orthodontic Activity 241. VT Vocational Trainee 242. VFM Value for Money 243. VO Variation Order 244. WIC Walk in Centre 245. WCC World Class Commissioning 246. WMQRS West Midlands Quality Review Service 247. WMSCG West Midlands Strategic Commissioning Group 248. WTE Whole Time Equivalent

Declarations of Interest Register for Stafford & Surrounds Governing Body

January 2015

Page | 1 02 July 2014

Name Date of Declaration

Position/Role Designation Potential or actual area where interest could occur

Dr Manu Agrawal 24.11.2014 GP Rising Brook Surgery

Practice member of GP First Director of GPF Rising Brook Limited Membership Board Member

Neil Chambers 13.01.2015 Lay Member for Governance

CC & SaS CCG Working across both CCGs.

Non Exec Board Member Wyre Forest Community Housing Group

Andrew Donald 12.01.2015 Chief Officer CC & SaS CCG Spouse - Chief Operating Officer North division Staffordshire & Stoke on Trent Partnership Trust. Working across both CCGs.

Ruth Goodison 26.01.2015 Lay Member for PPI

Stafford & Surrounds CCG

Nil to declare

Dr Paddy Hannigan 13.01.2015 GP Holmcroft Surgery Partner at Holmcroft Surgery

Salaried sessional post as GP to Weston House Nursing Home owned by MHA Practice is Shareholder in GP First

Spouse - Consultant Neonatologist at UHNM

Jean Harrison 13.01.2015 Lay Member (Non Statutory)


Sibling is Director of Stafford Railway Circle Ltd Trustee and Chair of The Proteus Family Network UK Charity

Bank Staff in Finance Department at Katharine House Hospice 'Member of the Proteus Family Network UK Medical Advisory Board at Gt Ormond St Hospital, London

Dr Marianne Holmes

13.01.2015 GP Hazeldene House Surgery

Partner Great Haywood Health Centre Practice Member GP First

Dr Anne-Marie Houlder

12.01.2015 Chair Brewood Surgery / Stafford & Surrounds CCG

Salaried GP Brewood Surgery

Occupational Health Advisor Spirit Occupational Health Ltd (salaried)

Assistant Medical Director Staffordshire & Shropshire Area Team

NED Stafford FM Radio (unpaid)

Spouse is GP Partner & Shareholder in Brewood Medical Services

Brewood Medical Services minority shareholder in GP First

Brewood Surgery are a provider of GMS services, some community surgical procedures and some community dermatology

Declarations of Interest Register for Stafford & Surrounds Governing Body

January 2015

Page | 2 02 July 2014

Name Date of Declaration

Position/Role Designation Potential or actual area where interest could occur

Val Jones 12.01.2015 Director Quality & Safety/ Chief Nurse

CC & SaS CCG Working across both CCGs.

Dr Kate Millward 19.12.2014 GP Mansion House Partner Mansion House Surgery

Practice Member GP First

Practice representative on CCG Membership Board & Governing Body

Clinical Advisor in Quality & Safety for CCG

David Pearsall 14.01.2015 Lay Member (Non Statutory)


Spouse works for MEDACS, Beaconside Technology Park Spouse is a Governor on the Board at SSSFT

Paul Simpson 06.12.2014 Director of Finance

CC & SaS CCG Working across both CCGs

Diana Smith 13.01.2015 Lay Member (Non Statutory)


None Declared

Non- voting – In attendance

Adele Edmondson 12.01.2015 Communications & Engagement Manager


Lynn Millar 12.01.2015 Head of Strategic Change


Tamsin Parker 12.01.2015 Locality Communications & Engagement Lead

CSU Work for the CSU Work across both CCGs Freelance as a newsreader at Signal Radio

Sally Young 12.01.2015 Head of Governance


Present

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Page 5 of 9

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Update (Completed items will remain on the Action List until the following meeting) GB at OD session SY to organise for next available OD session.

19.08.14

CCG Prioritisation of Health Care Resources

– Recommendations from Clinical Priorities Policy Group (CPPG)

9.0 MH to bring the paper to the next GB meeting. Marianne Holmes

To be carried forward to the next OD session in March

Presentation titlegoes here…

17th February 2015

Chief Officers Report

Andrew Donald

Item: 06 Enc: 04

Items to be Covered • Winter Resilience

• Better Care Fund

• Transition of Services

• County Hospital

• Regional Escalation Meeting

• Finance and Activity

Item: 06 Enc: 04

Winter Resilience • County Hospital performance(significantly better)

• Pressures at Royal Stoke but being managed

• Strategic Resilience Group – meeting weekly at Chief Executive/Accountable Officer level

Item: 06 Enc: 04

Better Care Fund • Approved with Support

• Good progress on underpinning implementation work

• Next Steps

• Commissioning Healthwatch/engaging communities in Staffordshire to undertake public engagement

• Agreed joint work with CCGs at Commissioning Congress

Item: 06 Enc: 04

Better Care Fund • Risks

• Need to identify capacity to support delivery

Item: 06 Enc: 04

Transition• Acute surgery transferred 9th February 2015

• Agreed to move Paediatric transfer to May 2015

• Work to develop community paediatrics service – this will involve engagement with families

Item: 06 Enc: 04

Regional Escalation Meeting• Finance / Activity

• Significant challenges on delivery of finance/activity 2015/16

• Robust Plans

• Challenge to deliver Control Total 2014/15

Item: 06 Enc: 04

Item No: Enc:

1 | P a g e

REPORT TO THE STAFFORD & SURROUNDS CONFIDENTIAL Governing Body Meeting

TO BE HELD ON: Tuesday 17th FEBRUARY 2015

Subject: Quality Report

Board Lead: Val Jones

Officer Lead: Lynn Tolley

Recommendation: For Approval For Discussion For Information

PURPOSE OF THE REPORT:

To update the Governing Board on the quality and safety issues reported at the Clinical Quality Review Meetings (CQRMs)

KEY POINTS:

1. The level of concern for the County site is AMBER RED due to a period of deteriorating A&E performance which has since recovered. There were no Trolley breaches reported. However, the local economy is under pressure. There is still a concerning level of nurse vacancies although this is being mitigated with bank and agency staff some of whom are now to be offered interim contracts. Ward fill rates are being met. SAS CCG has made two unannounced visits pre and post the transfer of services. The Trust is to provide the CCG with weekly assurance on staffing and the CCG have escalated the issue of the cancellation of three consecutive Internal Quality Committees.

2. The level of concern for the RSUH site for this month is rated at RED due to escalating concerns from consistently poor deteriorating A&E performance and the highest number of trolley breaches in the country. A summit meeting was held by NHSE and actions agreed to improve performance and mitigate any risks to patients. The Trust continues to be monitored closely by the lead commissioners and is making every effort to address particular flow issues.

3. The level of concern for SSOTPT is rated at GREEN as there are no major quality or safety

concerns at this time.

4. .The level of concern for SSSFT is rated at GREEN as there are no major quality or safety concerns at this time.

5. The level of concern for BHT is rated at AMBER to reflect that the Trust remain sin special

measures. The Trust has reported a Never event and has exceeded the trajectory for C Diff

Item No: Enc:

2 | P a g e

cases however only on case was found to be avoidable

6. The level of concern for RWT is rated at AMBER reflecting the issues relating to the problems in meeting referral to treatment times and the waits for cancer treatment which are under close scrutiny by the CCG.

7. The level of concern for WHT is rated at AMBER to reflect the fact that the Trust is struggling to meet its cancer targets and has also reported a Never Event.

Relevance to Key Goals A 10% reduction the levels of obesity against the expected prevalence

Commissioning for quality will enable the CCG to put in place exemplary systems for commissioning

intentions and provider performance management that will deliver its Key Goals

A reduction in the proportion of people with undiagnosed disease from 30 – 10 %. A “levelling up” of health outcomes so that all residents experience the same health care outcomes A reduction in excess winter deaths of 50% A reduction in unplanned admissions to hospital for people with Long Term Conditions of 50%

Implications

Legal and/or Risk Enable the CCG to meet its statutory responsibilities for commissioning quality; reduce and mitigate risks to the organisation and to patients.

CQC Enable the CCG to meet commissioner responsibilities for CQC Essential Standards for Health including that providers have up to date registration with the CQC.

Patient Safety Integral element of the Quality Strategy which describes the systems that will be deployed to “keep patients safe.”

Patient Engagement Integral element of the Quality Strategy which describes how the CCG will use patient engagement and experience to form the intelligence essential for effective and safe commissioning

Financial Following the baseline assessment of the CCG structure, systems and processes there maybe implications for additional funding.

Sustainability A three year plan which will be refreshed on an annual basis through the annual Quality Improvement Plan

Workforce / Training Organisational Development Plan for the CCG is in place to develop members, staff and leadership.

Item No: Enc:

3 | P a g e

RECOMMENDATIONS / ACTION REQUIRED:

The SAS CCG Governing Board is asked to: Note the key quality and safety issues in the report and actions taken to improve quality and reduce risk.

KEY REQUIREMENTS Yes No Not Applicable

Has a quality impact assessment been undertaken?

Has an equality impact assessment been undertaken?

Has a privacy impact assessment been completed?

Have partners / public been involved in design?

Are partners / public involved in implementation?

Are partners / public involved in evaluation?

1

SAS CCG Governing body Quality and Safety Report

January 2015 Main Issues/Top Themes For Providers

1. Mid Staffordshire Hospital Foundation Trust (MSHFT) a. Cancellation of UHNM CQRM and County Internal Quality Committee b. Unannounced visit on 14th January 2015 c. Mortality Review of Backlog

2. University Hospital of North Midlands (UHNM) – County Hospital a. Cancellation of UHNM CQRM and County Internal Quality Committee b. Unannounced visit on 14th January 2015 c. Mortality Review – new back log University Hospital of North Midlands (UHNM) – Royal Stoke

a. Cancellation of UHNM CQRM b. Consecutive Cancellations of County Internal Quality Committee c. Never Event Update d. 12 hour trolley breaches e. Unannounced visit update

3. Staffordshire Stoke On Trent Partnership Trust (SSOTPT) a. No major issues

4. South Staffordshire Shropshire Healthcare Foundation Trust (SSSHFT) a. Delayed Transfers of Care b. CRHT Four Hourly Responses

5. Burton Hospital Foundation Trust (BHFT) a. Monitor Update b. Never Event c. Infection Control

6. Royal Wolverhampton Hospital Trust (RWHT) a. CQC ‐ RTT (Referral to Treat)

b. Cancer waiting times update 7. Walsall Hospital Trust (WHT)

a. Cancer 62 day Referral to Treatment (RTT) b. Never Event 8. British Pregnancy Advisory Service (BPAS)

a. Reporting timescales 9. Hospices

a. Reporting styles b. DNAR paperwork

10. Safe Guarding Reports a. Quarterly report to Quality Committee

12. Nursing Home Quality Assurance (NHQA) Update a. Quarterly report to Quality Committee

13. BADGER (OOH) a. No issues

14. 111 Service a. KPIs

2

University Hospital of North Midlands – County Hospital MAIN ISSUES FOR PROVIDERS

Cancellation of UHNM CQRM and County Internal Quality Committee The first UHNM CQRM post transfer was cancelled along with the County Internal Quality Committee which has now been cancelled on 3 consecutive occasions due to hospital pressures and timetabling. The dates are to be rearranged and a member of the CCG is to attend. The CCG has raised this as a concern with the lead commissioners. However this has been mitigated by this CCG having conducted two unannounced visits to County Hospital post transfer of services to provide additional assurance and have received a separate Quality Assurance Report for County.

Unannounced visit on 14th January 2015 An unannounced visit took place due to the deteriorating A&E performance and to scrutinise the arrangements for surge beds. The visit focused on issues relating to bed management, staffing, discharge arrangements and risk management. There were no serious issued although there was a concern over the number of vacancies although this had been mitigated by the use of bank and long standing agency staff. The staffing issues are monitored on a daily basis. Mortality Review – new back log

Total number of overdue (3 months) mortality reviews 2014

End Apr End May End Jun 14/07 05/08 20/08 03/09 23/09 06/10 07/11Medicine 82 48 36 33 12 4 21 19 33 40

Surgery 18 15 13 13 9 2 12 12 12 6

Total 100 63 49 46 21 6 33 31 45 46

The mortality back log will be monitored through the Internal County Hospital Mortality group which the CCG Clinical lead attends. There is to be a meeting scheduled for early January 2015. Family and Friends Test (FFT)

PATIENT EXPERIENCE

UHNM Sept Oct UHNM County RWHT BHFT WHT

November

Mid Staffordshire Foundation Hospital TrustMAIN ISSUES FOR PROVIDERS

Final CQRM In November a CQRM took place to review the final contractual submission of data covering October 2014. All actions were either closed or allocated to the new Providers. The back log of mortality reviews are being addressed by UHNM who have committed to completing the backlog by end of March and any ongoing Serious incident RCAs were allocated respectively to Wolverhampton or UHNM. The dissolution of MSFT occurred on 31st October 2014 and the ownership of the services was transferred to RWT and UHNM (previously known as UHNS) in line with the TSA plan. The Stafford site of UHNM (now known as the “The County Hospital”) will be reported within the ‘County’ section of this report and the Cannock site will be reported within the ‘Cannock’ site section.

3

Eliminating Mixed Sex No breaches for November 2014 Complaints A total of 8 complaints were reported for the month of November.

PATIENT SAFETY

Out of a total of 26 Serious Incidents reported in December at UHNM, 2 Serious Incidents appertained to County Hospital of which were Intrauterine deaths.

Intrauterine Deaths ‐ There has been 3 intrauterine deaths over a 2 month (October & November) period at the County site. These are being fully investigated via an RCA. It was identified there was a need to have a consistent definition for recording an intrauterine death across Staffordshire to be able to make meaningful comparisons. It is noted that the women concerned would not have met the criteria for delivery at the MLU

F & F Inpatient Percentage Recommended 95 96 96 95 92 97 94

F & F Inpatient Response Rate (%) 31.38 33.53 30.64 25.7 36.17 37.08 46.10 F & F A & E Percentage Recommended 91 95 86 92 83 93 94

F & F A & E Response Rate (%) 22.6 19.6 14.6 21.8 30.0 14.2 7.1

F & F Maternity (Birth) Percentage Recommended 96 97 97 94 100 98 96

F & F ‐ Maternity Response Rate (%) 31.4 38.2 10.0 23.9 14.5 42.3 19.1

November 2014 December 2014 Maternity Services ‐ Intrauterine death x 1 Maternity Services ‐ Intrauterine death x 2 Pressure Ulcer Grade 3 x 1 Slips/Trips/Falls x 2

University Hospital of North Midlands (UHNM) – Royal Stoke site REGULATORS INVOLVEMENT AND ISSUES

No issues reported this month

MAIN ISSUES FOR PROVIDERS.

Never Event Update‐ Naso Gastric Tube update The RCA has been signed off at the December 2014 CQRM. An action plan including an ongoing audit programme which will be shared with Commissioners. 12 Hour Trolley Breaches During August to November 2014, the pressures on patient flow within UHNM have resulted in delays in patients being admitted via A&E and in 12 hours breaches. The number of breaches has risen considerably and is a cause for concern.

August ‐ 2 September ‐ 4

4

October – 23 (awaiting confirmation) November – 20

A previous review of trolley breaches which occurred in September identified that there was a higher than expected number of admissions which impacted on the availability of cubicles in A&E. A contract query has been raised in November 2014 against the low performance in A & E. Root Cause Analysis (RCA's) were undertaken for all events which identified that there was a high demand for side rooms due to increased numbers of patients attending with infection control issues and a reduction in the numbers of beds available due to wards being closed both internally and within the Community, again due to infection control issues. Actions were identified as follows:‐ Review of escalation plan to be undertaken‐ Infection control processes to be reviewed to include side room

audits, protocol for the cohorting of patients and infection control presence at daily bed meetings. The RCA's will be presented to the Trust's Quality & Safety Forum and the Serious Incident Panel. A Quality summit was held in December with the NTDA, with a further summit is being scheduled for January 15. CCGs are currently in the process of producing an internal process/flowchart for the management of RCAs following trolley breaches to provide staff on with clarity around this process. UHNM have provided their internal audit results on this process to the December CQRM which will be incorporated within the CCG internal process. Unannounced Visit on 6th January to UHNM An unannounced visit was made to A&E by the lead commissioners. Although the A&E was busy, it was evident that patients The staff felt supported by the Trust in regards solutions following escalation and patients praised the staff in A & E. It was noted that staff sickness had increased over December and January; however, this was anticipated and managed. Patient numbers and acuity are reviewed by the Director of Nursing and Associate Chief Nurses. Staffing ratios are adjusted accordingly to maintain 96% of planned staffing.

INFECTION CONTROL

MRSA/ Clostridium difficile/ Outbreaks and Serious Incidents

2014 UHNS Target Trend Apr May Jun Jul Aug Sep Oct Nov YTD

MRSA Bacteraemia 0 0 1 1 0 0 0 1 0 3C Difficile 50 5 4 2 3 9 7 1 1 31

MRSA bacteraemia There have been no cases of MRSA in November 2014. Clostridium difficile Infection There has been 1 Trust apportioned Clostridium difficile cases identified in November 2014. (County Site) Closures There were seven ward areas closed in November 2014 due to D&V/Norovirus, 65 patients and 19 staff have been affected on the Stoke Site and no closures on the County Site

PATIENT EXPERIENCE

Family and Friends Test (FFT) UHNM Sept Oct UHNM Royal Stoke RWHT BHFT WHT

November

5

F & F Inpatient Percentage Rec. 95 96 96 97 92 97 94 F & F Inpatient Response Rate (%) 31.38 33.53 30.64 31.95 36.17 37.08 46.10 F & F A & E Percentage Rec. 91 95 86 82 83 93 94 F & F A & E Response Rate (%) 22.6 19.6 14.6 12.4 30.0 14.2 7.1 F & F Maternity (Birth) Percentage Rec. 96 97 97 100 100 98 96 F & F ‐ Maternity Response Rate (%) 31.4 38.2 10.0 6.3 14.5 42.3 19.1

There is a significant increase in the Family and Friends rates. This is a result of a change to the methodology for reporting in response to National Guidance. The impact of this is that there will be an increase in all scores.

Complaints During November 2014, there has been 70 formal complaints, which is a slight decrease from 73 in October 2014. Eliminating Mixed Sex Accommodation No breaches for November 2014

PATIENT SAFETY

Serious Incidents UHNM’s SI’s have been split by site, Royal Stoke reported 24 and County Hospital reported 2.

Delayed Diagnosis ‐ UHNM have reported a serious incident of a delayed diagnosis where the patient died. This is subject to an RCA and it is not known yet whether the delay in diagnosis was a significant factor.

November 2014 December 2014 Maternity Services ‐ Unexpected admission to NICU (neonatal intensive

care unit) x 2 Delayed Diagnosis x 1

Other – Potential media attention x 1 Maternity Services ‐ Intrapartum death x 1

Slips/Trips/Falls x 7 Maternity Services ‐ Unexpected admission to NICU (neonatal intensive care unit) x 2

Ward/Unit Closure x 1 Pressure Ulcer Grade 3 x 14

C’Diff x 1 Slips/Trips/Falls x 5

Pressure Ulcers grade 3 x 2 Ward Closure 1

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

Awaiting CQC formal report on unannounced visit reported in October.

MAIN ISSUES FOR PROVIDER

District Nursing Update. Awaiting outcome of the meeting of CCG and Trust operational group.

INFECTION CONTROL

2014 SSOTP Target Trend Apr May Jun Jul Aug Sep Oct Nov YTD MRSA

Bacteraemia 0 = 0 0 0 0 0 0 1 1

C Difficile 8 � 0 1 0 3 1 2 0 7

MRSA/ Clostridium difficile/ Outbreaks and Serious Incidents No update available for November 2014 at the time of writing report and the data is to be revalidated against the head of Infection Prevention and Control due to minor anomalies.

6

PATIENT EXPERIENCE No further information available for October/November 2014

Complaints No further information available for October/November 2014 In total: The Trust received 31 complaints in October 2014, a slight decrease from 37 reported in September 2014.

2014 A M J Q1 J A S Q2

Total Health & ASC 28 40 29 97 35 37 37 109 South 20 22 14 56 23 13 13 49

Eliminating Mixed Sex Accommodation No breaches for November 2014.

PATIENT SAFETY

Serious Incident (SIs) North & South Divisions The number of SIs reported to commissioners for November 2014 for SSOTP was 24 a slight increase from 21 reported in November. The majority of which were pressure Ulcers, which accounted for 17 of total incidents. This is an increase of 6 from October 2014.

Trust Overall Feb Mar Apr May June July Aug Sept

No Data

available

F & F Score 72.12 70.61 70.32 69.79 73.57 68.31 68.66 71.31 Number of surveys received 2915 2419 2092 2189 2417 2977 1768 1969 Neighbourhood Area FFT Score Feb Mar Apr May June July Aug Sept Stafford (27 users)* 66.66 81.40 59.26 76.47 82.26 78.87 ‐ ‐ Cannock (28) * 88.99 100 75 87.50 70.00 92.86 ‐ ‐ *Data extracted from South Community Teams Dashboard

November 2014 December 2014 Pressure Ulcer Grade 3 x 11 7 South

1 Burton 3 North

Child Serious Injury Unknown

Attempted Suicide by Inpatient (not in receipt) x 1 1 South Pressure Ulcer Grade 3 13 North2 South

Ward Closure x 3 3 North Pressure Ulcer Grade 4 2 North

Death in Custody x 1 1 South Slips/Trips/Falls x 2 1 South 1 North

Suicide x 1 1 South Unexpected Death of Inpatient (not in receipt 1 North

Slips/Trips/Falls x 4 4 North

South Staffordshire Shropshire Healthcare Foundation Trust (SSSHFT) REGULATORS INVOLVEMENT AND ISSUES

No issues reported this month


Delayed Transfer of Care – Total of 18 delayed discharges of which 2 related to East Staffordshire CCG and 6 to South East Staffordshire and Seisdon CCG. The last CQRM held in December agreed to formulate a sub Task and Finish Group to undertake a focused piece of work. Meeting has been arranged for the end of January 2015. Crisis Resolution Home Team ‐ Four Hourly Responses:

7

East ‐ 5 breaches for relating to service users not being available, all contacted by phone, 3 cold calls to addresses. Of which, 2 declined input, 1 continually cancelled appointments, 2 had police safe and well check carried out, of which 1 has now declined to engage with the service. West ‐ 3 breaches relating to service user requested appointment the following morning following discharge. 1 service user failed to keep assessment appointment and CRHT did a spot check to the home, but service user was discharged following lack of engagement with team. 1 service user discharged from A & E prior to being seen by CRHT and was later returned to A & E by Police and the service user requested to see CRHT later.

