Annual General Meeting of the West Suffolk CCG Governing · PDF fileAnnual General Meeting of...

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Annual General Meeting of the West Suffolk CCG Governing Body

to be held from 0915–1200 hrs on Wednesday 29 July 2015 at The Lounge, The Athenaeum, Bury St Edmunds, Suffolk, IP33 1LU

AGENDA

The Governing Body will be available to meet with members of the public from 0900 – 0915

1. Apologies for Absence Bill Banks 2. West Suffolk CCG – Annual Report and Accounts 2014/15

Link to report on CCG website: http://www.westsuffolkccg.nhs.uk/annual-report/ and; Q3 Area Team Assurance Letter

Bill Banks/ Julian Herbert WSCCG15-35

WSCCG15-35a 3. Annual Audit Letter 2014/15 Carl Goulton

WSCCG15-36 Questions and Answers

GENERAL BUSINESS 1. Apologies for Absence Bill Banks 2. Declarations of Interest

To declare any interests specific to agenda items All

3. Minutes of the previous West Suffolk CCG Governing Body

meeting. To approve as a correct record the Minutes of the West Suffolk CCG Governing Body meeting held on 20 May 2015

Bill Banks

4. Matters Arising and Action Log Bill Banks 5. General Update

To receive a verbal report from the Chief Officer Julian Herbert

PATIENT AND PUBLIC ENGAGEMENT 6. Community Engagement Group Minutes

To receive and endorse minutes of the Community Engagement Anne Nicholls

Report No:

http://www.westsuffolkccg.nhs.uk/annual-report/

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Group meeting held on 25 June 2015 WSCCG15-37 7. Patient and Public Engagement

To receive and note a report from the Chief Operating Officer Ed Garratt Report No:

WSCCG15-38 CLINICAL SERVICES 8. West Suffolk Care Home Model

To receive a presentation from the Care Homes Clinical Support Manager

Sue Smith Care Homes Clinical

Support Manager 9. Continuing Healthcare

To receive and note a report from the Continuing Healthcare Programme Director

Hilary Finegan Report No:

WSCCG15-39 10. Procurement Update

To receive and note a report from the Chief Contracts Officer Wendy Tankard

Report No: WSCCG15-40

FINANCE, PERFORMANCE AND SCRUTINY 11. Integrated Performance Report - Are the CCGs finances,

performance and quality on track? To receive and note a report from the Chief Finance Officer, the Chief Nursing Officer, the Chief Operating Officer and Chief Contracts Officer.

Carl Goulton/ Barbara McLean/

Ed Garratt/ Wendy Tankard

Report No: WSCCG 15-41

GOVERNANCE AND CORPORATE BUSINESS 12. Freedom of Information Quarterly Update (as at 30 June 2015)

To receive and note an update on Freedom of Information requests received by the CCG.

Julian Herbert Report No:

WSCCG15-42 13. Governing Body Assurance Framework

To receive and endorse a report from the Chief Corporate Services Officer

Julian Herbert Report No:

WSCCG15-43 14. Revised Terms of Reference – Remuneration and HR Committee

To receive and approve revised terms of reference for the Remuneration and HR Committee

Bill Banks Report No:

WSCCG15-44 15. Governing Body Self-Assessment Feedback

To receive and note feedback from the Governing Body’s recent self-assessment exercise


WSCCG15-45 16. Minutes of Meetings:

To receive a report from the Lay Member for Governance seeking the endorsement of minutes of West Suffolk CCG Sub Committees, those being;

(i) Audit Committee

The unconfirmed minutes of an extraordinary meeting held on 18 May 2015 and meeting held on 2 June 2015.

(ii) Remuneration and HR Committee

The unconfirmed minutes of a meeting held on 16 June 2015


WSCCG15-46

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(iii) Clinical Scrutiny Committee The unconfirmed minutes of a meeting held on 24 June 2015

(iv) CCG Collaborative Group

The unconfirmed minutes of a meeting held on 18 June 2015

(v) Commissioning Governance Committee Decisions from a meeting held on 20 May 2015

17. Any Other Business 18. Date and Time of future Governing Body meetings

0915 - 1230 Wednesday 30 September 2015, The Lecture Room, St Edmundsbury Cathedral, Bury St Edmunds, Suffolk

Questions from the public – Maximum 15 minutes

Please note questions should relate to the items under discussion and must be a question rather than statement. Where individuals deviate from this requirement they will be asked to stop and will not be invited to take any further part in the meeting.

Exclusion of the Press and Public

To resolve to exclude representatives of the press, and other members of the public, from the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be

prejudicial to the public interest; Section 1(2), Public Bodies (Admission to Meetings) Act 1960.

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Typewritten Text

Agenda item AGM 02 Reference No WSCCG 15-35a

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NHS West Suffolk Clinical Commissioning Group

Annual Audit Letter for the year ended 31 March 2015

8 June 2015

Ernst & Young LLP

Ernst & Young LLP One Cambridge Business Park Cambridge

CB4 0WZ

Tel: + 44 1223 394400 Fax: + 44 1223 394401 ey.com

Governing Body

NHS West Suffolk Clinical Commissioning Group

Rushbrook House

Paper Mill Lane

Bramford

Ipswich

IP8 4DE

8 June 2015

Dear Member

NHS West Suffolk CCG - Annual Audit Letter 2014/15

The purpose of this annual audit letter is to communicate to the Members and external stakeholders, including members of the public, the key issues arising from our work, which we consider should be brought to the attention of the Clinical Commissioning Group (CCG).

We have already reported the detailed findings from our audit work in our 2014/15 annual Audit Results Report to the 18 May 2015 Audit Committee, representing those charged with governance. We do not repeat those detailed findings in this letter.

The matters reported here are the most significant for the CCG.

We would like to take this opportunity to thank the CCG staff for their assistance during the course of our work.

Yours faithfully

Mark Hodgson Director For and on behalf of Ernst & Young LLP Enc.

The UK firm Ernst & Young LLP is a limited liability partnership registered in England and Wales with registered number OC300001 and is a member firm of Ernst & Young Global Limited. A list of members’ XNAMEXs is available for inspection at 1 More London Place, London SE1 2AF, the firm’s principal place of business and registered office.

Contents

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Contents

1. Executive summary ....................................................................................................1

2. Key findings ................................................................................................................3

3. Control themes and observations..............................................................................6

4. Fees .............................................................................................................................7

In April 2014 the Audit Commission issued a revised version of the ‘Statement of responsibilities of auditors and audited bodies’ (Statement of responsibilities). It is available from the accountable officer of each audited body and via the Audit Commission’s website.

The Statement of responsibilities serves as the formal terms of engagement between the Audit Commission’s appointed auditors and audited bodies. It summarises where the different responsibilities of auditors and audited bodies begin and end, and what is to be expected of the audited body in certain areas.

The Standing Guidance serves as our terms of appointment as auditors appointed by the Audit Commission. The Standing Guidance sets out additional requirements that auditors must comply with, over and above those set

out in the Code of Audit Practice 2010 (the Code) and statute, and covers matters of practice and procedure which are of a recurring nature.

This Annual Audit Letter is prepared in the context of the Statement of responsibilities. It is addressed to the Members of the audited body, and is prepared for their sole use. W e, as appointed auditor, take no responsibility to any third party.

Our Complaints Procedure – If at any time you would like to discuss with us how our service to you could be improved, or if you are dissatisfied with the service you are receiving, you may take the issue up with your usual partner or director contact. If you prefer an alternative route, please contact Steve Varley, our Managing Partner, 1 More London Place, London SE1 2AF. W e undertake to look into any complaint carefully and promptly and to do all we can to explain the position to you. Should you remain dissatisfied with any aspect of our service, you may of course take matters up with our professional institute. W e can provide further information on how you may contact our professional institute.

Executive summary

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1. Executive summary

Our 2014/15 audit work has been undertaken in accordance with the Audit Plan that we issued on 10 February 2015 and is conducted in accordance with the Audit Commission’s Code of Audit Practice, International Standards on Auditing (UK and Ireland) and other guidance issued by the Audit Commission.

The Clinical Commissioning Group (CCG) is responsible for preparing and publishing its statement of accounts, annual report and annual governance statement. It is also responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources.

As auditors we are responsible for:

► expressing an opinion:

► on the 2014/15 financial statements;

► on the regularity of expenditure and income;

► on the parts of the remuneration report to be audited; and

► on the consistency of the information given in the annual report with the financial

statements.

► reporting by exception:

► if the annual governance statement does not comply with NHSE Guidance or is not

consistent with our understanding of the CCG;

► to the Secretary of State for Health and NHS England if we have concerns about

the legality of transactions of decisions taken by the CCG;

► any significant matters that are in the public interest.

► forming a conclusion on the arrangements the CCG has in place to secure economy,

efficiency and effectiveness in its use of resources.

► reporting to the National Audit Office (NAO) any differences over £250,000 between the accounts template used for the production of the whole of government accounts (WGA) and the audited financial statements.

Executive summary

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Summarised below are the results of our work across all these areas:

Area of work Result

Opinion on the:

► Financial statements

Regularity of income and expenditure

► Parts of remuneration report to be audited

► Consistency of the Annual Report with

the financial statements

Unqualified – the accounts reported fairly on the CCG’s finances.

Unqualified – financial transactions were conducted within the CCG legal framework. No matters to report – the remuneration report was prepared properly within the rules set.

Financial information in the Annual Report was consistent with the Annual Accounts.

Reports by exception:

► Consistency of Governance Statement

► Referrals to the Secretary of State and

NHS England

► Public interest report and

The Governance Statement was consistent with our understanding of the CCG. No matters to report or refer. No matters to report in the public interest.

Value for money conclusion In considering the CCG’s arrangements for

challenging how it secures economy, efficiency and effectiveness, we identified that the CCG has breached the 28 day assessment period for a received claim as stipulated within the NHS Continuing Health Care Framework as a result of a backlog of Continuing Health Care cases. 82% of claims do not meet this 28 day assessment target. The current average claim assessment period for over 70% of cases is in excess of 90 days.

We modified our VFM conclusion wording as a

result.

Reporting to the National Audit Office No matters to report.

(NAO) in line with group instructions

As a result of the above we have also:

Issue a report to those charged with governance of the CCG communicating significant findings resulting from our audit.

Issue a certificate that we have completed the audit in accordance with the requirements of the Audit Commission Act 1998 and the Code of Practice issued by the Audit Commission.

Audit Results Report (final) issued on 18 May 2015.

Issued on 22 May 2015.

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Key findings

2. Key findings

2.1 Financial statement audit

The Annual Report and Accounts is an important tool for the CCG to show how it has used public money and how it can demonstrate its financial management and financial health.

We audited the CCG’s Statement of Accounts in line with the Audit Commission’s Code of Audit Practice, International Standards on Auditing (UK and Ireland) and other guidance issued by the Audit Commission and issued an unqualified audit report on 22 May 2015.

Our detailed findings were reported to the 18 May 2015 Audit Committee.

The main issues identified as part of our audit were:

Significant risk : Fraud & Management Override

As identified in ISA (UK and Ireland) 240, management is in a unique position to perpetrate fraud because of their ability to directly or indirectly manipulate accounting records and prepare fraudulent financial statements by overriding controls that otherwise appear to be operating effectively.

There were no matters to report from our audit.

Other Audit risk 1: Continuing Health Care provision

This area was problematic in 2013/14, with guidance on accounting for retrospective cases emerging through the year. CCGs (and predecessor PCTs) had not adopted a consistent approach to calculating provisions which resulted in some difficulties. Although accounting arrangements seem to be clearer in 2014/15 there is a risk of further issues emerging as part of the closure process e.g. NHS England returning legacy balances to CCGs.

Our audit identified that the financial statements include a provision of £0.667 million that relate to cases received prior to 1 April 2013 that still have not yet been assessed at the 31 March 2015. The provision is an estimate of the additional years cost of the claim (2013/14 and 2014/15) because the claims remain un-assessed.

However, under the Accounts Directions these liabilities remain the responsibility of NHS England and it is NHS England’s responsibility under IAS 37 to assess its own provision for its financial statements. The CCG has therefore overstated its provision.

Other Audit Risk 2: Delivery of the financial statements by the required deadline

The deadline for the audit opinion has been brought forward to noon on Friday 29 May 2015. This opinion covers the completed Annual report and Remuneration report.

The planned date for the Audit Committee to approve the financial statements is 18 May 2015.

There is a risk that these deadline pressures may have an impact on the timeliness and quality of the financial statements and supporting working papers.

The draft financial statements provided for audit and the supporting working papers were improved in quality and timeliness compared to last year.

However, the draft Annual Report provided for audit had a number of omissions when compared to the requirements set out within the Manual for Accounts.

We issued our audit opinions ahead of the 29 May deadline.

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Key findings

2.2 Value for money conclusion

We carry out sufficient and relevant work to conclude whether the CCG has put in place proper arrangements to secure economy, efficiency and effectiveness in the use of resources. This is known as our value for money conclusion.

In accordance with guidance issued by the Audit Commission, our 2014/15 value for money conclusion was based on two criteria. We consider whether the CCG had proper arrangements in place for: ► Securing financial resilience

► Challenging how it secures economy, efficiency and effectiveness

Criteria 1: Securing financial resilience

We have during the course of our audit, since issuing our Audit Plan, identified a new significant risks in relation to this criteria:

The CCG’s achievement of its forecast outturn position in 2015/16 is dependent on the delivery of the Quality, Innovation, Productivity and Prevention (QIPP) plan.

The CCG is forecasting a £2.86 million surplus for 2015/16. However, this is predicated on delivering the £8.10 million QIPP target. Historically, over the last two financial years the CCG only delivered an average of 28% of the QIPP plan target.

We have gained sufficient assurance for our conclusion about the financial resilience of the CCG, as a number of QIPP savings have been built into contracts with provider Trusts (£2.3 million). In addition the reported surplus above is after the inclusion of a £1.43 million contingency reserve.

However, the CCG’s ability to deliver a significant QIPP programme, based on the track record of delivery remains a significant challenge. The CCG needs to monitor the delivery of the QIPP programme throughout the financial year and take action as necessary to ensure the quantum of savings required is achieved.

Criteria 2: Securing economy, efficiency and effectiveness

We identified one significant risks in relation to this criteria:

Continuing Health Care backlog - Last year we reported in that the CCG had a significant backlog of unassessed continuing healthcare claims and was in breach of the NHS Continuing Health Care (CHC) Framework target.

We found that the CCG remains in breach of the NHS Continuing Health Care (CHC) Framework target for the assessment of CHC claims. The CCG has a significant backlog of unassessed claims. The current performance is that 82% of claims do not meet this 28 day assessment target. The current average claim assessment period for over 70% of cases is in excess of 90 days.

We modified our VFM Conclusion to report this issue. The ‘except for’ modification wording was issued on 22 May 2015

Recommendation: The CCG needs to review the arrangements it has in place to assess Continuing Health Care claims in order to clear the significant backlog of cases and achieve the 28 day framework target.

I require the Governing Body to consider this recommendation within the next three months and respond formally to me.

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Key findings

2.3

2.4

Department of Health group instructions

We had no matters to report to the National Audit office (NAO). We did not identify any areas of concern.

Annual governance statement

We are required to consider the completeness of disclosures in the CCG’s annual governance statement, identify any inconsistencies with the other information of which we are aware from our work, and consider whether it complies with Department of Health guidance.

We completed this work and identified a small number of areas where further disclosure was required to reflect the position at the CCG. The CCG amended the annual governance statement to include these areas.

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Control themes and observations

3. Control themes and observations

As part of our work, we obtained an understanding of internal control sufficient to plan our audit and determine the nature, timing and extent of testing performed. Although our audit was not designed to express an opinion on the effectiveness of internal control, we are required to communicate to you significant deficiencies in internal control identified during our audit.

The matters reported are shown below and are limited to those deficiencies that we identified during the audit and that we concluded are of sufficient importance to merit being reported.

Description Impact

A number of ex-gratia payments have been made during the financial year. We would expect any Losses or Special payments to be reviewed by the Audit Committee, in accordance with the CCG’s constitution. This has not occurred.

The CCG’s formal governance arrangements have not been adhered to.

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Fees

4. Fees

Our fee for 2014/15 is in line with the scale fee set by the Audit Commission and reported in our 18 May 2015 Annual Results Report.

Final fee Planned fee Scale fee Final fee

2014/15 2014/15 2014/15 2013/14

Total Audit Fee – Code work £65,000 £65,000 £65,000 £72,000

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Minutes of the West Suffolk CCG Governing Body Meeting held in public on

Wednesday 20 May 2015 in the Lecture Room at St Edmundsbury Cathedral, Bury St. Edmunds, Suffolk

PRESENT: Dr Christopher Browning Chair Dr Simon Arthur GP Member Bill Banks Lay Member for Governance. Kevin Bernard Member Dr Crawford Jamieson Secondary Care Doctor Peter Knights Member Dr Daniel Knowles GP Member Dr Rakesh Raja GP Member Dr Giles Stevens GP Member Dr Rosalind Tandy GP Member Dr Andrew Yager GP Member Dr Ed Garratt Chief Operating Officer Carl Goulton Chief Finance Officer Julian Herbert Chief Officer Amanda Lyes Chief Corporate Services Officer Barbara McLean Chief Nursing Officer Wendy Tankard Chief Contracts Officer IN ATTENDANCE: David Kanka Assistant Director of Public Health Linda Lord Chief Pharmacist Jo Mael Corporate and Governance Officer Anne Nicholls Chair: Clinical Engagement Group 15/040 WELCOME AND APOLOGIES FOR ABSENCE

The CCG Chair welcomed everyone to the meeting and apologies for absence

were noted from: Jo Finn Lay Member for Patient and Public Engagement Tessa Lindfield Director of Public Health

15/041 DECLARATIONS OF INTEREST

No declarations of interest were received.

15/042 MINUTES OF PREVIOUS MEETING

The minutes of the meeting held on 25 March 2015 were agreed as a correct record.

15/043 MATTERS ARISING AND ACTION LOG

There were no matters arising and the action log was reviewed and updated.

15/044 GENERAL UPDATE

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The Chief Officer reported that;

Preferred bidder status in respect of the Community Services contract had been awarded to West Suffolk Hospital as contract holder, in conjunction with Ipswich Hospital NHS Trust and Norfolk Community Healthcare Trust.

The CCG’s tele-dermatology work had been listed for a Health Service Journal award.

The Chair reported that Dr Daniel Knowles would shortly be leaving the Governing Body. Dr Knowles was thanked for all his hard work whilst a Governing Body member.

15/045 CHAIR’S PRESENTATION

The Chair gave an Annual Review presentation for 2014/15 which outlined the

CCG’s ambition for integrated working going forward, identified the implementation of services and public engagement that had taken place during 2014/15, set out the CCG’s financial position and achievements, together with looking forward to 2015/16.

15/046 COMMUNITY ENGAGEMENT GROUP MINUTES

The Chair of the Community Engagement Group (CEG) presented the minutes

of the Group’s last meeting, which had been held on 30 April 2015 in Brandon. Key points highlighted from the meeting included;

Mental health had been the dedicated theme for the meeting with the CEG receiving a presentation from the Chief Nursing Officer on the Care Quality Commission’s (CQC) inspection of Norfolk and Suffolk NHS Foundation Trust. Having discussed and noted actions from the CQC’s report there was concern as to whether the situation could have been highlighted earlier and whether there was a need for the CCG’s monitoring processes to be more rigorous.

The CEG also received a presentation on the commissioning process in respect of mental health services and was introduced to Vicky Versey the Youth Ambassador for Community Action Suffolk.

The GP Lead for Mental Health advised that prior to the CQC’s inspection contractual monitoring of Norfolk and Suffolk NHS Foundation Trust had seen them perform well in respect of key performance indicators (KPI’s) and perhaps there was a need to look beyond KPI’s in future. It was highlighted that the CQC inspection had been carried out at a time of post re-organisation at the Trust with the inspection having applied to services across Norfolk and Suffolk with much of the concerns raised being in relation to Norfolk services. The Governing Body noted the content of the report.

15/047 NORFOLK AND SUFFOLK NHS FOUNDATION TRUST STAKEHOLDER

ASSURANCE MEETING 29 APRIL 2015

Report WSCCG 15-25 from the Chief Nursing Officer sought to inform the Governing Body of progress made by Norfolk and Suffolk NHS Foundation Trust (NSFT) in addressing the quality concerns raised by the Care Quality Commission (CQC) following its inspection of the Trust in the autumn of 2014, which had resulted in the Trust receiving an overall CQC rating of

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“inadequate”. NSFT provided monthly updates to Stakeholder meetings, which were chaired by Monitor’s appointed Improvement Director and included report by NSFT as to progress made with implementation of its quality improvement plan. At each meeting a more in-depth review of an agreed area was undertaken which at the last meeting had been in respect of staffing. The meetings facilitated stakeholder challenge to the reported progress and enabled emerging quality issues to be raised. The Chief Nurses Office team was responsible for providing representation and challenge at the meetings and for ensuring that information was appropriately cascaded within the CCG. The report went on to detail progress against the quality improvement plan and that agreement had been reached in respect of the content of a quality dashboard which NSFT would report on monthly. The dashboard was to form one part of the agenda for the quality meetings, with other sections of the agenda featuring a schedule of papers following presentation to NSFT’s Quality Governance Committee and Trust Board, together with a section for arising issues, external inspections, and issues raised via the GP log or other forms of intelligence. Structuring the agenda in such a way was expected to ensure that all elements of quality reporting were captured. Although it was recognised that prior to the CQC’s inspection the CCG had been aware of some of the issues and improvements had been seen, the need to incorporate the use of soft intelligence when contract monitoring was emphasized, together with ensuring the robustness of outcomes in order to facilitate delivery of required services. Having been advised that the GP contract issues log was reviewed monthly in order to identify any themes or areas of concern, the Governing Body suggested that a communication be issued to GP members highlighting use of the log. The Governing Body noted the content of the report.

15/048 PROCUREMENT UPDATE: SUMMARY OF ACTIVITY IN 2014/15 AND

FORWARD LOOK AT 2015/16

The Governing Body received a report from the Chief Contracts Officer which provided an update on procurements undertaken in 2014/15 and looked forward to 2015/16. Procurement activity during 2014/15 was detailed in Section 2 of the report and the Chief Contracts Officer reported that preferred bidder status in respect of the Domiciliary Care contract was expected to be announced on 8 June 2015. It was also reported that following completion of the evaluation stage, preferred bidder status in respect of the Community Services contract had been awarded to West Suffolk NHS Foundation Trust as contract holder, in conjunction with Ipswich Hospital NHS Trust and Norfolk Community Healthcare Trust. Procurements anticipated in 2015/16 included a potential joint procurement with Suffolk County Council in respect of Care Homes, together with procurement of a primary mental health service. The Governing Body noted work completed in 2014/15 and the evolving work programme for 2015/16.

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The Chair advised that agenda item 10 (Infection prevention and control and antibiotic prescribing) would be taken at the end of the agenda to allow those presenting to attend.

15/049 ANNUAL HEALTH CHECKS FOR PEOPLE WITH LEARNING DISABILITY

The Governing Body was in receipt of a report which sought to clarify the

Learning Disability Health Check requirements for West Suffolk CCG and recommend an action plan to meet them.

It was explained that the lack of uptake of health checks by people with Learning Disability had been identified as a priority to address by NHS England and the CCG. People with learning disabilities often had difficulty in recognising illness, communicating their needs and using health services. Research indicated that regular health checks for people with learning disabilities often uncovered treatable health conditions. Whilst most of those were simple to treat and make the person feel better, sometimes serious illnesses such as cancer were found at an early stage when they could be treated.

The Annual Health Check was also a chance for the person to get used to going to their GP practice, which reduced their fear of going at other times.

The report detailed information which compared West Suffolk with the other East of England CCG’s with regard to the uptake of Learning Disability health checks. A rate of 49.7% measured reasonably well with the rest of the CCG’s in the region. The CCG had not been given a target for achievement; however its ambition was to increase the number of people who received an annual health check in order that its performance was an exemplar for the region. The cohort was identified in the quality outcomes framework and, as such, the target for West Suffolk was to achieve 781 health checks, an increase of 350.

The paper went on to outline the barriers to uptake and considered key activities to improve uptake, together with identifying risks.

The initiative was welcomed by the Governing Body although the need to gain assurance in respect of the completeness of practice Quality Outcomes Framework (QOF) registers was highlighted, together with exploring opportunities from the sharing of information with Suffolk County Council. Whilst noting that the target was ambitious, it was felt appropriate in order to assist the CCG in its aim to become the best performing CCG.

The Governing Body noted the content of the report and the proposed plan to increase the uptake of health checks in primary care.

15/050 NURSE REVALIDATION

The Governing Body was in receipt of a report from the Chief Nursing Officer

which informed of the National Nurse Revalidation programme and the work being carried out by the CCG to implement the programme of revalidation and support Registered Nurses in the CCG area and services, to meet the national requirements for revalidation within the timescales set for each stage of the programme. CCG leadership for the implementation programme sat with the Chief Nurses

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Office, working closely with the Chief Officer for Corporate Services, Human Resources Team. Revalidation was a process that all nurses and midwives would need to engage with in order to demonstrate safe and effective practise throughout their career. It was about promoting good practice and was not an assessment of a nurse or midwife’s fitness to practise. Participation was on an on-going basis and nurses and midwives would be required to revalidate every three years, at the point of their renewal of registration which would replace the current Prep requirements and Notification of Practise form. The report went on to detail the process and revalidation requirements. It was noted that revalidation was due to be introduced by the end of 2015. It was explained that responsibility for validation remained with the individual although there was likely to be strong oversight by NHS England and from the CCG in respect of providers. It was anticipated that a new mechanism would be put in place for those individuals returning to work after a long period of absence which was likely to incorporate a period of re-training. The Governing Body noted the content of the report.

15/051 INTEGRATED PERFORMANCE REPORT

The Chief Nursing Officer, Chief Finance Officer, Chief Operating Officer and

Chief Contracts Officer presented the Integrated Performance Report, which provided members with a summary of performance against national targets, contractual targets, clinical quality and patient safety issues, financial performance and acute activity, together with detailing work being carried out by the CCG’s work streams. Clinical Quality and Patient Safety Key points highlighted included;

The report from an adult safeguarding review had been presented to families on 12/13 May 2015 prior to publication and it was anticipated that the Governing Body would receive an update to its next meeting.

Quality Improvement Visits (QIV) – the report now contained the next quarter’s programme of work as a forward plan. A formal quarterly information sharing forum had been set up to facilitate the sharing of information across organisations and QIV documentation had been revised to bring it in line with the template and reporting domains used by the Care Quality Commission.

There was an improved position in respect of patient experience at two providers where previous concerns had been raised, as detailed on pages 10/11 of the report.

The Harm Free Care forum had recently received a presentation from the CCG’s Care Home Clinical Support Nurse, and all providers had been keen to explore and review care pathways in an attempt to improve patient experience.

Since contractual escalation of the issue of outstanding reports associated to the contract issues log the situation had recently improved.

The report contained improved information in respect of adult safeguarding which was being acquired via the multi-agency safeguarding hub.

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C.difficile continued to be a cause for concern within the community and there was increased focus on staff training and support.

Having questioned at what point dashboard reporting information in respect of continuing healthcare might be reintroduced to the report, it was explained that inaccuracies identified from data cleanse work had resulted in it being withdrawn and it was anticipated that the workstream would be informed on 21 May 2015 as to when requested revisions to the reporting software would be complete. Whilst it was noted from the report that GP or commissioning manager participation in quality improvement visits was beneficial, the difficulty in scheduling visits to facilitate such attendance was recognised. Having noted from page 26 of the report that there had been a number of Patient Advice and Liaison Service contacts in respect of Norfolk and Suffolk NHS Foundation Trust communication issues, the Chief Nursing Officer agreed to investigate further and report back. Financial and Performance Delivery Key points highlighted included;

As there was no 2015/16 information at present there was no requirement to submit a Month 1 report to NHS England.

The 2014/15 month 12 position continued to be finalised with the auditors although the unaudited position indicated that the CCG’s £2.8m surplus had been delivered. As the surplus included £2.6m from the previous year a break even position had been achieved at year end.

The surplus had been achieved from the use of one-off non-recurrent funding and, although a positive result, there was likely to be considerable challenge going forward into 2015/16.

The Governing Body was advised that the CCG’s role was to negotiate contracts with its providers and, as such, any request for the provision of funding elsewhere within the system would be subject to agreement by the Governing Body. Clinical Workstreams Key points highlighted included; The Chief Operating Officer led a discussion about the engagement of primary care colleagues in the QIPP programme. He set out positive steps being made by the CCG:

Development of a GP recruitment scheme.

The recruitment of five pharmacists to provide support to practices.

The introduction of new prescribing and PMS incentives.

Development of the map of medicine software and tele-dermatology.

The provision of monthly support visits to practices. He also shared concerns raised by primary care colleagues:

There was a perceived decrease in incentive schemes.

The health economy seemed to be bias to the acute sector.

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There was no active planning to support primary care.

There was no one body to represent primary care. The Governing Body recognised the challenges being faced by primary care and the need for the CCG to maintain engagement with its wider membership. The CCG’s role was to provide the best services for its patients and, as such, there would be a need for services to be commissioned from the most appropriate provider. In an attempt to enhance working relationships going forward and provide clarity in respect of the roles of organisations, the Chief Operating Officer agreed to pursue the drafting of a Primary Care Strategy. Workstream updates included;

Planned Care – the CCG was working jointly with West Suffolk Hospital to develop new pathways in respect of heart failure and diabetes.