INFECTION CONTROL

2014 SSSFT Target Trend Apr May Jun Jul Aug Sep Oct Nov YTD

MRSA Bacteraemia 0 = 0 0 0 0 0 0 0 0 0C Difficile 8 � 0 1 0 3 0 0 0 0 4

MRSA/ Clostridium difficile/ Outbreaks and Serious Incidents Darwin Centre (Children’s and Adolescent Mental Health) which was closed for 4 days. CCG Head of Infection Prevention traced the index case back to a member of staff who returned to work within the 48 hours of being symptomatic. Action Plan and reminder to staff on return to work Policy in place.

PATIENT EXPERIENCE

Complaints Complaints for Q1 were 28. Q2 report has not been published. The top three categories were:

1. Clinical Treatment 2. Communication and information for patients 3. Attitude of staff

Eliminating Mixed Sex Accommodation The Trust reported no breaches in November 2014.

PATIENT SAFETY

Serious Incidents (SIs) The number of SIs reported to commissioners for December 2014 was 7, a slight increase from November of 6.

November 2014 December 2014 Suspected Suicide x 3 Unexpected Death (general) x 4 Safeguarding Vulnerable Adult x 1 Suspected suicide x 3 Serious Self Inflected Injury Outpatient x 1

Unexpected Death (general) x 1 *Captured by reported date so we can capture any serious incidents which are reported late

Burton Hospital Foundation Trust (BHFT) REGULATORS INVOLVEMENT AND ISSUES

Monitor Regulatory Updates – confirmed that the Trust were still subject to Enforcement Action and subject to Special Measures from the Keogh review. They have been rated as having an elevated risk for Patient safety incidents, Mortality, Audit and Partner Sections.


8

Never Event – Retained foreign object This was a retained foreign object relating to maternity patient, which is being investigated

INFECTION CONTROL

MRSA There were 0 reports of Trust apportioned MRSA Bacteraemia during November 2014.

Clostridium difficile There were 2 reports of Clostridium difficile from Burton Hospitals NHS Foundation Trust during November 2014. Therefore, the Trust had 16 cases against an annual objective of 15. Only 1 of these cases was avoidable. A quality summit took place, with attendance from Public Health England and the Area Team; BHFT presented all of the actions they had taken to reduce C.diff level, which included enlisting the support of the Area Team to address inappropriate prescribing in Primary Care. Outbreaks and Serious Incidents There have been a number of outbreaks due to diarrhoea and vomiting and to norovirus which has resulted in the closure of bed bays, 16 patients and 1 member of staff have been affected.

PATIENT EXPERIENCE

Family and Friend Test (FFT)

BHFT Sept Oct Nov UHNM

RWHT WHT

F & F Inpatient Score 95 96 97 96 92 94F & F Inpatient Response Rate (%) 31.38 33.53 37.08 30.64 36.17 46.10 F & F Score ‐ A & E 91 95 93 86 83 94 F & F ‐ A & E Response Rate (%) 22.6 19.6 14.2 14.6 30.0 7.1F & F Score – maternity 96 97 98 97 100 96 F & F ‐ Maternity Response Rate (%) 31.4 38.2 42.3 10.0 14.5 19.1

There is a significant increase in the Family and Friends rates. This is a result of a change to the methodology for reporting in response to National Guidance. The impact of this is that there will be an increase in all scores.

Complaints

The number of formal complaint received in November 2014 reduced to 20. This is a 58% (48) reduction from 2013/14 and 57% (47) reduction from 2012/13. Medicine and Surgery both received 9 complaints each and Community Medicine received 2 formal complaints. The highest complaint theme for November is medical care & treatment within the surgical division, communication & information is the highest complaint theme for medicine. The Trust has self‐referred 1 case to the Parliamentary & Health Service Ombudsman (PHSO). Top 5 themes are:‐

1. Communication/Information 2. Medical Care and Treatment 3. Nursing Care & Treatment 4. Attitude of Staff 5. Medication

2014 Burton Target Trend Apr May Jun Jul Aug Sep Oct Nov YTD

MRSA Bacteraemia 0 = 1 0 0 1 0 0 0 0 2 C Difficile 15 � 2 1 6 4 0 0 1 2 16

9

Eliminating Mixed Sex Accommodation No breaches for November 2014.

PATIENT SAFETY

Serious Incidents (SIs) The number of SIs reported for December 2014 was 7, a slight decrease from 10 reported in November 2014. There have been 3 falls reported as serious incidents and any trends or issues arising from these will be monitored and reported through the BHT CQRM.

November 2014 December 2014 Premature Discharge x 1 Communication Issue x 1

Failure to obtain consent x 1 Delayed diagnosis x 1 Slips/Trips/Falls x 3 Slips/Trips/Falls x 3

Pressure Ulcer Grade 3 x 1 Sub‐optimal care of the deteriorating patient x 1 Ward/Unit Closure x 3 Unexpected Death (general) x 1 Outpatient appointment Delay x 1

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

Royal Wolverhampton Hospital Trust (RWT) REGULATORS INVOLVMENT AND ISSUES

NHS England and Trust Development Authority (TDA) are commencing a process to validate all Trusts Nationally in relation to RTT data. This will commence within RWT the first week in January 2015 and will take approximately 4/5 weeks. RWT have reported they are confident that systems are in place regarding governance and feel they are ahead of trajectory in terms of the improvement plan agreed with the TDA.


Cancer Waiting Times – Update The Trust has been experiencing problems in compliance against the national cancer waiting Times Targets. The particular areas of concern are the 31 day subsequent surgery target (94%) and the 62 day referral to treatment compliance against the national target (85%). The Trust has submitted a Cancer Recovery Plan and an RTT Remedial Action Plan. RTT: The Admitted target was not achieved and Specialty level for the targets has not been achieved this is a deliberate move in order to treat as many breach patients as possible and to reduce the overall backlog for the Trust (this has been agreed with the Commissioners and the TDA). Emergency Department: A&E continues to see increasing numbers with attendances in November 8.92% higher than the same period last year this equates to an additional 851 attendances. There were no patients who breached the 12 hour target during the month. Cancelled Elective Operations 70 operations were cancelled during November. A root cause analysis continues to be undertaken for every cancelled operation for non‐medical reasons and continues to be reviewed weekly at the Divisional Managers meeting. 78.6% of the cancellations in month were due to bed pressures. There was 1 cancelled operation at Cannock Chase Hospital (CCH) in November. – All readmitted within 28 days.

10

INFECTION CONTROL

2014 RWT Target Trend Apr May Jun Jul Aug Sep Oct Nov YTD

MRSA Bacteraemia 0 1 0 0 1 0 0 0 0 2C Difficile 39 2 1 2 3 1 7 4 4 24

Clostridium Difficile (C Diff) – Target 39

C.diff rates have remained stable at 4 for October and November 2014, however this still exceeds the trajectory of 3.

PATIENT EXPERIENCE

Family and Friend Test (FFT)

There is a significant increase in the Family and Friends rates. This is a result of a change to the methodology for reporting in response to National Guidance. The impact of this is that there will be an increase in all scores. Complaints There have been 30 complaints received in November 2014. Complaints audit action plan has now been implemented. Eliminating Mixed Sex Accommodation No breaches reported in November 2014.

PATIENT SAFETY

Serious Incidents The number of incidents in November is 25. Eight were pressure ulcers all of which were hospital acquired.

October 2014 November 2014 Pressure ulcer Grade 3 Hospital acquired x 1 Pressure ulcer Grade 3 Hospital Acquired x 8 Unexpected death x 2 Ward closure x1Attempted suicide of inpatient (not in receipt) x 1 Slip, Trip, Fall x 5Slip, trip, fall x 9 Pressure Ulcer Grade 3 Community x 6 Surgical Error x 1 Pressure Ulcer Grade 4 Community x 1 Pressure ulcers Grade 3 community acquired x 3 Confidentiality Incidents x 4Pressure ulcers Grade 4 community acquired x 1 VTE death x 1

Health Acquired infection x 1 Confidentiality incidents x 1

Royal Wolverhampton Trust Sept Oct Nov Comb

New Cross

Cannock UHNM Comb

BHFT WHT

November F & F Inpatient Percentage Rec. 89 93 92 92 No Data 96 97 94 F & F Inpatient Response Rate (%) 33.89 20.12 36.17 37.78 4.08 30.64 37.08 46.10F & F A & E Percentage Rec. 80 82 83 83 86 93 94 F & F ‐ A & E Response Rate (%) 23.1 28.2 30.0 30.0 14.6 14.2 7.1 F & F Maternity Percentage Rec. 100 100 100 100 97 98 96 F & F ‐ Maternity Response Rate (%) 14.1 8.6 14.5 14.5 10.0 42.3 19.1

11

Walsall Hospital Trust (WHT) REGULATORS INVOLVEMENT AND ISSUES

Care Quality Commission (CQC) Intelligent Monitoring Report (DRAFT) July 2014 CQC have highlighted a high risk in relation to Referral to Treatment (RTT) targets and Walsall Healthcare NHS Trust (WHT) has submitted a detailed improvement plan relating to Outpatients, Diagnostic Waits and RTT. It has been recognised that the impact of the new patient administration system and data quality issues are affecting the accurate reporting in relation to RTT. However, the Commissioners are being vigilant with their monitoring of the Providers progress against action plan to reduce the RTT. Monitor Framework ‐ Automatic override to red due to A&E, 18 Weeks RTT and Cancer. NTDA Performance Monitoring – indicates the Trust is rated as having concerns regarding performance as requiring investigation

MAIN ISSUES FOR PROVIDER As a result of the impact of emergency pressures, increases in elective demand and difficulties following the launch of the new Patient Administration System, the Trust faces significant difficulties in delivering the national elective access standards, especially the 18 week standards. As a result of the implementation of the new Patient Administration System, the Trust has identified significant data quality issues and they are working with the Trust Development Authority (TDA) and Walsall CCG to validate the data available. Contractual Notices remain open for 18 weeks RTT, Cancer Services, A&E 4 hour wait, Emergency readmissions. Walsall CCG issued a Contract Query Notice in October 2014, and requested a Remedial Action Plan for not achieving the 6 week diagnostic target in July and August. Never Event 1 Never Event has been reported in October 2014. This is the first never event reported since November 2013 and relates to a patient who had a retained swab which was not identified until some months later where the patient required extensive surgery to address the affects. RCA completed and action plan devised. 18 Weeks The Trust is working with Walsall CCG (WCCG) and the Trust Development Authority to recover the 18 weeks position. Collaborative working is promoted.

Infection Control

WHT Target Trend Apr May Jun Jul Aug Sep Oct Nov YTDMRSA Bacteraemia 0 = 0 0 0 0 0 0 0 0 0

C Difficile 28 1 5 1 1 3 0 1 0 12

There have been no reported cases of MRSA Bacteraemia in the last 2 Quarters. There has been no case of C.difficile reported in November. Year to date total is 12 against a target of 28.

PATIENT EXPERIENCE

Family and Friends Test (FFT)

12

There is a significant increase in the Family and Friends rates. This is a result of a change to the methodology for reporting in response to National Guidance. The impact of this is that there will be an increase in all scores. Complaints There has been an increase in formal complaints received during November, which were 37 compared to 32 in October. Clinical care/treatment/assessment is again the main theme (22) for November 2014. Appointments were the second highest category (6). There are also 5 complaints relating to staffing Eliminating Mixed Sex Accommodation Nil reported in November 2014.

PATIENT SAFETY Serious Incidents There were 3 SI’s reported to Walsall CCG in November, which is a significant decrease compared to the 13 reported in October.

Walsall Hospital Trust Sept Oct Nov BHFT

UHNM

RWHT

November F & F Inpatient Score 87 92 94 97 96 92 F & F Inpatient Response Rate (%) 46.18 58.93 46.10 37.08 30.64 36.17F & F Score ‐ A & E 92 90 94 93 86 83 F & F ‐ A & E Response Rate (%) 5.1 4.2 7.1 14.2 14.6 30.0 F & F Score – Maternity 97 87 96 98 97 100 F & F ‐ Maternity Response Rate (%) 8.7 10.9 19.1 42.3 10.0 14.5

October 2014 November 2014 Grade 4 Community Acquired Pressure Ulcers x 1 Grade 4 Community Acquired Pressure Ulcers x 1 Grade 3 Community Acquired Pressure Ulcers x 3 Grade 3 Community Acquired Pressure Ulcers x 1 Never Event x 1 Pressure Ulcer Grade 3 (Hospital) x 1 Safeguarding Children x 2 Intra‐uterine death x 1 Abscond x 1 Sub‐optimal care x 1 Patient Fall x 1

Unexpected Admission to NICU x 1 Ward Closure x 1

British Pregnancy Advisory Bureau (BPAS) REGULATORS INVOLVEMENT AND ISSUES

Nil reported for this month


Timescale for reporting information to the CCG is not in line with National Contract and a Contract Variation has been agreed for BPAS to provide their reports and information requirements on a 4 monthly basis during 2014/2015.This issue has been discussed at CQRM due to the impact it has on the contractual and finance processes. However, BPAS confirmed in November CQRM that it will not be possible to change this as they have a requirement to report to 160 CCGs at present. Quality Dashboard

13

The Quality Dashboard is based on Staffordshire patients and the infection data is based on information from clinics in Cannock and Tamworth. Quality Reporting exceptions: nil reported Serious Incidents – No serious incidents. zero complaints – BPAS confirmed all complaint policies and processes are clearly sighted in all clinics CQUIN – no CQUIN for 14/15 and agreed no CQUIN for 15/16

Hospices MAIN ISSUES FOR PROVIDER

A Hospice CQRM was held in December 2014. Our Hospices provide interesting and useful reports however the style and approach varies considerable. Commissioners have provided hospices with a suggested dashboard and report summary framework. Hospices will be piloting these in Q3 14/15 and using for Q4 onwards. Hospices have been given a simple template to use to report clinical incidents that arise in other providers. Medication supplier changes Hospices remain concerned that the changes to the wholesale supplier licencing system for controlled drugs will have an adverse impact on quality. Examples given were that out of hours urgently needed pain relief medication might take several hours to be delivered for example from Birmingham. Hospices were concerned that once existing contracts with supplier expire there may be a cost pressure. This has been escalated to Area Team previously and one of the hospices has noted that it is a national issue. DNAR (Do Not Attempt Resuscitation) Katherine House Hospice commented that it experiences difficulties with sharing Do Not Attempt Resuscitation (DNAR) Orders with GPs in the Stafford Area. This Hospice uses its own paperwork which complies with national guidelines. Other hospices are not reporting similar problems. All hospices confirmed that they had completed nationally recommended medicines security audits (developed in response to serious incidents in Stockport) and there were no outstanding shortfalls. St Giles Hospice raised the issue that District nurses are the key workers for end of life services but they receive a significant number of referrals for patients who ae not on a district nursing case load. The CCG has requested further information around this. The next Hospice CQRM meeting will focus on Children’s hospice services and on end of life care plans.

BADGER (Birmingham and District General Emergency Rooms) REGULATORS INVOLVEMENT AND ISSUES

Nil reported for this month‐

MAIN ISSUES FOR PROVIDER No major issues to report

PATIENT EXPERIENCE

Friends & Family Test (FFT)

Complaints 1 complaint received – UTI Diabetes – not referred, this is currently under investigation.

PATIENT SAFETY

BADGER July/Aug/Sept F & F Would you recommend this service 873 responded yes out of 977 feedback cards

14

Significant Events and Untoward Incidents No SI’s reported for October 2014. Two incidents were raised in relation to the Prison Service.

Head laceration‐ no visit undertaken

Under investigation

Prison security informed clinician the nurse had gone home & no information available

Call handler followed protocol for new healthcare professional line instead of prison protocol.

closed Training for call handler/reminder to all call handlers &Team Leaders on correct protocol to follow and new prison.

Never Events Nil reported for this month KPI’s All met, no exceptions to report

111 Service REGULATORS INVOLVEMENT AND ISSUES Nil reported for this month

MAIN ISSUES FOR PROVIDER Ambulances dispatched 10.9% of calls received resulted in an ambulance being dispatched, and the KPI Target is <10%, therefore target was not achieved in November. This has been a continued challenge as they have not achieved this target since August 2014. The Provider is carrying out ‘probing workshops’ which allows call handlers to listen to the calls and a clinical coordinator then goes through learning points. ED Referrals As a result of a public campaign to use 111 the number of calls has increased the percentage of referrals to A&E and 999 are expected to increase due to the call activity increasing. In order to manage this increase, all calls since July 2014, requiring disposition to A & E or 999 are passed to a clinician to validate. This has resulted in the number of ED referrals hitting target in October and November 2014.

PATIENT SAFETY Serious Incidents No Serious incidents reported in November 2014.

PATIENT EXPERIENCE Complaints 3 complaints received in November.

Acronym Explanation BADGER Birmingham And District General Emergency Rooms BHFT Burton Hospitals Foundation TrustCCG Clinical Commissioning Group CHKS Leading provider of healthcare intelligence and quality improvement services CHRT Crisis Home Resolution TeamCDIFF Clostridium Difficile CQRM Clinical Quality Review Meeting CSU Clinical Support UnitEMSA Eliminating Mixed Single Sex Accommodation EPR Electronic Patient Record FFT Friends and Family TestHEFT Heart of England Foundation Trust IPC Infection Prevention and Control MRSA Methicillin Resistant Staphylococcus AureusNHQA Nursing Home Quality Assurance

15

NICU Neonatal intensive care unit NSL Non Urgent Patient transport providerOFSTED Office for Standards in Education, Children’s Services and Skills PALS Patient Advisory Liaison Service RCA Root Cause AnalysisRTT Referral to Treatment Times RWT Royal Wolverhampton Trust SSOTPT Staffordshire and Stoke on Trent Partnership TrustSSSFT South Staffordshire and Shropshire NHS Mental Health Foundation Trust

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

Performance metric to be developed to show improvement.

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


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


A reduction in excess winter deaths of 50% Performance metric to be developed to show improvement.

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


IMPLICATIONS

Legal and/or Risk

Note the risks identified relating to delivery of Quality, Improvement, Productivity and Prevention (QIPP), Acute Trust Activity and Continuing Care. Reputation risks if any of the elements of the national operating framework are not delivered.

CQC None

Patient Safety Patients and their safety are at the centre of everything the CCG commission. Poor performance in services where patients are waiting longer than required to access services may be a patient safety risk.

Patient Engagement The inclusion of patient feedback in performance reporting is essential for Board assurance. Work is ongoing with colleagues in the Quality and Governance team to establish lines of reporting.

Financial Financial risks associated with delivering key performance targets and delivering contracts in line with contract values.

Sustainability None

Workforce/Training Work to develop understanding of performance management

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

Item: 08 Enc: 06

Page | 3





Have partners/public been involved in design?

Are partners/public involved in implementation?

Are partners/public involved in evaluation?

73% 90%91 93 91 89 87 85 86 94 94 93 94 92 90 n/a

N D J F M A M J J A S O N P

56 patients breached the 18 week

admitted adjusted standard in

November 2014

16 x RWHT, 17 x Rowley Hall,

14 x UHNM,

9 x Other providers

85% 95%98 97 97 97 97 98 98 97 98 98 98 98 98 n/aN D J F M A M J J A S O N P


18 months annualised trend

to Mar-14

Referral to Treatment pathways

The percentage of admitted pathways

within 18 weeks for admitted patients

whose clocks stopped during the period

on an adjusted basis. (E.B.1)

Current

RTT 18 weeks admitted adjusted Standard

89.6%

YTD

NHS Stafford And Surrounds CCG - Constitution Report

92%

The percentage of incomplete pathways

within 18 weeks for patients on

incomplete pathways at the end of the

period. (E.B.3)

90%

107%

Month Nov-1418 months annualised trend

to Mar-14

91.1%

97.9% 105%18 months annualised trend

to Mar-14

101%

RTT Non-admitted Standard 95%

The percentage of non-admitted

pathways within 18 weeks for non-

admitted patients whose clocks

stopped during the period. (E.B.2)

Current 98.4%

YTD

Month Nov-14

RTT Incomplete Standard

Current

Month Nov-14

96.9%

YTD 95.8%

Prov Org Name Treatment Function Description No. over 18

weeks

THE CHRISTIE NHS FOUNDATION TRUST Urology 1

UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUSTTrauma & Orthopaedics 1

THE ROYAL WOLVERHAMPTON NHS TRUST General Surgery 1

THE ROYAL WOLVERHAMPTON NHS TRUST Urology 1

THE ROYAL WOLVERHAMPTON NHS TRUST Ophthalmology 12

THE ROYAL WOLVERHAMPTON NHS TRUST Gynaecology 2

BIRMINGHAM CHILDREN'S HOSPITAL NHS FOUNDATION TRUST Other 2

HEART OF ENGLAND NHS FOUNDATION TRUST Trauma & Orthopaedics 1

THE ROYAL ORTHOPAEDIC HOSPITAL NHS FOUNDATION TRUST Trauma & Orthopaedics 1

UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST General Surgery 1

ROWLEY HALL HOSPITAL Trauma & Orthopaedics 10

ROWLEY HALL HOSPITAL Ophthalmology 3

ROWLEY HALL HOSPITAL Other 4

UNIVERSITY HOSPITALS OF NORTH MIDLANDS NHS TRUST General Surgery 6

UNIVERSITY HOSPITALS OF NORTH MIDLANDS NHS TRUST Urology 3

UNIVERSITY HOSPITALS OF NORTH MIDLANDS NHS TRUST Trauma & Orthopaedics 2

UNIVERSITY HOSPITALS OF NORTH MIDLANDS NHS TRUST ENT 2

UNIVERSITY HOSPITALS OF NORTH MIDLANDS NHS TRUST Gynaecology 1

THE ROBERT JONES AND AGNES HUNT ORTHOPAEDIC HOSPITAL NHS FOUNDATION TRUSTTrauma & Orthopaedics 2

56

Printed: 05/02/2015 Page 1 of 6 Prepared by Midlands and Lancashire Commissioning Support Unit



64% 95%85 88 85 92 89 88 84 87 87 83 89 85 80 77D J F M A M J J A S O N D P

YTD 99.1%

Nov-14

Diagnostic test waiting times

79.9%

YTD 86.4%

Standard 95%

Percentage of patients who spent 4

hours or less in A&E. (E.B.5)

Current

Month18 months annualised trend

to Mar-14

Diagnostic Wait Standard 99%

Four hour wait

109%

98.8%

A&E waiting time - total time in the A&E department

126%

Month Dec-14

21 patients waiting 6 weeks or more, breakdown as follows:-

13 Breaches at UHNM - 7 x MRI, 1 x Audiology, 2 x Sleep Studies, 2 Colonoscopy, 1 Cystoscopy.

2 x East Cheshire - Urodynamics.