Integrated Care – the ambulatory care CQUIN was now outcome based. Multi-disciplinary teams continued to highlight and provide support to those patients most at risk of hospital admission.

Mental Health – progress against the dementia diagnosis target of 67% was currently at 62%.

Cancer – the Community Cancer Nurse role had been extended for a further year and, following the departure of the present nurse, would be seconded to West Suffolk Hospital which should provide opportunity to test the role across the acute and community sector.

Children and Young People/Prescribing – evaluation as to the benefit of introducing asthma and epilepsy nurses was expected in the Autumn. The prescribing incentive scheme had recently been released to practices.

Contractual Performance Key points highlighted included;

West Suffolk Hospital – contract queries existed in relation to ambulance arrival to handover times, the acute oncology service one hour door to needle for all patients with suspected neutropenic sepsis, MRSA and A&E attendances where the service user was admitted, transferred or discharged within four hours. Performance in respect of handover times remained consistent and improved when compared to other hospitals. Acute oncology performance continued to give cause for concern and the hospital had been advised of the possibility of contractual escalation. The Chief Officer and Chief Contracts Officer agreed that disparity between reported information and that of an internal audit would be further discussed at forthcoming Chief Executive and Service Level Agreement meetings. It was anticipated that the MRSA contract query would be closed in the near future and a revised remedial action plan had been received in respect of A&E performance. Concern at a recent general decline in performance across a number of areas would be discussed at a Service Level Agreement meeting to be held later in the day.

111 Service – the service was now compliant in respect of calls answered in 60 seconds and calls abandoned although performance in relation to warm transfers and call back in 10 minutes continued to be an issue and a recruitment plan was in place.

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Out of Hours – speak to a GP within 60 minutes and two hours performance had fallen below target although there had been an increase in demand. A remedial action plan was in place which was being monitored closely.

Suffolk Community Healthcare – Serco – the contract query in relation to the non-achievement of KPIs had been closed and although there had been improvement in respect of community equipment service performance, targets were still not being met and the contract query remained in place. A drop in the performance of the continence service and care coordination centre was being monitored closely.

Norfolk and Suffolk Foundation Trust (NSFT) – performance against contract queries had improved. Non-IAPT waiting times, ligature works and IAPT wellbeing service contract queries had all been closed with the query relating to staff training remaining open and a revised remedial action plan in development.

The Governing Body noted the content of the report.


The Governing Body was in receipt of report WSCCG 15-31 from the Chief

Corporate Services Officer which detailed interests declared by members of the Governing Body and its sub-committees. The Governing Body noted the interests as detailed within the report and that they were to be published on the CCG’s website

15/053 HEALTH AND SAFETY UPDATE

The Governing Body was in receipt of a report which provided an update on

work currently being undertaken by the Health and Safety and Risk Committee. The Committee meets every other month to review health and safety and risk issues relating to both Ipswich and East Suffolk CCG and West Suffolk CCG. Key points from its last meeting held on 20 April 2015, included that;

Over the last year training had continued to be provided by Safetyboss in the form of a two hour classroom session covering manual handling, fire safety and general Health and Safety awareness. The content of the training had been refreshed in January 2015 and now placed increased emphasis on health and safety in an office environment.

During 2014/15 the Committee had dealt with issues regarding the “Farm Car Park” at Rushbrook House, which included the quality of the surface and the lighting.

The issue of a safe working environment was always on the agenda and to that end the Committee had developed a set of “housekeeping” guidelines for Rushbrook House. (West Suffolk House staff had the benefit of the Councils guidelines already).

Two fire evacuation exercises had been carried out which the Committee had reviewed and was pleased to note that improvement had been made. The most recent evacuation had included the staging of an emergency

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planning exercise. In response to a question as to whether there had been any preparedness in respect of a potential terrorist threat, it was explained that, on a CCG basis the matter was being followed through the CCG’s Health and Safety Advisors and the Health and Safety and Risk Committee. On a wider perspective the issue was addressed in respect of whole system preparedness which included annual system review and regular exercises. The Governing Body noted the content of the report.

15/054 GOVERNING BODY ASSURANCE FRAMEWORK

The Chief Corporate Services Officer presented the Governing Body

Assurance Framework (GBAF) for May 2015. The GBAF continued to be reviewed by the Chief Officers Team every month and by the Governing Body and Audit Committee at each of their meetings. Revisions to the GBAF were detailed within Section 3 of the report. The Governing Body noted the GBAF as presented.

15/055 MINUTES OF MEETINGS

Presented by the Lay Member for Governance, consideration was given to the

minutes of the following meetings:

Audit Committee - the unconfirmed minutes of a meeting held on 7 April 2015.

Remuneration and HR Committee - the unconfirmed minutes of a meeting held on 5 May 2015.

Clinical Scrutiny Committee - the unconfirmed minutes of a meeting held on 29 April 2015.

CCG Collaborative Group - the unconfirmed minutes of a meeting held on 16 April 2015.

Commissioning Governance Committee – decisions from meetings held on 25 March 2015, and virtual meetings held from 13-22 April 2015 and 17-24 April 2015.

The Governing Body received and endorsed the minutes.

15/056 INFECTION PREVENTION AND CONTROL AND ANTIBIOTIC

PRESCRIBING

The Governing Body received a report from the Infection Prevention and Control Lead which set out current infection prevention and control (IPC) status with regards to Healthcare Associated Infections (HCAIs), in particular MRSA and Clostridium difficile infection (CDI), and outlined the proposed strategy to further reduce HCAIs in West Suffolk.

Alongside the report the Governing Body was in receipt of a presentation from the Head of Prescribing in respect of antibiotic prescribing.

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_____________________________ _______________________ Chair Date

Next steps, as set out within the report, included;

That it was proposed to raise antibiotic awareness for the general public to reduce the expectation of being prescribed antibiotics for self-limiting conditions.

The Infection Prevention and Control Lead would work with the Public Health Forum of Suffolk County Council and West Suffolk CCG Communications Team to produce and distribute/publish antibiotics awareness materials.

In addition to an antibiotics public awareness campaign, it was recommended that the CCG support and encourage as many people as possible in West Suffolk to become antibiotic guardians by accessing the website at antibioticguardian.com/ and making a pledge.

Due to the importance of reducing antibiotic prescribing it was suggested that ways to encourage clinicians in both primary and secondary care to self-reflect on their prescribing levels should perhaps be explored. It was explained that although it was currently not possible to identify individual clinicians prescribing, practice level information was available and was reviewed during practice visits.

The Governing Body noted the content of the report and presentation.

15/057 ANY OTHER BUSINESS

No items of other business were received.

15/058 DATE OF NEXT MEETING

The next meeting of the West Suffolk CCG in public was scheduled to take place on Wednesday 29 July 2015 at 0900 hrs in the Lounge, The Athenaeum, Bury St. Edmunds, Suffolk.

QUESTIONS FROM THE PUBLIC

No questions were received from members of the public.

EXCLUSION OF PRESS AND PUBLIC

The Governing Body agreed that representatives of the press, and other members of the public, be excluded from Part Two of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest; Section 1(2), Public Bodies (Admission to Meetings) Act 1960.

WEST SUFFOLK CCG Governing Body

ACTION LOG: 20 May 2015 (Updated)

MINUTE DETAILS ACTION BY WHOM TIMESCALE/UPDATE Meeting of 25 March 2015

15/025 General Update To present the assurance letter from NHS

England to the May 2015 meeting.

Julian Herbert Complete – see agenda item AGM 02

15/034 Managing Conflicts

of Interest – Revised

Statutory Guidance

for CCGs

That information in respect of the required

attestation of compliance would be presented

to the May 2015 meeting of the Governing Body

together with the terms of reference for the

Commissioning Governance Committee.

Amanda Lyes 20 May 2015: 20 May 2015: Further guidance on

the attestation process still awaited & it is

considered unlikely that this will now be received in

advance of the General Election. In view of the

agreement to the Joint Commissioning Committee

ToR’s, the Commissioning Governance Committee

ToR’s remain unchanged for dealing with CCG

commissioning recommendations where a conflict

of interest exists

Meeting of 20 May 2015

15/047 Norfolk and Suffolk

NHS Foundation Trust

Stakeholder

Assurance Meeting

29 April 2015

That a communication be issued to GP

members highlighting use of the GP contract

issues log.

Ed Garratt/

Barbara

McLean

Complete

15/051 Integrated

Performance Report

Clinical Quality and Patient Safety

Having noted from page 26 of the report that

there had been a number of Patient Advice and

Liaison Service contacts in respect of Norfolk and

Suffolk NHS Foundation Trust communication

issues, the Chief Nursing Officer agreed to

investigate further and report back.

Workstreams

In an attempt to enhance working relationships

going forward and provide clarity in respect of

Barbara

McLean

Ed Garratt

6 July 2015 – upon investigation the rate of referral

to PALs in respect of NSFT had been consistently low

for some months, and the rate of response good -

Complete

Complete - July locality meetings to be dedicated

to primary care strategy.

MINUTE DETAILS ACTION BY WHOM TIMESCALE/UPDATE the roles of organisations, the Chief Operating

Officer agreed to pursue the development of a

Primary Care Strategy.

Contracting

That disparity between reported information and

that of an internal audit in respect of the acute

oncology service be further discussed at

forthcoming Chief Executive and Service Level

Agreement meetings.

Julian Herbert/

Wendy

Tankard

Complete

Agenda Item No. 06

Reference No. WSCCG 15-37

From: Anne Nicholls, Chair of Community Engagement Group COMMUNITY ENGAGEMENT GROUP

1. Purpose 1.1 This report contains the unconfirmed minutes from the Community Engagement Group

meeting held on 25 June 2015.

2. Recommendation 2.1 The Governing Body is asked to consider and note the key items of discussion from the

Community Engagement Group. Author: Jack Tappin Engagement and Consultation Officer

1

Community Engagement Group

Minutes Date: 25 June 2015 Venue: Haverhill Arts Centre Chair: Anne Nicholls (AN) Present: Michael Simpkin (MS), David Dawson (DD), David Taylor (DT) In attendance Jack Tappin (JT – Engagement and Consultation Officer), Jo John (JJ-

Communications Manager), Isabel Cockayne (IC – Head of Communications), Michael Wigg (MW – Lead Nurse), Gabrielle Irwin (Head of Clinical Quality and Patient Experience), Kate Walker (Head of ICT and Informatics), Simon Chase (East of England Ambulance Trust – West Suffolk Manager)

Apologies: Ed Garratt (EG – WS CCG Chief Operating Officer), Carla Pinto (CP – Communications and Engagement Officer), Karen Smith (KS), Jane Carpenter (JC), Karen Turner (KT), Jo Finn (JF – WS CCG Lay Member), Phil Worsley (PW), Jon Rapley (JR), Peter Owen (PO), Dianne Wright (DW), Carol Mansell (CM)

Absent: Carol Dalton (CD), Geraldine Dougall (GD – Community Action Suffolk), Warwick Hirst

(WH), Jane Carpenter (JC), Roy Banks (RB), Lucasz Nowak (LN)

Item

Discussion/Action Responsible Officer

Due date

1. Welcome, introductions and apologies AN welcomed everyone to the meeting and apologies were noted. Due to the low attendance the CEG was not quorate and thus not able to ratify decisions.

2. Minutes and Actions Arising The minutes of the April meeting were approved, with the only change being to note the attendance of DT. You can view the previous minutes by clicking here.

3. Matters arising not on the agenda MS apologised for the delay in sending out details to the group on the

Social Value Act.

MS

4. Terms of reference (ToR) for CEG members.

JT and AN presented the paper (click here to view). The ToR have not

been updated since the formation of the CEG in 2013. There was some

discussion around the following areas:

Removing members who do not attend CEG meetings regularly to enable

new members to join who could get involved. Currently there are no

AN, JT

http://www.westsuffolkccg.nhs.uk/wp-content/uploads/2013/01/CEG-mins-30-April.docx

http://www.westsuffolkccg.nhs.uk/wp-content/uploads/2013/01/CEG-mins-30-April.docx

http://www.westsuffolkccg.nhs.uk/wp-content/uploads/2013/01/Paper-2.pdf

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Item


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clauses stipulating a minimum number of CEG members. Succession

planning was discussed and choosing a CEG member to become chair

once AN’s tenure ends. Proposed changes included:

removing CEG members who fail to attend three successive

meetings or less than three in 12 months without reasonable

grounds to be absent, bringing the CEG in line with local

authorities;

ratifying that the chair serves no more than three one-year terms

(not necessarily in succession) before being replaced. To elect a

new chair, members must propose and second a candidate, going

to a vote if this is contested;

having a ‘desired’ number of members that the CCG will

endeavour to fill, and this could include demographic as well as

geographical representation.

Also presented were changes JF proposed to the ToR.

MS said the changes seemed sensible, and asked what local authorities

considered reasonable grounds for absence. DT was happy with the

changes and suggested health was reasonable grounds for absence. AN

said some members have not attended for over a year but still want to be

members, which is not appropriate. DD said that it would be good for the

CEG to have better links with locality work of the CCG.

AN proposed that in November there should be discussion about the

appointment of her replacement as chair.

JT agreed to incorporate JF’s proposed changes into the revised ToR.

With the CEG not quorate the changes could not be ratified.

It was agreed that AN would write to all CEG members with the revised

ToR informing them of the proposed changes which will be ratified at the

next CEG meeting.

JT

AN

5. Continuing Healthcare MW delivered the presentation, supported by GI (click here to view the

presentation).

Continuing healthcare is a package of care arranged and funded by the

NHS for adults with long term significant health needs. There are eligibility

criteria to be met before a decision on funding is made. People can come

off continuing healthcare if their needs change. From October 2014 those

MW



3

Item


Due date

receiving continuing healthcare had the right to a personal health budget.

MW evidenced how this can be beneficial using ‘Steven’s story’, where a

paralysed patient had his wife nurse him and used the funding previously

used on nursing to buy an iPad to read bedtime stories to his daughter.

DD asked how decisions were made about [mental] capacity, and if there

would be a role for the voluntary sector to support in providing advice. MW

said nurses start off assuming a patient does have capacity, and that the

multi-disciplinary teams (MDTs) involve various organisations in their

assessment.

MS asked if care plans are involved. MW said staff will ask if there is a

care plan and seek specialist advice if the patient has a special condition.

DT asked how many people in Suffolk have a personal health budget. MW

said Suffolk only went live in October and was behind schedule. About 19

people are going through the application process.

DT asked about the effect of the Winterbourne Review in providing more

appropriate care. GI said Connect Sudbury will aim to provide this, and

though it will not be overnight it is the direction of travel.

DD said it would be good to know about the economic impact and to have

an update within the next 18 months. MW said costs are rising as

continuing healthcare goes up, but that the CCG is aware.

AN said that continuing healthcare comes up frequently at CCG Board

meetings as a cost pressure, and will increase as the area’s elderly

population rises, and she understands that there is a backlog of

assessments. MW said the Previously Unassessed Periods of Care

(PUPOC) team has around 300 cases to get through, which must be done

by a certain time to receive the NHS England funding. Those who are

assessed as eligible will be entitled to retrospective funding.

6. Communications and Engagement Strategy IC explained that the initial strategy was developed following the inaugural

Patient Revolution, and the CCG has since been shown to be one of the

country’s best at engagement.

JJ said there was an opportunity to refresh the strategy, and has looked

back at feedback received from engagement to update it (click here to

view JJ’s paper). The strategy aims to give patients a voice, update the

CCG’s website, develop the 500-strong Health Forum and facilitate the

CEG, among other goals. Everyone has said that engagement has gone

JJ



4

Item


Due date

well and the CCG has listened to their views, through events like the

Mental Health Conversations and Dementia Workshops. Engagement

with BME communities and young people are areas for improvement, and

more people need to be encouraged to attend CEG and Governing Body

meetings. More honesty and transparency around finances is needed and

greater engagement with Redesign colleagues within the CCG.

MS praised the engagement work done with students at Castle Manor

Academy and said thought had been given to the next steps. He asked if

the CCG could be involved with the work of Haverhill Police in engaging

students at Samuel Ward Academy. AN said the CCG must go and talk to

marginalised groups rather than expect them to attend engagement

events. MS suggested approaching U3A in Haverhill to engage with older

people. DD offered to support getting in contact with St Benedict’s School

as he is the chair of governors.

DD said financial information needs to be shared more publically, such as

the finance workshop he attended following the last CEG meeting.

Although he does not wish to disrupt the format of Patient Revolution, he

said there needs to be a greater public understanding of NHS economics.

IC said that Patient Revolution could have a financial theme, though the

CCG would still record all health stories that arise in the discussion

groups. DD raised medications waste as a financial issue people are

unaware of, and IC said work is being done to raise awareness of this and

reduce waste.

DT asked what benefit the CCG has gained from the strategy. IC said a

2001 Ipsos Mori survey showed that companies that invest in

communications perform much better. She agreed to share this survey

with the group.

MS said there is an apathy towards public services – he spoke to

councillors at a CCG market stall on Friday who said they would attend

but did not, and of 16 Haverhill councillors none turned up for CEG.

IC

7. Patient and Carer access to records KW presented to members and said everyone now has a right to see their GP held patient record (click here to view her presentation). Across all parts of the health system currently there is a mix of paper records and digital records, though records are being digitised. Health professionals are poor at sharing records with one another, and often different departments within the same organisation (i.e. hospital wards) fail to share records with each other. This leads to frustration as patients have to repeat things. The Suffolk Shared Care Record programme has started

KW

http://www.westsuffolkccg.nhs.uk/wp-content/uploads/2013/01/patients_presentation.pptx

5

Item


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and more than 5,000 shared care records were viewed in urgent care last month.

AN asked if 111 can access patient records. KW said 111 can now access summary care records and the CCG is working with Care UK so 111 can access detailed care records by the end of 2015.

DD said telemedicine is becoming routine but people need an input device. KW said technology is changing and becoming cheaper and that there is a question of if the NHS should invest in technology for people to better reach them. There is a new NHS ‘kite mark’ for health apps.

MS said he has seen [health secretary] Jeremy Hunt wants to replace targets with transparency, and thus how can health records be shared across the entire system. KW said there’s been lots of investment and capability now needs to be given to patients, as it can be particularly useful for people with long terms conditions like diabetes.

SC asked about resilience for the technology. KW said there are robust resilience, business continuity and disaster recovery plans

AN asked about confidentiality. KW said it’s the patient’s choice whether their record is shared, and that only authorised people can access the records and have a legitimate reason to do so, and organisations across Suffolk are holding one another to account, with the CCG assuring that process.

DT said it would be useful to have a wider public debate around ownership of care records, as the patient owns their own record. He said young people are the experts in technology and should drive the changes as they will be the beneficiaries. IC asked if young people could be involved in the design of sharing care records. It was also agreed to aim development discussions to those with Long Term Medical Conditions.

KW said nothing could be designed that would suit everyone, and that in five years the work will have fundamentally progressed to ensure better access. She agreed to provide a biannual update to the CEG on progress.

8. Feedback from CEG members Again referencing the Jeremy Hunt article, MS said the minister has pledged £7.5 million for the integration of community pharmacies and GPs, with 10,000 extra primary care staff and 5,000 extra GPs resulting from a national campaign to encourage them to join.

MS

9. AOB SC said the ambulance trust has received further funding so will be providing approximately 420 hours extra – 15 response staff. The trust now has 127 west Suffolk staff and the new money creates the need for more vacancies and vehicles. The trust has looked bad following the problems with accrediting qualification courses. Only one student is affected and there will be 22

SC

6

Item


Due date

cohorts of students over the next 12 months. In year two, four students may be affected. Students may have to gain their accreditation through doing modules rather than just their qualification. There will be a 24-hour response car available in Haverhill and there will be an ambulance in the town 10 hours a day, seven days a week. There are plans to increase the west Suffolk workforce by 20 by April 2016 – there are already 25 extra from the year before. The trust is achieving national standards for responding to life threatening calls in west Suffolk. The trust is also responding quicker to other calls. The trust is in a much stronger position than 18 months ago. Staff dealt with 5,000 emergency responses in west Suffolk last month – just 0.8% more than the rate they are commissioned at, with the figure hard to estimate from month to month. MS asked if the trust had approached the local press, and SC said they usually approach larger tabloids as that’s where negative stories trickle down from.

10. Items for next time: - Health and Care Review – pooled £50 million fund - Whistle-blowers within the CCG

11. Date of next meeting: 27 August 2015, 1300-1530 – Sudbury

12. Questions from the public None

Action Log

DATE DETAILS ACTION BY WHOM DUE DATE UPDATE

25/06/15 Changes to Terms of Reference

JT to make amends to the ToR, including JF’s

suggestions and those provisionally agreed by the

CEG.

JT 27/08/15

25/06/15 Informing members of changes to Changes to Terms of Reference

AN to write to members of the CEG informing them of

proposed changes to ToR and the impact this will have

on them.

JT 27/08/15

25/06/15 Ipsos Mori 2001 survey IC to send to members to Ipsos Mori 2001 survey detailing the benefits of investing in communications.

IC 27/08/15

25/06/15 Biannual report on patient and carer access to records

KW to report back to the CEG on a biannual basis to

update them on progress about accessing and sharing

care records.

KW Ongoing

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Agenda Item No. 07


From: Ed Garratt, Chief Operating Officer PATIENT AND PUBLIC ENGAGEMENT – SUMMER 2015 1. Purpose 1.1 To provide the Governing Body with an update on engagement activities that

have been taking place throughout the summer. 2. Background 2.1 The CCG is committed to patient and public engagement. During the summer this

has included stalls at markets in all of west Suffolk’s towns, attendance at summer fairs, and the annual ‘Patient Revolution’ conference.

2.2 Market stalls were held in June in Mildenhall (12th); Brandon (18th); Haverhill (19th); Bury St Edmunds (24th); Newmarket (30th) and in July in Sudbury (2nd). Summer fairs were attended at Newmarket (4th July); Mildenhall (11th); and Haverhill (19th). ‘Patient Revolution’ was held in Newmarket, Clare and Bury St Edmunds on 15th July.

2.3 This is the third year that the CCG has held market stalls; the second it has attended summer fairs; and the fourth time it has hosted ‘Patient Revolution’.

2.4 The CCG engagement team has been joined at these events by Community Engagement Group members, colleagues and a range of partner healthcare organisations including Diabetes UK, Healthwatch Suffolk, LiveWell Suffolk, Age UK Suffolk, the Terrence Higgins Trust, Community Dental Services, Community Healthcare, and the Suffolk Wellbeing Service.

3. Impact 3.1 The numbers of people we spoke with and the demographics varied across the

different events. Generally, market stalls attracted older people while summer fairs attracted young families.

3.2 We heard from 200 people at market stalls – 20 in Mildenhall, 20 in Brandon, 40

in Haverhill, 50 in Bury St Edmunds, 30 in Newmarket and 40 in Sudbury. 3.3 We heard from over 300 people at summer fairs – 150 at Newmarket, 50 at

Mildenhall and 120 at Haverhill.

3.4 The market stalls and summer fairs provided a valuable opportunity to meet and talk to members of the public, face-to-face, as well as an opportunity to hand out Health Service Guides and to seek feedback on ophthalmology services.

3.5 Whilst feedback on the Health Service Guides has been overwhelmingly positive,

few people we spoke to already had a copy. 3.6 100 people attended ‘Patient Revolution’– 40 in Newmarket, 30 in Clare, and 30

in Bury St Edmunds. A total of 47 conversations were documented. 3.7 Key themes raised at this year’s ‘Patient Revolution’ included coordinating

services, access to services, living with long term conditions, mental health, preventative care, personalised care, transport, and dementia.

3.8 A record of the feedback from ‘Patient Revolution’ will be shared by the end of

July 2015. In six months’ time, the CCG will report back to members of the public on how we have addressed the key issues they have raised.

4. Recommendation 4.1 The Governing Body is asked to note the engagement events held with public

and patients in west Suffolk throughout summer 2015. Author: Jack Tappin, Engagement and Consultation Officer

1

West Suffolk

Care Home Model

Improving the delivery of complex care

Sue Smith – Care Homes Clinical Support Manager

2

What we know about WSFT hospital admissions

• 47 West Suffolk care homes =1950 beds

• Over 800 admissions to WSFT 2014/15

• Approximately 6300 bed days

Majority of EOL emergency admissions from care homes either/or

• Die in hospital

• Are referred to in-house specialist Palliative Care team

• Are fast track discharges back to the care home

• Are discharged with Yellow Folder, DNACPR – Advanced Care Plan

Admissions due to Advanced or End Stage symptoms…

• Heart and /or Kidney Failure

• COPD -Type 2 Respiratory Failure

• Stroke

• Cancer

• Parkinson’s

• General Deterioration and / or Frailty

3

What we know about national hospital admissions

• >70% want to die at home

• <20% die at home.

• 50-70% die in hospital

• Suffolk 50% in preferred place of death

30% of all hospital inpatients are in their

last year of life

4

West Suffolk Model for care homes

1. Identification of deteriorating resident

2. Discussion with resident and/or family about future planning

3. Completion of Advance Care Plan – ‘In Case of Emergency’

symptom control specifically

4. Coordination of document registration with 111 / 999

5. End of Life (just in case medication) in place within the care

home to support symptom control

5

Integrated Work Undertaken

Prior to project Currently

Resident / family

discussions

213

Yellow Folders 75 138

DNACPR 53 116

Advanced Care

Plan

19 139

Current Outcomes Reduction in presentations and admissions from care homes currently

supported by Care Homes Clinical Support Manager

6

Community Clinical Nurse Specialists:

Identify deteriorating resident - End

Stage plan discussion & symptom

management in place

Specialist Consultant: Identify

deteriorating condition for

conservative management only –

Future plan discussion & symptom

management in place:

WSFT A&E / Ward / Clinical Nurse:

Identify deteriorating resident - future

plan discussion & symptom

management in place.

GP / practice nurse: Identify

deteriorating resident – Future plan

discussions & symptom management

in place

Care home with & without nursing: Identify

deteriorating resident –’In Case of

Emergency’ plan discussion & symptom

management in place

Supporting care home residents to remain in

their preferred place of care and death

7

Care Home

residents

reviewed

Average

monthly

admissions

before resident

review

(2014/15 data)

Initial resident

review

undertaken by

CHCSM

Resident review

completed with

care home,

families & GP

WSFT EPRO

patient data set

– residents

reviewed within

project.

Care Home 1 3.9 p/month Jan 15 Feb 15 1 admission

Care Home 2 2.2 p/month Feb 15 Mar 15 1 admission

Care Home 3 3.3 p/month Feb 15 Mar 15 1 admission

Care Home 4 3.4 p/month Apr 15 May 15 3 Admissions

Care Home 5 1.9 p/month July 15 Jul 15

Care home 6 4.9 p/month July 15 Jul 15

Care Home 7 4.4 p/month July 15 Jul 15

Care Home 8 2.3 p/month Oct 15 Oct 15

Care Home 9 5.5 p/month TBC TBC

Care Home 10 3.7p/month TBC TBC

8

Thank you for listening

Any questions?

of 4

Agenda Item No. 09


From: Julian Herbert, Chief Officer CONTINUING HEALTHCARE BACKLOG CLEARANCE (Response to the Annual Audit Letter for the year ended 31 March 2015. 8 June 2015, Ernst and Young)

1. Purpose 1.1 This paper contains an outline plan to prepare a response from the Governing Body to

Ernst and Young (EY) in relation to para 2.2 of their Annual Audit Letter dated 8th June 2015. A final response is required from the Governing Body within 3 months of the letter i.e. by the 7th September 2015

1.2 The Governing Body is not meeting in August to approve the response before the

submission deadline. It is asked to agree the approach being taken to prepare a clearance plan and a response to EY. The Governing Body is also asked to delegate authority for the approval of the final response to the Executive Scrutiny Committee at its meeting on 25th August 2015.

2. Background 2.1 The CCG’s external auditors, EY, completed their audit and issued their Audit Result

Report (final) on 18 May 2015 and their Annual Audit Letter for the year ending 31 March 2015 on 8th June 2015. An aspect of their audit, known as the Value for Money Conclusion, considers whether the CCG has proper arrangements in place for:

Securing financial resilience

Challenging how it secures economy. efficiency and effectiveness 2.2 In the Audit Letter EY reported the following outcome of their consideration:

Criteria 2: Securing economy, efficiency and effectiveness We identified one significant risk in relation to this criteria: Continuing Health Care backlog - Last year we reported in that the CCG had a significant backlog of unassessed continuing healthcare claims and was in breach of the NHS Continuing Health Care (CHC) Framework target. We found that the CCG remains in breach of the NHS Continuing Health Care (CHC) Framework target for the assessment of CHC claims. The CCG has a significant backlog of unassessed claims. The current performance is that 81% of claims do not meet this 28 day assessment target. The current average claim assessment period for over 66% of cases is in excess of 90 days.

We modified our VFM Conclusion to report this issue. The ‘except for’ modification wording was issued on 22 May 2015

Recommendation: The CCG needs to review the arrangements it has in place to assess Continuing Health Care claims in order to clear the significant backlog of cases and achieve the 28 day framework target. I require the Governing Body to consider this recommendation within the next three months and respond formally to me.