2 x Birmingham Childrens Hospital - MRI.

3 x UHB - Urodynamics.

1 x Uni. College London Hospitals - Gastro.


to Mar-14

A&E Performance at County Hospital and UHNM as a whole has deteriorated during December, and the Trust will not be able to recover its position. December monthly

performance:- County Hospital achieved 90.6%, UHNM (including County Hospital) achieved 82.17% and Royal Wolverhampton 92.9%. The CCGs and Urgent Care Team have been

working closely with County Hospital, however, and improvements are expected in January. As usual the main problems around County Hospital relate to poor patient flow. Internal

action plans have been agreed and are being implemented by the Trust and working in partnership with commissioners and other providers to expedite patient discharge. CCG

representatives continue to attend the weekly Trust Urgent Care Recovery Board and when necessary the Staffordshire Urgent Care Team is deployed on site to assist flow.

The percentage of patients waiting 6

weeks or more for a diagnostic test.

(E.B.4)

Current



83% 93%96 96 97 97 98 95 97 97 95 95 98 96 97 n/a


71% 93%88 93 100 98 98 91 95 89 98 98 100 98 94 n/a


92% 96%98 100 99 100 99 100 97 98 99 98 99 100 99 n/a


86% 94%100 100 100 100 100 93 100 100 92 93 89 100 100 n/a


96% 98%100 100 100 100 100 100 100 100 100 100 100 100 100 n/a


115%18 months annualised trend

to Mar-14

Cancer waits - 31 days

Month Nov-14


to Mar-14

100%

Month Nov-14

Current

Cancer waits - 2 week waits


to Mar-14

Standard 98%

100%

Nov-14

102%

Month Nov-1418 months annualised trend

to Mar-14

Subsequent surgery

Drug Treatments

Standard 94%

Percentage of patients receiving

subsequent treatment for cancer within

31-days, where that treatment is

Surgery. (E.B.9)

YTD 95.5%

98.7%



31-days, where that treatment is an

Anti-Cancer Drug Regimen. (E.B.10)

Current 100%

YTD 100%

Month

First Definitive Treatment Standard 96%

Percentage of patients receiving first

definitive treatment within one month

of a cancer diagnosis. (E.B.8)

Current 98.6%

YTD

97.4%

YTD 96.2%

Percentage of patients seen within two

weeks of an urgent referral for breast

symptoms where cancer was not

initially suspected. (E.B.7)

Breast Symptoms Referrals

Urgent GP Referrals

Percentage of patients seen within two

weeks of an urgent GP referral for

suspected cancer. (E.B.6)

Current


to Mar-14

Current 93.8%

YTD 95.0%

Month Nov-14

Standard 93%

Standard 93%



75% 94%

100 96 100 100 100 100 100 98 100 100 100 100 100 n/a


70% 85%

89 88 88 85 93 94 89 87 88 81 90 87 79 n/a


40% 90%

100 100 100 100 100 100 100 100 100 100 100 100 89 n/a



Screening service referral


definitive treatment for cancer within

62- days of referral from an NHS Cancer

Screening Service. (E.B.13)

88.9%

Standard

YTD 98.1%

Urgent GP referral Standard

90%

100%

Month Nov-14

140%


to Mar-14

Current

Current

85%



two months (62 days) of an urgent GP

referral for suspected cancer. (E.B.12)

Current 79.3%

YTD 87.2%

Month

6 out of 29 patients were treated after 62 days. with the breaches occurring as follows:-

2 x Patients breached when they were first seen at UHNS and treated at UHNM (Urology)

(i)Repeat PSA required 6-8 weeks & patient factors (ii)Delay to MDT discussions

2x Patients breached when they were seen and treated at University Hospitals of North Midlands (Haematology)

Breach Reason: (i)22 day wait for Biopsy following initial CT plus 14 day wait for discussion at Haematology MDT at New cross

(ii)Follow up OPA not escalated and brought forward to reduce risk of breach 1x

Patient required inpatient admission for Colostomy prior to cancer treatment planning (LGI)

1x Patient underwent several investigations prior to cancer diagnosis being confirmed for (other)

YTD


to Mar-14


to Mar-14

Nov-14

100%

Radiotherapy Treatments Standard 94%

113%

Month Nov-14

99.6%




31-days, where that treatment is a

Radiotherapy Treatment Course.

(E.B.11)



0% 50%

94 100 96 100 90 100 100 82 100 91 95 100 95 n/a


Consultant upgrade

Month

Standard N.O.S.

95.0%



62- days of a consultant decision to

upgrade their priority status. (E.B.14)

Current


to Mar-14Nov-14

94.7%

YTD100%

1 out of 9 patients were treated after 62 days. Patient was first seen at Mid Staffs and treated at UHNM (breast). -Delay

to treatment planning - awaited Histology slides from referring Trust



47% 75%

70 80 90 83 78 77 47 53 78 73 69 72 55 n/a

D J F M A M J J A S O N D P

59% 75%

66 66 66 69 70 69 67 70 72 71 69 68 67 n/a


86% 95%

94 93 91 94 94 94 95 93 96 95 93 95 93 n/a


The CCG has failed to achieve the Red 1 indicator 75% standard with 54.7% performance, this equated to 29 out of a total 53 patients responded to within 8 minutes. There has

been significant deterioration in performance when compared to last month’s 71.7% performance.

The Red 2 indicator has failed to achieve the 75% standard with 67.3% performance. This equated to 631 out of a total 937 patients responded to within 8 minutes.

The CCG has failed to achieve the Red 19 indicator 95% standard with 93.4% performance. This equated to 925 out of a total 990 patients responded to within 19 minutes.

Ambulance Red 2

Category A calls resulting in an

emergency response arriving within 8

minutes - Red 2 incidents: life

threatening but less time critical than

Red 1. (E.B.15.ii)

Current

69.3%


emergency response arriving within 8

minutes - Red 1 incidents: immediately

life threatening and the most time

critical. (E.B.15.i)

Current

Month Dec-14

54.7%

YTD 65.7%


to Mar-14

Ambulance clinical quality

benchmarking based on current

month

Dec-14

67.3%

YTD

Ambulance Red 1 Standard 75%

104%

103%


to Mar-14

91%


to Mar-14


month


month

Standard 75%

Month

Ambulance Red 19 Standard 95%


ambulance arriving at the scene within

19 minutes. (E.B.16)

Current 93.4%

YTD

Month Dec-14

94.4%


Item: 09 Enc: 07

Page | 1

REPORT TO THE Clinical Commissioning Group Governing Body Meeting in public

TO BE HELD ON: Tuesday 17th February 2015

Subject: Board Assurance Framework (BAF)

Board Lead: Paul Simpson

Officer Lead: Sally Young

Recommendation: For Approval For

Ratification For

Discussion For

Information

PURPOSE OF THE REPORT:

To update the Governing Body.

KEY POINTS:

To note updates to high level risks.

Relevance to Key Goals Cannock Chase To reduce health inequalities across Cannock Chase through targeted interventions

N/A To identify and support patients with Long Term Conditions to ensure care delivery closer to home To improve and increase overall life expectancy To develop integrated services with simple, easy access

Relevance to Key Goals Stafford & Surrounds A 10% reduction the levels of obesity against the expected prevalence

N/A

A reduction in the proportion of people with undiagnosed disease from 30 – 10 %. A “levelling up” of health outcomes so that all residents experience the same health care outcomes A reduction in excess winter deaths of 50% A reduction in unplanned admissions to hospital for people with Long Term Conditions of 50%

Item: 09 Enc: 07

Page | 2

Implications

Legal and/or Risk The CCG has a duty to identify its high level risks and put in place actions to redress them. Exec Management Team will monitor these on a monthly basis, they will also be presented to the Audit Committee and to the Governing Body.

CQC N/A

Patient Safety The high level risks are identified, rag rated and mitigating actions included.

Patient Engagement The high level risks are identified, rag rated and mitigating actions included.

Financial The high level risks are identified, rag rated and mitigating actions included.

Sustainability N/A

Workforce/Training N/A

RECOMMENDATIONS/ACTION REQUIRED:

The Governing Body is asked to:

Review the Board Assurance Framework.








Risk ID

Date Ad

ded

Source of R

isk Associated Risks Strategic Risk Area Description of Risk

Initial

Likelih

ood

Initial

Conseq

uence

Initial Risk

Score

Curren

t Likelih

ood

Curren

t Co

nseq

uence

Curren

t Risk

Score

Clinical Risk Last Controls to Mitigate Last Action Comment Gaps in Assurance

Last Review

Date

CCG

Date of Next

Review

Exec Lead

BAF 001

12/11/2014

Finance

134, 62, 130, 181, 146, 141, 140, 29, 145, 132, 113, 25, 142

Financial Performance The CCG fails to deliver its 14/15 control total. This could relates to Non delivery of QIPP Programme for 14/15.Contract overperformance on all acute and community contracts within planned, unplanned care, specialised services and primary care.Better Care Fund. Additional savings through reduction in emergency activity will be insufficient to cover costs of additional commitments through BCF.CHC increased costs and number of placements.Rowley Hall Contract ‐ significant overperformance.National Framework for Continuing Health Care will increase expenditure.Disputes from 13/14.Risk share arragements for funding nursing care and CHC care in Nursing Homes not funded by other CCGs.Insufficient resources to deliver the National Stroke strategy.Levels of funding will not cover committed costs on winter pressures.

5 5 25 4 5 20 Yes 13.08.14 ‐ Finance Performance & Contracting Committee has greater focus on contract performance. Commissioning lead assigned to every contract. QIPP delivery structure in place.September 14 Single version of the Truth now produces monthly reviews by Executive Management Team which identifies mitigating actions and monitoring progress.September 14 Monthly meeting AD/DoF to ensure achievement of control total on track.

September 14 ‐ Further number of mitigating actions agreed.* Finalise impact of MSFT Dissolution including ongoing modelling of bed closures at Stafford Hospital.* Review of expenditure and demand at Rowley Hospital.* Additional efficiency / non recurring cost reduction in SSSFT Mental Health Contract agreed* Progress further Continuing Healthcare QIPP including reviewing Methodist Homes for the Aged contractual position.* Progress reconciliation of Walsall Contract position and flex and freeze arrangements.* Progress reconciliation of Wolverhampton Contract position and target expenditure reductions.* Review Burton Overspend in particular non elective threshold.* Review application of fines levied against West Midlands Ambulance Trust.* Progress recharge of relevant dissolution costs to MSFT.

October 14 ‐ £1.6m achieved through arbitration, £1m agreed with MH Trust, further funding to cover Primary Care costs AVS £0.25m received.Recruitment of two experienced contract managers funded through CSU to drive out further £2 million efficiences in last five months of 2014/15.

January 15 ‐ Further £1.4m agreed with mental health trust (£1m non‐recurrent contract variation and £400,000 non‐recurrent underspend on out of area contract). Additional £400k on CHC, further contractual fines/penalties including information breaches being levied against Mid Staffs.

Still concerns that timelines for information to deliver single version of the truth not robust and concern follow through on actions slow due to capacity challenges. This is being mitigated through new appointments.

20/01/2015

both

28/02/2015

Director of Finance

BAF 002

12/11/2014

Commissioning

24, 53, 128, 138 Mid Staffordshire NHS Trust Dissolution/Transaction and Transition

Implementation of stemming the flow.Risk that patients on waiting lists could be lost in transition and transfer of care.Additional costs from the dissolution will fall to the CCG.

4 5 20 4 4 16 yes November 14 ‐ Transaction completed succesfully managed through Local Transition Board. Team in place within CCG to manage any matters of substance during transition which includes transfer of services. Joint work between CCGs and UHNM to fund initial work to implement stemming the flow has been agreed. Frail Elderly pilot in place alongside other community based schemes.

January 2015 ‐ Team remains in place. UHNM agreed to fund* Ambulatory care unit* Re‐ablement

CCG agreed to increase District Nursing resource, Stafford.

01.08.14 ‐ Risk managed through the Sustaining Services Board (SSB) and Local Transition Board across the LHE on a monthly basis. Actions ongoing to mitigate any operational day to day risks.Weekly MDT meetings continue. The Urgent Care Team are supporting the Trust on a daily basis. WMAS are diverting 15 ambulances to local alternative providers to enable MSFT to close 58 beds and avoid approximately 6 admissions per day.November 14 ‐ Agreement by UHNM to fund elements of commissioning provision to reduce pressure on acute services and reduce non‐elective admissions.

12 January 2015 ‐ Assurance measures delivered December for acute service and obstetrics. CCG reviewing assurance and signed off transfers.

Local Transition Board reviewing all material and singed off transfers.

Further support available over date or transfer.

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

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

11.02.2015 ‐ Acute Surgery transferred 9th February 2015.

Long term funding source.

11/02/2015

both

11/03/2015

Chief O

fficer

BAF 003

12/11/2014

Commissioning

136, 124, 22, 139, 108, 44, 51, 27, 121 (DN some of these will need to shift)

Contract Management and Performance (Delivering the NHS Constitution Standards, national targets and legislative and compliance requirements) (DN move this to Performance)

Lack of effective collaboration with other CCGs to manage contracts and control expenditure effectively

4 4 16 3 4 12 No November 14 ‐ Agreed to Joint integrated working across all CCGs to manage contracts jointly with CSU for 15/16 to ensure standard terms are consistent across all contractsNovember 14 ‐ Contract Board between all CCGs/CSU to set standard contract terms in process of being set up. In year mitigations to manage down contract costs through procurement of specialist contract resource to drive out unecessary costs and apply contract terms rigourously in the last five months of 14/15

November 14 ‐ Systems being set up to implement single contractual approach. Appointments to support in year contract monitoring completed and in place.

January 15 ‐ Looking to strengthen internal capacity to ensure rigorus contract management into 15/16.

20.01.2015

both

28/02/2015

Director of Finance

BAF 004

12/11/2014

Commissioning

135 Collaboration/Partnerships (DN specific to CHC) The collaborative commissioning arrangements for the CHC contract do not currently include a formal governance mechanism which includes an established CMB and CQRM.

4 4 16 3 4 12 No See mitigation to Associated risks 113 and 123 (closed). A new procurement process has been established for the CHC contract and a Programme Board to oversee the management and governanceof CHC contract. A Governance Framework is in development which clarifies roles and responsibilities of lead and Associate CCGs and the formal establishment of a CMB and CQRM. For nursing home residents specific mitigations are in place see risk 58.

10.11.14 ‐ CCH draft governance document developed and for consultation which sets out the accountability arrangements between lead and assocaite CCGs and the governance mechanism for qulaity and safety issues. This will go to the next CHC Programme Board for ratification.

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

The absence of a formal governance mechanism poses a potential Quality and Safety risk to patients. In addition the associated risks of insuffient funding and lack of commitment to risk sharing from Associate CCGs increases the risk to patients.

10/02/2015

Both

10/03/2015

Director of O

peratio

ns

BAF 005

12/11/2014

Corporate

137, 147, 120, 119, 148, 48, 143, 133, 83

Capability and Capacity The risk is the lack of capability and capacity to implement the KPMG Distressed Economy Report recommendations.Lack of performance team.CSU failing to deliver the quality of services required.Winterbourne.Local Authority capacity to deliver MCA/DOLS for vulnerable adults.Capacity to manage contracts.Key individuals not in post.Lack of resillience from CSU to support provider CQRM.Lack of CCG capacity.

4 4 16 3 4 12 No October 14 Resource procured to support transaction/transition at MSFT.November 14 ‐ Further resource sourced for delivery group and ongoing contract management. Continuing review of capability and capacity overall joint integration work agreed between CCGs in Northern footprint will further mitigate risk

October 14 ‐ Financial Resource confirmed to procure capacity and capacity procuredNovember 14 ‐ New management structure in CCGs in place.

February 2015 ‐ * New reablement structure now embedded.* Extra resource remains in place.*Commissioning congress agreed move to single Project Management team across CCGs.* Increased joint working across CCGs.

January 15 ‐ SaS Governing Body asked for clinical leadership to be listed as an issue on the BAF under capability and capacity.

11/02/2015

All CCG

s

11/03/2015

Chief O

fficer

CC/SaS CCGs ‐ BOARD ASSURANCE FRAMEWORK

Risk ID

Date Ad

ded

Source of R

isk Associated Risks Strategic Risk Area Description of Risk

Initial

Likelih

ood

Initial

Conseq

uence

Initial Risk

Score

Curren

t Likelih

ood

Curren

t Co

nseq

uence

Curren

t Risk

Score

Clinical Risk Last Controls to Mitigate Last Action Comment Gaps in Assurance

Last Review

Date

CCG

Date of Next

Review

Exec Lead

BAF 006

12/11/2014

Comms &

Engagem

ent

184, 183, 34,131, 21

Communications & Engagement Failure to appropriate communicate and engage with the public, partners and staff to deliver high quality safe services, constitional and financial performance

4 5 20 4 4 16 yes September 14 ‐ Communications and Engagement team reconfigured and resource base significantly increased. Focus on transition of MSFT and dissolution. Internal communications with staff. Transforming Cancer and EOLC and MIU conmsultation.

January 2015* Continued development of internal comms.* Discussion with ECS Staffordshire on developing communication and environment beyond MSFT transition, transforming Cancer and End of Life, MIU to open agreed.

October 14 ‐ Significant progress on Communications /Engagement with increased proactive approach with media, politicians and the public. Evidenced through engagements events MSFT, attendance at local / national assurance meetings.MIU consultation.

January 2015 ‐ Ensures proactive communication to public through:* Work Well.* Radio and media

11.02.2015 ‐ Commissioned Healthwatch/Engaging Communities 12 month risk of work to involve all CCGs/County Council to cover Better Care Fund/General Commissioning and the Care Act..

Further work with general popualtion plan to deliver

11/02/2015

both

11/03/2015

Chief O

fficer

BAF 007

12/11/2014

Quality

53, 133, 135, 147 Quality and Safety The is a risk that the CCG will be unable to fulfil its statutory duty to assure the quality and safety of Commissioned services. As a result of clinical and financial sustainability issues, the services from MSHFT have now been transferred to new Providers. Some services will transfer across Providers more than once. The CCG is not the lead Commissioner and will need to work through North and Wolverhampton CCG's to assure SAS and CC Governing Bodies and the public of the quality and safety of those services. For the remainder of 2014/15 contract a CVO arrangement has been imposed upon the CCG, which potentially restricts the CCG's ability to assure quality.Some specific services are being transferred early. Two (obstetrics/paediatrics) of which are highly contentious with the public. The CCG has to work with a range of statutory and local stake holders to assure their safe and acceptable transition. There are on going capacity issues within the CCG team itself in meeting those requirements. In addition to the resilience and sustainability of the CSU support to the CCG for those Providers; in particular SSOTP. The governance frameworks for traditionally underdeveloped services‐ i.e. CHC, dementia require strengthening. The CCG functions are being undertaken within the context of a potentially large scale, strategic change across Staffordshire.

5 4 20 2 4 8 Yes 01/12/2014 ‐ UHNM ‐ To mitigate the restrictiveapproach of a HoTs the CCG Quality team have negotiated a MOU, with UHNM where the majority of the quality metrics identified as high priority for the County Hospital (Stafford) is specified These will be reported in a separate County Quality Assurance Report to the CCG. Other measures include:* CCG attendance at the County Hospital internal Quality Commitee meeting on a monthly basis* CCG representation at the monthly TDA Clinical Oversight Group (COG)where the TDA meet with the Nurse Directors and Medical Directors of the recieving Provider Trusts.* CCG representation on the monthly UHNM CQRM

Early Transition of Services ‐ The CCG has developed an assurance process which involves an assessment framework and panel review for each of 4 early transitioning services ‐ obstetrics, paediatrics, critical care, acute surgery.

Economy Wide Assurance ‐Economy Wide Assurance ‐ There is economy wide scrutiny of the transtion process through the Local Transtion Board (LTB) which meets fortnightly and the Area Quality Surveillance Group (QSG) which meets monthly.

01.12.2014

Both

02.01.2015

Director of Q

uality & Safety

12/11/2014

Quality

53, 133, 135, 147 Quality and Safety Royal Wolverhampton Trust ‐ Please see BAF risk 007 which descibes the risk condtions relating to the transfer of MHSFT services to the receiver Trusts. The CCG has been unable to agree with the RWT an MOU for the quality metrics which it was able to do with UHNM that provided mitigation for the restrictive approach of a HoTs. The compare and contrast exercise conducted prior to transfre also identified a greater distance between the qulaity monitering schedule of RWT with UHNM and MSHFT.

5 4 20 3 4 12 Yes 01/12/2014 ‐ Wolverhampton Trust ‐ * CCG represntation at the monthly COG where the Medical Director and Nurse Director for RWT are in attendance.*CCG representation at Early Transition of Services ‐ The CCG has developed an assurance process which involves an assessment framework and panel review for each of 4 early transitioning services ‐ obstetrics, paediatrics, critical care, acute surgery.Economy Wide Assurance ‐ There is economy wide scrutiny of the transtion process through the Local Transtion Board (LTB) which meets fortnightly and the Area Quality Surveillance Group (QSG) which meets monthly.

01.12.2014

Both

02.01.2015

Director of Q

uality & Safety

BAF 008

12/11/2014

Performance

108,44,51,27,121 (DN add in from 3 above)

Delivery of NHS Constitution standards and compliance other regulatory standards

Failure to deliver NHS Constitution Standards and therefore affect patient care

3 4 12 2 4 8 yes April 14 ‐ Monthly Performance monitoring of standards through Perormance Lead, Contract Reviews, Executive Team, AT Assurance and Governing Body Meetings

November 14‐ Performance reviewed fro Quarter 2 assurance minor issues performance being investigated. Key outstanding issue is A&E which now has agreed trajectories to achieve 95% standrard December 7th as part of Strategic Resillience Plan.10.02.2015 ‐ Past three weeks A&E has performed over 95% following collaborative work across Stafford health economy. 10

/02/2015

Both

10/03/2015

Director of O

peratio

ns

BAF009

27/11/2014

Prim

ary Ca

re

Primary Care The risk is that the capacity and man‐power in primary care does not meet the current and future requirements. The CCG is unable to reduce variation in quality and activity in primary care

3 4 12 3 4 12 Yes 27.11.2014 ‐ Approval of Primary Care strategy by membership map of medicine approved.

27.11.2014 ‐ Primary Care Strategy approved Cannock Membership Board January for approval SaS.

11.02.2015 ‐ Cannock Chase CCG : The three networks are now in place and have developed business plans.

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

Primary Care Strategy not yet approved in SaS. Wide variation currently exists between practices.

11.02.2015 ‐ Lack of capacity in Primary Care means that the TSA recommendations may not be fulfilled.

11.02.2015* Many small practices in Cannock Chase CCG* Networks and collaboration in a fledgling state* Demographic "time‐bomb" * Legitimate increase in demand and expectation

11/02/2015

both

11/03/2015

Director of P

rimary Ca

re

CC/SaS CCGs ‐ BOARD ASSURANCE FRAMEWORK

Subject:

Board Le

Officer L

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PURPOS

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Item: 10 Enc: 08

Page | 2

IMPLICATIONS

Legal and/or Risk See risk section in body of report.

CQC None

Patient Safety None

Patient Engagement None

Financial Deficit of £1.509m for the year to date

Sustainability Supports financial sustainability and best value commissioning

Workforce/Training None


The CCG Governing Body is asked to:

- Note the position to date, the forecast for the year and the risks and mitigating actions.








Stafford and Surrounds CCG

Month 9 Finance report

1. Introduction

This is the report to the end of December, based on Month 8 (November) contracting information. The aim is to present clearly the key financial issues for the year to date and highlight any risks to achievement of our planned financial position.

2. Planned deficit

The planned deficit for the full year is £9.167m. At 31st December the year to date planned deficit was £8.966m. The variance of £1.509m reported below is the variance from this year to date plan.

3. Financial position to Month 9

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

This shows a year to date deficit against plan of £1.509m, represents an improvement of nearly £200k from the position reported at Month 8 of £1.696m, confirming that overspends early in the year are continuing to revert to plan. The ytd position is largely driven by an overspend across the contract portfolio of £2.329m. There are also overspends in Continuing Healthcare (£0.542m) and Other

Forecast

Table 1 - Stafford and Surrounds CCG Outturn

Summary Financial Statement as at 31st December 2014Annual Budget

Budget to date

Actual to date

Variance Variance

£000's £000's £000's £000's £000's

Acute Contracts 94,094 69,325 71,584 2,259 3,236

Mental Health 16,307 12,305 11,989 (315) (680)

Community Services 13,690 10,212 10,598 386 304

Total HCHS 124,091 91,842 94,171 2,329 2,861

Continuing Healthcare 15,548 11,756 12,297 542 (193)

Primary Care Services 25,906 19,503 19,832 329 290

Other Programme Services 1,263 947 1,267 320 403

Reserves

Contingency Reserve 800 297 0 (297) (800)

Winter / Resilliance Monies 568 575 0 (575) (633)

QIPP Reinvestments 553 315 0 (315) (403)

QIPP to be allocated (53) 0 0 0 53

QIPP Risk Reserve 1,151 753 0 (753) (1,151)

Commissioning Reserve 427 103 0 (103) (427)

Total Reserves 3,446 2,043 0 (2,043) (3,361)

Corporate Running Costs 3,578 2,538 2,571 33 0

Corporate Non Running Costs 214 160 160 (0) 0

CCG Total Expenditure 174,045 128,789 130,298 1,509 (0)

Revenue Resource Limit prior to repaying previous year deficit (164,878) (119,823) (119,823) 0 0

In Year Position (Surplus)/Deficit 9,167 8,966 10,476 1,509 (0)

Repayment of previous year deficit 9,646 4,019 4,019 0 0

Cumulative Position (Surplus)/Deficit 18,813 12,985 14,495 1,509 (0)

programme services, predominantly patient transport services (£0.32m) supported by a year to date release of reserves (£2.043m) More detail is given in Appendix 1.

4. Running costs

CCG running costs are monitored separately within the Revenue Resource Limit. The year to date position is a small overspend against budget which is being reviewed to ensure it is eliminated by the financial year end. The detailed running cost position is shown in Table 2 below:

5. Allocations

No allocation adjustments have been made in Month 9. In year changes to the initial allocation are shown in table 3 below

Table 2 - NHS Stafford & Surrounds CCG AnnualSummary of Running Costs as at 31st December 2014 Budget Budget Actual Variance

£000's £000's £000's £000's

Pay 1,576 1,083 1,060 (23)

Non Pay 1,509 860 884 24

Commissioning Support Service 1,263 948 987 39

Income (770) (353) (360) (7)

CCG Total 3,578 2,538 2,571 33

Year to Date

Table 3Revenue Resource Limit as at 31st December 2014

Original Plan

Confirmed Healthcare Allocation 154,797

Initial CCG Running Costs Allocation 3,578

In year Movements

Brought Forward Deficit (9,646)

GPIT 367

Training Transfer from Shropshire & Staffs AT 19

Secondary Care Funding Returned to CCG's 192

GPIT 93

14/15 RTT Funding 633

CHC Risk Sharing Rebasing 2,410

Adjustments to 13/14 Baseline 105

European Overseas Visitors (118)

Armed Forces (40)

Winter Resilience 2,791

NHS 111 51

Total Current Resource Limit - Programme & Admin 155,232

£000s

6. Contracting position at month 8

Contracting information has been received covering the period to the end of November (Month 8). The month 8 variances against plan have been extrapolated to give an estimated Month 9 position, which is included in the table above.

The main contributors to the reported overspend of £1.509m against plan are University Hospitals North Staffordshire (£1,041k), Rowley Hall (£895k) and Royal Wolverhampton Trust (£308k). At the point of the dissolution of Mid‐Staffordshire Hospitals NHS Foundation Trust it had generated an underspend position (£583k) as a result of agreed reductions in capacity from July, a slow down in elective activity, continuation of the application of performance penalties that had been imposed and under‐achievement of CQUIN targets. The over‐performance at UHNS is almost entirely due to over‐performance on emergencies. Rowley Hall, which is an elective contract, continues to over‐perform, but discussions are taking place with the provider about curtailing this increase in activity. The over‐performance at Royal Wolverhampton includes increasing Outpatient attendances and costs of Lucentis, which is subject to further investigation.

7. Reserves position

Reserves are detailed within Table 1. As at Month 9, £2.04m of reserves have been used to support the reported position including an element of the contingency.

8. QIPP progress

Delivery of the CCG financial control total is still heavily dependent on achieving the planned QIPP savings. Progress on QIPP implementation is considered in more detail within a separate QIPP Performance Report. In the first nine months, it is estimated that savings of just over £2.5m have been delivered, which is £1.0m below plan. The CCG had created a reserve to mitigate against QIPP slippage and within the reserves figure highlighted above, £753k has been released from this reserve to support the programme. The projected savings continue to be validated against contract performance information and will be revised as necessary but due to slippage in some schemes, the projected full year savings are now £3.46m against a plan of £5.47m, a shortfall of £2.009m. The risk reserve highlighted above is £1.15m in total and therefore current projections are that the shortfall will exceed the reserve available by £0.858m. The PMO responsible for the QIPP programme is assessing further schemes and mitigations to address this shortfall.

The detailed programme is shown at Appendix 2.

9. Balance Sheet, Better Payment Policy Compliance, Cash

The Summary balance sheet (Statement of Financial Position) confirming the position at the end of the previous financial year and the most recent three months of the current financial year is included in table 4 below

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

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

10. Risks and mitigations

Several financial risks have been identified and are contained within the CCG risk register. The more material risks are highlighted below. There is a risk that elective activity will continue to over‐perform in future months due to increased referrals. There is a Commissioning reserve of £427k, which will be used to offset any projected over‐performance.

Table 4Summary Statement of Financial Position

Current assets:

Trade and other receivables 3,069 5,973 6,633 5,299

Cash and cash equivalents 46 238 83 75

Total current assets 3,115 6,211 6,716 5,374

Current liabilities

Trade and other payables (13,083) (12,077) (12,712) (12,624)

Total Assets Employed (9,968) (5,866) (5,996) (7,250)

Financed by Taxpayers’ Equity

General fund (9,968) (5,866) (5,996) (7,250)

Total Taxpayers Equity (9,968) (5,866) (5,996) (7,250)

31st December

2014 £000s

31st March 2014 £000s

31st October

2014 £000s

30th November

2014 £000s

60.0

65.0

70.0

75.0

80.0

85.0

90.0

95.0

100.0

APR MAY JUNE JULY AUG SEPT OCT NOV DEC

% Compliance

BPPC Compliance 2014/15 NHS

Number

Value

60.0

65.0

70.0

75.0

80.0

85.0

90.0

95.0

100.0

APR MAY JUNE JULY AUG SEPT OCT NOV DEC

% Compliance

BPPC Compliance 2014/15 Non NHS

Number

Value

Delivery of projected savings from the QIPP programme remains a risk. Performance is being monitored through the PMO and Finance, Performance and Contracts Committee. As identified above, the risk reserve of £1.15m is currently insufficient to offset the projected under‐delivery in year.

There are still some 2013/14 contractual issues unresolved and the outcome of formal dispute resolution with University Hospitals North Staffordshire will be available imminently.

11. Forecast outturn

The CCG continues to forecast achievement of its control total for 2014‐15 and continues to hold regular reviews of the forecast position on a line by line basis through the Executive Management team. This work has highlighted a range of risks as identified above and a series of compensating mitigations. Table 1 above and appendix 1 below show the current forecast assumptions per area and these will continue to be reviewed in light of the risks highlighted above.

12. Recommendations

12.1. The Governing Body is asked to note the position to date, the forecast for the year and the risks and mitigating actions.

Paul Simpson Director of Finance 6th February 2015

Appendix 1

Stafford and Surrounds CCG Forecast Annual OutturnBudget Budget Actual Variance Variance

£000 £000 £000 £000 £000Acute ServicesNHS ContractsMid Staffordshire Foundation Trust 31,174 31,738 31,155 (583) 138Burton Hospitals Foundation Trust 394 295 262 (34) (51)Heart of England Founation Trust (HEFT) 255 191 166 (25) (0)Royal Wolverhampton Hospital Trust 11,456 6,652 6,960 308 310Dudley Group of Hospitals 102 77 156 79 58University Hospitals of Birmingham 644 483 388 (96) (92)University Hospital North Staffordshire NHS Trust 34,194 19,573 20,614 1,041 1,162Derby Foundation Trust 179 134 118 (16) (25)Walsall Manor Hospital Trust 304 229 159 (70) (98)Birmingham Childrens Hospital 267 200 161 (39) (63)Robert Jones & Agnes Hunt 937 706 679 (27) (24)Shrewsbury & Telford Hospitals 440 329 337 8 10Royal Orthopaedic 268 201 208 8 3Sandwell & West Birmingham NHS Trust 170 128 125 (3) (1)Other NHS 25 19 45 27 49West Midlands Ambulance 4,653 3,531 3,471 (60) (40)Other Provider Contracts - Non NHSRowley Hall 3,845 2,885 3,780 895 635Other acute 738 512 1,225 713 499NHS Contract ExclusionsNHS - Other 0 0 88 88 0NCA's 1,207 905 937 32 41Other 0 0 12 12 204Winter Pressures 2,842 538 539 1 521

Acute Services 94,094 69,325 71,584 2,259 3,236Mental Health ServicesNHS ContractsStaffordshire & Shropshire NHS FT 13,883 10,481 9,889 (592) (1,074)Other Mental Health & Learning Disabilities 472 354 406 52 5Other Provider Contracts - Non NHSStarfish Mental Health Services 744 558 599 41 10Midland Psychology 250 187 228 41 39MAC UK Neuroscience 0 0 0 0 0Other 959 724 866 142 341NHS Contract Exclusions 0 0 0 0 0Other 0 0 0 0 0

Mental Health Services 16,307 12,305 11,989 (315) (680)Community Health ServicesNHS Contracts

Staffordshire & SOT Partnership Trust 10,780 8,022 8,216 194 35Walsall Manor Hospital Trust 666 500 500 0 0Royal Wolverhampton Hospital Trust 299 224 239 15 (12)Other NHS (104) (104) (87) 17 198Other Provider Contracts - Non NHSRowley House Nursing Home 143 141 141 (0) (0)Methodist Homes for the Aged 297 223 162 (61) (0)Other 514 386 521 136 58NHS Contract Exclusions 0 0 0 0 0NCA's 0 0 0 0 0Hospices 1,094 820 910 90 25Other 0 0 (3) (3) 0Community Health Services 13,690 10,212 10,598 386 304Total Healthcare Contracts 124,091 91,842 94,171 2,329 2,861Continuing Care ServicesContinuing Care 13,797 10,460 10,641 181 (606)Funded Nursing Care 1,750 1,296 1,656 360 413

Continuing Care Services 15,548 11,756 12,297 542 (193)Primary Care ServicesPrescribing 22,937 17,301 17,423 123 120Enhhanced Services 538 408 407 (1) 0Out of Hours 608 456 561 105 80

Other 1,824 1,338 1,441 102 90

Primary Care Services 25,906 19,503 19,832 329 290Other Programme ServicesPatient Transport Services 764 573 860 287 383

Other non acute - NHS 498 374 407 33 20

Other Programme Services 1,263 947 1,267 320 403Commissioning Services 166,807 124,047 127,567 3,519 3,361Reserves / QIPPContingency Reserve 800 297 0 (297) (800)Winter / Resilliance Monies 568 575 0 (575) (633)QIPP Reinvestments 553 315 0 (315) (403)QIPP to be allocated (53) 0 0 0 53QIPP Risk Reserve 1,151 753 0 (753) (1,151)Commissioning Reserve 427 103 0 (103) (427)

Reserves / QIPP 3,446 2,043 0 (2,043) (3,361)Corporate CostsRunning Costs 3,578 2,538 2,571 33 0Non Running Costs 214 160 160 (0) 0

Corporate Costs 3,792 2,698 2,732 33 0Stafford & Surrounds CCG Operational Budgets 174,045 128,789 130,298 1,509 (0)

Revenue Resource Limit prior to repaying previous year deficit

(164,878) (119,823) (119,823) 0 0

In Year Position (Surplus)/Deficit 9,167 8,966 10,476 1,509 (0)

Repayment of previous year deficit 9,646 4,019 4,019 0 0

Cumulative Position (Surplus)/Deficit 18,813 12,985 14,495 1,509 (0)

Financial Year 2014/15Financial Position as at 31st December 2014 - Month 9

Appendix 2

QIPP Programme – Stafford and Surrounds CCG

ID Scheme Description Lead PhasingYTD Target

SavingsYTD Actual

SavingsYTD

Variance

Annual Planned Savings

FOT Savings

ConfirmedFOT

VarianceFOT

SavingsMovement

in FOTComments

BV01 Continuing Healthcare Rob Lusardi M1-M12 (704,791) (717,060) (12,269) (1,000,000) (1,000,000) 0 (1,000,000) 0 Multiple schemes to deliver including Methodist HomesUP01 Extend Acute Visiting Services (AVS) Alex Bennett M4-M12 (379,075) (286,798) 92,277 (568,612) (385,882) 182,730 (296,766) (89,116) Potential for increased uptake through roll out to 111 etc.P02 Pharmacy Schemes Sam Buckingham M1-M12 (460,215) (535,135) (74,920) (546,446) (546,446) (0) (546,446) 0 Potential savings will reduce as near year-endLTC Long Term Conditions- Redesign of services Ashleigh Pettigrew M7-M12 (218,327) (32,000) 186,327 (436,653) (32,000) 404,653 (4,742) (27,258) Non-achievement of target agreed at previous FPC BV03 MSFT locally agreed tariffs Rob Lusardi M1-M12 (265,073) (265,073) 0 (353,430) (353,430) 0 (353,430) 0 Rolled over into UHNM and RWT contractsFE Frail Elderly- To develop pathways and services Tammy Lott M7-M12 (149,792) (15,747) 134,045 (299,584) (31,495) 268,089 (31,495) 0 Adverse variance reflects stemming the flow funding DD04 Acute Contracts (MSFT PAU) Alex Bennett M7-M12 (125,000) - 125,000 (250,000) - 250,000 - 0 Scheme not taking placePC02 Gastro / Calprotectin Mel Savage M1-M12 (187,025) (131,962) 55,063 (249,366) (176,623) 72,743 (173,405) (3,219) Uptake increasing at practices following promotionPIP01 WMAS A&E overnight contract Alex Bennett M6-M12 (135,255) - 135,255 (236,696) - 236,696 - 0 No budget to QIPPBV04 SSOTP efficiencies above national requirement Rob Lusardi M1-M12 (171,364) (171,364) (0) (228,485) (228,485) 0 (228,485) 0 In contractsP06 Demand Management Lynn Miller M4-M12 (132,115) - 132,115 (198,183) - 198,183 20,535 (20,535) Movement in FOT reflects move to reporting on actualsPC01 MSK one stop shop prime provider model Mel Savage M7-M12 (87,160) (87,160) 0 (174,319) (174,319) 0 (174,319) 0 Contract blocked, actuals at acutes to be reviewedPIP05 SSSFT - LD Transformation & Milford closure Shirley Goodchild M6-M12 (64,286) (64,286) 0 (112,500) (69,000) 43,500 (69,000) 0 FOT reflects worse case, TBC in negotiations with SSSFTDD03 Voluntary Block Contacts Mel Savage M5-M12 (82,050) (21,956) 60,094 (109,400) (35,130) 74,270 (35,130) 0 In contractsPC04 BNP Ashleigh Pettigrew M1-M12 (79,286) (102,840) (23,553) (105,715) (137,119) (31,404) 55,345 (192,464) Scheme being reviewed by Frank HamiltonPIP08 SSSFT - Further Contractual Efficiency Shirley Goodchild M6-M12 (57,143) - 57,143 (100,000) - 100,000 (100,000) 100,000 To be confirmed in negotiations with SSSFTPIP13 Decommissioning Further Services Jonathan Bletcher M6-M12 (57,143) - 57,143 (100,000) (40,000) 60,000 (40,000) 0 £40k to be delivered through Hospice at HomeP01 Medicines Optimisation – Care Homes Sharuna Reddy M1-M12 (63,714) (36,772) 26,942 (63,714) (36,772) 26,942 (36,772) 0 Scheme has underdelivered in StaffordPIP09 Ophthalmology Mel Savage M6-M12 (28,571) - 28,571 (50,000) - 50,000 - 0 Currently, no scheme to deliverPIP11 Primary Care Medicines Management Lynn Miller M6-M12 (28,571) (28,571) 0 (50,000) (50,000) 0 (50,000) 0 Taken out of budgets, to be delivered via P02P05 Back Pain triage - use of Start back tool Alex Birch M5-M12 (18,320) - 18,320 (29,312) - 29,312 - 0 Not achievable as budget blocked for 14/15 as per PC01

Major Schemes Sub-Total (3,494,274) (2,496,722) 997,552 (5,262,415) (3,296,702) 1,965,713 (3,064,110) (232,592)

DD01 Section 256 Staffs County council Mel Savage M1-M12 (18,750) (19,335) (585) (25,000) (25,780) (780) (25,780) 0 In contracts PIP06 SSSFT - Out of Areas placement contract Shirley Goodchild M6-M12 - - 0 (25,000) (75,000) (50,000) (25,000) (50,000) To be confirmed in negotiations with SSSFT PIP03 Cardiology - reduction in 1st OPA and FU's Ashleigh Pettigrew M6-M12 (14,286) - 14,286 (25,000) - 25,000 - 0 Currently, no scheme to deliver PIP12 E consultation (Reduction in FU's) Ashleigh Pettigrew M6-M12 (14,286) - 14,286 (25,000) - 25,000 - 0 Currently, no scheme to deliver DD02 Voluntary Sector Grants Mel Savage M5-M12 (9,938) - 9,938 (23,800) - 23,800 (115,570) 115,570 In contracts PIP04 PLCV list & audit for 14/15 while Oregon worked up Mel Savage M6-M12 (11,429) (11,429) 0 (20,000) (20,000) 0 (20,000) 0 Introduced in October, actual data to be reviewed PIP07 SSSFT - Children's Community Support Service Shirley Goodchild M6-M12 - - 0 (15,625) - 15,625 (15,625) 15,625 To be confirmed in negotiations with SSSFT PC06 Ophthalmology - duplicate firsts Mel Savage M7-M12 (7,374) (4,916) 2,458 (14,747) (14,747) 0 (14,747) 0 Saved referrals from MSFT to RWT, actual data to be reviewed DD02 Section 256 HIV/AIDS Mel Savage M1-M12 (9,938) - 9,938 (13,250) - 13,250 - 0 No budget to QIPP PIP02 Glaucoma refinement service Mel Savage M6-M12 (6,286) (15,114) (8,828) (11,000) (19,888) (8,888) (19,888) 0 Scheme started early PIP10 Primary Care Lynn Miller M6-M12 (4,571) (4,571) 0 (8,000) (8,000) 0 (8,000) 0 To be delivered via COPD telehealth scheme

Minor Schemes Sub-Total (96,857) (55,364) 41,492 (206,422) (163,415) 43,007 (244,610) 81,195

Grand-Total (3,591,131) (2,552,086) 1,039,045 (5,468,837) (3,460,116) 2,008,721 (3,308,720) (151,397) Risk reserve 1,151,063 Variance to Risk Reserve 857,658

Key

#### FOT variance £25,000 adverse or greater 1,000 FOT has worsened relative to FOT in previous month Savings confirmed, e.g. in contracts#### FOT variance between £1 and £25,000 adverse 0 FOT has remained the same as FOT in previous month Savings not confirmed, e.g. dependent upon future negotiations etc. #### FOT variance 0 or favourable ##### FOT has improved relative to FOT in previous month

Stafford & Surrounds CCG - 2014/15 QIPP Performance Report

M9 PMO Report

Minor Schemes (£25,000 and under)

Major Schemes (over £25,000)

M8 PMO Report

Month 9

Item: 11 Enc: 09

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REPORT TO THE Stafford & Surrounds Clinical Commissioning Group Governing Body TO BE HELD ON: Tuesday 17th February 2015

Subject: Primary Care Strategy

Board Lead: Dr Paddy Hannigan

Officer Lead: Lynn Millar

Recommendation: For Approval For

Ratification For Discussion For

Information PURPOSE OF THE REPORT:

The purpose of the report is to discuss and approve the Primary Care Strategy

KEY POINTS: The aim of the strategy is to improve quality and build capacity and capability in primary care to ensure the future sustainability of general practices in Stafford and Surrounds

The Strategy will improve quality through effective, efficient and accessible primary care and the provision of a wider range of primary care services.