3. Key Points 3.1 The backlog has developed over several years due to a wide range of circumstances

including historically very low levels of CHC eligibility decision-making. Although further analysis is required it is likely that the backlog is a bubble of unmet assessment need resulting from this historically low baseline position. The CHC team had not anticipated this bubble or planned for the adjustment required to scale up its capacity to process higher activity levels or to lean the assessment process steps to ensure timely processing of cases within 28 calendar days. As a result the CHC team is not currently resourced to either stem the increased flow of referrals or process the backlog that continues to develop. It will also struggle to handle the consequential case management workload for those backlog cases that become eligible. A significant transformation of the CHC team is required to respond to these challenges and this work has commenced.

3.2 Action completed since the receipt of the Annual Audit Letter.

The Executive Committee has taken the following steps to prepare for the clearance of the backlog cases:

Appointed an interim CHC Programme Director to develop a backlog clearance plan and deliver a new operating model for CHC assessments that will provide sustainable achievement of a 28 day full considerations process.

High level review of the total departmental workload to identify any opportunity to reassigning staff in the short term to the backlog clearance. This is not possible due to the shortage of available clinical staff and the volume of active case management interventions required for existing CHC eligible patients.

Commenced the clinical risk stratification of the backlog cohort. o Until such time as the CCG makes a CHC eligibility decision, the individual

cases remain the responsibility of the local authority who should therefore alert the CHC team if there are any significant care risks. No alerts have been received to date.

o The individual cases at potentially the highest clinical risk are those living in their own home or a residential care setting. These are the priority group for the clearance plan.

o Individuals known to have died are the lowest risk priority and may be a cohort that could be outsourced (see below).

Commenced the preparatory work for the priority group clearance i.e. checking the NHS spine patient record to ascertain whether the individual remains alive, their current place of residence and whether they remain the responsibility of the CCG.

Commenced the development of a new approach to processing cases that screen in for a full CHC consideration in order to deliver a 28 calendar day turnaround time in most cases. This includes work underway to:

o Review of the existing assessment process and the design of a new lean standard operating procedure (SOP) for the process which is deliverable within 28 calendar days.

o A review of the clinical and non-clinical roles within the process to enable scarce clinical resource to focus on only the clinical input tasks of the process and assigning all non-clinical tasks to other roles.

o Review and learning from a sample backlog caseload review exercise conducted by a senior CHC clinician which estimated the tasks and time commitment required for each case to prepare it for the full assessment.

o Development of a new organisational structure for the CHC workforce based on teams of clinical and non-clinical roles to be responsible for cohort of backlog cases.

o A review of existing case load and opportunities to change staff work priorities from PUPOC and case management to backlog clearance.

o Exploring the possibility of outsourcing the assessments of the deceased caseload as these can be handled as a desk-top exercise similar to the PUPOC case reviews. Living cases cannot effectively be outsourced as their assessment requires the participation of local clinicians and social workers that are currently involved in the patient’s care or for assessing the future health and social care needs and taken action to respond to those needs.

o Development of a workforce plan to scale up the available permanent clinical and non-clinical resource available and temporary project resources to facilitate the changes needed in business processes and the management of tranches of backlog cases.

o Development of a recruitment plan to improve the effectiveness of recruitment to CHC posts and the conversion rate from advert response to new starter.

o Mobilisation of a project to access GP records electronically. o A review of the accommodation and office equipment requirements to enable

the scaling up of the workforce to start the clearance work. o The development of work packages (cohorts of backlog cases) for teams, daily

case tracking reports and weekly performance reporting to facilitate proactive flow management based on the SOP standards.

o Review of the SCH contractual obligations to deliver CHC assessments and their readiness to deliver these obligations from 1 October 2015 to stop a portion of the in-flow of cases to the CCG CHC team.

3.3 Actions to be completed to prepare for clearing the backlog.

This is a significant project and the recruitment of interim project support resources has been approved to facilitate the speedy set up and mobilisation of the work outlined below. It is expected that this resource will be place by mid August.

The project stages, headline tasks and milestones (subject to resource availability and

detailed project planning) are outlined below:

Phase 0 Project set up Completion 31st July 2015

Phase 1 Preparation Completion 31st Aug 2015

Complete risk stratification of backlog and update case status

Produce masterlist of backlog cases sorted into priority cohorts with target assessment timetable for each case.

Complete full consideration SOP design

Work package planning to produce team assignment and schedule for each priority backlog cohort.

Develop business process change plan to implement re. SOP

Develop patient comms strategy, handling plan and materials (including advice to patients re. their entitlement to refunds due to the delay in the assessment)

A workforce strategy for the backlog clearance (including CCG, local authority and other specialist healthcare assessors most often involved in the CHC assessment)

Business case for additional CCG workforce requirements

Prepare job specs, adverts and run recruitment exercise.

Develop rapid induction/training plan for new starter

Complete option appraisal to meet the accommodation requirements

Develop proposal for outsourcing of deceased cases for executive go/no go decision to run a procurement exercise.

Develop workforce change proposals and consult with existing staff.

Develop and agree with the local authority and SCH their resource plan to provide specialist assessments or the provision of current care assessment information. (Note: each assessment has to be conducted by a multidisciplinary team (MDT) relevant to the individual. The minimum membership of the MDT is either two different healthcare professionals or one healthcare professional and one social care professional and if possible staff familiar with the patient).

Develop a target clearance trajectory

Phase 2 Pre-clearance mobilisation Commencing 1st Sept 2015

Implement patient communications strategy

Implement any agreed workforce role changes

Implement any agreed accommodation changes

Implement new starter rapid training and induction programme Phase 3 Commencement of Backlog Clearance Commencing 1st Sept 2015 Phase 4 Project Closure To be determined

4. Public Engagement

4.1 The patient communication strategy, handling plan and materials are central and significant

to this project and are to be developed during the preparatory phase. No communications have been issued to date and there is a pressing need to do so.

5. Risks to the success of the project

5.1 The most significant risk to the clearance work progressing, and the pace of clearance, is

likely to be the success of any approved recruitment campaign, the availability of social workers to support the assessments and eligibility decision-making processes and the availability of specialist clinicians including community health staff to participate in the mulit-disciplinary team assessments.

6. Recommendations

1. The Governing Board support the approach being taken or suggest an alternative. 2. The Governing Body delegate authority for the approval of the clearance plan and the

response to para 2.2 of their Annual Audit Letter dated 8th June 2015 to the Executive Scrutiny Committee at its meeting on 25th August 2015.

Author: Hilary Finegan CHC Programme Director

of 2

From: Wendy Tankard, Chief Contracts Officer PROCUREMENT UPDATE 1. Purpose 1.1 The purpose of this report is to update the Governing Body on the procurements completed

since the last procurement update and those currently in progress and planned for 2015/16. 2. Background 2.1 The table below summarises the health service procurement activity in 2014/15.

Procurement Name PQQ Bidders ITT Bidders Awarded to Contract Start

Domiciliary Care (joint with Suffolk County Council)

Lots 1-33 - 43 Lot 34 - 11

Lots 1-33 - 29 Lot 34 - 6

Lots 1-33 – 11 providers Lot 34 Care Uk Ltd Mears Cephas All Hallows Allied Healthcare Headway

September 2015

Community Services 2 2 West Suffolk Foundation Trust

October 2015

Primary Care Mental Health

TBA TBA TBC July 2016

Care Homes (joint with Suffolk County Council)

TBA TBA TBC TBC

Continuing Healthcare - RRS (mini competition)

TBA TBA TBC TBC

Winter beds quotations

TBA TBA TBC TBC

Agenda Item No. 10


2.2 In addition to the above the following procurements (discussed below) are anticipated in

2015/16: 2.2.1 Marginalised and Vulnerable adults

2.2.2 Ophthalmology 3. Key Points

Care Homes 3.1 Work is progressing in this area and market engagement events have taken place around

the proposed service specifications. The event was well attended. Suffolk County Council are looking to be involved in the procurement.

Primary Mental Health Service

3.3 The Primary Care Mental Health Service PQQ has been released. 4. Recommendation 4.1 It is recommended that the Governing Body notes the work completed in 2014/15 and the

evolving work programme for 2015/16. Author: Jane Garnett Procurement Lead

1

Agenda Item No. 11

Reference No. WSCCG15-41

From: Carl Goulton, Chief Finance Officer, Barbara McLean, Chief Nursing Officer, Wendy Tankard, Chief Contracts Officer and Ed Garratt, Chief Operating Officer INTEGRATED PERFORMANCE REPORT

1. Purpose 1.1 This report provides members with a summary of performance against national targets,

contractual targets, clinical quality and patient safety issues, financial position and workstream activity.

2. Public Engagement Not applicable. 3. Recommendations 3.1 It is recommended that members:

note the position regarding financial and service performance;

review the actions being taken with regard to patient safety and clinical quality issues; and

note any actions to mitigate risks or poor performance.

Author: Carl Goulton Chief Finance Officer

Integrated Performance Report

July 2015

1

Contents CCG Executive ‘Dashboard’…………………………………………………................................ Part 1 – Detailed Clinical Quality & Patient Safety Report Part 2 - Financial and Performance Delivery Report • Financial and QIPP Summary…………………………..………………………………………... • Quality Premium Indicators……………………………..………………………………………... • NHS National and Contractual Performance Measures……………………………………….. Part 3 - Clinical Work Streams Part 4 - Contractual performance, by exception, by provider • West Suffolk hospital……………………………………………………………………………..... • Care UK (Out of hours & ‘111’)……………………………………………………….…..………. • Community Services (Serco) Performance Report…………………………………….……..... • Norfolk & Suffolk FT ……………………………………………………………..…………………

3-4

5-61

62-74 63-70

71 72-75

76-105

106-122 107-111 112-115 116-117 118-122

2

Executive Dashboard

Clinical Quality & Patient Safety…. Financial position against plan…… QIPP delivery (* see note below)…..… Local Quality Premium Indicators .. NHS Constitution/national targets.. CQUIN…………………………….

Current month

Headlines: Previous 6 months

Overall CCG position:

Notes:

• WSCCG reported 8 cases of CDI for the month of May against a monthly trajectory of 4. This breaks down into 2 acute and 3 non acute (community) of which 5 were diagnosed out of area. WSH YTD is 11 against a YTD trajectory of 8. Non-acute YTD cases are 3 against a YTD trajectory of 5. Total CCG YTD cases are 11 against YTD trajectory of 8 and an end of year trajectory of 45.

• Safeguarding Adults SCR – The Independent Management Reviews for both

Suffolk residents are completed and with the author. Early learning has been identified and will be progressed with each provider. This will be reported to the clinical executive and governing body. This will be reported to the clinical executive and governing body once the reports have been published. The two IMR authors have met with and shared hard copies of the reports with the families of the individuals concerned and their questions have prompted some further amendments to the reports. The reports have yet to be published. This is now likely to occur in July 2015.

• The SCR Draft Final Report has been reviewed by all stakeholders. The final report has been agreed following amendments and will be published in July. A briefing will be presented to CYP Workstream and Clinical Executive on the Report, Recommendations and on Schedule of Incidental Learning, identified by the Author.

3

Executive Dashboard (continued)

Current month (June)

West Suffolk hospital……. Care UK (OOH)..………… Care UK (‘111’)…………… Serco………………………. NSFT……………………….

Headlines: Previous 6 months as at

May 15

Overall CCG position:

Notes:

Finance, QIPP & Activity At Month 03 the CCG delivered its planned surplus of £0.7m. Within the overall position there are significant variances, mainly : • West Suffolk Hospital – Over performance of £0.1m against post QIPP plan

predominantly driven by QIPP under delivery. • GP Prescribing –£0.7m adverse to plan, driven by M1 overspend and

assumption that the over performance in M1 will continue in M2 & M3.

These adverse variances are offset by favourable timing variances in: • Community £0.2m • Non recurrent funding £0.2m • Contingency £0.2m

Provider Performance • West Suffolk NHS Foundation Trust (WSFT) (p107-111) performance

remains static. Performance in A&E is improving compared to the winter months. Performance in the Acute Oncology Service requires further improvement and review. Ambulance Handover Times remain static with data validation in progress. 18 weeks and diagnostic performance has deteriorated and plans are being worked up by the Provider to remedy.

• Care UK ‘111’ (p112-114) 60 second call back performance met the target in February but issues with call back and warm transfer persist largely due to insufficient levels of clinical adviser capacity.

• Care UK GP out of hours services (p115) have not met some of their key targets for 3 months now. A contract notice has been issued and consequences applied

• Community Services (Serco Ltd) (p116-117) are generally performing well against their Key Performance Indicators ( KPIs). The Contract Query relating to Community Equipment Services (CES) remains open with performance improving but falling slightly short of the levels required in the contract.

• Mental Health Services (Norfolk and Suffolk Foundation Trust (NSFT) (p118-122). A Contract Query Notice has been issued in light of failings highlighted by the Care Quality Commission. Further work needs to be done to improve waiting times for routine children’s assessments.

4

Part 1

Detailed Clinical Quality & Patient Safety Report

5

6

Quality Improvement Visits………… SIRIs………………………………… Never Events………………………… Infection Control (HCAI)……………. Falls………………………………….. Pressure Ulcers…………………....... Patient Advice & Liaison Service….. Contract Query Log………………… Net Promoter Score (NPS)………… Complaints………………………….. Safeguarding Children …………….. Safeguarding Adults…………………

Headlines:

• WSCCG reported 8 cases of CDI for the month of May against a monthly trajectory of 4. This

breaks down into 2 acute and 3 non acute (community) of which 5 were diagnosed out of area. WSH YTD is 11 against a YTD trajectory of 8. Non-acute YTD cases are 3 against a YTD trajectory of 5. Total CCG YTD cases are 11 against YTD trajectory of 8 and an end of year trajectory of 45.

• Safeguarding Adults SCR – The Independent Management Reviews for both Suffolk residents

are completed and with the author. Early learning has been identified and will be progressed with each provider. This will be reported to the clinical executive and governing body. This will be reported to the clinical executive and governing body once the reports have been published. The two IMR authors have met with and shared hard copies of the reports with the families of the individuals concerned and their questions have prompted some further amendments to the reports. The reports have yet to be published. This is now likely to occur in July 2015.

• The SCR Draft Final Report has been reviewed by all stakeholders. The final report has been agreed following amendments and will be published in July. A briefing will be presented to CYP Workstream and Clinical Executive on the Report, Recommendations and on Schedule of Incidental Learning, identified by the Author.

Notes:

Current position

Executive Dashboard – Clinical Quality & Patient Safety

6

SHMI - WSH

The Summary Hospital-level Mortality Indicator (SHMI) is an indicator which reports on mortality at trust level across the NHS in England using a standard and transparent methodology. It is produced and published quarterly as an official statistic by the Health and Social Care Information Centre (HSCIC) with the first publication in October 2011. The SHMI gives an indication of whether the mortality ratio of a trust is as expected, higher than expected or lower than expected when compared to the national baseline (England). The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there. The number of deaths is the total number of finished provider spells for the trust which resulted in a death either in-hospital or within 30 days (inclusive) of discharge from the trust. If the patient is treated by another trust within 30 days of discharge, their death is attributed to the last non-specialist acute trust to treat them.

7

SHMI - WSH

Summary Hospital-level Mortality Indicator (SHMI) - Deaths associated with hospitalisation, England, October 2013 - September 2014

8

Quality Improvement Visits (QIVs)

QIV Programme for Ipswich and East Suffolk CCG and West Suffolk CCG Care Home and NHS providers. A new spreadsheet for the visits in 2015 /2016 is now available, the first 6 months schedule completed to date, as last year the reports and action plans are maintained by an administrator in the quality team, each QIV will have a written report, which are available on request from [email protected]. This year the QIVs to the Acute Hospitals will continue on alternate months; starting in May 2015 with Diabetes, WSHT completed on the 20th May, IHT has been changed to the 13th August as the diabetic clinic is not open on a Tuesday. General Surgery will be in July; Gastro-enterology in September. For Community Services the plans this year are to visit the community teams on alternative months, April visits were to the Care Coordination Centre and the Haverhill community team; June visits will be to Stowmarket and Aldeburgh community teams; August visits to Newmarket and Woodbridge community teams. The first 2 visits to the community teams have commenced. The key issues have been the changes to improve the connectivity to SystmOne and the use of the Community App for the teams to access care records remotely. The relationship with the Care Coordination Centre has generally improved, but it is very dependent on the call handlers some of whom are very experienced, with others less familiar with health terminology. The aim is to have a GP/ Clinician and a manager as well as the Professional Advisor for each of the NHS visits. Workstreams are encouraged to direct areas to visit in the Acute Hospitals and other services, where this intelligence would support a programme of work. NSFT have arranged a programme of mock CQC visits, the planed dates for Suffolk are: 26th June 2015 St Clements, Foxhall House low secure unit and the Chilton houses; 7th July 2015 Woodlands; 16th July 2015 Wedgewood. WSFT have also arranged a programme of mock CQC visits in preparation for the anticipated Inspection in late 2015. A visit to A&E and Medical Assessment Wards took place on 19th June.

9


QIV Programme for Ipswich and East Suffolk CCG and West Suffolk CCG Care Home and NHS providers Care Home visits to date The visit template has been revised to include the CQC 5 key questions – is it Safe, is it Effective, is it Caring, is it Responsive and is it Well Led. • Mill Lane, Felixstowe • Northcourt, Bury St Edmunds – new manager who is well regarded by the staff improved morale noted. • Risby Park Nursing Home • Aldringham Court Care Home • Leopold Road Nursing Home- rated inadequate by CQC, closed to admissions by SCC. • Alice Grange Care Home – significant improvements noted under the new manager • Friars Hall, Hadleigh – a new manager who is an experienced RMN and manager, some improvements noted. • Bucklesham Grange • Brandon Park - new owners and a new manager, significant improvement in the environment, care systems to be addressed by the new manager. • Broad Acres – improvement in the meal experience required, from being a task to a pleasurable experience for residents. • Melford Court – concerns over the meal experience and the lack of permanent clinical staff, a new manager in place.

10


Care Home/Provider

Date of visit Issues raised Actions Review

WSFT Diabetes 20/05/2015

The assessors found the following: A risk assessment is carried out on all patients in the hospital, with diabetes, to review their insulin dependence and that their blood sugars over 24 hours are stable. The Band 6 ward Sister is new to her role; she is enthusiastic about her role and proud of her ward. The ward is clean, spacious and well laid out with 5 male beds for high dependency with a member of staff always in the area. On the female wing there are 8 beds in the high visibility area. The Specialist Nurses cover all the wards, to give advice and support. All insulin dependent patients are seen and supported; some non-insulin dependent inpatients will only be seen if there are diabetes related complications. Diabetics on medication control have group support sessions as well as lifestyle education. The specialist nurses both on the hospital and the community work independently and have developed key skills in the management of diabetes which are acknowledged by the wards and the community.

Key points for both the CCG Workstream and WSHT to consider: 1. Consideration for a small number of ring-fenced beds for direct admission of patients with severe unstable diabetes or diabetic coma, to avoid delay and of potentially half to one day. 2. On G9 to have mobile work stations in the ward areas to ensure that the nurses/ carer are able to observe high risk patients. 3. To have links with the community drug and alcohol services. 4. Processes to be in place to ensure that the hospital based diabetic nurses are alerted when known diabetic are admitted. 5. To support the programme to up-skill the practice nurses. 6. To develop clinics in the community to move from a medicalised model in the Hospital. 7. Investigate the number of repeat readmissions due to patients unfit for discharge being signed off as fit by social workers. 8. Consider a pathway/governance improvement.

The provider has been advised of recommendations and will report back to West Suffolk CCG as the Commissioner.

Serco - Stowmarket Community Team 09/06/2015

The assessors found the following: The management of mandatory training for all staff is a challenge, it is helped with having the training suite on site. The team have good relationships with both St Elizabeth and St Nicholas Hospices. There is a consistent pool of nursing staff. Previously assessments were 24/25 weeks, they are now down to 13 weeks with time for follow-ups. Regarding the Care Coordination Centre, there have been improvements but there are still inconsistencies between the various call handlers. There is a good working relationship with both the pulmonary rehabilitation and the COPD teams. Regarding CES, Bed collections can take up to 12 days, collections are still an issue for many carers. There is strong leadership from both the Team Lead and the Locality manager.

Key points for both the CCG and SCH to consider: 1. To review the equipment list to include a high grade pressure relieving mattress as part of the 4 hour end of life list. 2. To identify a crib list for the Care Coordination Centre call handlers to ensure the basic questions are covered, to be advised by the community teams. 3. To confirm the information governance arrangement that staff have agreed access to patient information when they have changed base. 4. The teams to have contact with the Suffolk CC Quality and Improvement teams in relation to working with residential homes. 5. To work with GPs to ensure effective and separate MDT and GSF meetings, with appropriate membership. 6. Discuss the ability for community teams to have access rights to GP SystmOne information.


11


Care Home/Provider Date of visit Issues raised Actions Review

Brandon Park Nursing Home 12/06/2015

The assessors found the following: Medication round observed, the trolley was not left unattended. The home was warm and a comfortable temperature for the residents. All staff spoken to had a knowledge of the residents' needs. All statutory training is in progress. Residents spoke highly about the quality of care given, some residents did report that at times there were delays with call bells being answered. Staff have, as part of mandatory training, completed dementia awareness training, safeguarding, and mental capacity act and end of life care. The activities coordinator is a full time post, a varied programme of activities are being organised. The kitchen has been awarded 5 stars by Environmental Health audits in the last 2 years. Staff were noted to knock on the doors before entering a resident room, and to speak respectfully to residents. Nutritional assessments depending on the individual resident’s needs are in place. The owners are very supportive of the home and attend regularly.

Recommendations included the following: To keep a separate log of the out of hours calls to identify any training needs; Each bath to have a cleaning schedule; To keep personal items out of the communal shower room; As part of the infection control audits to include observational audits of all staff; To have a programme that the waterproof covers are removed from the mattresses on at least a monthly frequency; To review all residents against the Cheshire West guidance and complete the required DOLs; Reminder to staff that the medicine trolleys are to be secured to the wall even in a locked room; Confirmation that fire drills for both night and day staff are in place; To consider alternative arrangements for residents who require full support with their meal, instead of in a corner of a busy dining room; To complete the Induction and Mandatory training programmes; To produce the proposed audit calendar; To develop a supervision programme which identifies the skills required by the individual staff groups; To ensure an annual appraisal process is in place which identifies the training and development needs of staff; To have first aiders in at least the kitchen and laundry; To have an eye wash kit in the laundry.


Melford Court Nursing Home 19/06/2015

The assessors found the following: The majority of staff were noted to have good appropriate eye to eye contact with residents when they were being supported with drinks or their meals, staff were seen to be sitting with the resident when supporting them with their meal. Staff induction training includes manual handling, Health and Safety, Fire, Basic Food Hygiene, Infection Control, Safeguarding, Dementia and Customer Care. Residents and relatives spoke highly about the care of the care staff. The home decoration on the first floor was good. There is a secure and safe garden area accessible to residents. Hand washing facilities in place, the kitchen achieved 5 stars for their environmental audit in May 2014. The home has a maintenance man and a gardener responsible for maintaining the environment. The reception area to the home has information on making a complaint. The manager is working for the home to be part of the community, she is on the Long Melford events committee, the home is in the main street and the centre of a busy community.

Recommendations included the following: to keep a separate log of the out of hours calls to identify any training needs; Each bath to have a cleaning schedule; to include observational audits of all staff; Mattress checks to be carried out; Staff not to carry dirty linen but to use a linen bag; It is recommended that slings are air dried to ensure they are not damaged; To review all residents against the Cheshire West guidance and complete the required DOLs; Confirmation that fire drills for both night and day staff are in place; Induction and Mandatory training programmes to be completed; To ensure an annual appraisal process is in place which identifies the training and development needs of staff; The fridge requires urgent defrosting; All care staff to have updated training in the prevention and management of pressure ulcers, in particular heel protection; To re-consider the use of the lounge / activities room; To consider avoiding meal delivery times for the delivery of medications; To ensure a programme is in place for new RN and the existing RN; To consider an increase in the number of RNs to ensure sufficient cover to address the needs of dependent residents with complex needs.


12

QIVS and CQCs Information Sharing

There is an internal Information sharing via teleconference between SCC and the CCG fortnightly to discuss new or on-going concerns raised during Quality Improvements Visits to care homes or concerns raised through Continuing health care assessments. This will also include information raised through complaints, serious incidents, adult safeguarding referrals or general soft intelligence. A more formal quarterly information sharing forum occurs to enable Suffolk County Council, the Care Quality Commission, the Suffolk Clinical Commissioning Groups (CCGs), Environmental Health, Fire Service, and Healthwatch Suffolk to share information about their own organisations, and to work collaboratively to share information concerning all registered Health, Care and Support Services (and the providers of these services), that are commissioned by Suffolk County Council or CCGs within Suffolk. The purpose of sharing this information is to: Ensure commissioning authorities, CQC and other regulatory organisations have a shared oversight of the quality of Health, Care and Support being delivered within Suffolk Provide a forum to share learning points from investigations/inspections Allow representatives from each organisation to provide an update on any issues with individual providers, where necessary a strategy can be agreed to ensure a co-ordinated response Act as an early warning system to identify any shared concerns about providers Provide a forum to share good practice Provide a forum to agree thematic and shared approach to improve quality Develop methods for informing members when suspensions or enforcement actions are put in place or are lifted.

13

Serious Incidents Requiring Investigation (SIRI)

SIRI reporting April 2015

West Suffolk Clinical Commissioning Group

Provider No. of Serious Incidents Category

Total overdue 45 day reports up until

30 June 2015 (East and West)

WSH

4

1 x Never Event - Wrong Site Surgery 1 x Unexpected/potentially avoidable injury causing serious harm 1 x Slip/Trip/Fall 1 x Confidential Information Leak 0

NSFT 1 1 x Serious Harm 0 SCH 0 N/A 0 Care UK 0 N/A 0

EEAST (West Suffolk CCG only)

0

N/A 0

14

West Suffolk Hospital – Serious Incidents

• There has been 1 never event reported this month.

15

Infection Control – C.difficile

WSCCG WSCCG reported 0 cases of MRSA bacteraemia for the month of May. Total MRSA YTD cases are 0 against end of year trajectory of 0.

16

Infection Control – C.difficile

• WSCCG reported 9 cases of CDI for the month of May against a monthly trajectory of 4. • This breaks down into 2 acute and 5 non acute (community) of which 5 were diagnosed out of area. • WSH YTD is 12 against a YTD trajectory of 8. • Non-acute YTD cases are 5 against a YTD trajectory of 5. • Total CCG YTD cases are 12 against YTD trajectory of 8 and an end of year trajectory of 45.

17

Infection Control

There is action being taken to address the community cases, working with Public Health. We have a Specialist Nurse Control of Infection in place having recruited to the vacancy. The following action plan is in place:- 1. Infection prevention lead and the medicines management team are reviewing what data is collected to investigate potential links between CDI and particular medicines (antibiotics, laxatives, proton pump inhibitors). 2. Establishing closer links with the communications team to explore the public messages that could be released about the risks of acquiring CDI – revisiting the “not all coughs need antibiotics” message 3. Exploring the possibility of information leaflets given out by the prescriber or by pharmacists when dispensing antibiotics, explaining the risks of acquiring CDI. 4. Exploring the possibility of issuing a card to patients who have had recent acute in-patient care and antibiotics to show to their GP if they need any more antibiotics within 2 months of discharge (this will highlight to the GP that caution needs to be taken when prescribing) 5. Linking with GP IPC lead Dr Ben Solway to assess the adaptation of a similar CDI information pack developed by Norfolk IPC commissioning team, for Suffolk GPs. 6. A robust surveillance and monitoring system has been developed within the CCG. Additionally, for acute care providers: 7. Assurance has been received from all providers that they promote prudent prescribing, implement preventive IPC measures and discharge information about CDI acquisition. 8. An RCA tool for use in primary care is being developed with plans to roll out during 2015 that will provide information on themes and trends for action.

18

Falls

19

Pressure Ulcer Incidents

This chart shows the latest pressure ulcers reported by NSFT, SCH and WSH. NB: NSFT and SCH data is IESCCG and WSCCG combined.

20

Pressure Ulcer Incidents

This chart shows the year to date figures for West Suffolk Hospital.