The focus will be on promoting health, wellbeing and illness prevention and addressing our health inequalities. It will enhance patient experience and outcomes by improving clinical and service quality. Operating across the traditional boundaries, it will begin to integrate the delivery of care and reduce the variation between practices The strategy proposes six programme areas:

1. Quality 2. Primary Care Operating Model 3. Co-Commissioning Primary Care 4. Information Management and Technology 5. Workforce Development and Education 6. Medicines Optimisation

Item: 11 Enc: 09

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

No


Yes a key priority of the strategy is to increase expected prevalence rates for LTCs and Dementia


Yes the Strategy is focussed on reducing unwarranted variation between practices

A reduction in excess winter deaths of 50%

Yes more vulnerable patients will be risk stratified and managed in the community

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

Yes, as above, and through improved educational opportunities and models of care

IMPLICATIONS

Legal and/or Risk N/A

CQC N/A

Patient Safety The strategy will support safe, high quality primary care services

Patient Engagement The strategy has been developed on the basis of public feedback. Patients will continue to be involved in the work programme

Financial The strategy will support the shift of resources from secondary to primary care and the community, however, implementation of the strategy may require investment to pump prime services in primary careThe

Sustainability Implementation complements to the wider programme of developing a sustainable health economy

Workforce / Training The strategy will inform Health Education West Midlands workforce planning and the NHS England Workforce review

RECOMMENDATIONS / ACTION REQUIRED:

The SAS CCG Membership Board is asked to:

Approve the draft primary care strategy

Oversee the monitoring of the strategy through the Plan on a Page

Request an update to receive progress in 6 months

Item: 11 Enc: 09

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1

Stafford and Surrounds CCG Primary Care Strategy – 2014-2019 Contents

1. Introduction ....................................................................................................................................... 3

1.1 The Patients’ View ................................................................................................................. 4

1.2 What will primary care look like to the patient in five years’ time…A,B,C ..................... 4

1.2 The View from General Practice ......................................................................................... 5

3. Primary Care in Stafford and Surrounds ...................................................................................... 6

3. Case for Change .............................................................................................................................. 7

3.1 Health Outcomes ................................................................................................................... 7

3.3 Access ..................................................................................................................................... 9

3.4 Workforce .............................................................................................................................. 10

6. Transformation Strategy ............................................................................................................... 12

6.1 Innovation and Quality ........................................................................................................ 13

6.2 Primary Care Operating Model .......................................................................................... 14

6.3 Co-Commissioning of Primary Care ................................................................................. 17

6.4 Information Management and Technology ...................................................................... 18

6.6 Medicines Optimisation ....................................................................................................... 20

7. How we will do it? .......................................................................................................................... 21

7.1 Programme Management ................................................................................................... 21

7.2 Governance .......................................................................................................................... 21

7.5 Stakeholders ......................................................................................................................... 22

7.6 Communications and Engagement ................................................................................... 23

7.6 Risks ...................................................................................................................................... 24

Appendix 1 Stafford & Surrounds CCG Practice Area ................................................................. 25

2

Appendix 2 Achievements ................................................................................................................ 26

Appendix 3 – Call To Action ............................................................................................................. 27

Appendix 4 – Plan on a Page ........................................................................................................... 28

3

1. Introduction

General Practice is the foundation of health care delivery in the NHS. It is central to bringing care closer to home, preventing unnecessary hospital care and identifying which people need specialist services. However, General practice is under pressure; patient expectations are rising, practice income is falling, there is a growing need to keep people out of hospital and provide a greater range of services in the community. CCGs were established to enable GPs as clinical leaders to change the way health care is commissioned and delivered.

The expectation of Primary Care is to provide better clinical outcomes despite rising patient expectation, increasing demand, a falling percentage of the NHS budget and workforce capacity issues. This is clearly a challenging situation and demands new and flexible thinking about how we will deliver services. One of the great strengths of Primary Care has always been its ability to adapt to meet the demands made upon it.

The Primary Care workforce is under pressure with fewer graduates entering into the profession, a large proportion of older GPs approaching retirement and a lack of training for alternative workers such as Nurse Practitioners or Physician’s Assistants.

There is a need for a stronger role for Primary Care, at scale, which will require a new operating model serving larger populations and delivering a wider range of services. Across South Western Staffordshire, all 41 practices have already joined together to form a Primary Care Federation – GP First Ltd - that serves a population of over 270,000 people.

Central to the vision of better health outcomes for communities will be greater integration across organisational boundaries with GPs playing a pivotal role at the heart of the health and social care system. Integrated IT systems and data sharing between organisations will be central to this and will require organisations to share clinical information to improve patient outcomes and ensure better coordination and continuity of care

A major transformation is required to ensure the demand does not outstrip the capacity and reduce the ability of General Practice to continue to provide high quality, accessible and effective care.

There is no doubt that primary care will need to change in order to tackle the challenges ahead. There will need to be a fundamental shift in culture from one where practices work as independent entities to a model of collaboration and partnership. GPs as clinical commissioners will be at the heart of this change with Members working together to develop new ways of working to improve outcomes for patients and to ensure a sustainable model of primary care.

Dr Paddy Hannigan

Membership Board Chair

4

1.1 The Patients’ View

As part of the ‘Call to Action’ the CCG has engaged with patients, patient groups and carers to understand the patient’s view of effective primary care in the future (see Appendix 3)

Patients want to see…

A greater role for the wider primary care team Care that supports the needs of the individual Seamless care between organisations and professionals Support for Carers More Education and Awareness

1.2 What will primary care look like to the patient in five years’ time…A,B,C

1.2.1 Access to services…For the busy, working parent

Much more of your interaction with the NHS will be on-line. Your experience of using the NHS will be similar to using the best service

industries - consistently high quality and effective You only go to the surgery when you need to see your doctor face to face -

telephone consultations, email and the internet will ensure that access to health care is convenient.

On line appointments and e-booking will be the norm. Information about your health care health will freely available to you. We will help you and your family to stay well and live healthy lives

1.2.2 Bridging your health care …For people with one or more long term conditions

You will be supported to manage your own condition. We will build bridges between everyone involved in looking after you to

ensure proactive, high quality and coordinated care. You will have rapid access to specialist advice and care when you most need

it. Your care will be largely delivered in the community.

1.2.3 Continuity of care…For a frail, older person with health problems

You value your personal relationship with your healthcare team and this will be reflected in the care that you receive.

Your care will be designed around you and your Carer’s needs. Your GP practice will be central to the delivery of your healthcare. Your health care records will be available to the people who are caring for you

- whoever is treating you will always know about you and your needs.

5

1.2 The View from General Practice

In February 2014, practice teams and the CCG attended a primary care workshop to discuss the development of primary care services of the future. Members raised concerns around the increasing demands placed on primary care, falling practice income and the growing difficulty recruiting and retraining staff. Despite these concerns, members recognised that primary care is best placed to coordinate and deliver care for patients and local communities. However, for primary care to flourish there will need to be a shift of resources from secondary care in order to build capacity and capability in the primary care setting.

The Royal College of General Practitioners agrees that primary care organisations are best placed to develop services within primary care and community settings as these are the services that are closest to the concerns of GPs and practice teams. The RCGP concludes that major service transformation will require highly organised and appropriately incentivised primary care as a foundation for delivery.

The members agreed that there is a need to maintain and improve high quality general practice by ensuring primary care services that are

effective efficient accessible

Further consultation was carried out with GPs across Stafford and Surrounds in the Summer of 2014. Practices raised concerns about capacity to deliver 7 day working, falling practice incomes, difficult work/life balance, and greater demands to do more within the same resources. There was a recognition that more investment in primary care is required to shift activity from secondary care into the Community.

6

3. Primary Care in Stafford and Surrounds

The relationship between the CCG and Member Practices is currently defined by three areas of responsibility:

1. Non-core Primary Care Medical Provision e.g. Locally Enhanced Services, Any Qualified Provider (AQP) and prime provider services.

2. Primary Care Quality - Access and variation are the two national priorities 3. The commissioning role of GP practices as members of the CCG

The CCG currently has 14 GP practices serving a population of approximately 145,000 residents (See Appendix 1 for Practice map). There are 6 practices with a General Medical Services (GMS) contract and 8 practices with a Primary Medical Services (PMS) contract. In Stafford and Surrounds, the average list size is higher than the national average with around 10,372 registered patients per practice compared to a national average of 7,058.

Table1. Stafford and Surrounds List Sizes by Practice

CCG Practice Code Lead GP GMS,PMS or

APMS

Raw List

01.01.14

List size

group (000's)

Stafford and Surrounds M83024 Castlefields Surgery Dr Munslow PMS 6,198 5-10 Stafford and Surrounds M83092 Crown Surgery Dr Bland PMS 7,282 5-10 Stafford and Surrounds M83070 Gnosall Health Centre Dr Greaves PMS 7,930 5-10 Stafford and Surrounds M83022 Great Haywood Surgery Dr M Davis PMS 8,322 5-10

Stafford and Surrounds M83044 Browning Street Surgery Dr P Glennon GMS 9,427 5-10

Stafford and Surrounds M83057 Mill Bank Surgery Dr Hodgkinson GMS 9,985 5-10

Stafford and Surrounds M83009 Brewood Surgery Dr Husselbee GMS 9,991 5-10

Stafford and Surrounds M83045 Penkridge Medical Practice Dr Grocott GMS 10,039 10-15

Stafford and Surrounds M83036 Rising Brook Surgery Dr Beal PMS 10,328 10-15

Stafford and Surrounds M83049 Holmcroft Surgery Dr Hannigan PMS 10,546 10-15

Stafford and Surrounds M83050 Wolverhampton Road Surgery Dr Albright PMS 10,613 10-15

Stafford and Surrounds M83020 Cumberland House Dr Griffiths GMS 12,638 10-15 Stafford and Surrounds M83069 Mansion House Surgery Dr Eames GMS 13,376 10-15

Stafford and Surrounds M83052 Weeping Cross Health Centre Dr Lloyd PMS 18,537 15+

CCG TOTAL 145,212Average List

size 10,372

7

3. Case for Change

3.1 Health Outcomes

3.1.1 Disease Prevalence

The population of Stafford and Surrounds is in relatively good health. Men live six months longer and women live nine months longer than the England average. Expected prevalence shows a significant number of people may be undiagnosed or unrecorded, particularly for Coronary Heart Disease (17.6%) and hypertension (43.7%).

However, there are pockets of deprivation where health outcomes are less favourable and where clinical outcomes could be improved. In addition, the CCG is an outlier for the management of high blood pressure in patients with CHD and Diabetes (Table 2).

Table 2 Quality and Outcomes Framework (QOF) indicators for Stafford and Surrounds CCG

Outcome Indicator SD below z score* CCG source

% of diabetic patients whose last blood pressure was 140/80 or less (DM31) 2011/12 -2.56 Practice level

% of patients with CHD whose last blood pressure reading (as measured within the last 15 months) is 150/90 or less,(CHD06) 2011/12 -1.85 Practice level

Source: SPOT tool, 2011/12.* Z score (normalised score for the organisation using the England mean and CCG/PCT standard deviations)

Many patients have 2 or more long-term conditions (LTCs), it is essential that primary care develops an integrated approach to the management of LTCs. This will involve working with all members of the multi-disciplinary team, particularly nurses, to support patients to remain at the lowest level of dependency.

3.1.2 Prevention

Uptake for flu Immunisations has historically been one of the lowest in the West Midlands, both for the over 65 age groups and ‘at risk’ risk target groups. However, practices have made significant progress in 2014/15 to increase uptake rates to 72.1% compared to 69% in the previous year. The CCG will continue to work with practices in the next 12 months to further improve flu uptake rates for all at risk groups, particularly paediatrics. Table 3 shows flu immunisation rates by practice.

8

Table 3 Flu Vaccine Updtake for Stafford and Surrounds CCG for over 65s – 31st January 2015

3.1.3 Clinical Effectiveness

The prescribing of broad spectrum antibiotics, a known driver of community acquired infection, is the highest in the West Midlands. In September 2013, prescribing rates for Quinolones and Cephalosporins reached 12%, more than double the national average of 5.45%. Significant progress has been made in the last 12 months with practices achieving a 24% reduction in the prescribing of these drugs in Q1 2014, however, rates are still high at 9.43% compared to 5.41% nationally. The CCG will work with practices to reduce the prescribing of broad spectrum antibiotics to the national average by 2016.

Table 4 Prescribing rates for Broad Spectrum Antibiotic’s in the West Midlands Q1 2014/15 compared to 2013/14

79.1 78.676.0 75.7 75.1

73.4 73.171.8

70.6 70.3 69.8 69.667.9

66.2

72.1

60.0

65.0

70.0

75.0

80.0Flu Vaccine Uptake % for 65s and Over

% uptake w/e 25/1/2015 % Uptake Jan 2014

0.00%2.00%4.00%6.00%8.00%

10.00%12.00%14.00%16.00%18.00%20.00%

Cephalosporins & Quinolones % Items ‐ Quarter 1 2014/15

Q1 2013/14 Q1 2014/15 National average

9

3.1.4. Referral Rates

SAS CCG has significantly higher than average activity rates in secondary care across all admission sources including outpatients, elective inpatients and emergency admissions. This over-reliance on acute care has served to increase activity rates beyond national and peer group averages

The high referral rates, along with high reference costs in provider organisations and a growing reliance on continuing health care, have left the CCG facing a financial deficit in 2014/15.

The Anytown activity modelling produced by NHS England in January 2014 suggest the cost of variation (all admission sources) between practices in Stafford and Surrounds equates to £1.7m (http://www.england.nhs.uk/2014/01/24/any-town/).

One of the key aims of this strategy will be to reduce referrals and inpatient procedures in acute settings by introducing best practice care pathways through the Map of Medicine, targeted education, peer review and delivering a greater range of services in primary care.

3.3 Access

Patients have good access to primary care in Stafford and Surrounds with practices achieving higher than average results in the GP survey. While results have decreased on 2013 compared to the previous year, Appendix 7 shows response rates in seven key areas.

Table 5 GP Survey results

Eng. Average

Stafford & Surrounds CCG %

GP practice survey results online 2012/2013 Jan 2012-Sept 2012

Jan 2013-Sept 2013

Q.29 Patients who would recommend their GP surgery to friends/family

79% 88.1% 81.1%

Q.4 Patients who found the receptionist helpful 88% 90.9% 88.3%

Q.22 Patients who were satisfied with the Doctor 93% 96.0% 93.3%

Q.24 Patients who were satisfied with the Nurse 86% 92.4% 87.5%

Q.3 Patients who found it easy to get through to someone at GP surgery on the phone

74% 84.2% 79.6%

Q.18 Patients with a good experience of making an appointment

75% 84.0% 77.7%

Q.32 Patients who felt they had enough support with LTCs in the last 6mths

64% 66.3% 68.1%

Despite good response rates to the GP Survey, clinical audits in A&E suggest that 40% of patients might be treated in a community or primary care setting.

This strategy will support practices to provide responsive primary care services for those that most need it, when they need it. This will involve improving access

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The CCG will provide high quality educational opportunities through Protected Learning Time, expanding the frequency and including opportunities for all practice staff. Development opportunities will be opened up to clinicians and practice staff through the GP Bulleting and the Intranet.

The CCG will appoint a clinical lead for nursing in order to support nurse education and training. We will also establish a Practice Nurse Network to support nurse development and encourage peer support across primary, community and secondary care.

12

6. Transformation Strategy

We want to raise the standard across the board so that all patients have access to the very best in primary care.

This section describes our plans to transform primary care over the next five years to make the aspirational future landscape a reality. Addressing quality, safety and improving patient experience are key aims. This strategy recognises that transformational changes are needed to support the development and capacity of primary care, and describes the steps towards implementing that transformation. It will take time and resource. We want to work with our independent contractors to motivate, incentivise and support them on the transformational journey.

The CCG will adopt a programmed approach to transforming primary care across six programme areas:

1. Innovation and Quality 2. Primary Care Operating Model 3. Clinical Commissioning of Primary Care 4. Information Management and Technology 5. Workforce 6. Medicines Quality and Safety

13

6.1 Innovation and Quality

To maintain and improve quality in primary care through the development of effective, efficient and innovative primary care services

At the forefront of this strategy is a drive to improve quality in primary care delivering better clinical outcomes for patients and the population and to maximise the limited resources of the CCG. While Practices across Stafford and Surrounds CCG deliver high quality, accessible care to their patients; member practices want to raise that standard. Key delivery areas will be improving flu uptake rates for at risk groups and increased prevalence rates for long term conditions and dementia.

The CCG will work with Practices and the Membership Board to introduce a programme that focuses on productive general practice and seamless care with the wider primary care system.

The CCG will use technology such as Map of Medicine to support clinical decision making, standardise referral processes and reduce the variation that exists between practices. The Map will be rolled out across all practices and will initially focus on 40 planned care pathways and procedures of limited clinical value. It is expected however, that the MoM will be used to access all clinical pathways and referral templates.

The CCG has an active Innovation Network attended by all practices in Stafford and Surrounds. The CCG will continue to support the Network to develop and promote new ways of working in primary care.

The CCG will work with the Area Team to assess capacity and demand in primary care to ensure sufficient and appropriate capacity is available in primary care to support the shift from reactive to proactive care planning.

14

6.2 Primary Care Operating Model

To develop a more integrated primary care operating model that strengthens the role of general practice to improve quality, creates capacity and capability

and ensure that more people can receive care in their communities.

Nationally, there is a growing consensus to enable General Practice to work at greater scale. Everyone Counts (2014) describes a need for new models of primary care that provide more proactive, holistic and responsive services for patients.

Simons Steven’s Five Year Forward View describes two emerging models primary care.

Multi-specialty Community Providers (MCPs) While independent GP practices will remain where patients and GPs want that, the RCGP points out that primary care is entering its next phase of evolution. MCPs would provide a wider scope of services, making it possible for extended group practices to form through either Federations, Networks or single organsations

Primary and Acute Care Systems (PACs) New contracting forms will allow a new variant of integrated care by allowing single organisations to provide list based GP and hospital services together, together with mental health and the community. This could be led by an acute Trust or where there is a mature Multi-specialty Community Provider

We will work with member practices to ensure the models for primary care in Stafford and Surrounds are consistent with our ambitions for high quality, strengthened primary care.

We will build on the clinical leadership that exists in our member practices to ensure clinicians are fully involved in decision making and new models of care.

In addition, the CCG will work with Primary Care across three service levels which are described below:

1. Level 1 – General Practice 2. Level 2 – Locality Networks 3. Level 3 – Primary Care Federations

6.2.1 General Practice

In the NHS, the main source of primary health care is general practice, providing the first point of contact in the health care system.

Primary health care is based on caring for people rather than specific diseases. Therefore, the aim is to provide an easily accessible route to care, tailored to the patient’s health care needs. This may mean, continuity of care for frail older people; nurse-led seamless care for patients with multiple long term conditions and urgent access for patients when they need it.

15

General practice will offer care in fundamentally different ways, making more use of digital technology, new skills and roles and greater convenience for patients.

The new 2014/15 General Medical Services contract goes some way to support more integrated ways of working , particularly for frail older people and those with long term conditions. Patients aged over 75 will have a named GP, accountable for overseeing their care and there will be more systematic arrangements for risk profiling and proactive case management. To support this approach, the CCG will be expected to commission additional services from primary care that will support the role of the accountable GP and improve services for older people.

The CCG will work with practices to support new ways of working that respond to patient needs and benefit the practice in terms of time and skills. This may include different ways of providing urgent appointments, home visits and support to nursing homes.

6.2.2 Locality Networks

Practice list sizes are slightly above the national average in Stafford and Surrounds, however, it is recognised that the current demands placed on individual practices is unsustainable and practices will need to work differencely in the future to manage demand in new ways.

The CCG will support practices to work together through the introduction of locality networks. This may be ‘practice to practice’ to encourage practices to provide more services on a locality basis or as part of integrated primary and community health and social care teams. The network will decide what services it wants to provide and how it will operate to deliver patient and practice benefits. This may include how practices support nursing homes, inter-practice referals or shared approachs to improve outcomes for patients.

Patients have told us they want to see a ‘one stop’ approach to health care and have greater access to the wider primary care team. The CCG will work with primary care and community teams to introduce integrated community health and social care teams attached to practices on a locality basis:

Long term condition services will be better integrated There will be close working with case managers to avoid hospital

attendance and admission There will be truly integrated primary care and community teams More services provided closer to home, shared records and skills to avoid

duplication and fragmentation of work.

Where practices have ambitions to explore new models of care, for example multi-specialty providers, we will support this approach.

16

6.2.3 GP Federation

Primary care is largely based around independent contractors serving relatively small populations. It is envisaged that collaborative, primary care led services will go beyond the current scope of GP contracts, providing accessible and responsive out-of-hospital care led in conjunction with other practices and provider organisations (Addicot, 2014). Concepts, such as Family Health Networks (Kings Fund, 2014), describe a model of care whereby most forms of non-acute, non-specialist care are provided at scale by primary care, in the community setting, with GPs playing a coordinating role on behalf of their populations. Pressures facing General Practice as providers, mean that practices are increasingly working together to share economies of scale.

In Stafford and Surrounds, all 14 practices have formed a provider federation (GP First Ltd) which will allow practices to work in a more collaborative way, sharing back room economies of scale and providing a vehicle to provide a wider range of services. To date, the CCG and the Federation has piloted a number of work programmes around Dementia care and Acute Visiting Service whereby services are provided by the Federation in conjunction with other providers such as the voluntary sector, out of hours and the Mental Health Trust

The CCG will work with the federation to develop new models of care that provide a greater range of services in the primary care setting, while maintaining quality, efficiency and equitable access for all patients.