21

Harm free care - Pressure Ulcers and Falls

Progress report on Harm Free Care in Suffolk Background The providers of care within Suffolk are contributing to the Harm Free Care Agenda in an established forum. The forum established baselines and explored if ‘improvements’ that have been implemented have made a positive change (statistically). The outcome of this approach is that we will move away from ‘judgmental’ data noting avoidable or unavoidable, to ‘Measurement for Improvement’. Purpose of the Group To support system wide Harm Reduction by reviewing the data in relation to: • Review last 3 year’s data on Safety Thermometer to plan strategy • Medication Safety • Pressure Ulcers (PU) and Falls – work • VTE will be looked following the completion of PU and Falls. • Continence management. Conclusion Overall falls seem to be reducing with some reduction in avoidable pressure ulcers. There seems to be an increase in pressure ulcers generally although more work is required to understand why there is an increase, and this could be due to greater awareness and better reporting. Recommendations Extensive discussions were had regarding adding value by linking the falls and pressure ulcer data using NHS numbers to understand if it is possible to predict adverse events, in the same way that the Global Trigger Tool is able to calculate positive predictive values (Chapman SM, Fitzsimons J, Davey N et al. BMJ Open 2014; 4:e005066. doi:10.1136/bmjopen-2014-005066). Matt Tite created the data for the BMJ article and encouraged the group to undertake the analysis. The aim of the work would be to see if we could inform the ‘Ordinary Falls’ piece of work, as no one has ever linked together all the falls and pressure sore data to see the analysis that can be extracted from it. The continuation of the forum and work is recommended to ensure that we can successfully capture reliable information. The work to date shows statistically that the interventions providers are putting into place are reducing harm. The next stage is to move to the work in relation to VTA, medication safety and safer staffing levels and a further report will be presented in due course. Further information regarding Harm Free Care can be found here: http://harmfreecare.org/

22

http://harmfreecare.org/

Clinical Effectiveness/Research Activity

The NHS Constitution requires that NHS patients are provided with the opportunity to access approved clinical research the GP Practices within Suffolk CCGs have been involved in the following activity: Research Site Initiative Contracts (RSI) The Clinical Research Network (CRN) annually awards RSI contracts to financially support General Practices to enable them to appropriately train their staff and select approved studies from the National Institute of Health Research (NIHR) portfolio. This equates to £38,850 for Ipswich and East Suffolk (9 General Practices) and £23,200 for West Suffolk (7 sites). Presently the RSI portfolio of contracted sites consists mainly of Practices that have significant research experience and capability. Research Capability Funding (RCF) RCF funding is released at the behest of the NIHR on an annual basis. In recent times recruitment in excess of 500 participants has resulted in financial award. £20,000 has been awarded to Ipswich and East Suffolk CCG as a result of their recruitment in the 2013/14 financial year. Funding has been allocated to two GP Research Leads to “champion” research during the first six months of this year. The Annual Forum was also funded using the RCF budget. Allocation of the remainder of the RCF budget is currently under review. It must be noted that the RCF must be used to increase the potential for participant engagement rather than supplement existing study activity. Nationally in excess of 345,000 participants have been recruited to NIHR studies this financial year. Primary Care is relied upon for high volumes of recruitment whereas secondary care activity tends to be more specialist and clinically demanding. A performance table detailing levels of site interest and recruitment for site contracted studies is contained in the table below. A comparison has been made focusing on the study portfolio because study implementation varies significantly in complexity. With the exception of Melatools and CAPE, the Suffolk study portfolio is all interventional involving patient consultations. Suffolk has been recruiting at approximately average benchmark when number of active sites is taken into account in respect of recruitment.

23

Clinical Effectiveness/Research Activity (continued)

STUDY RECRUITMENT FROM 1/4/14 - 24/10/14

STUDY

HEAT - Helicobacter

Eradication in patients on

Aspirin

TWICS - Theophyllin

e with Inhaled

Corticosteroid for COPD

exacerbation

prevention

FAST - Quadrupling

of inhaled steroid for patients

with asthma for

exacerbation prevention

CAPE - Evaluation of Community pathways at End of Life

CORDIA - Lifestyle

counselling for Type 2 Diabetes

patients for avoidance of CHD

BARACK D - Benefits of

Aldosterone Receptor

Antagonism in Chronic Kidney

Disease patients

GARFIELD - Global

Anticoagulant Register in the

Field

CCG TOTAL-

Excluding non-

comparative Studies

Melatools - Evaluation of

risk of melanoma

Other - Either Nationally

Recruiting or not running in

Suffolk

CCG TOTAL

Recruit No.

Sites No

.

Recruit No.

Sites No.

Recruit No.

Sites No.

Recruit No.

Sites No.

Recruit No.

Sites No.

Recruit No.

Sites No.

Recruit No.

Sites No. Recruit No. Recruit

No. Sites No.

Recruit No.

Studies No. Recruits

No.

Bedfordshire CCG 6 1 10 4 16 893 2 67 976 Norwich CCG 59 4 10 1 16 4 26 3 85 760 17 845 E & N Herts CCG 61 2 1 19 1 5 1 82 774 2 18 996 Camb & P'boro CCG 47 2 8 2 25 6 12 4 92 718 26 810 South Norfolk CCG 85 2 10 3 3 1 2 1 12 4 98 449 11 547 Ips & E. Suffolk CCG 12 1 5 1 4 2 1 1 15 2 3 2 37 361 2 104 6 502 North Norfolk CCG 88 2 9 2 1 1 8 2 98 353 13 451 N E Essex CCG 0 276 2 74 3 350 Yar & Waveney CCG 42 2 13 2 13 3 7 1 14 2 68 240 11 308 West Norfolk CCG 12 1 12 146 8 158 West Suffolk CCG 8 1 3 1 25 4 12 2 36 38 74 TOTAL CRN:Eastern 412 63 77 38 34 12 77 624 2304 2949 6017

24

Patient Advice & Liaison Service (PALS)

• Total PALS activity across both CCG’s for June 2015 showed 647 compared with 502 for June 2014. • For locality breakdown, the overall figure for June for West Suffolk CCG was 192 and for queries out of the CCG area was 16.

These PALS figures include the emergency dental appointments, orthodontics and general dental queries around treatment and charges. The dental figures for West Suffolk CCG were 162 and out of area 7. The appeals process for hospital transport continues to be managed by PALS with the out of contract area transport now co-ordinated through the service. There has been some considerable savings by PALS investigating charges on invoices for journeys where the patients were not Suffolk registered. Included in the miscellaneous figures are Phlebotomy, District Nursing, Help for Health Costs and signposting to Social Care and Suffolk Carers.

Example of good patient outcome with PALS intervention: Patient rang PALS as required INR testing but due to the dates available at Brandon was unable to be tested on the appropriate date to ensure her condition had continuous monitoring. The patient is elderly and unable to travel to West Suffolk Hospital or Mildenhall for the test to take place. PALS contacted Suffolk Community Healthcare and negotiated with the Community Team who agreed to provide a home visit to take the patient’s bloods.

Primary Care Dental 162 Primary Care GP query 3 Primary Care Optical 4 Primary Care Meds/Pharmacy 2 CCG Continuing Care 1 CCG Individual Funding

Requests 0 CCG

Low Priority Procedures 0 Public Health

Screening - bowel/breast/ cervical 0

Public Health Child Weight Mgt 0 WSFT Acute 4 WSFT

PALS - other provider 1 SEPT Podiatry 0 SERCO Physiotherapy 0 SERCO Med cert/recs 1 SERCO Continence 0 SERCO Equipment 1 SERCO

Community Hospitals 0 Care UK Out of hours 0 NSFT Mental health 0 PTCAAS Transport 8 PTCAAS

Out of contract transport 0 N/A Miscellaneous 5

25

Patient Advice & Liaison Service (PALS)

Provider data for May (validated) West Suffolk Hospital WSHFT recorded 104 PALS contacts in May 2015. Trust-wide the most common problem areas are as follows:

Norfolk and Suffolk Foundation Trust NSFT recorded a total of 38 PALS contacts across Suffolk during May 2015, 3 of these were recorded as specifically within the West Suffolk area, 32 were regarding Ipswich and East Suffolk and the remaining 3 were recorded as out of area. A breakdown of the contacts is as follows;

Appointments, delay and cancellation (outpatients) 29 Queries, advice and requests for information 25 All aspects of clinical treatment 10 Admissions, discharge and transfer arrangements 7 Patients property and expenses 5 Compliments 5 Other 23

PALS issue West Out of area Information 2 3 Communication 1

TOTAL 3 3

26

Complaints

CCG data for June (validated) • The Ombudsman have recently launched a new online form for complaints which makes it easier for people to make complaints to them and captures

all the information the Ombudsman need to deal with it quickly. • Essex held a PALS Awareness Week (PAW) June 15-19 when all Essex PALS promoted the services both in house and to the wider Essex

community. Depending on the feedback from this drive, this is something we could look to do in Suffolk. • An upcoming PALS conference is being held in August to discuss PALS and Complaints and the Patient Experience Managers will be attending and

providing feedback on this conference in the September report. 1 complaint was received during June 2015 for the Ipswich & East Suffolk CCG. No complaints were received for the West Suffolk CCG.

Update on outstanding May complaints

WEST Complaint category and details Outcome and actions identified Status

CCG - CHC Ref: 210

COMMUNICATIONS - Incorrect/inaccurate interpretation Claim company disputing checklist outcome.

Partially upheld Summary of response Apology that found assessment to be insufficient however reassured that case review shows staff acted in accordance with National Framework for NHS CHC. Some domains will be re-assessed and go to MDT for Panel decision around eligibility as some evidence is equivocal.

Complete – response 18 working days

CCG - CHC Ref: 212

COMMUNICATIONS – Conflicting information COMMUNICATIONS - Incorrect/no information given Unhappy that advised by Nurse Assessor patient eligible for CHC however after DST completed and validated patient deemed not eligible. Unhappy with process in general and failure to provide documentation as promised so appeal therefore delayed.

Appeal going ahead, to address complaint as part of appeal meeting. Waiting to be arranged when complainant returns from holiday.

27

Complaints

Update on outstanding April complaints

WEST Complaint category and details Outcome and actions identified Status

NSFT - Mental

Health Ref: 195

ACCESS TO TREATMENT OR DRUGS - Service Provision Concerns regarding provision of care for daughter by Mental Health Services

Not upheld Summary of response NSFT provided combined response to complainant outlining their involvement and reassuring from a CCG point of view that as commissioners we were seeking assurance as to capability of services and in no way delaying process of failing to accept responsibility for patient/her care.


SCH - Phlebo

tomy Ref: 198

CLINICAL TREATMENT – Other Phlebotomist at Mildenhall Clinic was very painful and would not want them to take blood again

Upheld Summary of response Apology for any pain or discomfort experienced. Staff member that took blood has since left the organisation therefore at future appts will be attended to by alternative member of staff.


28

Complaints

In order to provide a consistent comparison from previous years the above chart shows combined East and West figures.

Total number of complaints received across both CCGs

29

Complaints

May – validated data West Suffolk Hospital 26 complaints were received during May 2015 for the WSFT. Of these complaints, the breakdown by Primary Directorate is as follows: Medical (13), Surgical (6), Facilities (2), Clinical Support (1), Women and Childs Health (4). Trust-wide the most common problem areas are as follows (generally, more than one issue is identified per complaint):

All Aspects of Clinical Treatment 13 Admissions, Discharge and Transfer arrangements 8 Communication/Information to patients (written and oral) 5

30

Complaints

Suffolk Community Healthcare 5 formal complaints were received during May 2015 for Suffolk Community Healthcare. 11 informal complaints were also received and resolved promptly by the service lead. Of these combined complaints, the breakdown by service area is as follows; Community Health Team (11), Community Hospitals – outpatients (1), Community Equipment Service (1), COPD (1) and Other (2). A breakdown of the formal complaints is as follows:

Complaint details No. of complaints Phlebotomy 2 Details: Following a visit to the phlebotomy outpatient clinic at Newmarket Hospital the complainant stated they had found the blood test procedure very painful and had been left with bruising and a lump on her arm. Response: Whilst the process of obtaining a blood sample is relatively simple, it is subject to many variables which makes it different every time. These variables can include how hydrated the patient is and their general health on the day of the blood test. These factors can have a significant impact on the ease with which a blood sample can be taken. However, our staff will always try to ensure the patient is as comfortable a possible during the procedure. Member of staff no longer works for organisation, therefore at future appointments patient will be attended to by a different member of staff.

1

Details: A complaint received from the organiser of a community care scheme. The complaint concerns the frequent problems experienced by the patients she transports to Brandon phlebotomy clinic, specifically the frequent cancellations of the clinic. Response: Staffing issues have resulted in cancellation of some clinics. Try hard to avoid cancelling, including using bank phlebotomy staff. Actively recruiting and moving hours and staff around to minimise disruption but this is taking some time to have effect. We also recognise the situation where sessions are full and have experienced a large increase in demand for blood tests over the last 24 months. Elsewhere in Suffolk there are other arrangements for patients having their blood taken and SCH will be working with the CCG to explore if there is a more effective way of providing this service to patients in Brandon.

1

Community Health Team 2 Patients course of VAC therapy to treat a wound. The complainant states the process of arranging the start of treatment has been long and drawn out and has not been kept informed by the local nursing team. The complainant is not confident the nurses have the skills/experience to carry out the treatment.

1

Attitude of community nurse during two visits to a patient. The complainant states the nurse was rude and upset the patient. 1 COPD 1 Care and treatment provided by the COPD team to a now deceased patient. The complainant feels the COPD team did not take appropriate timely action when the patient’s condition was apparently worsening.

1

TOTAL

31

Complaints

East of England Ambulance Service 2 complaints were received during May 2015 for the Ambulance Service (West Suffolk). The breakdown for these complaints by subject type is as follows;

Complaint or Concern Primary Subject of complaint Sub-category

Concern Transport and driving Failure to provide transport/inappropriate transport 1

Complaint Clinical treatment and assessment Did not assist patient 1 TOTAL 2

Norfolk and Suffolk Foundation Trust 5 complaints were received during May 2015 for Norfolk and Suffolk Foundation Trust in the West Suffolk area. The breakdown for these complaints by subject type is as follows;

Subject of complaint Number of complaints Attitude of staff 1 Appointments, delay/cancellations (outpatients) 1 Communication/Information to patients (written and oral) 2 Other 4

TOTAL 5

Care UK 1 complaint was received by Care UK in May 2015 regarding OOH in the West. Details of this complaint are as follows;

Complaint details Received from EOEAST. Wife is unhappy with the length of time the ambulance took to arrive to take the patient to hospital. The OOH service triaged the call and visited the patient before calling for the ambulance.

1

TOTAL 1

32

Friends and Family Test

The Friends and Family Test (FFT) is an important feedback tool that supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience. It asks people if they would recommend the services they have used and offers a range of responses. When combined with supplementary follow-up questions, the FFT provides a mechanism to highlight both good and poor patient experience. This kind of feedback is vital in transforming NHS services and supporting patient choice. Launched in April 2013, the FFT question has been asked in all NHS inpatient and A&E departments across England and, since October 2013, all providers of NHS funded maternity services. The FFT is now being rolled out to additional areas of NHS care making the opportunity to leave feedback possible in almost all NHS services. From 1 April 2015, it expanded to NHS dental practices, ambulance services, patient transport services, acute hospital outpatients and day cases. While the results will not be statistically comparable against other organisations because of the various data collection methods, FFT will continue to provide a broad measure of patient experience that can be used alongside other data to inform service improvement and patient choice.

33


West Suffolk Hospital - % of respondents who would recommend the service

34


There is a requirement to ask the Friends and Family question four times across Maternity Services; at the 36 week antenatal appointment, following birth in the delivery suite or birthing unit, post-natally on discharge from the post natal ward and lastly at the time of discharge in the community. The graph below shows the percentage of respondents who would recommend the service.

WSHFT Maternity Services - % of respondents who would recommend the service

35

Friends and Family Test (Continued)

Serco - % of respondents who would recommend the service

The combined score for Suffolk Community Healthcare for May 2015 is 97%.

36

Contract Query Log

Queries received by the Patient Experience Team are logged and passed to the relevant provider for their investigation and response. Responses are provided within 20 working days and shared with the GP/Clinician who raised the issue. Requesting patient identifiable information and consent proved to delay responses and has not always been accessible, making some queries difficult to take forward. In these cases a generic response is provided. However, a new system put in place in October has reduced this level, as the Patient Experience Team is able to process patient identifiable information and pass to the provider for investigation. The Patient Experience Team works directly with providers in order to resolve queries quickly and pursue where there are delays in responses. All issues raised to the GP Contract Log are shared with the Contract Team throughout the month providing themes and trends for taking forward with the relevant provider. Queries to the GP Contract Log should be sent to the following e-mail addresses to be raised with the provider service: [email protected]

Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

Number of queries per month

16 23 26 30 26 24 31

Number closed per month 7 9 5 5 9 7 14 Overall number outstanding on system

25 28 41 50 41 38 38

Queries by Provider

Care UK 5 2 1 0 2 0 0 IHT 3 6 2 5 2 4 9 N&N 0 0 0 0 0 0 0 CUFT 1 0 3 3 3 2 1 Papworth 0 0 1 0 0 0 0 WSFT 1 0 12 9 9 4 4 NSFT 2 2 1 3 1 6 12 Serco 1 7 3 3 4 6 2 Private 0 0 0 0 0 0 0 Other 3 6 3 7 5 2 3

37

mailto:[email protected]





Contract Query Log (continued)

Please see table below for breakdown of queries in June 2015.

Provider Query trends Date raised

Status

WSFT Communication x 1 Referral x 1 Discharge summaries x 4 (with Richard Cracknell) Communication x 1

01.06.15 25.06.15 26.06.15 30.06.15

Open Open Open

Open

SERCO Access to services x 1

Access to services x 1 12.06.15 29.06.15

Open Open

Care UK Nil return N&N Nil return CUFT Discharge summary x 1 19.06.15 Open

NSFT Access to services x 1

Access to services x 1 Referral x 1 Access to services x 1 Access to services x 1 Access to services x 1 Communication x 1 Access to services x 1 Communication x 1 Access to services x 1 Access to services x 1 Access to services x 1

01.06.15 02.06.15 05.06.15 08.06.15 10.06.15 12.06.15 16.06.15 16.06.15 16.06.15 18.06.15 23.06.15 30.06.15

Closed Closed Closed Closed Closed Closed Closed Closed Open Open

Closed Open

Papworth Nil return Colchester General Hospital (CGH)

Nil return

EoEAST Nil return

Public Health

Nil return

Private Nil return IC24

Nil return

TPP Nil return

AHP Communication x 1 25.06.15

Closed

4YP Access to services x 1 16.06.15

Closed

Suffolk Feds

Referral x 1 05.06.15

Closed

Provider Query trends Date raised

Status

In relation to West Suffolk Foundation Trust there remain 13 outstanding issues pre-dating June 2015 which are due to delays in response from the provider. Regular meetings are held with the Contract Lead and Patient Experience Manager to address the outstanding issues and to agree a way forward with the Trust. All outstanding issues are chased by the Patient Experience Team with the providers on a regular basis.

38

Contract Query Log (continued)

The table below shows the outstanding queries prior to June 2015.

Provider Query trends Date Status

WSFT Communication x 1 Prescribing x 1 Referral x 1 Access to services x 1 Communication x 1 Discharge summary x 1 Discharge summary x 1 Referral x 1 Referral x 1 Prescribing x 1 Referral x 1 Prescribing x 1 Referral x 1

16.02.15 23.02.15 04.03.15 10.03.15 07.04.15 09.04.15 14.04.15 14.04.15 17.04.15 29.04.15 07.05.15 20.05.15 29.05.15

Outstanding Outstanding Outstanding Outstanding Outstanding Outstanding Outstanding Outstanding Outstanding Outstanding Outstanding Outstanding Outstanding

TPP Test results x 1 Communication x 1

30.03.15 07.05.15

Outstanding Outstanding

CGH Referral x 1 Referral x 1

30.03.15 30.03.15


Care UK Access to services x 1 Communication x 1

07.04.15 10.04.15


IHT Referral x 1 Referral x 1

01.05.15 01.05.15


39

GP Patient Survey results

Latest GP Patient Survey results The latest GP Patient Survey (GPPS), which seeks the views of over two and a half million people every year about their experience of GP services and NHS dentistry, was published on 2nd July 2015.

The GP Patient Survey measures patients’ experiences across a range of topics, including: • Making appointments • Waiting times • Perceptions of care at appointments • Practice opening hours • Out-of-hours services The GP Patient Survey provides data at practice level using a consistent methodology, which means it is comparable across organisations and over time.

National Overall experience • The majority of patients (84.8%) rate their overall experience of their GP surgery as good. Compared to the results for 2013-14, this has decreased by 0.9 percentage points from 85.7%. • Nearly three in four patients (73.3%) rate their overall experience of making an appointment as good. Compared to the results for 2013-14, this has decreased by 1.3 percentage points from 74.6%. • More than three in four patients (77.5%) would recommend their GP surgery to someone who has just moved into their local area, a decrease of 1.1 percentage points since the 2013-14 results. • More than one in ten patients (13.6%) say they tried to call an out-of-hours GP service in the past 6 months. Of these, more than two in three patients (68.6%) rate their overall experience of out-of-hours GP services as good, an increase of 2.4 percentage points since the results for 2013-14.

40

GP Patient Survey results

Latest GP Patient Survey results – WSCCG

In NHS WEST SUFFOLK CCG, 6,766 questionnaires were sent out, and 2,895 were returned completed. This represents a response rate of 43%. An example question is below:

Overall, how would you describe your experience of your GP surgery?

National results

For more information about the survey please visit https://gp-patient.co.uk/.

41

https://gp-patient.co.uk/

Children and Young People’s Complex Cases

Complex Case Panel (CYP Continuing Care) The Complex Case Panel for West Suffolk CCG in June considered one new case. This was agreed from commissioned services and therefore has no impact on the budget.

Graph 1

Graph 1 demonstrates a monthly pattern of spending over the last three years with an estimated monthly spend through to the end of 2015-16. The increased costs for 2015-16 is due to the package provided by an agency for a new high cost package.

42


Graph 2

• Graph 2 demonstrates an increase in the average cost for 2014/15 and a further increase for April and June 2015.

• There are 9 CYP Continuing Care cases in June 2015.

43


Inter Agency County Panel (CYP Out of Area Placements) • Two West Suffolk CCG responsible commissioner cases were presented to the Inter Agency County Panel in June but costs of these proposed

placements have not been agreed and have therefore not been included in the budget yet. • All young people currently placed out of Suffolk are Looked after Children and are in either Educational residential placements which could be

either 52 / 39 weeks or 52 week residential placements (e.g. Children’s Home). • NB any placement for less than 52 weeks would have the overall cost spread throughout the year therefore no dip in funding during school

holidays has been identified

Graph 3

The total spend on out of county cases has continued to decrease as demonstrated in the chart above.

44


Graph 4

The graph above demonstrates a decrease in the average spend per case.

45

Safeguarding Children

Local Child Protection Plan Statistics Data Refreshed on 19th May 2015:

46

Safeguarding Children

47

Safeguarding Adults

Care Homes under review Work is underway to scope the requirements for adult safeguarding across Suffolk. Agreement has been reached with NHS England, social care and the Safeguarding Adults Board, to fund the posts for a year to implement a comprehensive training programme for MCA/DOLs. Both of these posts have gone out to advert but recruitment to date has been unsuccessful. A communication has been sent out to all DoNs to offer and encourage secondment opportunities to nursing staff ( Band 7). Alternative options for the Band 8a post are being considered utilising possible existing resource. Safeguarding Adults Board Development session took place 4th February 2015 and reviewed the current structure, roles and responsibilities of the Board members. The delegates were asked to provide a response to the SAB request for confirmation of funding and the options presented in a paper provided. Key themes were around wider engagement with the public via social media in relation to safeguarding, training and integration of information and learning from sub groups. Current care homes receiving support from the quality teams within health and social care: These are homes with current action plans or in need of support from the quality teams to develop areas of service delivery. Some may relate to safeguarding concerns and other may be of an operational nature affecting quality.

KENT LODGE CARE HOME

48

Safeguarding Adults/CHC

The health quality team are supporting the care home group agenda and have integrated quality support visits for nursing homes to reduce duplication for providers and improve information sharing and action planning. This will help to ensure the homes have a clear single support review and actions to address avoiding multiple action logs and requests. The first 4 visits have now taken place and a joint assessment document drafted ready for a workshop to determine the key performance indicators required to meet each standard. A report will be generated for the home, action plans requested and monitored for homes with development needs and signposting to additional support will be offered as appropriate.

49

Safeguarding Adults (continued)

Transforming Care Cohort There are currently 4 West Suffolk Residents still requiring acute treatment. All have discharge plans and community based provision is being explored in partnership with SCC. West Suffolk CCG quality team are taking part in regular updates with the Department of Health to support new data capture methods. The first monthly data collection to the Health and Social Care Information Centre was submitted by 27-02-2015. NHS England is conducting weekly teleconferences with the commissioners to ensure that Care and Treatment reviews are completed by the end of December 2014. Further updates of information to the HSCIC happen contemporaneously as patients are discharged or transferred. NHS England – Care and Treatment Reviews for people with learning disabilities who are currently inpatients. As at 1st April 2014 there were 2615 people with Learning Disabilities commissioned by NHS England, or Clinical Commissioning Groups in a hospital bed, many of whom have been in hospital for a number of years. NHS England is therefore carrying out a programme of reviews to clarify in greater detail: • the nature of the care and treatment being provided, • the engagement of the individual and their families in these plans and • what is currently preventing the right care and support being provided in a community setting near to home. Care and Treatment Reviews will support the individual and their family to have a voice, and will support the team around them to work together with the person and their family to support a discharge into community. Where resources and support are not in place to facilitate someone’s discharge, the reviews will make clear recommendations for what needs to be done to get to the point of a safe discharge. Each review will be initiated and coordinated by the local commissioner responsible for the person’s care and treatment supported by Expert advisors, an expert by experience and a clinical expert. The “experts by experience” will be people with learning disabilities or family carers who have experience of inpatient admission, or of supporting people who present challenges to live safely in the community. It is important that commissioners (or their delegates) who are to be responsible for the care of the individual following discharge are involved in the review process, including local authority commissioners where this applies. A further round of care and treatment reviews for patients admitted after 31st March 2015 will be completed by 30th June 2015. Currently there is 1 patient in this cohort that will be in this round of reviews which are currently being commissioned in conjunction with the NHS England sub regional team. A patient safety tool is due to be published by the Department of Health for providers to self-assess their service against key criteria.

50


NHS England – Care and Treatment Reviews for people with learning disabilities who are currently inpatients - continued At the end of the review it is expected that there will be a detailed analysis of the care and treatment plan, the current barriers to discharge and ideas of how they could be overcome. The reviews are carried out on the basis of open, frank and constructive discussion that include the patient and their family, and bring together facts and opinions to reach a consensus for future action. The purpose of the reviews is not to criticize, to initiate or pursue complaint or to argue against individual clinicians’ diagnosis or to seek automatic discharge of the individual. It is expected that such reviews will lead to a marked reduction in the number of people with learning disabilities in hospital care and in turn, provide individuals with more appropriate local care. Ipswich & east CCG patients that were due to receive a review have had these completed in February 2015. Self Assessment of providers and commissioners National self assessment tools are being populated to assist in quality monitoring and shared via the SAB health and MCA/DOLS sub group to improve learning and analysis of key themes. The final submission date for the self assessment for providers in March 2015. SCR The Independent Management Reviews for both Suffolk residents are completed and with the author. Early learning has been identified and will be progressed with each provider. This will be reported to the clinical executive and governing body. The author has requested some further clarity relating to the IMRs. All providers involved in the SCR process have now submitted the further information to the author. A further update is expected end of July 2015. PREVENT (WRAP3) A review of the prevent training was completed in October 2014 and we have been instructed by the Home Office that this will be in the format of WRAP3. A DVD and script has been distributed to support the training. The level to which different groups of staff (patient facing/non patient facing) need to be trained has been set out in recent guidance from NHS England. Within Suffolk, the training will be delivered (internally) and monitored (externally) through the two new adult safeguarding posts when appointed to.

51


DOLS Data This table shows how many of each months referrals have been completed and how many are still awaiting allocation by SCC:

Referrals Received 2014/15

Referrals Allocated or Withdrawn

2014/15

Shortfall Referrals Received 2015/16

Referrals declined,

authorised or Withdrawn

2015/16

Number of cases

awaiting Authorisation

April 135 135 0 264 46 218 May 169 169 0 228 17 211 June 206 194 12 0 0 0 July 319 165 154 0 0 0 August 218 87 131 0 0 0 September 261 124 137 0 0 0 October 252 103 149 0 0 0 November 193 84 109 0 0 0 December 248 103 145 0 0 0 January 308 100 208 0 0 0 February 194 76 118 0 0 0 March 176 66 110 0 0 0 Total: 2679 1406 1273 492 63 429

52


53


54

Safeguarding Adults

Summary: Health Sub Group to Safeguarding Adult Board (10 June 2015) The health sub group considers issues related to safeguarding, MCA and DOLs. The group includes acute providers, CCGs, Suffolk County Council and other relevant agencies as required. The below articles were discussed in depth at the meeting - copies are available. Self-neglect • Paula Youell circulated the Multi-agency policy and procedures in

responding to concerns of self-neglect. • Once a meeting group is set up Health Sub group will feed into the self-

neglect meetings. Non-urgent transport • Guidance on how healthcare professionals can call different transport has

been collated. • SC has drawn up and circulated two flowcharts to the group. • Non-urgent transport will also be added to the QIV document in due course. Coroner’s involvement re Death occurring when a DOLS authorisation is in place. Paula Youell circulated a draft document to the group that included the below headings: • Death occurring when a DOLS authorisation is in place • Not treated as a death in state custody • Death in custody • Useful information

St John’s Hospital - medium secure unit, with mental health and learning disability patients Sarah Markham, Adult Protection Team (APT) presented finding to the group. • St John’s hospital has complex-wide spread cases. Staffing and dignity aspects have been reviewed. • The organisation is run by “Partnership in Care”. • Gabby Irwin (GI) has escalated CCG to commence a quality review. PU agreement re grade 3&4 reporting Providers have requested clarity regarding when pressure ulcers should be reported as safeguarding concerns. GI to follow up. Suffolk County Council Safeguarding Adults Policy And Operational Guidance 2015 – 2017 is now out. Learning the lessons – Serious Case review and update on training • Action plan has been written • It has been drawn into series of Board actions and are going to

SCR panels for discussions. • Detailed report will be given, once it had been published, in July. • Negotiation is still going on. • Safeguarding Adult Review Advisory Panel (SARAP) was set up.