A Memorandum of Understanding has been agreed between the local GP Federation and the CCG that outlines the working relationships between the Federation and the CCG.

17

6.3 Co-Commissioning of Primary Care

To develop new ways of commissioning primary care services that maximise capacity, innovation and resources

On 1st May 2014, Simon Stevens announced new opportunities for CCGs to co-commission primary care services in partnership with the NHS England. The NHS Five Year Forward View describes primary care co-commissioning as a key enabler in developing seamless, integrated out of hospital carebased around the diverse needs of local populations. It will also drive the development of new models of care such as multi-specialty community providers and primary and acute care systems. There are three models that the CCG could take forward:

Level 1 - Greater involvement in primary care commissioning Level 2 - Joint commissioning Level 3 - Delegated commissioning

Co-commissioning would allow us to create a joined up, integrated out of hospital service for our local population with primary care leading and shaping the desired model. Helping to drive the development of the MSCP described by Simon Stevens ‘Five Year Forward View’, and building around groups of GPs combined with nurses and other community health services, mental health and social care. The focus would be on a holistic, integrated approach to the individual and would be built around populations aligned with community and social care services

Co-commissioning is seen as an opportunity to collaboratively develop solutions around workforce, including exploring new models of working across health, for example Physician Assistants. Examples include supporting GP access arrangements and exploring seven day working by collaborative working. The CCG has invested heavily in IT infrastructure; co-commissioning would allow us to invest further in primary care, for example mobile working and telemedicine and other solutions which support general practice work more effectively.

In January 2015, the Membership Board voted in support of the CCG to commission level 2 joint commissioning with the NHS England Area Team in 2015/16. The timeframes for delivery are tight, however, through this process the CCG is committed to working closely with Member practices, NHS England and the LMC to agree how the policy will be implemented locally. It will be vital to engage with our member practices to ensure productive relationships with GPs as both commissioners and providers of services. The 4 CCGs in South Staffordshire have agreed in prinicple to adopt a collaborative approach to co-commissioning, and subject to NHS England approval, a Primary Care Co-Commissioning Committee will be formed in April 2015.

The latest policy guidance and timeframes can be found at:

https://www.england.nhs.uk/commissioning/pc-co-comms/

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6.4 Information Management and Technology

To deliver a coordinated IM&T Programme for General Practice that facilitates the sharing of records through integrated systems, delivers efficiency and productivity benefits for General Practice and the wider health system and

uses new technology to improve patient outcomes.

Underpinning these new models of care will be a need to ensure the right infrastructure is in place to promote integrated care records and robust systems for data sharing between practices and other health and social care professionals. By 2017, we will introduce a shared clinical record that is entirely accessible to the patient. This will put patients at the centre of their care and create shared responsibility for their own health.

The CCGs will adopt innovative approach to the development of Information Management and Technology in primary care to ensure right electronic infrastructure is in place to enable more integrated working. This will include systems and processes to enable the sharing of clinical information between health and social care professionals that will deliver better clinical outcomes for patients. Key outputs will include the introduction of:

Consistent practice systems. Software (EMIS Web) Summary Care Records and locally shared records. E-Referrals Electronic Prescribing2 Single shared solution with providers for electronic discharge process. Electronic ordering of investigations and viewing of secondary care results. Improving Data Quality Increased patient access via online prescription ordering and

appointment’s. Phased access for patients to access their own clinical records Use of patient portals to facilitate access to their health information Mobile working solutions

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6.5 Workforce Development

The Strategy aims to maximise the skills and experience that exist in general practice through education and workforce development

6.5.1 Workforce

The CCG will work with the Deanery, the Federation and secondary care to develop new workforce models including:

Post registration opportunities for newly qualified GPs Greater opportunities for portfolio working Secondary care clinicians, such as geriatricians, working alongside GPs in the

community.

6.5.2 Clinical Leadership

In addition, the CCG will work with individual Clinicians and the Membership board to strengthen clinical leadership within the CCG:

Clinically led Peer review to promote individual learning through best practice Investigate and reduce unwarranted variation in evidence-based clinical

processes and outcomes in primary care. Improved relationships with secondary care clinicians through Clinical

Networks and pathway redesign

6.5.3 Educational Opportunities

The CCG will maximise education and development opportunities made available to all members of the practice teams. This will include

CCG wide Protected Learning Time (PLTs) offering high quality educational opportunities for the MDT that support practices and contribute to the CCG’s vision and goals

Paired learning between GPs and Managers. Training opportunities will be put into place for practice managers and nurses

in order to help improve the profile of primary care as providers Appointment of a Nurse Clinical lead to shape the nursing workforce,

including nursing education and development Practice Nurse Network

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6.6 Medicines Optimisation

To ensure high quality, evidence based and safe prescribing that reduces waste and optimises patient outcomes

The NHS has fostered a culture which encourages activities designed to reduce prescribing spend and deliver short term cost ‘savings’. This will affect attitudes and behaviours toward new medicines which come to be seen as a cost burden to be ‘managed’ rather than an opportunity to improve the outcome from treatment by unlocking their intrinsic value to the NHS.

The CCG medicines management function will be repurposed toward Medicines Optimisation which will focus on introducing systems which support medicines adherence as a proxy of treatment outcome, so that pharmacist knowledge, skills and experience in commissioning and their analytical expertise is re-focussed to support waste reduction and the safe prescribing of medicines which can transform patient outcomes.

As described there are a number of areas where the CCG delivers poorly around medicines management, particularly around the prescribing of broad spectrum antibiotics. Therefore, this programme will also include a Medicines quality and safety plan. The plan will focus on medicines optimisation to deliver improvements to health outcomes, reduce patient harm and avoid waste.

In 2014/15, the Medicines team will work with practices, the Local Pharmaceutical Committee and the Association of the British Pharmaceutical Industry (ABPI) to:

Reduce known medicines waste, particularly unnecessary repeat prescriptions.

Roll out electronic Prescribing (EPS2) to all practices in the next 12 months. Work with GPs in nursing homes to undertake medication reviews to ensure

patients are receiving the best outcomes for their conditions. Ensure that all practices will receive regular support in their practices by a

community pharmacist and will receive practice specific prescribing information that supports decision making.

Practices in Stafford and Surrounds have high Scriptswitch uptake rates and the medicines team will continue to ensure the system is user-friendly providing up-to-date and accurate information. A monthly Scriptswith report will be shared with Practices to identify areas where the CCG can improve on prescribing in order to direct resources support better clinical outcomes for patients.

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7. How we will do it?

7.1 Programme Management

The CCG will adopt a programme management approach to transform primary care.

Table 8 Programme ars and the clinical and programme lead

7.2 Governance

The Primary Care team will support the delivery of the Strategy, as well as ensuring the operational requirements of the CCG are delivered. The team has three core functions:

Primary Care Contracting and Commissioning Transformation Quality and Safety

As the co-commissioning functions develops, it will be important that the contracting and transformational functions work independently in order to provide clarity to practices of the specific roles of the team and to ensure conflicts are minimised and relationships maintained.

Primary Care Programme

Clinical Lead – Dr Paddy Hannigan – Chair, Membership Board

Programme Lead – Lynn Millar, Head of Primary Care Programme Area Clinical/Executive/Practice

Lead Programme Lead

1. Innovation and Quality Practice lead Vacancy

Dr Mark Stone

Sarah Turner

2. Primary Care Operating Model Dr Paddy Hannigan Lynn Millar 3. Co- Commissioning of Primary

Care Dr Anne-Marie Houlder Lynn Millar

4. Information Management and Technology

Dr Paddy Hannigan Sarah Jefferey

5. Workforce Education and Development

Dr Janet Eames TBC

6. Medicines Optimisation Dr Paddy Hannigan Sam Buckingham

Communications and Engagement

Ruth Goodison (lay member)

Adele Edmondson

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Table 9. Governance arrangements

Function Reporting arrangements Measure Primary Care Contracting and Commissioning

Joint Co-commissioning committee

KPIs

Transformation Membership Board Plan on a Page

Quality and Safety Quality Committee Quality dashboard and soft intelligence

Outcome measures have been agreed as part of the Operational Planning Process for 2014/15 and will monitored on a monthly basis by the Membership Board through the monthly Plan on a Page (Appendix 4). In 2014, primary care targets will be reported on a monthly basis at a practice level and will include:

“Plan on a Page” - key measures 2014/15

Dementia - increase practice diagnosis rates to 67% for 14/15 IAPS - increase no. of people receiving psychological services to 16% COPD - increase QOF practice prevalence rates to 1.5% Hypertension - increase QOF practice prevalence rates to 16% Flu Immunisations - increase uptake for over 65’s and carers to 75% and

70% respectively First Outpatient Attendances (GP Referred) - 5% reduction on 2012/13 Elective spells - 2% reduction on 2012/13 A&E Attendances - 6% reduction on 2012/13 Non-Elective spells - 6% reduction on 2012/13

Further outcome measures will be developed that reflect the aims and objectives of this plan and any co-commissioning arrangements from 2015 onwards. Delivery of these outcomes will be reflective of the coordinated and individual efforts of practices. Programme targets and milestones will be monitored on a monthly basis by the Primary Care Development Group and reported to the Membership Board quarterly

7.5 Stakeholders

Although strongly focused on the role of general practice in primary care, the strategy recognises that the implementation of the strategy will require the support of all independent contractors, nurses, therapists, hospital doctors and all other clinicians and managers involved in the delivery of primary and community care. Community-based services such as district nursing, health visiting and therapy services are partners as members of the Extended Primary Care Team.

It will be essential that the CCG works closely with the Local Medical Committee to ensure good working relationships and a strong sense of partnership with practices.

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In addition, the CCG will work with partner organisations such as the Local Pharmaceutical Committee and Local Optometry Committee to develop new models of care

The CCG will work closely with patients and service users to ensure primary care services are person-centred, taking into account the aspirations of individuals alongside the diversity of the community

7.6 Communications and Engagement

The Call to Action identified that people did not know which services were available and where. One of the key aims of the Primary Care Strategy is to maintain the effective use of resources by ensuring that patients are managed in the right place, at the right time, by the right health professional. This means making it clear where and when and by whom a patient should be seen depending on their condition. It will improve continuity of care and reduce duplication while patients will get more appropriate and timely care and support. It will mean professionals working closer together, and will mean good coordination of care

Excellent communications with practices and the public will be essential to deliver this strategy. As such there will need to be a robust communications policy that ensures the efficient and CCG coordinated communications from CCG to practice teams and vice versa. This will include an Intranet system that provides information, data storage and networking between practices and the CCG.

To support practices, the primary care team within the CCG will have clearly defined roles and responsibilities to deliver the primary care strategy and a named liaison officer for member practices and the area team to communicate with the CCG. Key deliverables include:

CCG Intranet to support communication between CCG and practices, sharing best practice and IM&T solutions.

Patient education programme to encourage self care Programme of patient engagement to ensure patients are involved in the

development of primary care services Choose Well Campaign to ensure patients know where to go when they

are unwell Childrens minor illness education CCG Gateway will be used to ensure messages are received by primary

care teams and reduce the burden of emails sent to practices

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7.6 Risks

A full risk register has been developed and will be monitored by the operational delivery group. A summary of key risks and mitigations can be found in table 10 below.

Table 10 Summary of Risks and Mitigations

Risk Mitigation RAGGPs don’t engage Ownership and monitoring by Membership

Board

Wide and ongoing enagement and consultation with practices

Actions reflected in CCG Membership Agreement

Develop closer working relationships with Local Medical Committee

Area Team not supportive of commissioning plans for primary care

Joint Board to be established with AT and CCG

Stakeholders not aware of strategy

Robust communications plan

Limited capacity to deliver Programme Plan

Resources to be identified within the CCG

Primary Care team established

Clinical leads identified for all Programme Areas

Build capacity through GP Federation (G.P. First Ltd)

Outcomes not delivered KPIs established for work programmes

Robust performance monitoring put in place monitored by the Membership Board

Practice visits by exception

Primary Care Co-Commissioning

Limited appetite for Federated working

MOU with GP First

CCG supports organisational development

Conflict of Interest to co-commission primary care

Work with Area Team and Local Medical Committee to ensure plans are in line with procurement guidelines and contractual arrangements. Strong lay member leadership.

25

Appendix 1 Stafford & Surrounds CCG Practice Area

26

Appendix 2 Achievements

Flo Scoops Recognition in Stafford

GP surgeries in and around Stafford and Stone have gained national recognition for work they’re doing to help patients with high blood pressure. The Stafford and Surrounds Clinical Commissioning Group backed scheme has seen 430 patients enrol on the initiative which sees them using a mobile phoned based system called ‘Flo,’ to monitor their blood pressure levels.

GPs set wheels in motion for Acute Visiting Service

The wheels are in motion for patients in need of a home visit to be looked after by a new pilot service. Known locally as ‘GP in a car’, the Acute Visiting Service (AVS) has been rolled out across the county town. The AVS provides urgent afternoon visits for patients who are unable to wait for a GP to visit after evening surgery and would potentially go to A&E or call an ambulance in the meantime. It is ably steered by Stafford and Surrounds Clinical Commissioning (CCG) and GP First, a federation of all 41 GP practices in Cannock Chase and Stafford and its surrounding areas.

Research Networks

Stafford and Surrounds CCG has an active research network and is an integral and founding CCG in the Cross Staffordshire and Shropshire Research and Development group. The Cross Staffordshire group has been involved in ensuring a research infrastructure is in place to encourage research into the area. The group has established an excess treatment care funding scheme for Primary Care and a mechanism for research governance approval for non-portfolio studies. SAS CCG has also encouraged research by supporting the Clinical Research Network – Primary Care within the area. The Primary Care Research Network – Central England was the second highest recruiting network for 2013-14.

Trial will bring services closer to home for patients with breathing difficulties

Stafford and Surrounds Clinical Commissioning Group (CCG) and Cannock Chase CCG are launching a trial service that will see a hospital-based consultant move their outpatient clinics into the community alongside specialist respiratory nurses.

27

Appendix 3 – Call To Action

A greater role for the wider primary care team

“Access to other health professionals eg pharmacist to prescribe more, practice nurses to take on more active role. More flexible access”

“Quality standards of what to expect from GPs –there is too much variation between practices”

Care that supports the needs of the individual

“Proactive understanding of registered patients – need intimacy but on large scale”

“Face to face, 1:1 support for elderly – continuity of care and knowledge of an individual’s needs can help to avoid trigger factors”

“Better understanding of sensory needs“

Seamless care between organisations and professionals

“Blurred lines between health and social care – one stop practices with multidisciplinary services under one roof”

“Integrated medical records across health and social care – hand held records – data management – clear communication about how and why data is shared”

“Better organisation of appointments for people with more than one condition”

Support for Carers

“Staff awareness about carers entitlements eg flu vaccine”

“Proactive approach to carers health – they won’t always come forward with issues”

“Carers not always registered at same practice – makes it difficult for GPs to know who may be a carer

More Education and Awareness

“Awareness of the various support Groups, Medical Professionals could signpost to Groups to offer support which may reduce demand on Primary Care”

“Better awareness of medical/care pathways. .i. e where can I go for help when I have the first symptoms of getting ill for advice and help – not always a Doctor”

28

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Oocyte donation may be commissioned as part of IVF/ICSI policy when clinically appropriate: Premature ovarian failure Gonadal dysgenesis including Turner syndrome Bilateral oophorectomy Ovarian failure following chemotherapy or radiotherapy

Proposal to offer cryopreservation of gametes to all patients undergoing treatment that may render the patient infertile, rather than just those undergoing chemotherapy. This is a more equitable approach than NICE CG.

On the basis of equality, CCGs will fund IVF treatment for same sex couples and people with a physical disability, provided there is evidence of subfertility and where it is possible to do so within the eligibility criteria. This clearly excludes same sex male couples.

Consultation process: 2013: Initial preparation of first draft of a Staffordshire-wide policy in response to revised

NICE CG, in consultation with Mr Kevin Artley previous medical director of the Burton Centre for Reproductive Medicine (BCRM). This policy was adopted by N Staffs CCG, but not by S Staffs CCGs.

2014: Revised draft to take account of increasing financial constraints. Discussed at CPPG meetings where all S Staffs CCGs are represented.

2014: Draft policy sent to S Staffs CCGs for consideration. 2014: Discussion with Heather Stringer (Director of Operations) of ‘Nurture Fertility’ at

Queen’s, Nottingham, which now manages the BCRM.

2015: Final draft based on Greater East Midlands Commissioning Support Unit (GEM CSU) policy, which has been agreed by all EM CCGs and is the approach adopted at ‘Nurture’. This was debated and amended after presentation at CPPG, resulting in the current draft.

Relevance to Key Goals

A 10% reduction the levels of obesity against the expected prevalence N/A


N/A


N/A

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

N/A

Implications

Legal and/or Risk Reputational risk if we continue with existing policy. Revised policy reflects current practice and consistent with East Midlands CCG practice

CQC N/A

Item: 12 Enc: 10

Page | 3

Patient Safety N/A

Patient Engagement N/A

Financial Nil or marginal cost increase

Sustainability N/A

Workforce/Training N/A


The CCG Governing Body is asked to:

To approve the proposed modified IVF/ICSI policy, based on the amended GEM CSU policy








N.B. The above will be completed if commissioning criteria have been agreed

1

Proposed South Staffordshire commissioning policy for in vitro fertilisation (IVF) +/- intracytoplasmic sperm injection (ICSI) within tertiary infertility

services

The attached draft proposal for the commissioning of assisted reproduction services was originally prepared as a result of local consultation in response to revised NICE CG, and subsequently amended as a compromise due to financial constraints.

Key recommendations of the revised NICE CG156 (February 2013) reviewed for this draft policy:

3 full cycles of IVF +/- ICSI for couples who fit the eligibility criteria, where woman aged up to 39 years.

Increasing the upper age limit for women from 39 to 42 years (single cycle IVF for women aged 40-42 years).

Use female age as an initial predictor of overall chance of success + testing for ovarian response to gonadotrophin stimulation.

AI may be funded where appropriate. The use of donor insemination in the following male conditions: obstructive azoospermia. non-obstructive azoospermia. severe deficits in semen quality if couples do not wish to undergo ICSI. high risk of transmitting a genetic disorder to the offspring. high risk of transmitting infectious disease to the offspring or woman

from the man. severe rhesus isoimmunisation.

The use of oocyte donation in the following female conditions: premature ovarian failure. gonadal dysgenesis including Turner syndrome. bilateral oophorectomy. ovarian failure following chemotherapy or radiotherapy. certain cases of IVF treatment failure. in certain cases where there is a high risk of transmitting a genetic

disorder to the offspring. Cryopreservation only offered to patients awaiting chemotherapy. IUI available for people in same-sex relationships who fulfil eligibility criteria.

Key points for proposed SS CCG policy:

Single IVF cycle only for eligible couples. NICE 3 cycle recommendation is evidence based, but would increase costs considerably. Most CCGs currently offer 1 cycle only. A full cycle of fresh IVF can cost the NHS around £3,000. A cycle of intracytoplasmic sperm injection (ICSI) costs the NHS an extra £500.

Maintain current female age range 23-39 years. Additional costs estimated as £61k per annum for population of 600,000. This allows for approximately 20 additional cycles, which may be an underestimate.

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Decline with age in rates of conception is seen mostly after age 30 years and is more marked after age 35. Testing for ovarian reserve is recommended for women 35-39 years, using AMH as the test of choice, since it has been found to be reliable and can be performed at any stage of the cycle. It is proposed that a threshold of AMH >3 should be applied to all women 35 years or over for access to IVF treatment. Younger women have been shown to conceive using IVF, even if their ovarian reserve proves low on testing. Cost is around £29, and should be included in the provider fees.

Surgical sperm retrieval will be funded in appropriately selected patients, providing that azoospermia is not the result of a sterilisation process, and will only be funded where the couple meet the eligibility criteria set out within this document. Surgical correction should be considered as an alternative to surgical sperm recovery and IVF.

Sperm donation will not normally be available. Oocyte donation may be commissioned as part of IVF/ICSI policy when

clinically appropriate: Premature ovarian failure Gonadal dysgenesis including Turner syndrome Bilateral oophorectomy Ovarian failure following chemotherapy or radiotherapy

Proposal to offer cryopreservation of gametes to all patients undergoing treatment that may render the patient infertile, rather than just those undergoing chemotherapy. This is a more equitable approach than NICE CG.

On the basis of equality, CCGs will fund IVF treatment for same sex couples and people with a physical disability, provided there is evidence of subfertility and where it is possible to do so within the eligibility criteria. This clearly excludes same sex male couples.

Consultation process:

2013: Initial preparation of first draft of a Staffordshire-wide policy in response to revised NICE CG, in consultation with Mr Kevin Artley previous medical director of the Burton Centre for Reproductive Medicine (BCRM). This policy was adopted by N Staffs CCG, but not by S Staffs CCGs.

2014: Revised draft to take account of increasing financial constraints. Discussed at CPPG meetings where all S Staffs CCGs are represented.

2014: Draft policy sent to S Staffs CCGs for consideration. 2014: Discussion with Heather Stringer (Director of Operations) of ‘Nurture

Fertility’ at Queen’s, Nottingham, which now manages the BCRM. 2015: Final draft based on Greater East Midlands Commissioning Support

Unit (GEM CSU) policy, which has been agreed by all EM CCGs and is the approach adopted at ‘Nurture’. This was debated and amended after presentation at CPPG, resulting in the current draft.

3

COMMISSIONING POLICY FOR IN VITRO FERTILISATION (IVF)/ INTRACYTOPLASMIC SPERM INJECTION (ICSI) WITHIN TERTIARY

INFERTILITY SERVICES

Title: Final draft South Staffordshire policy for IVF/ICSI, based on the Greater East Midlands Commissioning Support Unit (GEM CSU) policy, prepared in light of the published NICE guidelines. (NICE CG156, February 2013)

Purpose: To review the proposed modified IVF/ICSI policy, based on the amended GEM CSU policy.

Proposal: For South Staffs CCGs to consider the modified East Midland CCGs policy for IVF/ICSI, and to decide upon commissioning the IVF/ICSI policy most appropriate for their needs and current financial position. Some sections of the current EM policy have been modified (mostly due to financial constraints), presented, discussed and agreed at CPPG.

Notes: It should be noted that this policy is only for IVF/ICSI, and does not cover PGD, surrogacy, viral transmission or IUI/DI. In addition, the Equality Commitments Statement below does not take account of any amendments.