Tim Clouter will chair and progress will be tracked through this meeting. The first meeting was on the 24 June.

• Safeguarding Adult Board chair, Roy Elmer is leaving the organisation at the end of July.

55

Safeguarding Adults

Provider Top Successes & development Suffolk Community Healthcare • 97 % of staff up to date with adult safeguarding training Ipswich Hospital Trust (IHT) • Female Genital Mutilation (FGM) reporting has been implemented (3-4 since April 2015, last year there were only 4 reported altogether) • IHT and the Police are developing a programme to work collaboratively on “trafficking” Suffolk County Council • Funding was provided for 90 further practitioners for Best Interest Assessor (BIA) training Safeguarding Adult Board • Serious Care Review – Multi agency collaboration to drive forward the changes from serious cases has commenced • The Board website has been developed West Suffolk Hospital (WSH) • Improving compliance with MCA/DoLs awareness, following CQC recommendation. Care Homes • Care Homes – new model with Sue Smith (SS) • 47 within west Suffolk. SS reviewed every single resident. Attendances, to WSH, within those care homes are now significantly reduced. • East of England Ambulance Service NHS Trust (EEAST) was approached for support • Dementia Alliance have developed a new harm free care application. This requires sign off from internal government prior to use by health professionals. EEAST • Safeguarding prompt cards have been circulated to clinicians and were very well received. • EEAST restructure on-going. Safeguarding Lead to be appointed to ensure on-going involvement.

56

NSFT CQC Update

Last Stakeholder Assurance meeting held on 24th June 2015 Key updates from meeting • Update provided on the structure of the Project Management Office (PMO) and governance reporting lines - PMO fully staffed with the

exception of the Quality Lead, expected to recruit to the post in the following week • Streamlined relationship between locality and Trust-wide plans – Preventing duplication of effort, ensuring consistency of approach • Developed / implemented a project at a glance progress sheet to track progress against milestones, enabling early identification of projects at

risk of not delivering / requiring additional support • Regular exception reports on slippage and identification of action to bring projects back on track Example of completed projects provided

57

NSFT CQC Update

Quality Dashboard – Collaborative development The start of regular / structured quality reporting – development required setting thresholds / reporting trends. Meeting scheduled to progress development.

58

NSFT CQC Update

Finance CIP’s • Annual Plan Target £8.9m of which 83% (£7.4m) has been identified to date. • CIP Internal Target £11m of which: • - £2.795m (25%) has been actioned and removed from budgets • - £0.958m (8%) is deemed low risk but not yet removed from budgets • - £2.830m (26%) is deemed medium risk • - £0.833m (8%) is deemed high risk; and • - £3.584m (33%) is unidentified. • £5.933m (80% of the £7.416m) are recurrent savings whilst 1.484m are non-recurrent. • As at 31 May 2015 £0.782m delivered against the year to date target of £0.702m

• October 2015 step change in CIP delivery by circa £0.5m per calendar month

59

NSFT CQC Update

CIP’s • Risk assessment of the savings identified indicate that £5.4m of the £11m will be delivered in 2015/16 which is £3.5m short of £8.9m annual target. • There are a number of schemes on the CIP Pipeline Tracker and at the last Transformation Programme Board, a number of schemes were

discussed that will be pursued over the next few weeks. They have the potential of delivering £0.4m in the financial year. • A meeting is being held with key members of staff on 22 June 2015 to develop more ideas and determine how some of the schemes in the pipeline

can be accelerated. • A CIP workshop is being held on 7 July 2015 with senior managers in the Trust to elicit further new ideas and projects. • Work is already commencing on identifying savings for future years. • NSFT Finance Team are working their counterparts in NHCFT in sharing methodology in identifying savings and monitoring and reporting on CIPs. • Plan for 2016/17: • To have plans identified for the full target by December 2015. • To have all plans QIA’d by end of January 2016 • 80% of the plans are actioned by April 2016 • The Pipeline tracker has over £18m in future years: • 2016/17 £6.10m • 2017/18 £7.23m • 2018/19 £4.30m • 2019/20 £0.90m • Please note that the future years are mainly based on • Estates rationalisation £3.1m, • Management Costs £2m, • Curtail demand to services £1.75m, • Increase face to face £1m, • Secure services £1.5m, • Bids and tenders £1m , and • Integration and/or merger of organisation and services £4.5 CCG to review and sign of all CIPs quality impact assessments – being scheduled

60

NSFT CQC Update

Additional Updates • Suffolk locality QIP now received by the CCG • CCG staff have been supporting NSFTs mock CQC inspections – feedback that these inspections have not been structured to provide maximum

benefit to the Trust. Absence of preparation for inspectors / not structured in line with the CQC’s inspection criteria Summary • External stakeholder consensus that progress to date has been slow • CQC suggesting that they may delay re-inspecting (should take place within 12 months of original inspection) • CCG to review and sign off the quality impact assessments for all CIPs – Meeting being scheduled to progress • CCG to continue to work with NSFT to further develop the quality dashboard / reporting – Meeting scheduled to progress • CCG to review progress against Trust wide and Suffolk locality QIPs prior to monthly quality meetings- Meetings scheduled to monitor • CCG to continue to engage in stakeholder assurance meetings • CCG to continue to internally brief through Contract and work-stream meetings and monthly performance reports

61

Part 2

Financial and Performance Delivery Report

* Note : The totals in the tables may not add up due to rounding.

62

63

Financial Performance Summary

• The M3 YTD surplus position is £0.7m, which is on plan. The CCG is expecting to achieve its planned full year surplus.

Within the overall position the main variances are:

West Suffolk Hospital – Over performance of £0.1m against post QIPP plan. QIPP saving of £0.1m was achieved against a plan of £0.4m (including provision for M3).

QIPP – The CCG has achieved £1.9m of the planned £2.5m QIPP savings YTD (see QIPP Delivery Summary)

These above adverse variances are offset by favourable variances in: • Community Health Services - £0.2m (timing variance) • Non Recurrent Funding - £0.2m (partly timing variance) • Contingency £0.2m

Prescribing (GP) – The CCG is over plan by £0.7m against a post QIPP plan of £9.1m. This is mainly due to over performance of £0.3m in M1, and the assumption that this over performance will continue in M2 & M3.

WSCCG

Full Year Surplus/(Deficit)

Running Costs

Non Recurrent Funding

QIPP on plan

Prescribing

63

Summary of Outcomes

Income & Expenditure (see page x)

Key variances in the overall position are: • Prescribing (GP) - £0.7m adverse to plan (see Finance Report commentary). • West Suffolk Hospital – over performance of £0.1m against post QIPP plan. See below. • Community - £0.2m favourable timing variance due to phasing of community plan. • Non recurrent funding - £0.2m favourable variance , partly used to support the achievement of surplus. • Contingency - £0.2m favourable variance

Acute Activity Summary

The key areas of over performance against plan at West Suffolk Hospital are: • Total Elective activity is 3% higher than this time last year and 13% higher than the Post-QIPP plan. • Total Outpatient activity is 4% higher than this time last year and 2% higher than the Post-QIPP plan. • The Pre-QIPP plan reflects an anticipated shift from Daycase to Outpatient . WSCCG are making a financial adjustment to reflect this benefit however there

will be a delay in the coding change. This is partially offset by: • Total Non-Elective activity is 4% lower than this time last year and 3% lower than the Post-QIPP plan, this includes Emergency admissions which are 2% lower

than 14/15, but it is important to note that the cost is 3% higher than the Post-QIPP plan due to case mix.

Risk & Opportunities (See page X)

The CCG shows a balanced Risks & Opportunities position. The full year key risks are: • QIPP Operational £1.5m • Other QIPP £0.9m • Prescribing £1.0m • West Suffolk over performance £0.5m • Mental Health £0.1m

The risks are mitigated by the following opportunities: • Non Recurrent Funding £0.9m • Contingency £0.8m • Consequences £0.5m • Other Acute Services (other opportunities) £0.4m • Clinical Academic Reserve £0.4m • Quality Premium £0.4m • Others (Ambulance , Primary Care and Corporate Running Costs) £0.6m

Investment Tracker (See Page X)

• Non Recurrent Funding is under plan due to projects which have not yet started and the balance is withheld pending the achievement of surplus • Recurrent investments: These include Stroke ESD and GP Map of Medicine, which is currently overspent by £2k. • QIPP Investments is underspent by £8k due to the Dermatology spend being lower than plan.

QIPP Summary (see Page X)

Month 3 shows QIPP delivery of £1.9m against a plan of £2.5m, made up as follows; • Activity data up to month 2 for WSFT (£85K) and a provision for month 3 (£43K). • Block contract including QIPP has been agreed for Addenbrookes and therefore delivery is confirmed. • Prescribing QIPP is assumed as not being delivered due to M1 prescribing data which shows an overspend against plan. • Continuing Healthcare has delivered £197K up to M2 and a provision for M3 of £102K, totalling £299K against a plan of £250K. • Other QIPP has delivered £926K up to M2 and a provision of £463K, totalling £1,389K against a plan of £1,606K

1. See Financial Performance Summary (Page 63) 2. Community Health services: favourable timing variance

due to contract plan phasing . 3. Prescribing (GP) : over spent by £0.7m, driven by over

performance of £0.3m against plan in M1. It has been assumed that this over performance will continue in M2 & M3.

4. Non recurrent funding: favourable variance of £0.2m due to the release of uncommitted transformation and savings on projects which have not yet started.

5. Contingency: favourable variance of £0.2m used to support the achievement of surplus.

Finance report for the period June 2015

Budget Actual Variance Budget Actual Variance Budget Forecast Variance£m £m £m £m £m £m £m £m £m

Allocation of Income 24.8 24.8 0.0 70.5 70.5 0.0 280.1 280.1 0.0Running Cost Allowance 0.5 0.5 0.0 1.4 1.4 0.0 5.4 5.4 0.0In Year Adjustments 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0Total Income 25.3 25.3 0.0 72.0 72.0 0.0 285.5 285.5 0.0

West Suffolk Hospital 8.9 8.7 0.2 25.9 26.0 (0.1) 1 104.6 104.6 0.0Addenbrookes 2.3 2.3 0.0 7.0 7.0 0.0 28.1 28.1 0.0Other Acute Services 1.5 1.2 0.2 4.4 4.4 0.0 18.8 18.8 0.0Ambulance 0.7 0.7 0.0 2.1 2.0 0.1 8.3 8.3 0.0Mental Health & LD Services 2.3 2.3 0.0 6.9 6.9 (0.0) 27.5 27.5 0.0Community Health services 2.0 2.0 (0.0) 5.9 5.7 0.2 2 24.5 24.5 0.0Children's Services 0.1 0.1 0.0 0.4 0.4 0.0 1.5 1.5 0.0Continuing Care Services 1.1 1.1 0.0 3.4 3.4 0.0 13.5 13.5 0.0Prescribing (GP) 3.2 3.9 (0.7) 9.1 9.8 (0.7) 3 36.2 36.2 0.0Prescribing Other 0.2 0.2 0.0 0.5 0.6 (0.1) 1.6 1.6 0.0Primary Care 0.2 0.3 (0.0) 0.7 0.7 0.0 3.0 3.0 0.0Other Programme services 0.2 0.2 0.0 0.3 0.3 0.0 1.2 1.2 0.0Recurrent Operational Costs 22.8 23.0 (0.2) 66.7 67.2 (0.5) 268.9 268.9 0.0

Better Care Fund 0.4 0.4 (0.0) 1.2 1.2 (0.0) 5.0 5.0 0.0Winter Pressure 0.1 0.3 (0.2) 0.4 0.3 0.0 1.5 1.5 0.0Property Recharges 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0Commissioning Reserve (0.0) (0.0) (0.0) (0.1) (0.1) (0.0) (0.4) (0.4) 0.0Non Recurrent Funding 1.3 1.1 0.2 1.8 1.5 0.2 4 2.7 2.7 0.0Recurrent Investment 0.1 0.1 0.0 0.2 0.2 0.0 0.9 0.9 0.0Corporate Running Costs 0.5 0.5 (0.1) 1.4 1.4 0.1 5.4 5.4 0.0Contingency 0.1 (0.1) 0.2 0.4 0.1 0.2 5 1.4 1.4 0.0Non Recurrent & Running Costs 2.5 2.3 0.2 5.3 4.8 0.5 16.5 16.5 0.0

Operating Surplus/(Deficit) (0.0) (0.0) 0.0 0.0 0.0 (0.0) 0.1 0.1 0.0

Surplus B/F (1%) 0.2 0.2 0.0 0.7 0.7 0.0 2.8 2.8 0.0

Mandate Surplus for 15/16 0.2 0.2 0.0 0.7 0.7 (0.0) 2.9 2.9 0.0

Month YTD Full Year

66

Comments: Month 2 data shows QIPP delivery aimed at West Suffolk Hospital of £85k against a plan of £252k. Non Elective financial over performance continues to be seen, which has impacted on the Care Homes, Diabetes, LTC and Respiratory QIPP programmes. However, Paediatric emergency admissions are under plan which has delivered £41k of this QIPP total. A block contract has been agreed with Addenbrookes which includes QIPP, so delivery is confirmed. Only 1 month of data is available for Prescribing and as the CCG is over budget, the assumption is that QIPP has not been delivered. A provision has been made in Month 3 which assumes the same level of delivery seen YTD. This takes the total QIPP delivery to £1,856k for 3 months, which is 75% delivery.

WSCCG QIPP Delivery Summary

WSCCG QIPP Activity Savings for 15/16 @ 13-Jul-15

Financial RAG Programme of Work Description ActivityIndicative Post Threshold (£k) Target Saving

Actual Saving

QIPP Variance

Target Saving (£k)

Actual Saving (£k)

QIPP Variance (£k)

Pain Pain Pathway 2,933 £414k - 228 228 - £23k £23kDermatology Telederm OP 1,076 £127k 169 73 (96) £20k £10k (£10k)Ophthamology Ophthamology 4,443 £265k - - - - - - Cardiology Pathways Cardiology Pathways 1,036 £87k 171 - (171) £14k - (£14k)T&O/MSK T&O/MSK 42 £129k 6 4 (3) £20k - (£20k)Care Homes Emergency Ad'n 160 £310k 27 - (27) £52k - (£52k)Respiratory Emergency Ad'n 215 £396k 36 - (36) £66k - (£66k)LTC LTC 92 £106k 15 - (15) £18k - (£18k)Paediatric Admissions Emergency Ad'n 146 £121k 24 49 24 £20k £41k £21kDiabetes Diabetes 589 £208k 93 15 (78) £34k - (£34k)A&E Minor Attendances 698 £49k 117 136 19 £8k £11k £3kWSFT TOTAL 11,431 £2,211k 659 505 (154) £252k £85k (£167k)Addenbrooke's Total £160k £27k £27k - Activity Contingency £2,002k £334k £334k - LPP £400k £67k £67k - Prescribing £750k £125k - (£125k)CHC £1,000k £167k £197k £30kLucentis £870k £145k - (£145k)Contingency £600k £100k £100k - Financial Management £1,853k £309k £309k - Corporate Costs £200k £33k £33k - Contract Management (consequences) £500k £83k £83k - Total QIPP £10,546k £1,641k £1,234k (£407k)Month 3 Provision £831k £622k (£209k)Total YTD £10,546k £2,472k £1,856k (£616k)

Full Year Target Saving Activity YTD Indicative Post Threshold Cost

£88k

£144k

£20k

£125k

£33k

£11k-

£41k

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

Plan

ned

Inte

grat

ed CYP

Pres

crib

ing

Planned Saving vs Actual Saving

67

Risks & Opportunities

Notes 1. West Suffolk, Addenbrookes, Prescribing & CHC QIPP. 2. Lucentis QIPP 3. Underspend on LES. 4. Underspend on Dressings, High Cost Drugs, & Central Drugs.

NotesYTD

Position Timing

YTD Position

Real

Total Variance

YTD

Full Year Opportunities

& Risks%

Risk Weighting

+£0.0 mOperational QIPP 1 +£0.0 m -£0.4 m -£0.4 m -£4.0 m 38% -£1.5 mWest Suffolk Hospital +£0.0 m +£0.2 m +£0.2 m -£1.0 m 45% -£0.5 mAddenbrookes +£0.0 m +£0.0 m +£0.0 m +£0.0 m 0% +£0.0 mPrescribing (GP) +£0.0 m -£0.7 m -£0.7 m -£1.2 m 86% -£1.0 mMental Health & LD +£0.0 m -£0.0 m -£0.0 m -£0.2 m 50% -£0.1 mOther QIPP 2 +£0.0 m -£0.2 m -£0.2 m -£0.9 m 100% -£0.9 m

+£0.0 mTotal Risks +£0.0 m -£1.2 m -£1.2 m -£7.2 m -£4.0 m

Ambulance +£0.0 m +£0.1 m +£0.1 m +£0.3 m 58% +£0.2 mCommunity +£0.2 m +£0.0 m +£0.2 m +£0.0 mContinuing Healthcare +£0.0 m +£0.0 m +£0.0 m +£0.0 m 0% +£0.0 mOther NHS Acute Providers +£0.0 m +£0.1 m +£0.1 m +£0.0 m 0% +£0.0 mOther Acute Services +£0.0 m +£0.1 m +£0.1 m +£1.5 m 30% +£0.4 mOther Primary Care 3 +£0.0 m +£0.0 m +£0.0 m +£0.2 m 90% +£0.2 mClinical Academic Reserve +£0.0 m +£0.0 m +£0.0 m +£0.7 m 50% +£0.4 mContingency +£0.2 m +£0.2 m +£0.8 m 100% +£0.8 m1.0% Transformational +£0.2 m +£0.0 m +£0.2 m +£1.9 m 50% +£0.9 mRecurrent Investments +£0.0 m +£0.0 m +£0.0 mPrescribing Other 4 +£0.0 m +£0.1 m +£0.1 mCorporate Running Costs +£0.1 m +£0.1 m +£0.9 m 20% +£0.2 mQuality Premium +£0.4 m 100% +£0.4 mConsequences & CQUIN +£0.5 m 100% +£0.5 m

Total Opportunities +£0.4 m +£0.8 m +£1.2 m +£7.1 m +£4.0 m

TOTAL +£0.5 m -£0.5 m +£0.0 m -£0.1 m ##########

Additional Funds Required:

Funded by:

Key Provider Financial Summary

West Suffolk Hospital shows over performance of £0.1 m against post QIPP plan. Addenbrookes shows no variance as the CCG has a block contract for 15/16 (shown by the green line below). The graph shows actual activity spend for M1 and M2 as per the monitoring statement from Addenbrookes.

Ambulance shows an underperformance of £0.08m, against YTD plan of £2.09m. Papworth shows an underperformance of £0.2m in M2. Analysis of M2 data has shown that Elective activity was £0.03m under plan, non-Elective was £0.04m over, and overall outpatient activity was £0.01m under.

69

Investment Tracker

Notes 1. Cost of reprovision in other settings 2. WSCCG share of Clinical Threshold Nurse 3. Cost of reprovision in other care settings 4. 2 x Band 7 care homes clinical support nurse 5. 2 x Band 7 Clinicians 6. To support investment of home carers, DIST, etc. 7. Share of CCG Risk Pool for 2015/16 8. New service provided by Norfolk Community & Care 9. New software 10. Cost of reprovision in other settings 11. Cost of reprovision in other settings

Budget ForecastPredicted Variance

Budget Actuals Variance

£'000 £'000 £'000 £'000 £'000 £'000NON-RECURRENT INVESTMENTOphthalmology 1 98 98 0 25 0 25Clinical Thresholds 2 22 22 0 6 5 1Cardiology Pathways 3 41 41 0 10 0 10Care Homes 4 88 88 0 22 11 11Respiratory 5 88 88 0 22 0 22Long Term Conditions 6 88 88 0 22 0 22

CHC Risk Pool 7 1,429 1,429 0 1,429 1,429 0

Ring Fenced Funding 890 890 0 223 100 123

NON-RECURRENT FUNDING 2,744 2,744 0 1,758 1,545 213

RECURRENT INVESTMENT (Non-QIPP)Stroke ESD 8 412 412 0 103 103 (0)GP MAP of Medicine 9 42 42 (0) 10 13 (2)

RECURRENT INVESTMENT TOTAL 454 454 (0) 113 116 (2)

QIPP INVESTMENTSPain 10 350 350 0 88 88 (0)Dermatology 11 56 56 (0) 14 6 8

QIPP INVESTMENT TOTAL 406 406 (0) 101 93 8

TOTAL INVESTMENTS 3,604 3,604 (0) 1,973 1,753 220

YTDFull Yr

Notes

Provider Commentary Continuity of Service Risk

Rating

West Suffolk Hospital

"The Income and Expenditure position for May 2015 is a deficit of £0.7m, against a planned deficit of £0.4m, resulting in an adverse variance of £0.3m in May. This includes a CIP target of £1.1m YTD. The month 2 YTD position is adverse to plan by £0.7k.” (Source: Finance and Workforce Report May 2015)

1

Addenbrookes (CUHFT)

“At the end of May the Trust had a deficit of £10.3m, which was £0.3m adverse to plan. Clinical income was less than plan, total expenditure was under spent, eHospital costs were on plan. The trusts cash position stands at £29.5m, which is £2.5m more than budget.” (Source: CUH Integrated report to April 2015)

1

Ipswich Hospital

“The financial position for 2015/16 is a deficit of £19.8m, at Month 1, the financial position is on plan with a deficit of £2.3m for the month and YTD. The focus is on controlling and then reducing the level of risk within the financial plan. A financial improvement position is under discussion with the TDA, this work will progress during quarter 1. Total income of £20.8m is £0.3m above plan, YTD operating expenditure of £21.9m which is £0.3m in excess of plan. The trust cash balance is £0.5m at the end of Month 1.” (Source: Ipswich Hospital Trust Board Meeting 28th May 2015)

2

Norfolk & Suffolk

Foundation Trust (NSFT)

"A deficit in the month of £0.9m, increases the year to date deficit position to £1.5m. The monthly run rate of income and expenditure remains broadly in line with that achieved during the latter months of 2014/15. The overall YTD deficit position is favourable against the Annual Plan by £1.2m but this is considered to be a timing difference, which has been caused by the phasing of some reserves in the earlier part of the year which will be utilised over the coming months. The cash held by the trust at the end of May was £8.4m, which is £2.4m behind the plan of £10.8m. This is considered a timing difference." (Source: NSFT Board Minutes 25th June 2015)

1

East of England Ambulance

Service Trust (EEAST)

“The Trust has a deficit of £0.7m for the month of April against the planned deficit of £0.4m (an adverse variance of £0.3m). Cash balance stands at £16.5m against plan of £16.5m, year-end forecast out-turn remains as plan (i.e. breakeven) at this early stage of the year.” (Source: EEAST Financial Position report for Meeting 28th May 2015)

3

System Wide View

Source: Monitor’s Risk assessment framework Updated March 2015 (also used by TDA as per the TDA Framework 15/16)

Continuity of service risk rating

Description Monitoring frequency Regulatory activity

4 No evident concerns Quarterly None3 Emerging or minor concern potentially requiring scrutiny Potential monthly Consideration for potential investigation if liquidity or capital service capacity component is rated 1

2* Level of risk is material but stable Potential monthly None2 Material risk Monthly or greater Consideration for potential investigation 1 Significant risk Monthly or greater Consideration for potential investigation

71

No. Indicator Ref Description Quality

PremiumContractual

MeasureCurrent Period

Current Period Target

Current Period Actual

Latest applicable

target

YTD Actual Comments Potential Value Probability of

SuccessPotential QP Achievable

33 EA1 Potential years of life lost (PYLL) from causes considered amenable to healthcare

10% N Annual 15/16 1,739 WSCCG - Available Nov 16 £121,559 Likely £121,559

Urgent and Emergency Care:Increase in level of discharges at weekends and Bank Holidays 30% N Monthly 15/16

Calculating baseline and current performance £364,676

Deliverable With Effort £0

Mental Health Measure:Reduction in the number of patients with A&E 4 hr breaches who have attended with a mental health need together with an improvement of coding in patients attending A&E

30% N Monthly 15/16Calculating baseline and

current performance £364,676 Likely £364,676

Improving Antibiotic Prescribing - 3 elements: 10% Combined measure of below £121,559 Deliverable With Effort

£0

(50%) Calculating baseline and current performance

(30%)Calculating baseline and

current performance

(20%) Calculating baseline and current performance

3 Local 1 (C2.13)

Estimated diagnosis rate for people with dementia 10% N Monthly 15/16 67% 67%WSCCG - new methodology in

15/16. Data not currently available, due Sept 2015

£121,559 Deliverable With Effort

£0

47 Local 2 (C3.5)

People who have had a stroke who are admitted to an acute stroke unit within four hours of arrival at hospital

10% N Monthly May-15 90% 83.9% 90% 76.5%

Measure is for WSCCG. Currently only able to report WSFT performance (shown

as an indication)

£121,559 Likely £121,559

West Suffolk CCG Quality Premiums - Potential reductions Sub-Total £1,215,585 £607,793

10 EB3The percentage of Referral to Treatment (RTT) pathways within 18 weeks for incomplete pathways

Reduction 30% Y Monthly May-15 92% 94.9% 92% 94.4% WSCCG

13 EB5 A&E waiting time - total time in the A&E departmentReduction

30% Y Monthly May-15 95% 95.9% 95% 94.4% WSFT

15 EB6 All Cancer 2 week waitsReduction

20% Y Monthly May-15 93% 97.8% 93% 95.3% WSCCG

24 EB15iAmbulance clinical quality – Category A (Red 1) 8 minute response time

Reduction 20% Y Monthly May-15 75% 76.8% 75% 68.3% WSCCG

Potential Reduction in QP -50% £303,896

Total Potential Quality Premium £303,896

Quality Premium Performance measures - 15/16 - West Suffolk CCG

West Suffolk CCG Quality Premiums

21/07/2015

3. Secondary Care validating their total antibiotic prescribing

Monthly 15/16

1. Reduction in the number of antibiotics prescribed in primary care by 1%2. Number of co-amoxiclav, cephalosporins and quinolones as a percentage of the total number of selected antibiotics prescribed in primary care to be reduced by 10%

72

14/07/2015No. Indicator Ref

15/16 Description Framework Quality Premium

Reporting Frequency

Current Period



Latest applicable

targetYTD Actual Direction of

Travel Comments

2. Enhancing quality of life for people with long term conditions

1 NHS 2.3.i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (WC1.1.1) NHS Outcomes - Monthly May-15 128 152 257 310 WSFT (indication of performance on Annual measure E.A.4)

2 NHS 2.3.ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s (WC1.1.2) NHS Outcomes - Monthly May-15 17 18 33 38 WSFT (indication of performance on Annual measure E.A.4)

3 E.A.S.1 Estimated diagnosis rate for people with dementiaNHS EC Annex A Support Measure 10% Monthly

WSCCG - new methodology in 15/16. Data not currently available

3. Helping people to recover from episodes of ill health or following injury

4 NHS 3a Emergency admissions for acute conditions that should not usually require hospital admission (WC1.1.3) NHS Outcomes - Monthly May-15 255 272 510 555 WSFT (indication of performance on Annual measure E.A.4)

5 NHS 3.2 Emergency admissions for children with Lower Respiratory Tract Infections (WC1.1.4) NHS Outcomes - Monthly May-15 14 4 27 17 WSFT (indication of performance on Annual measure E.A.4)

5. Treating and caring for people in a safe environment and protecting them from avoidable harm

6 E.A.S.4 Healthcare acquired infection (HCAI) measure (MRSA) NHS EC Annex A Support Measure - Monthly May-15 0 0 0 0 WSCCG

7 E.A.S.5 Healthcare acquired infection (HCAI) measure (clostridium difficile infections) NHS EC Annex A Support Measure - Monthly May-15 4 8 8 11 WSCCG

Referral To Treatment Pathways

8 E.B.1 The percentage of Referral to Treatment (RTT) pathways within 18 weeks for completed admitted pathways NHS EC Annex B Measure - Monthly May-15 90% 87.8% 90% 85.9% WSCCG

9 E.B.2 The percentage of Referral to Treatment (RTT) pathways within 18 weeks for completed non-admitted pathways NHS EC Annex B Measure - Monthly May-15 95% 94.2% 95% 94.0% WSCCG

10 E.B.3 The percentage of Referral to Treatment (RTT) pathways within 18 weeks for incomplete pathways NHS EC Annex B Measure - Monthly May-15 92% 94.9% 92% 94.4% WSCCG

11 E.B.S.4 Number of 52 week Referral to Treatment Pathways NHS EC Annex B Support Measure - Monthly May-15 0 4 0 6 WSCCG