Equality Act 2010 Equality Commitment Statement In carrying out their functions, the South Staffordshire Clinical Commissioning Groups and the Greater East Midlands Commissioning Support Unit (GEM CSU) are committed to having due regard to the Public Sector Equality Duty. This applies to all the activities for which the CCG’s and GEM CSU are responsible, including policy development and review. The GEM CSU IVF/ICSI policy has been reviewed in relation to having due regard to the Public Sector Equality Duty (PSED) of the Equality Act 2010 to: eliminate discrimination, harassment, victimisation; advance equality of opportunity; and foster good relations. The aim is to design and implement policy documents that meet the diverse needs of the populations to be served and the NHS workforce, ensuring that none are placed at a disadvantage over others. It takes into account current UK legislative requirements, including the Equality Act 2010 and the Human Rights Act 1998, and promotes equality of opportunity for all. This document has been designed to ensure that no-one receives less favourable treatment owing to their personal circumstances, in this instance their protected characteristics of their age, disability, sex (gender), gender reassignment, sexual orientation, marriage and civil partnership, race, religion or belief, pregnancy and maternity.

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1. Introduction

In vitro Fertilisation (IVF) is commissioned as a tertiary service within an overall infertility pathway. This policy describes circumstances in which the South Staffordshire Clinical Commissioning Groups (CCGs) will fund treatment for IVF/(ICSI.

1.1 This policy has drawn on the GEM CSU policy, based on guidance

issued by the Department of Health, Infertility Network UK and the revised NICE Clinical Guideline ‘Fertility, assessment and treatment for people with fertility problems’ (CG156 February 2013).

1.2 The following are outside the scope of this policy:

Intra-Uterine Insemination(IUI)/ Donor Insemination (DI) Surrogacy Pre-Implantation Genetic Diagnosis (PGD)

1.3 This policy replaces all previous IVF/ICSI polices and is inclusive of all

protected groups.

2. General Principles

2.1 IVF can be a legitimate medical intervention as part of NHS provision where a couple has a medical reason for being unable to conceive a child. Couples (including same sex couples) who are able to demonstrate this and fulfil the following criteria will be eligible for tertiary infertility treatments under this agreement.

2.2 The eligibility criteria set out below do not apply to clinical investigations

for subfertility which are available to anyone with a fertility problem as advised by a relevant clinician.

2.3 The eligibility criteria do not apply to the use of assisted conception

techniques for reasons other than subfertility, for example in families with serious inherited diseases where (IVF) is used to screen out embryos carrying the disease or to preserve fertility, for example for someone about to undergo chemotherapy, radiotherapy or other invasive treatments.

2.4 South Staffordshire CCGs respect the right of patients to be treated

according to the obligations set out in the NHS Constitution. 3. Definition of infertility, timing of access to treatment and age range

3.1 Fertility problems are common in the UK and it is estimated that they affect 1:7 couples. 84% of couples in the general population will conceive within one year if they do not use contraception and have regular sexual intercourse. Of those who do not conceive in the first year, about half will do so in the second year (cumulative pregnancy rate 92%). In 30% of infertility cases the cause cannot be identified.

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3.2 Where a woman is of reproductive age and having regular unprotected vaginal intercourse two to three times per week, failure to conceive within 12 months should be taken as an indication for further assessment and possible treatment.

3.3 Female partner must be aged 23 years, but less than 39 years, at

commencement of treatment (i.e. must not have reached 39th birthday). Commencement of treatment is regarded as completion of initial consultation, any treatment required to rectify clinical problems, and commencement of drug regime.

3.4 If the woman is aged 35 or over then such assessment should be

considered after 6 months of unprotected regular intercourse, since her chances of successful conception are lower and the window of opportunity for intervention is less.

3.5 If, as a result of investigations, a cause for the infertility is found, the

Individual should be referred for appropriate treatment without further delay.

3.6 Women aged 35 – 39 years will be offered treatment provided their

predicted ovarian reserve is found to be satisfactory, since this provides useful information regarding likely response to treatment. Although there is continuing debate around the most effective test, AMH is the test of choice for many providers, since it has been found to be reliable and can be performed at any stage of the cycle. It is proposed that a threshold of AMH >3 should be applied to all women 35 years or over for access to IVF treatment. Cost is around £29, and should be included in the provider fees.

4. Definition of childlessness

4.1 Funding for IVF/ICSI will be available to couples who do not have a living child from their current relationship nor any previous relationships.

4.2 A child adopted by a couple is considered to have the same status as a

biological child. This does not include foster children.

4.3 A couple accepted for treatment will cease to be eligible for treatment if a pregnancy occurs naturally leading to a live birth or if the couple adopts a child.

5. Treatment Options

5.1 This policy is intended, as per NICE Clinical Guidelines, for people able to have regular sexual intercourse who have failed to conceive due to a specific identified pathological problem or who have unexplained infertility. CCGs will fund IVF treatment for Same sex couples People with a physical disability

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provided there is evidence of subfertility, defined as no live birth following artificial insemination (AI) as per local CCG policy or proven by clinical investigation as per NICE guidelines. AI should be undertaken in a licensed clinical setting with an initial clinical assessment and appropriate investigations.

5.2 CCGs will not normally fund AI. Please refer to local CCG policy for

details of eligibility criteria for NHS funding for AI. 6. Surrogacy

6.1 Surrogacy will not be routinely funded by South Staffordshire CCGs. Cases will be considered via the CCGs’ Individual Funding Request route and must demonstrate exceptionality.

7. Reversal of sterilisation and treatment following reversal

7.1 IVF/ICSI treatment will not be funded where either partner has been sterilised or where reversal of sterilisation has been undertaken.

8. Body mass index (BMI)

8.1 Couples should be advised that having a BMI of 30 or over (in either or both partners) is associated with reduction in fertility and chances of conceiving, which may be reversed with weight loss.

8.2 Women being considered for IVF must have a stable BMI below 30 at

the commencement of IVF treatment. A BMI below 30 is a requirement as there is evidence to show that oocyte collection rates are significantly lower and early pregnancy loss rates are significantly higher, in women with BMI of 30 or more, compared with those with BMI less than 30.

8.3 Where there is a statement regarding BMI the criterion has not been

arbitrarily applied and has been included on the grounds of evidence for clinical and safety reasons.

9. Smoking

9.1 Both partners must be non-smoking for at least 28 days before treatment commences, and must continue to be non-smoking throughout treatment. Providers will seek evidence from referrers and confirmation from each partner. Providers should also include this undertaking on the consent form, and ask each partner to acknowledge that smoking will result either in cessation of treatment or treatment costs being applied.

.10. Definition and number of cycles

10.1 A cycle is the process whereby one course of IVF (+/- ICSI) commences with ovarian stimulation and is deemed to be complete when all viable fresh and frozen embryos resulting from that stimulation have been transferred. (NICE definition)

7

10.2 For women aged 23 - 39 years, where the couple meets the eligibility criteria, South Staffordshire CCGs offer funding for 1 completed cycle of IVF treatment (+/- ICSI), provided they have not previously undergone NHS funded IVF/ICSI.

10.3 Couples who have previously self- funded their IVF treatment will be

entitled to 1 NHS funded cycle provided they have not received more than 2 complete cycles of privately funded treatment. Where couples have previously self funded and frozen embryos exist, the couple must utilise any viable embryos rather than undergo ovarian stimulation, egg retrieval and fertilisation again. The use of these embryos in this circumstance will require self-funding.

11. Number of transferred embryos

11.1 In keeping with the Human Fertilisation and Embryology Authority’s (HFEA) multiple birth reduction strategy, couples will be counselled about the risks associated with multiple pregnancies and advised that they will receive a single embryo transfer (whether fresh or frozen) in line with NICE guidance, unless there is a clear clinical justification for not doing so (e.g. a single top quality embryo is not available, or for older women, see 11.3 below). In any event a maximum of 2 embryos will be transferred per procedure (either fresh or frozen).

11.2 Women with a good prognosis should be advised that a single embryo

transfer (SET), for both the fresh and any subsequent frozen embryo transfers, can almost remove the risk of a multiple pregnancy, while maintaining a live birth rate which is similar to that achieved by transferring 2 fresh or frozen embryos.

11.3 For women aged between 37-39 years double embryo transfer may be

considered if no top quality embryo is available. 12. Cancelled cycles

12.1 A cancelled cycle is defined by NICE as ‘egg collection not undertaken’.

Where IVF is charged by providers as an inclusive price, a cancelled cycle should not be charged. Couples will be eligible for one cancelled cycle as part of their NHS treatment.

13. Handling of existing frozen embryos from previous cycles

13.1 All stored and viable embryos should be used before a new cycle commences. This includes embryos resulting from previously self-funded cycles.

13.2 Embryos frozen as part of an NHS funded cycle will be stored for up to 3 years. After 3 years, couples will be required to self- fund storage of any embryos.

14. Surgical sperm retrieval

14.1 Surgical sperm retrieval (SSR) will be funded in appropriately selected patients, providing that azoospermia is not the result of a sterilisation

8

process, and will only be funded where the couple meet the eligibility criteria set out within this document. Men with obstructive azoospermia should be offered surgical correction of epididymal blockage to restore patency of the duct, unless it is following vasectomy which is not covered by this policy. Surgical correction should be considered as an alternative to surgical sperm recovery and IVF.

14.2 Funding will be provided for men who, with their partner, would be

eligible for NHS funded IVF/ICSI treatment. 14.3 Funding will not be provided for sperm retrieval in men who have

undergone vasectomy, whether or not the female partner also required infertility treatment.

15. Oocyte and sperm donation

15.1 Sperm donation is not normally funded. 15.2 Oocyte donation may be commissioned as part of IVF/ICSI policy when

clinically appropriate:

Premature ovarian failure Gonadal dysgenesis including Turner syndrome Bilateral oophorectomy Ovarian failure following chemotherapy or radiotherapy

15.3 NHS funding would not normally be available for women outside these groups who do not respond to follicular stimulation.

15.4 Egg donations will be sourced by providers.

16. Embryo and sperm storage

16.1 Embryo and sperm (when required after surgical retrieval) storage will be funded for couples who are undergoing NHS fertility treatment. Storage will be funded for a maximum of 3 years, or until 6 months post successful live birth, whichever is the shorter.

16.2 South Staffordshire CCGs will not separately fund access to, and the

use of, frozen embryos remaining after a live birth. Couples may be charged separately by providers for the use of these embryos.

17. Cryopreservation

17.1 For patients who meet the CCG criteria, and are undergoing medical treatment that is likely to make them infertile (e.g. chemotherapy for cancer) sperm, oocytes or embryos will normally be stored for a maximum of 10 years. There is no lower age limit for eligibility under these circumstances. There should be an annual review to ensure that patients still meet the criteria and wish to continue to have their semen, oocytes or embryos stored. Patients who no longer fulfil the criteria will be offered the option to self-fund continued storage of their semen,

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oocytes or embryos in line with the HFEA guidance around maximum storage times. Longer terms may be requested, and should be individually reviewed depending on the case.

Normal eligibility criteria for IVF apply when using stored gametes for

assisted conception in an NHS setting. Policy review This policy will be reviewed should there be any material changes to the guidelines issued by NICE or as agreed by all participating CCGs. References

10

NICE guidelines CG156. February 2013. Fertility: Assessment and treatment

for people with fertility problems. HFEA January 2012. Multiple births and single embryo transfer review. EMSCG P006 v2 Commissioning Policy for Invitro Fertilisation (IVF) /

Intracytoplasmic Sperm Injection (ICSI) within Tertiary Infertility Services (1st December 2010 v2)

Stoke on Trent Clinical Commissioning Group, Service Specification for Assisted Conception (2010)

NHS Bristol, North Somerset and South Gloucestershire, Fertility Treatment (2010)

East of England Specialised Commissioning Group, Fertility Services Commissioning Policy (2011)

Oxfordshire PCT, Assisted Conception Services (2010) Infertility Network UK, Standardising Access Criteria to NHS Fertility

Treatment (2010) South Staffordshire Primary Care Trust, Commissioning Policy and Referral

Guidelines for Assisted Reproduction Treatments (2010) Yorkshire and the Humber Specialised Commissioning Group,

Commissioning Policy for Fertility Services (2011) NICE Guidance CG001 ‘Fertility: assessment and treatment for people with

fertility problems’ (2004) NICE Guideline CG156 ‘Fertility: assessment and treatment for people with

fertility problems’ (2013) The Human Fertilisation and Embryology Authority (HFEA) document ‘The

Best Start to Life’ (2007) The Human Fertilisation and Embryology Authority (HFEA) Code of Practice

6th edition 2003 Regulated Fertility Services: A Commissioning Aid (2009) Schmidt L. Infertility and assisted Reproduction in Denmark. Epidemiology

and psychosocial consequences. Dan Med Bull. (2006) Nov;53 (4):390-417 Khader et al. Journal of Ovarian Research 2013, 6:3.

http://www.ovarianresearch.com/content/6/1/3

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GLOSSARY

Term

Meaning

Blastocyst Any undifferentiated embryonic cell (Lawrence, 2000: 75)

Body Mass Index (BMI) Body Mass Index (BMI) is a number calculated from a person's weight and height. BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems.

Donor Insemination (DI) The introduction of donor sperm into the vagina, the cervix or womb itself

Embryo A fertilised egg. Embryo transfer The replacement of embryo(s) back into the female

patient Frozen Embryo Replacement (FER) Where an excess of top quality embryos is

available, these embryos may be cryogenically frozen for future use. Once thawed, these embryos are transferred to the patient as a frozen cycle.

Gonadotrophins Hormones that stimulate the function of the organs in which reproductive cells are produced (Lawrence, 2000; 254)

Human Fertilisation and Embryology Authority (HFEA).

UK’s independent regulator overseeing the use of gametes and embryos in fertility treatment and research. (HFEA, c, 2009)

Invitro Fertilisation (IVF) This is a process whereby eggs are removed from the ovaries and fertilised with sperm in the laboratory.

Intra-cytoplasmic Sperm Injection (ICSI)

This is a technique that can be used in IVF whereby a sperm is injected into an egg to assist in fertilisation. (NHS Direct, 2009).

Intrauterine Insemination (IUI) A procedure to separate fast moving sperm from more sluggish or non-moving sperm. The fast moving sperm are then placed into the woman’s womb close to the time of ovulation when the egg is released from the ovary in the middle of the monthly cycle.

National Institute for Health & Clinical Excellence (NICE)

NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.

Oocyte A not yet fully developed egg cell. Ovarian Stimulation The process of stimulating one or more follicles to

grow by the administration of gonadotrophins. Pre-implantation genetic diagnosis (PGD) This is a technique that enables people with a

specific inherited condition in their family to avoid passing it on to their children. It involves checking the genes of embryos created through IVF for this genetic condition.

Dear Ann-Marie and Andy Re: CCG Quarter 2 Assurance Thank you for meeting with members of the Area Team on the 26 November 2014 to discuss the second quarter assessment of your CCG. This was split into three sections, the first section focused on Domain 3: delivery and outcomes, the second part on Domain 4: finance and governance, and the third part on remaining domains plus CCG agenda items. Quality and patient and public engagement domains continue to be assured and are progressing well, therefore discussions took place on those domains that were ‘assured with support’, with the CCG providing assurance on delivery between quarters 1 and 2. This letter sets out the key points arising from the discussion. Part 1 – Domain 3: Delivery and outcomes Referral to Treatment (RTT) The CCG has achieved all 3 headline RTT standards for quarter 2 with a reduction in the number of failing specialties, and has delivered the diagnostics standard. The Area Team congratulated the CCG on its hard work and progress in these areas. Cancer The CCG achieved all except one cancer standard in quarter 2. The 31 day wait for subsequent treatment was not achieved due to 4 breaches at Walsall, Royal Wolverhampton and the University Hospital of North Midlands. The CCG has liaised with host CCGs to ensure contract levers and recovery action plans are in place. The Area Team asked how the CCG ensured quality in cancer services where commissioned by other CCGs. The CCG Joint Quality Committee looks at breaches for lessons learnt, and assurance that no harm has come to the patient. The Area Team queried whether the CCG had individual patient tracking in place to provide additional information on the actual length of time patients waited before being treated. This would give the CCG additional assurance that the

Shropshire and Staffordshire Area Team Anglesey House

Wheelhouse Road Rugeley

Staffordshire WS15 1UL

15 December 2014 Dr Ann-Marie Houlder, Chair, Mr Andrew Donald, Accountable Officer Stafford and Surrounds CCG Greyfriars Therapy Centre Stafford ST16 2ST

reasons given by the provider for delays were valid and reasonable. Urgent Care A&E standards for the CCG did not deliver during Q2 at three sites: Royal Stoke Hospital, Country Hospital and Royal Wolverhampton Trust. A&E delivery at County Hospital has deteriorated from quarter 1. A revised recovery date of 6th December has been agreed, with a revised recovery plan and trajectory for the County Hospital A&E which is monitored daily and weekly with the Trust. The County Hospital has reported patient flow as a key contributing factor to delivery. The CCG are working with the Trust on several initiatives to improve patient flow, including hospital at home, early discharge, reviewing continuing care, and end of life fast track to avoid delays due to incomplete paperwork. The CCG are also exploring working with the voluntary sector for domiciliary care. Dementia The CCG dementia diagnosis rate for September was 47.5% and October data shows an improving position. The CCG have taken actions in quarter 2 to improve the rate of diagnosis, including data quality improvements with coding, improved data reporting at patient level to enable practices to validate their QoF registers, and practices signing up to the enhanced service. The CCG have raised the profile of this standard and dementia has been a recurring item on the monthly Membership Board. The CCG are confident the provider has capacity to meet demand and that the standard will be delivered in quarter 3. The Area Team acknowledged the challenge ahead to achieve the standard and the CCG should be able to achieve this. The Area Team requested practice level detail plans showing monthly improvement and actions for each to achieve the standard, to be sent to the Area Team by 9 January 2015. Continuing Healthcare/complex care The CCG reported there had been significant improvements in administrative processes and case management in order to deliver up to date enhanced care packages. The QIPP scheme is on track to deliver planned savings for all South Staffordshire CCGs. The CCG are reviewing nursing home quality assurance processes and have developed a quality dashboard with the CSU to ensure robust monitoring. There are proposed improvements to the collaborative commissioning arrangements for 2015/16 to include enhanced clarity of the lead CCG role and responsibility, governance and quality assurance role. Part 2 – Finance and Governance Finance The financial position has deteriorated from quarter 1 to quarter 2 by approximately £300,000. The CCG understand the issues affecting their financial position, this includes the financial impact of the lost arbitration with Mid Staffordshire Hospitals Foundation Trust. A finance recovery plan is in progress and the CCG is confident they will achieve their control total. As part of the recovery plan the CCG has taken a number of mitigating actions. These include strengthened monthly financial monitoring processes to ensure everyone in the CCG is working to one set of figures and assumptions, bed closures at County Hospital, additional CHC QIPP schemes, a robust review of all other QIPP schemes to deliver maximum benefit, the application of contract levers to maximise efficiencies, and additional contract management capacity to support delivery. The CCG are now focusing on transformational initiatives that

will deliver at scale, and future schemes are expected to impact in the long term such as Cancer/End of Life procurement in 2017/18. The Area Team recognises the Governing Body are committed to addressing the financial position and committed to the actions that are in place. The Area Team recognises the commitment to deliver, and would recommend for future presentations a run rate and confirmation that the predicted finances are heading in the right direction. The information would benefit from a subjective analysis on the current areas of spend and what needs to be in place going forward. The Area Team Finance Director will continue to meet monthly with the Chief Financial Officer. The linkage of activity to finance is fundamental and the Area Team recommends the CCG clearly defines the deliverables they expect from the Commissioning Support Unit (CSU). Governance The CCG confirmed that the Secondary Care Consultant post on the Governing Body has been vacant for 12 months despite several recruitment attempts including national advertising. The CCG informed the Area Team that they were now exploring recruiting with neighbouring CCGs. The Area Team acknowledge the efforts that have been taken to date and asked for an update at quarter 3 checkpoint. GP Out of Hours Contract The CCG holds the GP OOH contract for itself and Cannock Chase CCG. A new service specification has been produced to seek a more integrated service and includes faster response times, direct bookings from NHS 111 and on site appointments at both County Hospital and Cannock Hospital. The new service is expected to start date in April 2015. Part 3 – Domain 5 & 6 – Partnership and Leadership Partnership The CCG has good relationships with its Local Authorities and consideration is being given to shared posts with the County to further aid joint working, and integration. The KPMG Challenged health Economy report for Staffordshire challenged the CCGs to do things once where possible across the 6 CCGs. The CCG confirmed they are working jointly with Stoke and Staffordshire CCGs to implement the collaborative recommendations from the KPMG challenged health economy report. The 6 CCGs have agreed a number of areas where they will work collaboratively and now have in place a single strategic approach to primary care, NHS 111, frail elderly (single pathway agreed), planned care, learning disabilities, Integrated Community Equipment Service, mental health and contract management. The CCG is a member of a Joint Accountability Board across the Health and Social Care economy, to provide an overview on shared strategy and mutual accountability and, together with the other CCGs has established a Commissioning Congress to oversee the joint work, of which the first meeting takes place on 11 December. The Area Team recognised the hard work and effort of the CCG staff but commented on the length of time it has taken to agree collaboration arrangements. The Area Team reminded the CCG that collaboration is within their control and it is important to keep progressing this

agenda to strengthen collective capacity. The Area Team acknowledged the scale of the challenges of the Staffordshire economy for the CCG and felt it important that the CCG bolsters its capacity through collaboration. The Area Team will review this at quarter 3. Leadership The CCG management of change process has been completed and has aligned management with clinicians to ensure the Membership is taking ownership of the components they can control and influence. The CCG has written to the Area Team outlining how they have embedded the work of the interim Turnaround Director, who has now left the CCG. The Area Team agreed they would respond formally to the letter. There has been significant improvement of clinical leadership at practice level and a new clinician has joined the Governing Body. Better Care Fund (BCF) The Staffordshire Plan is currently rated as assured with conditions and remains a high risk plan, in particular around the protection of social care. The CCG is working with stakeholders to resubmit the plan by the 9 January 2015. The Accountable Officer confirmed that he has taken over as joint lead of the Better Care Fund (BCF) across Staffordshire and is working closely with the local authority. There is a weekly steering group in place, and a dedicated programme team, as well as support from a BCF national task force advisor. The Area Team recognised the challenges and asked that there is a signed single joint statement of aims between the CCGs and the Local Authority, so there is confidence that everyone shares the same belief and that there can be no misinterpretation of the statement. Primary Care Co-commissioning The CCG is part of a collaborative approach across the 6 CCGs, with a view to starting with co-commissioning moving towards full delegation in 2016. The CCG will be amending their constitution to allow joint committees and future flexibility. Conclusion Enclosure 1 outlines the outcomes of the Domain ratings. Below are the actions arising from this meeting:

• CCG to produce practice level action plans including timescales to achieve dementia standard by March 2015. CCG to send action plans to Area Team by 9 January 2015.

• CCG to recruit Secondary Care Consultant with neighbouring CCGs. • Area Team to formally respond to CCG’s revised structure proposal. This

includes embedding the work of the previous interim Turnaround Director. • CCG to ensure governance is in place for interim staff. • Recommendation that the CCGs and Local Authority have a BCF single

joint statement. • CCG to continue to progress the collaboration agenda at pace to free up

staff capacity. • Area Team Finance Director to continue to hold monthly 1:1 meetings with

Chief Finance Officer (CFO). • CCG to clearly define to CSU expected deliverables, in particular relation

to activity data and reconciliation between SUS and Unify.

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

Dawn Wickham, Director of Operations & Delivery On behalf of Graham Urwin, Area Team Director

Enclosure 1 – Stafford and Surrounds CCG – Domain Ratings

Domain Description Domain rating

1 Are patients receiving clinically commissioned, high quality services?

Assured

2 Are patients and the public actively engaged and involved?

Assured

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

Assured with support

4 Does the CCG have robust governance arrangements? • Finance • Secondary care consultant role on Governing Body


5 Are CCGs working in partnership with others?

• Collaborative commissioning


6 Does the CCG have strong and robust leadership?

• Embedding permanent Turnaround Director into CCG structure


Item: 14 Enc: 12

APPROVED: 22.01.15 Page 1 of 8

FINANCE, PERFORMANCE AND CONTRACTS (FPC) COMMITTEE

Thursday 18 December 2014

2.00 pm – 5.00 pm Room 2, Beacon International Centre, Unit 26 Anson Court,

Staffs Technology Park, Stafford ST18 0GB

MINUTES

Members:

Qu

ora

cy

20/1

1/14

18/1

2/14

22/0

1/15

19/0

2/15

19/0

3/15

Paul Woodhead (PW) Chair – Lay Member

Hal

f mem

bers

plu

s D

irect

or o

r D

eput

y D

irect

or o

f Fin

ance

Michael Brookes (MB) Head of Contracts, CSU

Martin Flowers (MF) Associate Director of Finance

x x

Dr Gary Free (GF) Clinical Lead

Dr Paddy Hannigan (PH) Clinical Lead

x

Dr Anne-Marie Houlder (AMH) CCG Chair – S&S

x

Dr Mohammed Huda (MH) Clinical Lead

x

Rob Lusuardi (RL) Director of Operations x x

Dr Johnny McMahon (JM) CCG Chair – CC

Lynn Millar (LM) Director of Primary Care

x x

David Pearsall (DP) Lay Member

Colin Groom (CG) Deputy Director of Finance

x

Paul Simpson (PS) Director of Finance

In attendance: Alex Bennett (AB) Director of Performance x x

Angela Hopper (AH) ASH Consultancy x

Mark Jones (MJ) Senior Commissioning Manager

Mel Mahon (Savage) (MM) Senior Commissioning Manager x

Claire McHugh – Minutes (CLM) Executive Assistant

x

Matthew Sanzeri (MS) Business Manager – CHC Team

x

Sarah Turner (ST) Senior Information Analyst

Item: 14 Enc: 12


Members:

Qu

ora

cy

20/1

1/14

18/1

2/14

22/0

1/15

19/0

2/15

19/0

3/15

Martin Wakeley (MW) Transition Director x

Action

1. Welcome by the Chairman

PW explained that the Agenda order had been revised to ensure quoracy. The revised agenda was distributed to those attending.

2. Apologies

Martin Flowers Dr Paddy Hannigan Dr Anne-Marie Houlder Dr Mohammed Huda Lynn Millar

3. Minutes of Previous Meeting

3.1

Minutes approved as a true and accurate record of the meeting.

3.2

3.2.1

14:04 Michael Brookes joined the meeting Action Log Ref: 64 – CSU Review Report PS has had a number of discussions and meetings following the submission of the CSU Review Report to FPC on 20.11.14. PS acknowledged PW concerns regarding difficulties that may be ongoing with CSU, however discussions continue including a meeting following this FPC to address issues/difficulties particularly around the year end and the control total 2014/15. PS explained that the issue is further complicated by the discussions around reconfiguring CCG services ie, North Staffs, Stoke and Stafford CCGs working more collaboratively. Whilst the CSU issue is still important, there are currently other priorities and it may be useful to realign the CSU service when the CCGs have been reconfigured. PW suggested that this be reviewed at FPC at a later date and PS agreed however, it would be useful for the matter to be reviewed when more information is available regarding reconfiguration of the CCGs. 14:13 Angela Hopper/Martin Wakeley joined the meeting Action: CSU Review to be included on Forward Plan Template

CLM

Item: 14 Enc: 12


Action

3.2.2

JM asked if a timescale has been identified and PS informed the meeting that a report by Dr Julie Oxtoby identified that there would be a Director for the 3 reconfigured CCGs by the end of the 2014/15 financial year. JM welcomed the opportunity to have discussions outside of FPC to identify ways to move the reconfiguration forward. MW offered information regarding NHS rules regarding changes within CCG and advised that there is a minimum 6 month notification for formal change to constitution. MW suggested that any change to CCG prior to an election (May 2015) is unlikely given the required timescales. Ref: 63 – CCG Performance Report – August 2014 (Cannock Chase) PW has discussed the 62 day wait with Quality and will report further.

4. Conflicts of Interest

JM is not identified on the Conflicts of Interest enclosure. No other conflicts to declare. Action: CLM arrange for Conflicts of Interest to include Paddy

Hannigan, JM and Anne-Marie Houlder who will attend where quoracy is required.

CLM

5. Transformation Programme Project Management Office (PMO) Governance Arrangements

PW welcomed MW to the meeting who introduced the paper. MW reported on the positive feedback received from the CSU and Wolverhampton Hospitals. There are a series of workshops looking at healthcare up to 2020 and working back from there. The first will be on 27/01/2015 and there will be representation from CCG and clinicians. MW explained that whilst he is the Transition Director, he does not have accountability on the Executive Board and this paper identifies that PS is the Lead Executive Officer for the Programme and the FPC as the appropriate governing forum. PS explained that the Project Initiation Documents (PID) summary sheets have been included within the documents and if Members would like sight of any of the full documents, they are available. Work continues on the PIDs and MW explained how the PIDs will be managed through various thresholds and how to manage them with providers. The Committee approved the proposed governance arrangements. 14:35 Angela Hopper/Martin Wakeley left the meeting

Item: 14 Enc: 12


Action

12. Long Term Financial Recovery Plan (LTFRP)

PS presented the paper and apologised to Members who attended Governing Body on 16/12/2014 who had already received the presentation. Feedback has been received from Area Team (AT) that S&S and CC are amongst 3 CCGs who have submitted credible plans but there is a concern about ability to deliver based on the challenge faced by the CCGs. PS identified that the national planning guidance is not yet available and as a result of this, no CCG nationally has had their plan signed off. There are two meetings in January, a telecon for CFOs with AT on 12/01/2015 and a meeting with CFO/AO and AT on 20/01/2015. PW asked if it is known what money is going to be made available to the CCGs including the Better Care Fund (BCF). PS understands that news will be available on 19/12/2015 regarding allocation of monies. PS has had a number of conversations regarding BCF with colleagues in Staffordshire County Council and there is more information required. PW raised concern about approval of PIDs where clinical advice is required and whether these should be approved at Governing Body. PS explained that the particular PID was written by Mel Mahon (Savage) in close consultation with GF. The Finance, Performance and Contracts Committee: - Noted the content of the report, in particular the work undertaken to

produce a LTFRP for the two CCGs; - Commented regarding the financial forecasts outlined; - Approved the PID Summaries to enable the various schemes to

proceed.

13. Request for “FLO” Telehealth funding for 2015/16

ST presented the paper and explained some of the processes. PW asked clinicians for their view of FLO as a tool. GF explained that blood pressure readings at home will reduce some of the ‘white coat’ higher readings. GF has concerns about Chronic Obstructive Pulmonary Disease (COPD), explaining that for some conditions, patients are potentially quite poorly when the readings are significant. However, JM/GF agreed that this could be useful in asthma. JM explained that another area that could benefit is heart failure/weight ie, weight often increases with water retention prior to heart failure. MB considered the contractual impact of this and explained that there may be reduction in admission/treatment costs. However, he expressed concern regarding training patients to address any risk that is highlighted by the FLO.

Item: 14 Enc: 12


Action

ST explained that she has requested additional funding because the project was so successful in the previous year. The additional monies will enable further development. JM asked if there is data available to identify where admissions to A&E/Hospital have been prevented as a result of this service. The Finance, Performance and Contracts Committee approved funding for business case for continued use of system during 2015/16 for both CCGs subject to an evaluation of the service to identify impact. Action: Forward Plan for evaluation feedback (6 months)

CLM

14. Dementia Enhanced Primary Care Pilot

PS presented the report on behalf of Jonathan Bletcher. PS explained that this paper is to be presented at both Governing Bodies and has been presented to FPC for information. PW expressed concern that consideration is being given to provide more funding for a service that has concerns. Action: PS to feed concerns to Jonathan Bletcher prior to Governing

Bodies

PS

9. CCG Performance Report – August 2014

ST presented the reports and explained that a member of staff has been recruited to support the Business Intelligence work. MB identified that there appears to be an improvement with Wolverhampton following the remedial action plan. JM identified that all the data is pre-transition and there should be a continued improvement within the reports. Committee moved to Item 10: Refinement Hub – Progress Report

10. Refinement Hub – Progress Report

ST explained that Lynn Millar is unable to attend but that further discussions are taking place around this. 15:38 Sarah Turner left the meeting

6. Contracts Month 6

MB presented the paper. PW asked about work taking place around contracts and maximising leverage out of contracts. MB confirmed that he is meeting with Patrick Butterworth and

Item: 14 Enc: 12


Action

Charles regularly to agree financial position with regard to Mid Staffordshire. PS informed the meeting that MBs team have identified contract breaches recently valuing approximately £1m. The mandated payment has already been made to Mid Staffordshire and this is approximately £2m over the revised figure and this will improve the opportunity to meet the control total. PW asked for further information regarding Rowley Hospital. MB informed that a further meeting took place and information is being requested from Rowley Hospital. JM asked if the CCG are obliged to have a contract. MB explained that it would be difficult to manage processes such as invoicing. JM asked if the planned care can be with the Acute Trusts. Discussion followed about whether the Acute Trusts can support the CCG to manage provision. CG asked MB about the 2015/16 contract round with West Midlands Ambulance Service (WMAS). 15:58 Johnny McMahon left the meeting Discussion followed around response times and commissioning. WMAS deliver to their corporate standards. GF asked if it is possible to commission with any other service and it was agreed that it is.

7. Initial Report on Month 8 Position and Ability to Deliver Control Total

16:02 Paul Simpson left the meeting Johnny McMahon returned to the meeting CG presented the report which shows activity information a month in arrears. CG explained about the ‘reserves’ which are effectively contingencies. Those figures shown within brackets on the table (page 3) are what have been released from reserves. 16:14 Paul Simpson returned to the meeting PW agreed that the reporting gives a more optimistic view that the control total will be met. PS supported CG report and identified that he is having discussions with RWHT and UHNM regarding meeting the control total. JM identified that this will happen at not too high a price ie, in terms of quality etc.

8. QIPP 2014-15 Programme Review Month 8

PS reported on this paper. There is some additional risk that has been identified (£370k). If the projections are achieved then the forecast should be delivered.

Item: 14 Enc: 12


Action

It is hoped that next year there will be a smaller number of schemes for a greater amount of money. In future, PS is planning to incorporate the QIPP analysis into the Financial Report that comes to FPC.

11. Finance and Contract Improvement Plan

CG presented the report on behalf of Martin Flowers. DP thanked those involved with the report and the work around it. PS talked about the work around the plan and acknowledged that this plan has been worked through, recommendations carried out and improvements made. PS asked for it to be noted that the work of the Finance Team and CSU has been excellent and thanked CG for the support that he has given to PS in the time that he has been working with the CCG.

15. Forward Plan Template

This will now be a Standing Item and CLM will access the Executive Management Team Forward Plan to use as a template for FPC.

16. Risk Register Review

The Failure to Deliver QIPP programme is identified at Risk ID 18, 62 and 61. There are a number of risks identified as ‘closed’ and could be removed. Action: CLM to raise Risk Register issues with Tracey Revill Tracey Revill to provide front sheet with future Risk Register JM suggested that Patient Choice is identified as a risk. Action: PS to consider Patient Choice as a risk

CLM TR

PS

15. Any Other Business

15.1

Proposal for the Commissioning of Blueteq® to Provide Assurance of Compliance with Commissioning Policy CG shared the paper on behalf of Mark Seaton and apologised for tabling the paper. This paper has been prioritised so that it can be built into contracts for 2015/16 to mandate providers to use the IT solution. Many neighbouring CCGs use this

Item: 14 Enc: 12


Action

system. JM advised caution if CCG in the north are not also using the system which may cause difficulty. It is far more likely to deliver if Stoke and North Staffs are also using the system, Wolverhampton, South East & Seisdon are using the system. JM recommended that North Staffs and Stoke are encouraged to use the system too. This will also reduce the risk of being accused of inequality eg, post code. Action: Confirm if North Staffs/Stoke are on the system The Finance, Performance and Contracts Committee approved the implementation of Bluetec® to support management of high cost drug approvals and PLCVs, subject to evaluation in 6 months.

CG

16. Next Meeting

Date: Thursday 22 January 2015 Time: 2.00 pm – 5.00 pm Venue: Dining Room, County Buildings, Martin Street, Stafford

Item No: 02 Enc:01

Joint Communications & Engagement Sub Committee

Wednesday 26th November 2014 Staffordshire Place

Present

Ruth Goodison (Chair) - RG Paul Gallagher (Vice Chair) -PG Sally Young - SY Tamsin Parker - TP Adele Edmondson - AE Diana Smith - DS Clive Cropper – CC Hester Parsons - HP Steve Platts – SP Jane Cannell - JC

Lay Member, Patient and Public Involvement SaS CCG Lay Member, Patient and Public Involvement CC CCG Assistant to Chief Executive Head of Communications & Engagement CSU Communications & Engagement Manager Lay Member, SaS CCG Practice Lead CC CCG Community Engagement Lead Healthwatch District PPG Member SaS District PPG Member SaS

In attendance

1. Apologies Carole Howard – Patient Champion CC Maureen Freeman – Patient Champion CC

2. Declaration of Interest Nil declared

3.

Minutes of the last meeting The minutes of the meeting were agreed as a true and accurate record.

4. Matters Arising Cancer and End of Life Care Programme – Richard Lakin transferring into the Commissioning Support Unit (CSU) and CSU will be supporting the programme around communications and engagement. Stakeholder Mapping - CCG is developing a stakeholder map to identify and prioritise stakeholders. The aim is to improve targeted engagement and make it more effective. Behind the stakeholder map will be information on the most appropriate method of engaging with individual groups. A digital stakeholder map also needs to be developed to identify the influence of key stakeholders via social media and other digital channels. Action – to bring a draft stakeholder map back to the Committee for discussion - Engagement Table to be recirculated to members for completion Myth Buster – PG gave a copy to Lynda Scott to see whether the CSU has something similar the CCG could use. Action – TP to chase Annual Conference – Need to look at the level of networking between PPGs and the reps of PPGs – many are working in isolation. It would be a good idea to hold an annual conference bringing together patient representatives from the Stafford District PPG and the Cannock Locality Networks

AE AE

TP

2

– it could be extended to members of individual practice PPGs and used to support wider engagement. Communications and Engagement Committee to shape the agenda Holding a conference would be part of the answer but only part of the answer. Information for PPGs could be cascaded through a web portal on the new website to ensure consistent messages. Some concern over those without access to website, however statistics show that over 80% of population now have access to internet. Need to look at widening the membership of the Stafford District PPG to include community and voluntary group representatives as well as PPGs. Actions - Check feasibility of holding annual conference with Chief Officer. To incorporate PPG page on the new website. To discuss membership of Stafford District PPG at next meeting.

SY TP/AE RG/AE

5. Terms of Reference

Terms of Reference needs to be revised to incorporate wider remit of Joint Communications and Engagement Committee – to include internal communications and engagement as well as external and to revisit membership. Action – PG, RG and SY to meet to discuss

PG/RG/SY

6. Communications and Engagement Audit TP and AE presented a communications and engagement audit which maps out current communication and engagement channels (internal and external), any issues with them and planned actions to take them forward. Action - The audit is to be a standing agenda item on the Joint Communications and Engagement Committee to monitor progress. Feedback – Need to add a column to identify where the work stream links to the five year strategy Communication Champions need to be identified within each CCG team to provide central point of contact between individual teams and CCG’s communication team. New teams within the CCG will include Communications and Engagement as a part of team objectives and team meetings will include the following as standing agenda items: - Risk Register - Potential hot topics - Positive News Stories/items for Annual Report - Communications and Engagement Impact Assessment (to identify and

communications or engagement opportunities, requirements at the start of projects)

Look at introducing a Team Brief on a monthly basis as part of the drive to create effective team meetings. Membership Scheme – CCG and CSU have met to look at re-launch/new drive of CCG Membership Scheme and actions have been agreed. The next edition will go out on 8th December and this will now be a bi-monthly publication. CSU will draft national/regional information and send over to CCG to add local copy. CCG will send back to CSU for formatting and distribution.

TP/AE

TP/AE

TP/AE/SY

3

A recruitment plan has been drawn up and will be worked through, starting with a re-launch in the New Year. Action – Membership Scheme to be standing item on the agenda.

TP/AE

7. Proactive Communications and Engagement Plan

- Website Development

The steering group to plan and develop the new CCG websites has been set up and held its first meeting. Membership included patient representatives, CCG officers, practice representatives and was led by the Commissioning Support Unit. Initial discussions were held about the desired purpose of the website, the type of content it should include and how the information should be presented. The CSU have taken the information away to build three options for each CCG, which will be circulated to members of the Communications and Engagement Committee for feedback. The main issue is going to be pulling all the website copy together – going to try and draft in additional resource from CSU to support. Action – to share website options with committee members and for members to feedback comments.

- To add a paragraph to the website saying – “This website is currently under development – do you want to help us get it right?”

- Press Schedule TP presented a press schedule that has been drawn up to take a more proactive approach to communications and highlight areas of good practice/workstreams. This approach needs to be built on and needs input from the various teams if it is to be maintained. Some press release suggestions included in the schedule are:

- Pre and post Governing Body - GP First – Acute Visiting Service, Frail and Elderly care

Action - Press releases issued to be included in the News in Brief It was suggested that the plasma screens in GP practices could be used more to get good news/information across to patients. Action – find out which practices have plasma screens.

TP

AE

AE

AE

8. CCG Updates MIU Consultation Press release being issued today to notify public of the change to the opening times of the Minor Injury Unit, following the consultation. The hours will be reduced from 8pm till midnight to 10.30am to 6.30pm from 1st December. A lessons-learnt document is being pulled together to address some of the recommendations made during the consultation.

4

TSA Transition The formal transition of services from Mid Staffs NHS Trust to Royal Wolverhampton Hospitals NHS Trust and University Hospital of North Midlands took place on 1st November. Communications to support the transition include a dedicated website – It’s Our Time, full page advertorials in the local press and a patient prospectus which is being delivered to 425,000 homes across the area outlining the changes to the County Hospital and the Royal Stoke University Hospital – delivery starting at the beginning of December. Royal Wolverhampton have been approached to produce something similar but at the moment are not inclined to do so. Public Meetings have also been held, although poorly attended, and there is still some disquiet about what is happening. Members thought he ‘It’s Our Time’ website needs to be publicised more as the information is very useful. Action - Information should be sent to the Membership Scheme. Choose Well On the back of the Minor Injury Unit consultation, one of the recommendations was to distribute information about the Choose Well campaign to raise awareness about the different services available and when you should use them. The CCG has carried out a wide reaching campaign, across Cannock Chase and Stafford and Surrounds, which has included:

- Pull Up Banners in GP practices, council buildings, supermarkets, local hospitals, leisure centres and children’s centres

- A3 and A4 posters in GP Practices, pharmacies, hospitals and distribution to a range of community venues, including shops, community centres, churches and hairdressers – supported by parish councillors

- A5 leaflets for patients to take away in GP practices, pharmacies, council buildings, leisure centres,supermarkets and other community venues

- A5 leaflets sent to Stafford Rural Homes for distribution to all of their premises

- Flyer being developed to go out with children’s reading packets at every primary school across Cannock Chase and Stafford and Surrounds

- Editorial included in the December edition of the Chase Matters magazine, which goes out as a wrap around on the Cannock Chronicle as well as publicised on the District Council website

- Editorial included in the South Staffordshire Partnership Directory of Services and the December editions of the CCG community newsletter

- Editorial included on both CCG websites and sent to local stakeholders for inclusion on their websites

- Editorial to be included in the Hospital prospectus – being delivered to every household

- Work is planned to work with local school children on developing child friendly versions of the information

Medicines Waste

- A Medicines Waste campaign is being developed with the Medicines Management Team – more information is to be brought back to the next committee

TP/AE

5

The Communications & Engagement Committee received and noted the update.

9. Any Other Business Action- To agree dates for future meetings and circulate to members

AE

10. Date and Time of Next Meeting Future meetings of the Joint Communications and Engagement Committee will be held on Tuesdays – between 1pm and 3pm at Staffordshire Place 2 (CCG Boardroom on 1st floor). Future meeting dates are: Tuesday 24th February Tuesday 25th August Tuesday 28th April Tuesday 27th October Tuesday 30th June Tuesday 15th December

AGENDA - NHS Stafford and Surrounds CCG

Documents

Transcript of AGENDA - NHS Stafford and Surrounds CCG