Diagnostic test waiting times

12 E.B.4 Diagnostic test waiting times NHS EC Annex B Measure - Monthly May-15 1% 10.13% 1% 9.63% WSCCG

A&E waits

13 E.B.5 A&E waiting time - total time in the A&E departmentNHS EC Annex B

Measure - Monthly May-15 95% 95.9% 95% 94.37% WSFT

14 E.B.S.5 Trolley waits in A&ENHS EC Annex B Support Measure - Monthly May-15 0 0 0 0 WSFT

Cancer waits - 2 week wait

15 E.B.6 All Cancer 2 week waits NHS EC Annex B Measure - Monthly May-15 93% 97.8% 93% 95.3% WSCCG

16 E.B.7 Two week wait for breast symptoms (where cancer was not initially suspected) NHS EC Annex B Measure - Monthly May-15 93% 96.7% 93% 95.7% WSCCG

Cancer waits - 31 days

17 E.B.8 Cancer day 31 waits: Percentage of patients receiving first definitive treatment within one month of a cancer diagnosis

NHS EC Annex B Measure - Monthly May-15 96% 98.2% 96% 96.2% WSCCG

18 E.B.9 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-surgery NHS EC Annex B Measure - Monthly May-15 94% 100.0% 94% 98.1% WSCCG

19 E.B.10 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-anti cancer drug regimens NHS EC Annex B Measure - Monthly May-15 98% 97.7% 98% 98.9% WSCCG

20 E.B.11 Cancer day 31 waits: 31-day standard for subsequent cancer treatments-radiotherapy NHS EC Annex B Measure - Monthly May-15 94% 100.0% 94% 99.0% WSCCG

Cancer waits - 62 days

21 E.B.12 Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within two months (62 days) of an urgent GP referral for suspected cancer


22 E.B.13 Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of referral from an NHS Cancer Screening Service


23 E.B.14 Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status

NHS EC Annex B Measure - Monthly May-15 88.9% 100.0% 89.7% 100.0% WSCCG - Target is Monthly National

Average

National Performance measures - 15/16 - West Suffolk CCG

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73



Reporting Frequency

Current Period



Latest applicable


Travel Comments

Ambulance Measures

24 E.B.15.i Ambulance clinical quality – Category A (Red 1) 8 minute response time NHS EC Annex B Measure - Monthly May-15 75% 76.8% 75% 68.3% WSCCG

25 E.B.15.ii Ambulance clinical quality – Category A (Red 2) 8 minute response timeNHS EC Annex B

Measure - Monthly May-15 75% 60.8% 75% 61.8% WSCCG

26 E.B.16 Ambulance clinical quality - Category A 19 minute transportation timeNHS EC Annex B

Measure - Monthly May-15 95% 88.4% 95% 89.5% WSCCG

27 EBS7a Ambulance handover time - 1) Handover delays over 30 minutesNHS EC Annex B Support Measure - Monthly May-15 0 75 0 158 WSFT

28 EBS7b Ambulance handover time - 2) Handover delays over 1 hourNHS EC Annex B Support Measure - Monthly May-15 0 6 0 10 WSFT

Mixed Sex Accomodation

29 E.B.S.1 Mixed Sex Accommodation (MSA) Breaches NHS EC Annex B Support Measure - Monthly May-15 0 0 0 0 WSCCG

Cancelled Operations

30 E.B.S.2 Cancelled OperationsNHS EC Annex B Support Measure - Monthly May-15 0 1 0 1 WSFT

31 E.B.S.6 Urgent Operations cancelled for a second timeNHS EC Annex B Support Measure - Monthly May-15 0 0 0 0 WSFT

Mental Health

32 E.A.3 IAPT Roll OutNHS EC Annex A

Measure - Quarterly Q4 14/15 3.82% 4.6% 3.76% 4.0% WSCCG

33 E.A.S.2 IAPT Recovery RateNHS EC Annex A Support Measure - Quarterly Q4 14/15 50% 49.1% 50% 48.1% WSCCG

34 E.B.S.3 Mental Health Measure – Care Programme Approach (CPA)NHS EC Annex B Support Measure - Quarterly

WSCCG - Unify data has not been updated since Q1 2014

National Performance measures - 15/16 - West Suffolk CCG



Reporting Frequency 2011/12 2012/13 2013/14 2014/15

Ambition2015/16 Ambition Comments

33 E.A.1 Potential years of life lost (PYLL) from causes considered amenable to healthcareNHS EC Annex A

Measure 10% Annual 1,446 1,866 1,576 1,806 1,739 WSCCG - 2014 available Summer 2015

34 E.A.2 Health-related quality of life for people with long term conditionsNHS EC Annex A

Measure - Annual 75.2% 75.7% 75.1% 76.3% 77.2% WSCCG - 2014 available Summer 2015

35 E.A.4 Composite measure on emergency admissionsNHS EC Annex A

Measure - Annual 1,846 1,955 1,969 2,004 1,948 WSCCG - 2014 available Summer 2015

36 E.A.5 Patient Experience of Hospital CareNHS EC Annex A

Measure - Annual 97 99 120 119 WSCCG - 2014 available Summer 2015

Data from Atlas of Variation -Levels of Ambition Tool

National Annual Performance measures - 15/16 - West Suffolk CCG

1. Preventing people from dying prematurely

2. Enhancing quality of life for people with long term conditions

4. Ensuring that people have a positive experience of care

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No. Indicator Ref 15/16 Description Framework Reporting

Frequency Current Period Current Period Target


Latest applicable


Travel Comments

41 W4C1.16 A maximum two-week wait standard for rapid access chest pain clinic WSFT Contract Quarterly Q1 15/16 100% 98.3% 100% 98.3% WSFT

42 WC2.2 Provider to ensure compliance with a maximum 18 week referral to treatment wait for non-consultant led services WSFT Contract Monthly May-15 95% 100.0% 95% 100.0% WSFT

43 W4C2.6 Direct Access Diagnostics WSFT Contract Monthly May-15 0 1 0 1 WSFT

44 W4C5.2 Current ratios of OP procedure to day case for agreed list WSFT Contract Monthly May-15 89.84% 90.76% 89.8% 90.73% WSFT

45 W4C2.7 Provider failure to ensure that “sufficient appointment slots” are made available on the Choose and Book system WSFT Contract Monthly May-15 3% 3.44% 3% 3.81% WSFT

46 Sc2 19.4/5 Provider cancellation of Elective Care operation for non-clinical reasons either before or after Service User admission

WSFT Contract Monthly May-15 1% 2.07% 1% 2.12% WSFT

47 W4C1.2 Proportion of Patients admitted to an acute stroke unit within 4 hours of hospital arrival WSFT Contract Monthly May-15 90% 83.9% 90% 76.5% WSFT

48 W4C1.3 Proportion of Patients in Atrial Fibrillation, presenting with stroke, receiving anti-co-agulation WSFT Contract Monthly May-15 60% 66.7% 60% 88.9% WSFT

49 W4C1.4 Proportion of Stroke Patients with access to a brain scan within 24 hours WSFT Contract Monthly May-15 100% 100.0% 100% 95.7% WSFT

50 W4C1.5 Proportion of Stroke Patients and carers with a joint health and social care plan on discharge WSFT Contract Monthly May-15 100% 100.0% 100% 100.0% WSFT

51 W4C1.6 Stroke - % of Stroke patients needing an URGENT brain scan getting access within 60 minutes WSFT Contract Monthly May-15 100% 100.0% 100% 88.0% WSFT

52 W4C1.7 Stroke - ->80% people treated on a stroke unit >90% of their stay WSFT Contract Monthly May-15 80% 83.9% 80% 80.9% WSFT

53 W4C1.8 Stroke->60% people who have a TIA and are high risk are scanned and treated within 24 hours of contact but not admitted


54 W4C1.9 Stroke - 65% of Patients with low risk TIA have access to MRI or carotid scan within 7 days WSFT Contract Monthly May-15 65% 43.8% 65% 68.8% WSFT

55 W4C1.10 Stroke - % of Patients, eligible for Thrombolysis, Thrombolysed within 4.5 hours (9A) WSFT Contract Monthly May-15 100% 100.0% 100% 100.0% WSFT

56 W4C1.11.1 Unplanned re-attendance rate at A&E within 7 days (excluding patients where the reattendance does not relate to the same condition) This includes those patients referred back by a Health Professional


57 W4C1.11.2 Left department without being seen [rate] WSFT Contract Monthly May-15 5% 1.3% 5% 1.3% WSFT

58 W4C1.12 Time to treatment in department (median) for all patients arriving by ambulance WSFT Contract Monthly May-15 01:00 01:20 WSFT

59 W4C1.13 Single longest total time spent by Patients in the A&E department, for admitted and non admitted Patients (excluding patients transferred to the CDU)

WSFT Contract Monthly May-15 06:00 11:24 WSFT

60 W4C1.14a Number of admissions for cellulitis per head of weighted population WSFT Contract Monthly May-15 23 26 45 58 WSFT

61 W4C1.14b Number of admissions for DVT per head of weighted population WSFT Contract Monthly May-15 7 6 7 23 WSFT

62 W4C1.15 Percentage of Patients presenting at type 1 and 2 (major) A & E sites in certain high risk categories who are reviewed by an emergency medicine consultant before being discharged


63 W4C1.18.2 Threshold for admission via A&E WSFT Contract Monthly May-15 27% 23.1% 27% 22.7% WSFT

64 W4C5.4 Excess bed days consolidated: Non-elective and Elective WSFT Contract Monthly May-15 0.407 0.411 0.407 0.469 WSFT - New combined measure for 15/16

Performance measures - 15/16 - West Suffolk CCG

Planned Care Clinical Workstream

Integrated Care/End of Life

14/07/2015

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Note – There are a few measures which have not been shown this month due to delays in data being submitted or published (mainly quality measures.) These will be added as soon as data is available. Key WSCCG measures which are over target this month are RTT and Cancer waits. Also, whilst Ambulance performance has improved for Category A (Red 1) 8 minute response in May, this remains below target YTD. The other 2 response time measures have declined this month and remain below target. Diagnostic Test Waiting times continue to be significantly below the target and performance has reduced further in May to 10.1% against a target of 1%. Key WSFT measures which are over target are Stroke measures on patients admitted to an acute stroke unit within 4 hours and patients with low risk TIA having access to MRI or carotid scan within 7 days (measures W4C1.2 and W4C1.9) Ambulance handover times continue to exceed 30 and 60 minutes.

No. Indicator Ref 15/16 Description Framework Reporting

Frequency Current Period Current Period Target


Latest applicable


Travel Comments

66 WC2.1 Acute oncology service - 1 hour door to needle for all patients presenting with suspected neutropenic sepsis WSFT Contract Monthly Apr-15 100% 50.0% 100% 50.0% WSFT

68 WC3.1 Breastfeeding initiation rates WSFT Contract Monthly May-15 80% 76.0% 80% 77.1% WSFT

69 WC3.2 Children (aged under 16) who have had bacterial meningitis or Meningococcal septicaemia who have a follow-up appointment 85% within 6 weeks of discharge

WSFT Contract Quarterly Q1 15/16 85% 100.0% 85% 100.0% WSFT

70 WC3.3 Maintain the proportion of births that are undertaken as caesarean sections WSFT Contract Monthly May-15 22.7% 21.3% 22.7% 21.7% WSFT

71 WC3.4 Maintain maternity 1:30 ratio WSFT Contract Monthly May-15 01:30 01:30 WSFT

72 WC3.5 Access to Maternity services (VSB06) WSFT Contract Monthly May-15 90% 94.8% 90% 96.1% WSFT

73 WC3.6 1:1 care in established labour WSFT Contract Monthly May-15 100% 100.0% 100% 100.0% WSFT

90 W4C2.3 Discharge Summaries: Outpatient WSFT Contract Monthly May-15 95.0% 91.4% 95.0% 91.0% WSFT

91 W4C2.4 Discharge Summaries: Inpatient WSFT Contract Monthly May-15 95.0% 90.9% 95.0% 90.6% WSFT

92 W4C2.5 Discharge Summaries: A&E WSFT Contract Monthly May-15 95.0% 96.5% 95.0% 96.0% WSFT

Cancer

Childen & Young People/Maternity

Other - Clinical Quality

Performance measures - 15/16 - West Suffolk CCG 14/07/2015

75

Part 3 Clinical Workstreams

Clinical workstreams – Summary Dashboard


* The above QIPP schemes are a subset of the CCG QIPP schemes. For detailed list of CCG QIPP schemes please refer to Page 66.

Planned NET Annual Saving

Planned NET Saving YTD

Actual NET Saving YTD

% delivery

YTD

RAG

Finance Milestones

£ 413,694 £ - £ 23,001 230.0% G G

Project: P1 - Pain

Activity: Activity under-plan due to Outpatients (Plan – 4,674, Actual – 4,446). QIPP savings phased from July. Community Pain Service: • Communication on new service and referral information circulated to primary care - new service promoting itself via GP practice visits • Pain SV with WSFT for signature - step down of existing WSFT patients to be finalised to new service LPP Pain Policies: • Pain Policies and checklists published on the website and circulated - circulated agreed communications including referral form to

GPs Next Steps: • Meeting on 30.07.15 to agree the route for patients from BANS to CPMS and onto WSFT. • Sign the CPMS contract. • Finalise the pain dashboard and pain website with CPMS Key Issues: • Referrals number to CPMS remain low – continue to promote the service • WSFT have not signed and appear to not directing referrals to CPMS or stepping down patients to the service.

Key issues, progress, risks and mitigations etc.:

Focus on developing a holistic integrated three tier approach (primary, community and secondary care) to pain management with a new clearly defined “tier 2” based in the community. develop a suite of clinical policies for procedures that are of limited benefit and support the implementation of the updated medication formulary (‘pain ladder’).




% delivery

YTD

RAG

Finance Milestones

£ 127,236 £ 19,946 £ 9,983 50.1% R G

Project: P2 – Dermatology

Activity: Outpatient reduction not meeting target levels. Target YTD OP savings is 169, Actual OP savings is 73 (43%)

New Service Model: • Paper to Executive in July 2015 to set out the service model as worked up and clarify the procurement route for the integrated model

(to go to market or not). • A second draft service specification has been produced and shared with stakeholders (26 June). Comments are awaited for any

amendments to be made.

Tele-dermatology Pilot: • In June 2015 there were 86 referrals. Of these, 13 (16%) were referred to secondary care and 73 were dealt with in primary care. • Guildhall, Clare and Brandon practice had tele-dermatology installed on 3 June. • A dashboard has been produced to track progress of the tele-dermatology initiative. This will be utilised to complete a review of the

initiative in September. The initial data gives encouragement that tele-dermatology is diverting unnecessary referrals from secondary care.

Next Steps: • Develop an outline Business Case with supporting service specification. • A webinar is planned to bring together all stakeholders in the integrated dermatology initiative and a visit to an established integrated

dermatology service is planned for July.

Key Issues: • Decision required as to extend the Vantage pilot beyond September 2015 or not. • Need Executive to agree the procurement model.


System wide integrated hub / prime contractor approach to Dermatology with a focus on developing the tele-dermatology for tele-lesions into a full expanded service. To reduce outpatient costs of patients who attend dermatology and plastics on the same day, and to reduce GP referrals to outpatient clinics.




% delivery

YTD

RAG

Finance Milestones

£ 265,312 £ - £ - 0.0% G A

Project: P3 – Ophthalmology

Activity: QIPP savings phased from July.

Community Glaucoma Service: • Community Glaucoma Service’ business case was not tabled at WSFT Trust Executive Group on 29 June as scheduled. It has been

delayed on 3 occasions. CCG escalated to WSFT. Service ‘go live’ delayed until at least August due to slippage.

West Suffolk Ophthalmology Forum: • Dry eyes guidance for Primary Care is awaiting final sign off by WSFT consultant ophthalmologist and CCG Medicines Management.

Patient information leaflets on dry eyes and blepharitis also in draft. • Evolutio have now produced a performance dashboard, which will be reported to CCG information on a monthly basis.

Next Steps: • Future ophthalmology model. Meeting organised between I&E/W CCG Clinical Leads on 14.07.15. Meeting with WSFT

ophthalmology senior team on 17.07.15 to engage & get feedback on draft model. Next Clinical Transformation Group meeting on 21.07.15.

• Work with WSFT and Medicines management to finalise dry eyes guidance for Primary Care and publish in collaboration with Practice Support team. Work with WSFT to produce patient information leaflets.

• Scope and agree agenda with WSFT by August for GP education event on ophthalmology & ENT (24 November)

Key Issues: • Clinical Transformation Group workshop on 16 June was challenging. Focus now on clinical engagement in East & West. • Need WSFT to sign off Community Glaucoma business case and mobilise Newmedica.


To work collaboratively with hospital eye service (HES) and other providers to provide best practice to ophthalmology patients. Develop new community services such as orthoptist-led children’s pathway/ glaucoma and retender existing community service with revised triaging/referral route from school nurses/health visitors/ children’s centres.

Project: P4 – Cardiology Pathways Planned NET

Annual Saving



% delivery

YTD

RAG

Finance Milestones

£ 86,931 £ 14,311 £ - 0.0% R G

Activity: Activity targets for Echocardiagram and OP not being achieved. Hence no QIPP savings to date. Progress: • Next clinical forum meeting on 02/9/15 • Atrial fibrillation (AF) options paper worked up for Planned Care on 08.07.15. • An independent programme offers a service to perform a clinical review of the practice data to identify patients at risk of AF and

check that AF patients’ medication is optimised. • Five WSCCG practices have taken up the invitation to undertake this review.

Next Steps: • Heart Failure (HF) pathway. Obtain BNP activity data from TPP and seek GPs feedback on pathway. • Atrial Fibrillation (AF). Develop action plan pending debate at Planned Care. Paper to Executive in July. Key Issues: • No information available from TPP. • Need to consider the protocols for working with Pharma.


To develop Heart Failure (HF) pathways in the community and HF services. Support clinical forum to monitor services and identify improvement opportunities. To reduce echocardiography appointments for heart failure; reduce outpatient appointments for 24 hour ECG; reduce prescribing costs for cardiology medication.




% delivery

YTD

RAG

Finance Milestones

£ 128,596 £ 19,643 £ - 0.0% R G

Project: P5 – T&O and MSK

Activity: Bunion LPP under plan, but off-set by over-performance in Hip replacement. Hence no overall QIPP saving YTD. Progress: • T&O forum on 17 June discussed virtual fracture clinic, clinical thresholds including the new bunions and pain thresholds, new

Community Pain Management Service and Community Physiotherapy. • Initial Bunions activity indicates savings are being accrued • BaNS pathway identified as an issue and links to the Community Pain Service. • Planned care reviewed the BMI Carpal Tunnel service and agreed that opportunities to work with WSFT to streamline the Carpal

Tunnel service should be pursued • The knee pathway was submitted for HSJ award consideration Next Steps: • CCG, AHPS and WSFT to meet to refine the pathway for BaNS interaction with the Community Pain Service (meeting on 30 July

2015) • Seek opportunities to work with WSFT to streamline the Carpal Tunnel service • Review papers from the 2nd meeting of the Ipswich and East Suffolk MSK Clinical Transformation Group and update planned care

with any headlines.


To embed T&O pathways and services and review clinical policies for clinically effective interventions to deliver improved quality and patient experience with associated cost savings. Focus on the hip pathway. Develop and implement a clinical threshold for bunions. Work with single-provider for integrated community MSK physiotherapy to implement further service improvements.




% delivery

YTD

RAG

Finance Milestones

£ 309,803 £ 51,634 £ - 0.0% R A

Project: P6 - Care Homes

Activity: Emergency admission reductions reported in the 10 targeted care homes have been absorbed into emergency admissions from all care homes, which are not meeting the target reductions. Hence, no overall QIPP savings YTD.

Progress: •The targeted 10 care homes which have had the full cycle of interventions to date demonstrating a 50% reduction in non elective emergency admissions (EPRO data) with marked improvement in care home staff engagement – 213 resident and family discussions have taken place and 138 yellow folders established and 139 advanced care plans developed. Progress to extend outside the top 10 targeted care homes delayed as unable to recruit to second clinical post - 0.2wte of redesign team time now in place supporting clinical reviews to mitigate some of this risk to QIPP plan. •Care Home Clinical Support Manager (CHCSM) - completed resident reviews at Fornham House, Hazell Court and St Josephs. Now progressing to Cornwallis Court. •HEE funding for training NOT successful – Hospice supporting some of the gap by providing 1 day a week of training to top ten care homes on key admission themes (EoL, UTI management, respiratory management). •Preparation commenced for West Suffolk Care Homes Conference, which will be held on 4th September •Progressing action plan of Suffolk Care Homes Group i.e. NHS.net accounts for care homes, agreeing acute discharge template •Engagement of primary care by the CHCSM to support development of shared care plans is challenging and placing some delay on progress of project Next steps: •Continued clinical review of residents and development of care plans with primary care support •Extension of planned approach to remainder of care homes subject to appointment of second post •Implementation of targeted training programme Risks & mitigation: •Recruitment to second post: redesign clinical team member providing 0.2wte support to delivery of the clinical reviews


To reduce emergency A&E attendances and acute admissions by 20% by improving the level and coordination of support to residents in care homes though the provision of proactive case management, system coordination, workforce development, improving quality and safety standards and creating a network of support for 47 care homes across West Suffolk.




% delivery

YTD

RAG

Finance Milestones

£ 395,684 £ 65,947 £ - 0.0% R A

Project: P7 – Respiratory/Frailty

Activity: Emergency admission reductions not achieving target levels. Hence, no QIPP savings YTD. Progress: •Top cohort of frequent flyers/high demand patients agreed and case finding either complete or in progress. To date:

• 15 frail elderly readmissions identified through the clinical and case note review and these patients are being managed as part of the CGA pathway process with Interface Geriatrician leadership,

• 81 COPD readmissions known to the service identified from the deep dive and work in place with consultants and COPD team to improve care planning, MDT review and case management approach

•System wide frailty workshop held 15th July, led by Interface Geriatrician at WSFT – this will aim to formalise the process for managing all the high demand complex frailty cohort •Falls and fragility fracture workshop held 23rd July to implement the same process as the 15 CGA patients for frequent fallers. •Data dashboard populated with April 2015 data •Draft shared care plan developed with GPs and Interface Geriatrician and aiming to implement end July. •Work continuing to develop Shared Care Plans (SCP) for the 81 COPD readmissions identified from the deep dive •Shared Care Plan Dashboard (at practice level) developed to monitor the targeted case management Next steps: •COPD discharge bundles to be improved to release COPD capacity in community •Implement actions from frailty workshop •Implement actions from falls workshop •Sign off and launch the shared care plan with the top high demand cohorts Risks & mitigation: •Primary care engagement to support partnership working to develop SCP: Interface geriatricians to lead system development •Leadership from the Interface Geriatricians: Collaborative working with WSFT in place to drive changes •Frailty CQUIN: this is still to be finalised and agreed and poses some risk to this project. The CCG is proposing to work with the Interface Geriatrician to mitigate some of the risk.


To reduce emergency admissions for respiratory HRGs by 15%. To develop and implement an integrated frailty model to underpin the management of complex patients. This would include identifying and managing patients through case finding and case management.




% delivery

YTD

RAG

Finance Milestones

£ 106,095 £ 17,683 £ - 0.0% R A

Project: P8a – Integrated Admission Avoidance

Activity: Emergency admission reductions not achieving target levels. Hence, no QIPP savings YTD. Progress: • Outreach of EEIT into the community to support admission avoidance now being progressed as a soft launch to new model • Full launch of the new model delayed until planned care activity undertaken by Admission Prevention Service (APS) nurses is released: plan in

place but will take until August to have any impact • Co-location base in WSFT agreed - being progressed by facilities management – planned completion date 30/07/15 • SRG approval of monitoring Dashboard – commitment to support effective collation of data to assist with monitoring/evaluation of IAPS • OOHs Crisis Response – agreement for function previously undertaken by Careline to be delivered by Integrated Admission Prevention Service)

IAPS – planning in progress to release proportion of funding to new model • Process mapping undertaken to inform pathway for central contact and triage of calls Next steps: • Impact Assessment Tool to be implemented following any changes using intelligence from trial. • Service Specification for IAPS to be finalised and shared with Task & Finish group • Launch of elements of model as part of phase 1 (APS and EEIT) - July • Formal launch in August subject to SystmOne write access for team being secured. • Communications and engagement plan with primary care to be developed and implemented Aug/Sept • APS to move to new base in WSFT early August • Process to be mapped / agreed for utilisation of Step Up Beds – community hospital Risks & mitigation: • KPIs have not been agreed by WSFT: model being moved forward to implementation. Non KPI agreement may stifle progress • Primary care engagement to refer into service: Case studies being developed to build confidence in model. GP leadership oversight of

implementation plan • Leadership from the Interface Geriatricians: Collaborative working with WSFT in place to drive changes and support to model • Pace of implementation: SRG sponsorship in place to drive system behaviour changes and support early escalation of issues/blocks.


To reduce emergency admissions by 8% by extending the Enhanced Early Intervention Team (EEIT) model of working beyond A&E through integration and development of community services. In addition, there are further developments with regard to Falls Prevention and Specialist Admission Avoidance relating to cancer – Acute Oncology Service (AOS).

Project: P8b – LTC enablers

Progress: • Repeat admissions audit - Review of top 36 patients that have attended over 6 times in 6 months – findings shared with System

Resilience Group (SRG) and plans in place • Repeat attenders audit – Review of top 25 patients that have attended over 6 times in 6 months – findings shared with SRG and

plans in place • Dashboard for Repeat Admissions and Repeat Attenders in development • Plan in place for mental health re-attendances • Dashboard of Shared Care Plans (from targeted areas) by practice in development • Since April 15, 229 contacts with family carers have been undertaken (including support provided to 46 carers of people with

Dementia)

Next steps: • Develop sustainable process for the top 3 repeat admissions profile • Agree system wide interventions required with NSFT (OD/Self Harm Repeat Admissions / Attenders) • Further review of next 25 repeat admissions and link to the early adopter site • Finalise Repeat Admissions/Attenders Dashboard • Shared Care Planning – Implement template to be used for patients identified through targeted approach • Finalise Shared Care Planning Dashboard • Develop outcomes for Interface Geriatrician specification

Risks & mitigation: • Primary care risk stratification - inconsistent approach adopted across practices / poor utilisation of RAIDR: case finding approach

on repeat attenders and readmissions


To improve the management of LTCs through the implementation of risk stratification, case management and care coordination; i.e. . Implementation of the falls case finding pathway, RAIDR, case finding of the top 100 readmissions into WSFT, shared care planning and Advanced Care Planning, care coordination and case management, CGA and Interface Geriatrics etc.

RAG

Milestones

A




% delivery

YTD

RAG

Finance Milestones

£120,829 £ 20,138 £ 41,021 203.7% G A

Project: P9 - Paediatric Admissions

Activity: Targets for reductions in emergency admissions being achieved.

Asthma & Epilepsy Paediatric Community Nurses (WSFT) • Epilepsy Specialist Nurse attended 01 July Workstream meeting to present their findings and an evaluation of the service to date.

Project is progressing well. Asthma Specialist Paediatric Nurse to attend August meeting.

Paediatric Community Clinics with WSFT • Agreement by Rookery Surgery to host Paediatric Community Allergy Clinics from 02 June 2015 onwards. • WSCCG advised that business case for establishing ‘Connected Health for Children’ is being discussed internally by WSFT.

Opportunity to potentially incorporate into 1+1 contract future model.

Main Actions & Outputs for Next Month: • Allergy Study Day postponed to 15/10/15 due to low uptake – planning meeting scheduled for 7/7/15 to review programme and

approach to maximise uptake. • Nocturnal Enuresis GP Bulletin – to be sent out to primary care on Friday 26 June 2015 & uploaded on Map of Medicine / Paediatric

Pearls • Specialist Community Paediatric Allergy Clinics commenced at Rookery Surgery in Newmarket on Tuesday 2 June 2015 for 0-18

year olds. Paediatric General Clinics commenced in Stowmarket in March 2015 for 0-18 year olds. • Work with Practice Support to facilitate Paediatrician attendance at future locality meetings to revisit and further strengthen track

record of working together to deliver such ‘local educational interventions’.

Key Issues: • Need to identify WSCCG CYPM Clinical Lead

Key issues, progress, risks and mitigations etc:

To build on initiatives already established in 2014/15 to further develop the paediatric urgent care pathway of care in West Suffolk for children and young people <19 and reduce the number of unplanned admissions to the acute hospital for common childhood illnesses.

Project: P10 – Diabetes Planned NET

Annual Saving



% delivery

YTD

RAG

Finance Milestones

£ 207,569 £ 34,298 £ - 0.0% R G

Activity: OP has delivered small QIPP, but off-set by over-performance in Emergency Admissions Progress: • Primary care enhanced service (ES) scheme signed off and offered to practices. 13 practices have signed up as at 02.07. Q&A

sheet produced as requested. • Community diabetes service formally launched during National Diabetes Week (14-20 June) accompanied by headline press articles

in the East Anglian Daily Times. 13 practices signed up to mentored clinics as at 02.07. • 3rd and 4th community diabetes specialist nurses are confirmed in post • Diabetic foot pathway comms finalised and pathway will be rolled out during July including Map of Medicine map. • GP practices have been reminded that newly diagnosed patients should be signposted to attend Desmond within 9 months • Work continues with WSFT to finalise diabetes prescribing pathway and complete the map of medicine pathway, now aiming for the

August Map of Medicine release Next Steps: • Continued promotion of the enhanced scheme. • Roll out diabetic foot pathway including Map of Medicine map • Work with WSFT to finalise diabetes prescribing pathway and diabetes pathway for map of medicine. • Meet with WSFT to agree approach to discharge of follow-up patients to primary care, in liaison with the community diabetes service

and the primary care enhanced scheme. • Analyse first data set received from the community diabetes service.


To develop an adult community diabetes service. To implement an integrated diabetic foot pathway. To develop system forum to monitor and evolve diabetes services across health and social care.




% delivery

YTD

RAG

Finance Milestones

£ 49,082 £ 8,239 £ 10,847 131.7% G G

Project: P11 – A&E

Activity: Target for reductions in A&E attendances being achieved. Progress: • Draft seasonal communications plan completed and considered at the July System Resilience Group (SRG) • Initial discussions held with ‘111’ concerning a hub in A&E • Practice profiling of attendance rates under review • As part of the NHSE 8 high impact interventions baselining assessment, a review of GP practice has been completed. Next steps: • Joint meeting between ‘111’ and WSFT to scope options for hub over winter months • Sign off Seasonal Communications Plan • Targeted support to practices with high attendance activity Risks & mitigation: • Managing public expectations: Communications Plan to target high demand public cohorts • WSFT do not support use of ‘111’ hub: strong rational plan to be developed and early escalation to SRG


To reduce the A&E attendance activity at WSFT by 5%. This plan runs in partnership with the Integrated Admission Avoidance project (P8a).

Project: P12 – Low Priority Procedures Planned NET

Annual Saving



% delivery

YTD

RAG

Finance Milestones

£ 400,000 £ 66,667 £ 66,667 100.0% G G

Clinical Threshold Service (CTS): • Maternity cover approved by the CCG Executive on 24/6 and job advertised on NHS Jobs. • Interview date for maternity cover set (22/7) and WSFT invited to be part of the panel. • Meeting held with WSFT to discuss the pre-procedure process. WSFT seeking to pilot General Surgery. Start date to be agreed. • Work is continuing on amending the checklists for each LPP to include evidence Next Steps: • Finalise the pilot CTS pre-procedure process and formalise with WSFT. • Select, interview and appoint maternity cover candidates for Clinical Threshold Nurse. • Finalise the evidence requirement within each policy. • Consultation on current draft polices prior to Clinical Effectiveness Group sign off


To ensure the CCG commissions clinically effective services meeting the latest evidence of a positive health impact for the population. To embed the use of the policies linking the Clinical Threshold Service with providers. Ensure that, working with providers, procedures are only undertaken when the criteria is met or individual funding where there are special circumstances.

* Note: Savings based on M2 data.

Planned NET Annual Saving £’000


£’000


£’000

% delivery

YTD

RAG

Finance Milestones

£ 750,000 £ 125,000 £ - 0.0% R G

Project: P13 - Prescribing

Progress in month

Campaigns, schemes, guidelines and supporting documents • Completed

o Prescribing scheme (with 22/24 practices signed up) o Constipation guidelines

• Under development: o Wasted medicines campaign o Self-care campaign o Ocular lubricant guidelines o Extensive list of prescribing recommendations (along with potential savings available) o Revised model for clinical pharmacists working in GP practices o Initiatives to reduce polypharmacy, including polypharmacy LES o Therapeutic switching by community pharmacists o ‘Food First’ leaflet

Practice work Medicines management technicians and primary care dietician are currently providing hands-on support to the following practices, implementing a range of cost effective prescribing changes: Botesdale, Forest, Swan, Guildhall and Barrow, Haverhill Family Practice, Brandon Medical Centre, Market Cross, Mount Farm, Hardwicke House, Clements and Christmas Maltings, Woolpit, Siam. ScriptSwitch 18/24 practices have ScriptSwitch installed. A further practice (Angel Hill) has agreed to have ScriptSwitch installed from August 2015. Further additions have been made to the profile.

Key issues, progress in month, risks and mitigations etc.:

Progress in month (continued) Clinical (sessional) pharmacists Sessional pharmacists are currently working in the following practices: Angel Hill, Brandon, Haverhill Family Practice, Clements and Christmas Maltings, Siam. They are also working with the following care homes: Brandon Park, St Leonards, Cleves Place, The Swallows, Eastcotts, The Meadows. 591 interventions made by the clinical pharmacists have been recorded. The following practices (14/24) have expressed an interest in working collaboratively with clinical pharmacists in 2015-16: Angel Hill, Brandon, Hardwicke House, Clements and Christmas Maltings, Haverhill Family Practice, Long Melford, Market Cross, Mount Farm, Oakfield, Orchard House, Rookery, Siam, White House/ Reynard, Woolpit.


Key issues • 2 practices have not signed up to the Prescribing Scheme. • Budgetary data is not yet available to determine if there is slippage on delivery of the milestone savings. • Practice prescribing reports are not yet available to highlight to each practice where potential opportunities for savings exist. • Technician team short staffed due to maternity leave.


Risks and mitigations


Risk Mitigating Action

GPs may not engage with the Prescribing Scheme and may not implement cost saving initiatives.

Encouragement, e.g. via practice and locality meetings.

Drug price increases. Scrutiny of prescribing data. Development of further prescribing recommendations and ScriptSwitch messages to provide strategies for minimising use of high cost drugs, if possible.

Impact of NICE Technology Appraisals. Not possible - Implementation is mandatory.

Increase in demands on prescribing due to an aging population and an increase in number of patients suffering with long term conditions.

Prescribing guidelines and support from the Medicines Management Team.


Project: P15 – GP Practice Referral Support

Map of Medicine: • 71 Maps live - 7 new maps were loaded in May and an additional 9 were revised • 99 referral forms currently live on Map, with 11 added in Map • High level reporting now available. Approx 40 referrals made via MAP each month. Advice and Guidance: • Communication to GP’s via practice support on the decommissioning of CMS and how GP’s can access consultant advice and

guidance via Choose & Book in February 2015. Need to send again, however we are waiting WSFT to confirm shut down of CMS services on e-Referral and fast track lung referral route.

Next Steps: • Work towards publishing 9 diabetes pathways, and other maps. • Advice and guidance communications to be finalised and circulated.


To develop a range of tools and support for GP practices. • Using WSCCG developed pathways. • Seeking advice and guidance • Using secondary care services.

RAG

Milestones

A

Managing variation in elective care (P16)

Project links to activity negotiated into 15/16 acute contract, incorporating Neil Wilson Associates work.


To review certain procedures and pathways to ensure the optimum patient outcomes and for the health system.

Population Health (P17)

Approaches to Obesity and Smoking Cessation in Elective Care: • Executive have agreed to work

with providers and people to develop an ethos/policy.

• Redesign and Communications team have linked to begin work on the engagement plan.

Key Issues: • Creating capacity to manage this

project.


To ensure better outcomes and improve the patient experience for people having a procedure. Reduce mortality and morbidity arising from procedures.

Advance Care Planning & EPaCCS (P19)

Enabler for LTC and Care Homes – programme of work absorbed into projects 6 and 7


To increase the number of people who die in their preferred place/usual place of residence; ensuring all patients at EoL have the best possible care and best possible death. Implement and embed Advance Care Planning, Electronic Palliative Care Co-ordination System (EPaCCS), and EoL Care Education.

Projects: P16, P17, P19

RAG

Milestones

G

RAG

Milestones

G

Project: P18 – Connect Sudbury

Progress • Connect Joint Commissioning Group in place to take oversight of plans and receive escalation reports on cross county issues • Connect Sudbury continues to develop with a number of task and finish groups (Integrated Neighbourhood Teams, Co-location, Neighbourhood

Networks, High demand customers, IRR, prevention) in line with overarching plan. • Provisional date for Sudbury ACS team to collocate with Sudbury Community Health Team - likely to be implemented in August 2015 • Integrated Neighbourhood Team model developed and launch programme phasing each practice in turn agreed • Closer working between the Sudbury and East Ipswich early adopter sites to ensure the most optimal approach to development of the INTs • INT directory and draft operational manual in development with front line partners • INT launch at Siam practice agreed as August and engagement approach with practice staff in place • Bid to HCISC to support testing the integration of social care in using the Summary Care Record submitted as the first test case nationally and

presentation to national board in July. Early feedback suggests a positive response by the external advisory group • Work has started to shape the development of Sudbury as a Dementia Friendly Community Next steps • Launch INT with Siam Surgery as Sudbury Health Centre • Continued engagement with other GP practices • Recruitment of Local Area Co-ordinator posts from September • Engagement with Transformation Challenge Award process to identify synergies and potential support opportunities for early adopter sites • Integrated Reablement and Rehabilitation (IRR) model development will be integrated into the Connect Sudbury plan • Think Big! A real time project support programme being implemented to support system integration • ‘Workforce shadowing’ pilot to improve integration and increase awareness (launched end May 2015). • Workforce profiling project including workforce vulnerabilities risk register – (June/July 2015). • Shared learning project evaluation – due to be completed July 2015 Risks & mitigation • Baseline assessment, Data collection and evaluation: Resource identified to support the pilots in gathering intelligence and data. Likely to be a

short term solution until longer term Public Health and Transformation Challenge Award resources are identified.


Connect Sudbury aims to take a new approach to the delivery of local services and has been informed from the outcomes of the Suffolk Health and Care review that sets out an integrated health and care model. It will help us to understand how we build a more cohesive health and care system and embed cross-organisational working for wider roll-out across West Suffolk.

RAG

Milestones

G

Project: P20 - CYPM Joint Working with SCC & I&ESCCG

Children’s Emotional Health & Wellbeing Group (CEWG) • CEWG Steering Group meeting 24/6/15. Strategy Action Plan reviewed and RAG rated; outline pathway mapping against provision

will inform gap analysis; workshops with system stakeholders and second with NSFT to inform strategy development on 14/7/15. Independent contractor to facilitate both workshops. Final planning through CEWG meeting as above. Report for HOSC on CYP and MH commissioning completed – to be discussed on 7/7/15.

• Reporting template for PMHW agreed – contracting taking through service variation. • SCC report uptake for proposed stakeholder workshop with schools in September is good – stakeholder engagement plan to be

considered at CEWG Steering Group. • Priory Mental Health Provider (Innovations Bid) development in Ipswich - discussions continuing on fit with Health agenda. Children’s Trust Joint Commissioning Group Meeting Held on 17/6/15 • Strategic direction for Suffolk discussed • 1+1 contract awarded - actions to be agreed with SCC as appropriate Main Actions & Outputs for Next Month: • Planning for 14/07/15 CEWG Workshops, continue development of strategy and transformation plan • SCC seeking to reconvene PMHW Reference Group Key Issues: None


To work with primary and secondary care in partnership in order to modernise services and respond to and implement new statutory requirements for children and families.

RAG

Milestones

A

Project: P21 - Dementia

Progress Update: • Teleconference held with Area Team 9/6/15 – confirmed 2015/16 target for dementia diagnosis will commence at 60.7%. However

national monthly reporting tool currently experiencing technical issues; refreshed data will not be available until September. • Practice Support continuing to promote target to practices with low diagnosis rates to re-offer technical support via Medicines Management

Teleconference held with Cambridge and Peterborough & HEE to discuss approach to develop dementia friendly practice accreditation. Advised that this requires practice education, review of environment, practice champions and effective annual reviews. Issue will be how to deliver training to clinical and non-clinical staff without dedicated resource and time.

• Paper taken to CCG Executive requesting community contracts are extended to 2017 to align with SCC contract with Age UK. Workshop 25/6/15 with providers set up by Dementia COG worked through how they can better work together

• Dementia and Advance Care Planning Workshop held on 29 April agreed benefits of blue folder approach and how to implement this. Next steps to collate feedback and develop action plan. Comments and feedback on ACP booklet requested by 19/6/15. Mock ‘blue folder’ created enclosing key information as discussed. To be tabled at July CYPM/MH workstream meeting. Next steps – virtual workshop with group to agree final content and roll out.

Main Actions & Outputs for Next Month: • Meeting with Care Homes Clinical Manager to plan care home engagement scheduled for 19/6/15 • Advance Care Plan Blue Folder to be confirmed and distributed • Action Plan for Dementia Friendly Practices to be produced Key Issues: • SCC funded Flexible Dementia Services contract due to end 31/3/16 –SCC seeking response on whether dementia contracts can be

extended to March 2017.


Evidence based research underpinning the National Dementia Strategy & service user & family carer feedback is for an integrated service that supports the individual & their Family Carer from diagnosis & through the pathway of the illness. The proposal is that health & social care commissioners work together to deliver the following functions: Prevention; Early Intervention & identification; Assessment & diagnosis; Information & advice; Shared care planning; Key working; Review Support; Optimising the care environment; Specialist input & crisis intervention; End of life care.

RAG

Milestones

A

Project: P22 - Mental Health & Learning Disabilities (Joint Working - SCC & IESCCG)

Progress Update: • MH Commissioning Strategy currently out to consultation and final stakeholder event on 5/6/15. Final Strategy to go to HWB

September 15. • Crisis Concordat workshop 5/6/15 cancelled due to low uptake – to be rescheduled by SCC and Suffolk Constabulary. • Pooled Fund meeting 10/6/15 – procurement plan reviewed and anticipated contract management post to be in place August 2015. • LD Strategy discussed at CCG Executive 18/6/15 – SCC agreed to review actions to reflect CCG comments. • Police Triage – meeting with I&ESCCG, Suffolk Police, NSFT 8/6/15 – awaiting final costings by NSFT agreed with CCG finance to

determine final model. • Primary Mental Health Wellbeing Service update taken to CCG Executive 17/6/15 and approved. Wellbeing cluster audit

progressing. Procurement timetable will require clinical commitment – leads to be identified. • LD Community Services & Inpatient redesign dependent upon decision whether GY&WCCG need to go out to consultation on

possible bed reduction. This decision is delaying implementation of new model. • LD Strategy final draft presented to CCG Executive on 17/6/15 – flagged actions include commitments which CCG needs to review

further. SCC agreed to review to respond to health commissioning comments. • NSFT Psychiatric Liaison & WSFT presented evaluation of maternal mental health pilot in hospital. Follow up meeting to be

arranged to discuss business case for full service.

Key Issues: • Police Triage finance and activity modelling, agree draft specification with partners • Progress procurement process and audit clustering for primary mental health model • Arrange meeting with Maternal Mental Health pilot team to progress business case


To work with SCC and IESCCG to identify and agree common commissioning priorities as partners in the Mental Health and Learning Disabilities Joint Commissioning Group, develop the Suffolk Mental Health Strategy by March 2015 and the Suffolk Learning Disability Strategy by July 2015. To manage and deliver joint commissioning arrangements with SCC through the Suffolk Mental Health Pooled fund and reach agreement on future plans to commission rehabilitation services that effectively move patients on from inpatient services and repatriate back to the local area whilst achieving cost effectiveness and efficiency. Develop comprehensive autism pathway.

RAG

Milestones

A

Project P22b - Learning Disabilities Annual Health Checks

Progress Update: • Letter about benefits and support of LD Health Check DES circulated to practices • Meeting with ACS Cluster Manager for West Transition and Learning Disabilities agreed identified opportunities to obtain patient

experience, agreed to join when meeting Practice Manager Swan Surgery to discuss templates for health checks and sharing information held by ACS

• Commenced progress on resolving data sharing issues between primary care and ACS to consolidate each other’s LD registers • Shared draft primary care resource pack with ACS and CCG workstream for comment • Meeting with Comms identified a need for LD Health check literature on market stalls and other Comms. events – work on designing

draft leaflets for approval through CCG and GPs to take to future stakeholder events for MH and LD • Practice Support Team obtaining quotes for LD awareness training • Raising profile of LD in other strategies e.g. Suffolk Walking Strategy Main Actions & Outputs for Next Month: • Primary care scoping meeting with Swan Surgery • Completion of resource pack and upload to Map of Medicine • Engagement with stakeholders – LD link nurses • Complete scoping with primary care of their training and education needs to inform education programme • Develop performance management framework for dashboard • Identify practices signed up to LD Health Check Enhanced Service • Plan for stakeholder consultation • Meeting with Care Home Lead to investigate offer in care homes and barriers to take up Key Issues: • GP Associate not available for practice liaison, Data sharing between primary care and ACS, Still awaiting information on practice

take up of LD DES.

To improve the % uptake of Health Checks in Primary Care for people with Learning Disabilities RAG

Milestones

A

Project: P23 – Shared Decision Making

Progress • Steering group meeting held end of May – new Community Pain Service pathway discussed and development of associated patient

Information to support now in development. Aim for draft at next meeting in August. • Female incontinence Booklet - final approval from Group and now out to print. For distribution to key identified individuals within

primary and secondary care by end of June. • ENT Sensory Hearing Loss patient information – agreed required more work by Mr Fahmy and team to incorporate a more SDM

focus. New telephone clinic will be delayed as a result. Meeting proposed early July to review next draft. • Update provided at the Steering Group on the dementia/EoL workshop. Agreement to start to develop the ‘blue folder’ initiative and

agree next steps – including funding to launch. Funding approval to be sought by end June. • Agreement by WSFT to develop a generic SDM leaflet to be included in all NP clinic letters. • Application for funding (£100k) submitted to support the Dementia and Eol initiative at the beginning. Next steps • Progress update on the Sensory Hearing Loss patient information leaflet – review of next draft • Promotion of the SCN initiative and sharing of information at the Patient Revolution Events • Update on progress for the WSFT generic SDM leaflet • Application for funding update • Discussion re: Care Home residents choice around preferred place of care • Further development on the Blue Folder initiative – agreeing contents and preparing to launch in the autumn • Discussion with Planned Care Transformation Lead around patient choice and Andrology/PVSA

Risks & mitigation • Additional financial support sought from The Health Foundation; Inspiring Improvement. Mitigated by seeking alternative funding

arrangements if unsuccessful.


To introduce the principles of Shared Decision Making across the whole health system in west Suffolk. Working to demonstrate the benefits of SDM to patients and staff; motivate and empower patients and staff to work closely with each other; help patients and staff to build SDM into consultations; explore how SDM can fit into and enrich the patient experience

RAG

Milestones

G

Other Projects:

Respiratory Wellbeing: • Respiratory Wellbeing meeting occurred on 21/5/15. WSFT & Suffolk Wellbeing Service agreed to work on the initiative where

people are supported by both services. Suffolk Wellbeing Service have stated work with Pulmonary Rehabilitation offering a session for people on the programme around managing their anxiety.

Andrology: • Teleconference has taken place with Addenbrookes. Meeting to be organised with Cambridge IVF and Swan surgery to work

through the difficulties associated with best practice British Andrology Society (BAS) standards and provider service offer. Proposal is that Swan offer choice to pts and the patient decides to attend the best practice at Cambridge or take the very small risk of the postal service. In the longer term we will need to tender for a provider that includes testing as no other CCG holds the separate contract.

DEXA: • Anglian Medical & Musculoskeletal contract is overdue for renewal and decision is needed on the timeframes and procurement.

Lymphoedema: • QP contract expires in September - discussions taking place regarding options to extend.


To reduce emergency A&E attendances and acute admissions by 20% by improving the level and coordination of support to residents in care homes though the provision of proactive case management, system coordination, workforce development, improving quality and safety standards and creating a network of support for 47 care homes across West Suffolk.

Part 4

Contractual Performance, by provider, reported by exception only

106

West Suffolk Hospital – Summary of contractual levers (contd.)

Performance Issue Contract Notice Stage Key Actions within RAP Current Status

Ambulance arrival to handover: Target is 90% of patients within 15 minutes or 100% within 30 minutes and 60 minutes

Contract Query (CQ 201213-06)

Overall performance and the number of breaches remains consistent. Data validation queries being concluded with Provider - It has been confirmed that Geofield technology does not activate until the ambulance is on the hospital site and this will be clarified within the Tripartite Agreement before this can be signed off. Number of 30 minute breaches (April) was 83. Number of 60 minute breaches (April) was 4 (un-validated position). This is an improved position from the previous month.

Latest Performance EBS7a - 30 Minute Handover Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

SLA Standard 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Actual Performance 86.27% 89.82% 90.77% 92.43% 93.60%

EBS7b - 60 Minute Handover Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

SLA Standard 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Actual Performance 97.54% 98.17% 99.13% 99.64% 99.49%

107

West Suffolk hospital – Summary of contractual levers (contd.) West Suffolk Hospital – Summary of contractual levers (contd.)

Performance Issue Contract Notice Stage

Key Actions within RAP Current Status

Acute oncology service: 1 hour door to needle for all patients presenting with suspected neutropenic sepsis. Contract target 100%

Contract Query (CQ1314-04)

An agreed RAP with a trajectory to reach 100% compliance by March 2014 for G1 (cancer ward)/MDU and A&E. Other key actions: Submission of concise RCA review with thematic analysis to address all out standing RCAs. Requirement to submit all future individual RCAs on the 10th Operational Day of each month after occurrence of any such incidents. Range of support actions to support delivery particularly in A&E. Including training, triage processes, and monitoring implementation of Patient Group Directive (PGD).

A Contract Query was issued in November 2013 with compliance set to be met by March 2014. Performance in both MDU and A&E continues to be variable. In March there was 1 breach in A&E and 0 breaches in MDU. Trust has updated their action plan including: i. Snapshot audit of patients with cancer

alerts and the time to review an attendance to A & E – due by 31/03/15 – CCG requesting update.

ii. Training of nursing staff to enable administration of IV antibiotics through PICC lines – due by 31/08/15

Latest Performance WC1.1 - 1 hour door to needle for all patients presenting with suspected neutropenic sepsis.Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

SLA Standard 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Actual Performance 50.00% 40.00% 50.00% 50.00%

108

West Suffolk Hospital – Summary of contractual levers (contd.)

Performance Issue Contract Notice Stage Key Actions within RAP Current Status

Percentage of A&E attendances where the Service User was admitted, transferred or discharged within 4 hours of their arrival at an A&E Contract Target 95%

Contract Query (CQ 201415-03)

Trajectory requires compliance to Threshold from April.

The Trust had failed to achieve the A&E Waits Standard for three consistent months and a Contract Query had been issued. The Trust issued an Excusing Notice on the basis that external demand was not being managed by the CCG. This was not accepted by the CCG Executive. Performance has improved during Q1 but the quarter performance was just missed. April: 93.1% May: 95.9% June: 96.1% Q1: 94.96% The Contract Query will remain open.

Latest Performance Percentage of A&E waits where the service user was admitted, transferred or discharged within 4 hrs of their arrival at an A&E dept.Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

SLA Standard 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%RAP Trajectory 90% 90% 90% 93% 95% 95% Actual Performance 86.27% 89.29% 95.12% 93.09% 95.94%

109

West Suffolk Hospital – Summary of contractual levers (contd.) Performance Issue Action Plan/ Contract Notice Stage

Key Actions within action plan/ RAP

Current Status

1). RTT waiting times for non-urgent consultant-led treatment; 2). Diagnostic test waiting times;

Internal action plans submitted by Trust.

1a). % of admitted Service Users starting treatment within a maximum of 18 weeks from Referral; Threshold: Operating standard 90% Actual: March: 86%; April 84.09% Speciality: General Surgery/ T&O /Urology/ ENT and Gynaecology: remedy date – July 2015: for all specialities with exception of General Surgery (October 2015) – CCG reviewing potential to bring forward remedy date. 1b). % of non-admitted Service Users starting treatment within a maximum of 18 weeks from Referral; Threshold: Operating standard 95% Actual: Met at aggregate; breached at speciality level for General Surgery/ urology/ Plastic Surgery and Cardiology: remedy date – July 2015 1c). % of Service Users on incomplete RTT pathways; Threshold: Operating standard 92% Actual: Met at aggregate; breached at speciality level for Speciality: General Surgery and Cardiothoracic: remedy date – July 2015 2). % of Service Users waiting less than 6 weeks from referral for a diagnostic test Threshold: Operating standard of < 99% Actual: March 7.05% and April 12.36% Speciality: Endoscopy, Flexi Sigmoidoscopy, Gastroscopy and Colonoscopy: remedy date – July 2015

• Additional outpatient sessions

• Reduce wait for 1st outpatient to 8 weeks

• Review follow up pathway for colorectal

• Increase endoscopy capacity.

i) General Surgery

• Weekend operating lists

• Utilise visiting consultants

• Increased Locum cover

ii) Urology – As above, plus:

1. 18 weeks: Recovery actions include:

2. Diagnostics. Key actions for endoscopy:

• Direct surveillance • Patients to BMI • Use private company

to provide short term weekend sessions

• Review shared use of resources with Urology.

110

West Suffolk Hospital – CQUIN Delivery

CQUIN Quarter 1 – 4

CQUIN Milestone Weighting

AchievementMilestone Weighting



Achievement

Friends and Family 1a 1.50%

Friends and Family 1b 0.75%

Friends and Family 1c 0.375% 0.375%

Friends and Family 1d 2.00%

Safety Thermometer - 2a Pressure Ulcers

1.56% 1.56% 0.94% 0.94%

Safety Thermometer - 2a Falls

2.50% 0.47% 0.47% 0.71%

Dementia - 3a 0.75% 0.75% 0.75% 0.75%

Dementia - 3b 0.25% 0.25%

Dementia - 3c 0.75% 0.75%

Psychiatric Liaison - 4a 1.50% 1.32% 2.25% 1.25%

IW Shared Access - 5a 3.00% 2.80% 2.70% 2.50%

IW Workforce - 5b 0.50% 0.50% 0.50% 0.50%

IW Info to Pts - 5c 0.25% 0.25% 0.25% 0.25%

7 Day Working - 6a 7.25% 7.25% 7.25% 1.00%

Ambulatory Care - 7a 1.50% 3.00% 0.75% 1.50%

Clinical Forums - 8a 1.30% 2.10% 2.10% 3.70%

Shared Care Drugs - 9a 0.50% 0.50% 0.00% 0.00%

Total: 22.74% 22.00% 17.96% 16.48%

Total Overall: 79.17%

Quarter 1 Quarter 2 Quarter 3 Quarter 4

111

Headlines: Performance for the KPI’s relating to warm transfers and call backs in 10 minutes remain below the compliant threshold. An Exception Notice relating to performance against these KPI’s has been raised with the Care UK board due to the outstanding warning notice not delivering the necessary improvement. A new performance improvement trajectory and actions to deliver this is still to be agreed by the CCG and Care UK.

Care UK ‘111’ – KPI Dashboard

112

Care UK Suffolk 111 Service – Calls answered in 60 second performance (mapped against region and country)

Headlines: Calls answered in 60 seconds for the Suffolk 111 service mapped against weekly national and regional performance.

113

Headlines: Calls requiring a warm transfer within the Suffolk 111 service mapped against national and regional performance

Care UK Suffolk 111 Service – Warm Transfer Performance (mapped against region and country)

114

Headlines: Speak to GP calls in 60 minutes and 2 hours have maintained full compliance for the month of May. Care UK continue to work through their submitted improvement action plan to sustain performance. Care UK continue the process of adapting the rota following review and focused recruitment plan ensuring resources are available and aligned with current demand profiles. A Contract Notice is still in place and the subsequent improvement plan is the focus of the CCG to continue improvement. .

Care UK Out of Hours – KPI Dashboard

QR No Quality Standard Target May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15

4 Clinical Audit of patient contacts 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

5 Patient experience audited 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

9(1) % calls speak to GP within 20 mins 97% 94% 97% 97% 97% 98% 97% 99% 98% 97% 97% 97% 98% 98%

9(2) % calls speak to GP within 60 mins 95% 96% 95% 96% 97% 95% 96% 95% 79% 84% 78% 85% 97% 95%

9(3) % calls speak to GP within 2 hours 95% 95% 97% 97% 98% 97% 99% 97% 91% 94% 91% 91% 98% 97%

9(4) % calls speak to GP within 6 hours 95% 100% 100% 100% 100% 100% 100% 100% 98% 99% 97% 98% 100% 100%

12(2) % patients consulted within 2 hours 95% 97% 98% 99% 97% 99% 96% 98% 95% 95% 96% 95% 98% 98%




12(2) % urgents visited within 2 hours 95% 95% 94% 94% 96% 96% 96% 95% 86% 90% 87% 93% 93% 91%

12(3) % patients visited within 6 hours 98% 97% 97% 96% 98% 96% 95% 98% 83% 87% 88% 91% 91% 94%



Local KPI % urgent face to face consultation 2 hours 95% 96% 96% 96% 95% 97% 96% 97% 92% 93% 93% 95% 96% 95%




115

Community Services (Serco) – Service Quality & Performance Headlines: Overall, Serco continues to perform well against contract KPIs and Quality Requirements. Contract Queries; The Community Equipment Service Contract Query remains open. The indicative equipment delivery figures in June suggest further improvements were made from May’s position, and remains just below the required performance thresholds of the Remedial Action Plan. 100% of deliveries were made within 4 hrs. for patients at the End of Life. Performance should be considered in line with an increase in activity through the service. The CCGs continue to review the actions that have been put in place to improve performance.

116

Summary of Contractual Levers – Serco

Performance Issue Contract Notice Stage Key Actions within RAP Current Status Latest Performance May 2015

Failure to achieve equipment provision and collection standards and Infection Control standards

Contract Query Analysis and Review phases built in the RAP timetable-full compliance was required by the end of June 2014, however due to development issues with Microsoft the compliance date was extended till July.

A Final RAP has now been agreed. The analysis phase completed on 1st April. The review phase completed on 3rd May. The testing phase is now complete and plans are on track and progressing well following full roll out.

May delivery times, 98% threshold for all standards; 4 hrs. – 95.35%, Next Working Day – 95.61%, 2 Working Days – 94.02% 7 Working Days 96.33% and collections within 10 Working Days 90.09%

117

Mental Health Services (Norfolk & Suffolk Foundation Trust) – Service Quality & Performance

Performance information NSFT migrated to Lorenzo and it was agreed that no performance data would be submitted for May. Information will be provided in June and backdated to April Contract Queries 1. Staff Training A First Exception Notice was issued on 30 May 2014 as the Trust had failed to meet the agreed trajectories set out in the Remedial Action Plan (RAP) of 21 February 2014. A revised trajectory has been agreed. NSFT are largely on track with the trajectory.

Training Area April 15 target

April 15 actual

May 15 target

May 15 actual

June 15 target

June 15 actual

July 15 Target

July 15 actual

Aug 15 target

Aug 15 actual

Sept 15 target

Sept 15 actual

% of relevant staff who have up to date DOLs training

95% 96.2% 95% 94.8% 95% TBC 95% 95% 95%

% of relevant staff who have up to date MCA training

95% 94.8% 95% 96.2% 95% TBC 95% 95% 95%

% of relevant clinical staff working in C F & Y pathway who have up to date Safeguarding Level 3 training

69.14% 75.7%

No

training April

72% 75.7%

No

training April

77% TBC 82% 85% 90%

118


2. Wellbeing Service - IAPT 15% prevalence target A contract query was issued 19 June 2014. NSFT submitted further revisions to the RAP action plans which have been agreed by CCGs. The Trust has delivered the 15% prevalence target ahead of the end of Q4. The Contract Query will be closed once confirmation is received from HSCIC that the target has been achieved as this is the information the AT will use to determine whether the CCGs have delivered the prevalence target Current performance shows under delivery of 2 for I&ESCCG whilst there is over activity for WSCC of 77.

Numbers entering Treatment Q1 2015/16 WSCCG

Week Ending Q1 15-16

5/4/15 12/4/1

5 19/4/1

5 26/4/1

5 3/5/15 10/5/1

5 17/5/1

5 24/5/1

5 31/5/1

5 7/6/15 14/6/1

5 21/6/1

5 28/6/15 29+30

Jun Total

New Referrals:

Total Referrals Received: 38 58 99 95 104 93 126 75 66 95 89 108 103 33 1182

Entered Treatment:

Plan (original) 40 67 67 67 67 67 67 67 67 67 67 67 67 27 872

Plan (revised) 34 53 73 84 98 56 97 58 47 75 70 91 84 29 949

Total Patients Seen 1st Treatment (actual) 34 53 73 84 98 56 97 58 47 75 70 91 84 29

QTD Original Plan % 0.2% 0.5% 0.8% 1.0% 1.3% 1.6% 1.9% 2.2% 2.5% 2.8% 3.1% 3.3% 3.6% 3.8%

QTD Revised Plan % 0.1% 0.4% 0.7% 1.0% 1.5% 1.7% 2.1% 2.4% 2.6% 2.9% 3.2% 3.6% 4.0% 4.1%

QTD Actual % 0.1% 0.4% 0.7% 1.0% 1.5% 1.7% 2.1% 2.4% 2.6% 2.9% 3.2% 3.6% 4.0% 4.1%

119


Wellbeing Service - IAPT 15% prevalence target (cont.)

Numbers entering Treatment Q1 2015/16 WSCCG

Week Ending Q1 15-16

5/4/15 12/4/1

5 19/4/1

5 26/4/1

5 3/5/15 10/5/1

5 17/5/1

5 24/5/1

5 31/5/1

5 7/6/15 14/6/1

5 21/6/1

5 28/6/15 29+30

Jun Total

New Referrals:

Total Referrals Received: 38 58 99 95 104 93 126 75 66 95 89 108 103 33 1182

Entered Treatment:

Plan (original) 40 67 67 67 67 67 67 67 67 67 67 67 67 27 872

Plan (revised) 34 53 73 84 98 56 97 58 47 75 70 91 84 29 949

Total Patients Seen 1st Treatment (actual) 34 53 73 84 98 56 97 58 47 75 70 91 84 29

QTD Original Plan % 0.2% 0.5% 0.8% 1.0% 1.3% 1.6% 1.9% 2.2% 2.5% 2.8% 3.1% 3.3% 3.6% 3.8%

QTD Revised Plan % 0.1% 0.4% 0.7% 1.0% 1.5% 1.7% 2.1% 2.4% 2.6% 2.9% 3.2% 3.6% 4.0% 4.1%

QTD Actual % 0.1% 0.4% 0.7% 1.0% 1.5% 1.7% 2.1% 2.4% 2.6% 2.9% 3.2% 3.6% 4.0% 4.1%

120


5. Information Notice NSFT have submitted the first report agreed as part of the 15/16 contract. The reports provided will be reviewed by CCGs to ensure it provides the information they need for reassurance regarding safe staff levels. 6. CQC action plan High level assurance is being provided through the monthly stakeholder assurance meetings. More granular assurance is being sought through review of the Trust and Suffolk locality QIPs through the extension to the monthly quality review meetings. In addition the CCG are supporting NSFT with the schedule of mock CQC inspections, due to concerns over how these inspections have been structured consideration is being given to scheduling a series of short unannounced quality improvement visits, themed against the 5 domains of the CQC and focused on identified areas of concern.

121


New emerging themes and performance concerns 1. CMAS NSFT will be meeting internally to review the CMAS service including performance and waiting times information, where GPs are in respect of service delivery and uptake of services at satellite GP practices. Following the meeting on 29 May 2015 they were asked to produce a report for CCGs to review. Current performance from July 2014 to April 2015 shows: • July 2014 – March 2015 = 315 IDT assessments • July 2014 - March 2015 = 508 CMAS assessments • April to May 2015 = 196 IDT & assessments • Total assessments to date = 1019 Target to date = 1142 Deficit against target = 123 (This figure does not take into account the activity seen within the IDT as it was agreed no performance information from Lorenzo would be reported for May) 2. PMHWs

Revised metrics agreed with NSFT and SCC have been sent out for final comment. An SV will need to be drafted to reflect and formalise the changes contractually

3. Eating Disorder Service An action plan has been submitted to CCGs which will be reviewed and feedback provided. 4. MATS As agreed with CCGs no Lorenzo performance data was submitted for May

122

From: Amanda Lyes, Chief Corporate Services Officer FREEDOM OF INFORMATION QUARTERLY UPDATE (as at 30 June 2015) 1. Purpose 1.1 To provide the Governing Body with an update on Freedom of Information management. 2. Background

2.1 The Freedom of Information Act 2000, provides a general right of access to information held by public authorities, including the NHS. Anyone can request information and has the right to be told:

Whether the public authority holds the information, and

If it does, to be provided with the information

2.2 Information includes anything held in a recorded form, such as paper files, loose papers, e-mails, electronic documents, photos, plans, maps, CCTV, videotapes, audiotapes, voice mails. Requests must be dealt with promptly and there is a requirement to provide the information within 20 working days unless there is good reason why this cannot be achieved.

2.3 There are exemptions to the provision of information covered by the Data Protection Act, including, for example, personal data. In some cases, also a decision has to be made if it is in the public interest to disclose information and if it is not, various exemptions applicable under the Freedom of Information Act can be applied.

3. Key Points

3.1 Statistics for the first complete quarter of 2015/16 show a slight decrease from last year.

This figure is slightly skewed by the high number of requests which were received in May 2014.

In general there is a slight increase year on year. 3.2 The General Election in May did not appear to affect the number of requests received even

though it had been anticipated that there may have been more activity at that time 3.3 Attached to this report are:

Agenda Item No. 12


of 2

A graphical representation of overall numbers of FOI requests received during Q1 into the management delivery team who deal with FOI requests on behalf of the CCGs.

And

Breakdown of requests by CCG, enquirer types and type of information requested. 3.4 Requests continue to be responded to within the statutory timeframe of 20 working days. 3.5 Members of the public and the media make up the bulk of the requesters and together with

general business (recruitment agencies and the like) account for over 50% of the number of requests received.

It should be noted however that a large proportion of the requests from the public actually

come from freelance journalists who make requests in their own name and do not quote an affiliation with any particular publications.

3.6 The main subjects of information requested are contracts and financial. These are requests

concerning how the CCGs spend their money, for example asking about spend on agency staff, and also requests for information about contracts for the provision of services.

4. Future Action 4.1 Further reports will be presented on a quarterly basis. 5. Recommendations 5.1 The Governing Body is requested to note the report. Author: Norman Pottinger Information Governance and Risk Manager

FOI requests received for period 01/04/2015 to 30/06/15

Total number of FOI requests received 65

I&ESCCG & WSCCG 61

I&ESCCG 0

WSCCG 1

MDT 0

SCH 3

n/a 0

65

Answered within 20 days 56

Not answered within 20 days 0

Not due for response 7

65

Source of request

Commerical Healthcare 6

Education 1

General Business 11

Healthcare Media/Publication 4

Interest Group 6

Legal 1

Local Media 1

Members of Public 19

MP 2

National Media 10

NHS/Local Authority 3

Not for Profit 0

Professional Body 0

Unknown 1

65

Type of information request

Acute Services 0

Clinical 0

Commissioning 8

Community Care Services 0

Contracts 14

Corporate 0

Estates/facilities 0

Financial 14

Financial & Contracting 0

HR 7

ICT 5

Other 4

Prescribing 8

Primary Care Services 0

Strategy/Developments 0

Treatements/Tariff 5

65

Main directorate responsible

Chief Nursing Office 3

Chief Officer 1

Chief Operating Office 17

Contracts Office 14

Corporate Services 11

Finance & Contracting 5

Finance Office 11

Other 1

Redeisgn Office 0

Suffolk Community 2

65

Disclosure categories

Full 38

Partial 6

Refusal 0

Not applicable 14

Not stated 0

58 (7 requests not due for a response yet)

Information available

Yes 39

No 11

Partial 6

Not stated 2

58 (7 requests not due for a response yet)

A breakdown on the number of FOIs received during quarter one of the last 3 years has been undertaken.

April has seen a steady increase in the number of requests received year on year. This year has seen a 9.5%

increase on the number of requests received during April compared to last year.

May this year has seen a 28.5% decrease in the number of requests received compared to 2014/15. However

the number of requests received for May last year was exceptionally high with no known cause identified for this

increase.

June has seen the number of requests stabilise. This year the same number of requests have been received as

last year

18

14 13

21

28

22 23

20

22

0

5

10

15

20

25

30

April May June

2013/14 2014/15 2015/16

FOI Comparison – 3 year Period (2013/14 to 2015/16)

Agenda Item No: 13

Reference No: WSCCG 15-43 From: Amanda Lyes, Chief Corporate Services Officer

GOVERNING BODY ASSURANCE FRAMEWORK

1. Purpose

To provide the Governing Body with the updated CCG Governing Body Assurance Framework (GBAF) document for July 2015.

2. Background

Content of the GBAF is reviewed by the Chief Officers Team every month and by the Governing Body and Audit Committee at each of their meetings.

3. Key Points

3.1 Further to review by the Chief Officers Team, the following amendments/additions have been incorporated:

Risk 02 Failure to achieve financial balance in 2014/15 and 2015-16 and deliver

optimum service from the financial resources available Key controls have been revised Action number 1 has a revised due date Additional action (Number 6 added)

Risk 04 Failure to achieve zero MRSA bacteraemia as set out in NHS England Planning Guidance Description of risk revised to better reflect national requirements Actions 1, 2 and 3 marked complete Action 4 revised

Risk 06 Failure to achieve the local reduction trajectories for Clostridium difficile

Actions 2, 5 and 6 marked complete Actions 7 and 8 revised

Risk 14a Failure to comply with NHS continuing Health care Framework

Action number 7 marked complete

Risk 14b Retrospective claims for CHC for September, 2012 and March 2013 cut off

dates Action number 2 marked complete New actions (3, 4, 5 and 6) added

Risk 24 A&E failing to meet 4 hour standard presenting a potential risk to patient safety and experience. Action 1 percentages revised

Risk 27 Potential impact of service quality delivered by NSFT This is a new risk added by the Chief Nursing Officer

4. Recommendations

The Governing Body is requested to review and approve the updated GBAF for July 2015

Author: Norman Pottinger

Information Governance and Risk Manager

Governing Body Assurance Framework and Action Plan

2015 - 2016

Version Control:

MONTH

VERSION No

REVIEWED BY

SUMMARY OF CHANGES

April 2015

25

COT 30 March 2015

Audit Committee 7 April 2015 Clinical Scrutiny 29 April 2015

Approved

May 2015

26

COT 11 May 2015

Governing Body 20 May 2015 Audit Committee 2 June 2015

Approved

June 2015

27

COT 8 June 2015

Clinical Scrutiny 24 June 2015

Approved

July 2015

28

COT 6 July 2015

Governing Body 29 July 2015

August 2015

29

September 2015

30

October 2015

31

November 2015

32

December 2015

33

January 2016

34

February 2016

35

March 2016

36

Board Assurance Framework

Overview

The Governing Body Assurance Framework (GBAF) provides the NHS West Suffolk Clinical Commissioning Group (CCG) with a simple but comprehensive method for the effective and focused management of risk. Through the GBAF the CCG Governing Body gains assurance that risks are being appropriately managed throughout the organisation.

The GBAF identifies which of the organisation’s strategic objectives may be at risk because of inadequacies in the operation of controls, or where the CCG has insufficient assurance. At the same time it encompasses the control of risk, provides structured assurances about where risks are being managed and ensures that objectives are being delivered. This allows the Governing Body to determine how to make the most efficient use of resources and address the issues identified in order to improve the quality and safety of care. The GBAF also brings together all of the evidence required to support the Annual Governance Statement.

The GBAF should be seen as a working document and will be updated regularly by the Chief Officers Team, monitored by the Audit Committee and reported to the Governing Body at each of its meetings. The GBAF is linked to the CCG Risk Register, the content of which is also provided for review by the Chief Officers Team. A flow chart setting out how risks are identified and managed is set out overleaf.

In order to ensure consistency in the risk assessment process, the likelihood and consequences of all risks on the Risk Register are assessed against the former National Patient Safety Agency (NPSA) 5X5 risk matrix and those scoring 15 and above migrate to the GBAF and thereby inform the Governing Body agenda. Once added to the GBAF, a risk should remain in place until its RAG rating has been mitigated to a score of 1-6 when it is considered manageable and therefore no longer a strategic concern.

The 5X5 risk matrix and subsequent red, amber, green (RAG) score identify the level at which identified risks will be managed within the organisation. It also assigns priorities for remedial action, and determines whether risks are to be accepted on the basis of the colour bandings and risk ratings. In terms of evaluation of effectiveness, the RAG rating system is also used to present how well the agreed controls are operating.

RISKS IDENTIFIED THROUGH:

Work Stream Risk

Assessments

External Assessment &

Audit + Guidance & Alerts

Serious Incidents, Complaints, Public Health &

Quality Issues

CCG Governing Body Own & Manage Risks & the Chief Officers Team Reviews the

Risk Register/GBAF

Public & Stakeholder

Engagement

Business & Service Delivery

Plans

Individual Risks Jointly Managed by Designated Chief

Officers & Clinical Leads

Governing Body

Assurance Framework

Overview & Scrutiny by

the Audit Committee

Assurance to the

Governing Body

RAG Score Framework

Likelihood score → 1: Rare 2: Unlikely 3: Possible 4: Likely 5: Almost Certain

Consequence score ↓

5: Catastrophic 5 10 15 20 25

4: Major 4 8 12 16 20

3: Moderate 3 6 9 12 15

2: Minor 2 4 6 8 10

1: Negligible 1 2 3 4 5

The subsequent red, amber, green (RAG) scores identify the level at which identified risks will be managed within the organisation. It also assigns priorities for remedial action, and determines whether risks are to be accepted on the basis of the colour bandings and risk ratings. In terms of evaluation of effectiveness, the RAG rating system is also used to present how well the agreed controls are operating within the following classifications:

RAG Score

Progress

Risk Assessment

Revising Risk Ratings

CRITICAL (15-25)

There may be significant gaps in controls to

ensure effective management.

Controls are in place but insufficient resources

Controls are in place but external forces may be preventing progress.

There are insufficient controls in place to address the cause or source of the risk

Controls are considered insubstantial or ineffective

Controls are being implemented but are not yet in place

If this risk were to materialise, the situation could be irrecoverable in terms of the CCGs reputational/financial well being and or service continuity.

If controls are inadequate then the revised risk rating increases

If controls are uncertain, the revised risk rating stays the same as the original risk rating

If they are perceived as adequate, then the revised risk rating decreases

CHALLENGING (8-12)

Progress is being made but there is concern that the objective may not be achieved. Additional controls or management action is being taken to improve the likelihood of success.

There are few controls in place, which are considered substantial and/or effective and address the cause of the risk. The consequences of the risk materialising, though severe, can be managed to some extent via contingency plans.

MANAGEABLE

(1-6)

Progress is being made in accordance with plans. There are no significant concerns.

The risk is considered to be small and there are sufficient controls in place which address or substantially effective the cause of the risk. The consequences of the risk materialising can be managed via contingency plans.

In order to determine the likely consequence arising from an identified risk and using the 5X5 matrix:

Define the risk explicitly in terms of the adverse consequence or consequences that might arise

Use the table below for examples, by risk domains, to determine the consequence score relevant to the risk identified

Consequence score (severity levels) and example of descriptions

1 2 3 4 5

Risk Domains Negligible Minor Moderate Major Catastrophic

1. Impact on the safety of patients, staff or public (physical/psychological harm)

Minimal injury requiring no/minimal intervention or treatment.

No time off work

Minor injury or illness, requiring minor intervention

Requiring time off work for >3 days

Increase in length of hospital stay by 1-3 days

Moderate injury requiring professional intervention

Requiring time off work for 4-14 days

Increase in length of hospital stay by 4-15 days

RIDDOR/agency reportable incident

An event which impacts on a small number of patients

Major injury leading to long-term incapacity/disability

Requiring time off work for >14 days

Increase in length of hospital stay by >15 days

Mismanagement of patient care with long-term effects

Incident leading to death

Multiple permanent injuries or irreversible health effects

An event which impacts on a large number of patients

2. Quality/complaints/audit

Peripheral element of treatment or service suboptimal

Informal complaint/inquiry

Overall treatment or service suboptimal

Formal complaint (stage 1)

Local resolution

Single failure to meet internal standards

Minor implications for patient safety if unresolved

Reduced performance rating if unresolved

Treatment or service has significantly reduced effectiveness

Formal complaint (stage 2) complaint

Local resolution (with potential to go to independent review)

Repeated failure to meet internal standards

Major patient safety implications if findings are not acted on

Non-compliance with national standards with significant risk to patients if unresolved

Multiple complaints/ independent review

Low performance rating

Critical report

Totally unacceptable level or quality of treatment/service

Gross failure of patient safety if findings not acted on

Inquest/ombudsman inquiry

Gross failure to meet national standards

3. Human resources/ organisational development/staffing/ competence

Short-term low staffing level that temporarily reduces service quality (< 1 day)

Low staffing level that reduces the service quality

Late delivery of key objective/ service due to lack of staff

Unsafe staffing level or competence (>1 day)

Low staff morale

Poor staff attendance for mandatory/key training

Uncertain delivery of key objective/service due to lack of staff

Unsafe staffing level or competence (>5 days)

Loss of key staff

Very low staff morale

No staff attending mandatory/ key training

Non-delivery of key objective/service due to lack of staff

Ongoing unsafe staffing levels or competence

Loss of several key staff

No staff attending mandatory training /key training on an ongoing basis

4. Statutory duty/ inspections

No or minimal impact or breech of guidance/ statutory duty

Breech of statutory legislation

Reduced performance rating if unresolved

Single breech in statutory duty

Challenging external recommendations/ improvement notice

Enforcement action

Multiple breeches in statutory duty

Improvement notices

Low performance rating

Critical report

Multiple breeches in statutory duty

Prosecution

Complete systems change required

Zero performance rating

Severely critical report

5. Adverse publicity/ reputation

Rumours

Potential for public concern

Local media coverage – short-term reduction in public confidence

Elements of public expectation not being met

Local media coverage – long-term reduction in public confidence

National media coverage with <3 days service well below reasonable public expectation

National media coverage with >3 days service well below reasonable public expectation. MP concerned (questions in the House)

Total loss of public confidence

6. Business objectives/ projects

Insignificant cost increase/ schedule slippage

<5 per cent over project budget

Schedule slippage

5–10 per cent over project budget

Schedule slippage

Non-compliance with national 10–25 per cent over project budget

Schedule slippage

Key objectives not met

Incident leading >25 per cent over project budget

Schedule slippage

Key objectives not met

7. Finance including claims

Small loss Risk of claim remote

Loss of 0.1–0.25 per cent of budget

Claim less than £10,000

Loss of 0.25–0.5 per cent of budget

Claim(s) between £10,000 and £100,000

Uncertain delivery of key objective/Loss of 0.5–1.0 per cent of budget

Claim(s) between £100,000 and £1 million

Purchasers failing to pay on time

Non-delivery of key objective/ Loss of >1 per cent of budget

Failure to meet specification/ slippage

Loss of contract / payment by results

Claim(s) >£1 million

8. Service/business interruption

Loss/interruption of >1 hour

Loss/interruption of >8 hours

Loss/interruption of >1 day

Loss/interruption of >1 week

Permanent loss of service or facility

9. Environmental impact

Minimal or no impact on the environment

Minor impact on environment

Moderate impact on environment

Major impact on environment

Catastrophic impact on environment

RISK NUMBER: 02 DATE RISK ADDED:

AC

CO

UN

TA

BL

E O

FF

ICE

R

& G

P O

WN

ER

DESCRIPTION OF STRATEGIC RISK

GRANULAR OPERATIONAL RISKS

IN

ITIA

L R

AG

RA

TIN

G

(LIK

EL

IHO

OD

x C

ON

SE

QU

EN

CE

)

KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

R

AG

R

AT

ING

LA

ST

MO

NT

H

R

EV

ISE

D R

AG

RA

TIN

G

ACTION POINTS & TARGET DATES FOR

COMPLETION

CG

+ C

B

Failure to achieve financial balance in 2015-16 and deliver optimum service from the financial resources available

Failure to achieve

financial balance in 2015- 16.

In 2014-15 the CCG delivered the mandated surplus through the use of a number of non-recurrent items such as Contingency and Transformation funding. The CCG has not addressed the underlying recurrent deficit.

In 2015-16 the CCG have a QIPP gap of approximately £10.5m. QIPP delivered in 2014-15 totaled £1.6m.

West Suffolk Foundation Trust has undertaken a programme of work to improve efficiency and create additional capacity in order to repatriate work form Addenbrookes. If the Trust is unsuccessful in repatriation the CCG could see increase in activity.

Demand increase over growth rates applied in the 2015-16 plans.

Increase in prescribing costs

Increasing cost pressures from Continuing

4x5

20

Project management approach to delivery of the QIPP plans

Continue to benchmark and horizon scan to identify further QIPP opportunities.

Focus on activity levels at acute provider with clear actions to mitigate against over performance

Close monitoring of the delivery of QIPP initiatives through KPI’s

Encourage innovative changes principally via CCGs to improve efficiency

Participation in regional and national discussions

Clinical Executive and Governing Body review of expenditure and significant investments

CHC Project Board

Review progress on the system implementation on a regular basis through Activity & Finance Meetings. Any escalated issues will be raised at the contract monitoring meeting / CEO: CEO meeting.

Financial Recovery plan has been developed to mitigate the in-year

COT

Project managers appointed

GP engagement

Governing Body

NHS England performance reviews

Internal & External Audit

Monthly SLA provider meetings

█

CHALLENGING

4x5

20

4x5

20

1. Series of workshops to be arranged with GPs to identify any further opportunities supported by benchmarking.

Target: End of July 2015 Completed:

2. Prioritise investments 15/16

Target: June 2015 Completed:

3. QIPP project management, tracking and prioritisation

Target: Tracking part of monthly reporting process Completed:

4.prioritization CHC Project board milestones

Target: Monthly review Completed: Last review March 2015

5.. Monthly identification of risks and opportunities

Target: Monthly review Completed

6. Financial Recovery Plan Target: Plans in place by end of July then ongoing monthly reporting

Healthcare activity

Providers require extra financial support (cash) to maintain or meet clinical quality and contractual standards.

West Suffolk Foundation Trust will move to a new PAS (E-Care) system which may impact on the data quality. This risk will also affect the CCG’s ability to quantify the impact and deduct from the Addenbrookes block contract the value of repatriation from Addenbrookes to WSFT

West Suffolk Foundation Trust has successfully bid for the new Community Service Contract. The contract will go live in October which also coincides with the implementation of the E- Care system.

overspends against acute activity contracts.

Target: July 2015 Completed:

See following sheet for next risk

RISK NUMBER: 04 DATE RISK ADDED:

AC

CO

UN

TA

BL

E O

FF

ICE

R

& G

P O

WN

ER



IN

ITIA

L R

AG

RA

TIN

G

(LIK

EL

IHO

OD

x C

ON

SE

QU

EN

CE

)



RAG RATING OF

GAPS IN CONTROLS

R

AG

R

AT

ING

LA

ST

MO

NT

H

R

EV

ISE

D R

AG

RA

TIN

G


COMPLETION

BM

+ C

B

Failure to achieve zero MRSA bacteraemia as set out in NHS England Planning Guidance Everyone Counts: Planning for patients 2013/14 and Guidance on the reporting and monitoring arrangement and post infection review process for MRSA bloodstream infections from April 2015

(Failure to achieve outcome ambition 7: ‘making significant progress towards eliminating avoidable death in our hospitals caused by problems in care’ set out in : NHS England Everyone Counts: Planning for patients 2014/15 to 2018/19)

Attendance at all IP&C

Committee meetings and PIRs by Shared Management Team, reviewing assurance PIR learning and management systems

4x3

12

All MRSA bacteraemia

cases are subject to NHS England Post Infection Review (PIR)

CCG leads PIR pre 48hr

cases

Acute provider where

case occurred leads post 48hr cases

Review of all audits and

contract monitoring information against CQC recommended IC standards (to include antibiotic prescribing) in all CCG commissioned services at Quality Monitoring meetings

Review of compliance

against national and locally agreed MRSA screening standards

Bi-monthly reviews of PIR

findings at Infection Prevention Network

External scrutiny provided

Infection Control

scrutiny at QIVs, to ensure quality standards being met

Regular evidence submission linked to the provider action plan, demonstrating progress against plan

Performance report data to CCG Governing Body and Clinical Executive demonstrating compliance with zero tolerance

Details of individual cases reported to CCG with identified actions to improve clinical practice

Scrutiny at Quality Review Group (QRG) meetings with escalation to contract meetings were required, promoting wider scrutiny

INTERNAL AUDIT PLAN:

█

CHALLENGING

2x4

8

2x4

8

1. Review of CCG Infection Prevention Strategy

Target: May 2015 Completed: Yes June 2015

2. Review of Networks priority focuses

Target: June 2015 Completed: Yes June 2015

3. Annual review of ICSN work plan

Target: May 2015 Completed: Yes June 2015

4. Regular monthly meeting between CCG and WSH IP Leads

Target: July 2015 Completed: on target

5. Schedule of planned QIV in place

Target: September 2015 Completed:

6 Feedback learning from PIR at HICC


7.

Target: Completed:

8.

by Public Health England 4.2 Monitoring of Contracts ; 1.4 Clinical Governance – Overview

CCG PRIORITY:

To ensure high quality local services To demonstrate excellence in patient experience; and patient engagement and safety

Target:


RISK NUMBER: 06 DATE RISK ADDED: NOVEMBER 2012

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Failure to achieve the local reduction trajectories for Clostridium difficile as set out in NHS England: Clostridium difficile objectives for NHS organisations in 2015/16 and guidance on sanction implementation.

(Failure to achieve outcome ambition 7: ‘making significant progress towards eliminating avoidable death in our hospitals caused by problems in care’ set out in : NHS England Everyone Counts: Planning for patients 2014/15 to

Currently community onset

C.diff cases are not subject to PIR

GP ownership of primary

care cases with clinical review identifying those for CCG Assessment

Provider and CCG joint

thematic analysis of all cases of Cdiff

4x4

16

Robust RCA/PIR

process for each provider case and submitted to CCG for assessment.

Audit programme of CQC recommended IC standards (to include antibiotic prescribing) in all CCG commissioned services

CCG attendance at

PIR revie2ws and IPC Committee meetings

Provider delivery of

targeted infection control education and audit in all CCG commissioned services.

15/16 trajectory

agreed in SLA – ceiling for 16 Acute cases and 29 non-acute cases (45 in total)

Bi-monthly reviews of

PIR findings at Infection Prevention Network

External scrutiny provided

Monitoring of PIR

process and audit results at QRG evidencing the standards are being met

Shared learning from PIRs will take place through the IC Network on a bi monthly basis for dissemination within providers to improve clinical practice.

System wide action plan updated in line with PIR outcomes with bimonthly review at IC Network, demonstrating implementation of detailed actions

CCG scrutiny of monthly CDI cases reported within the data capture system HPA

INTERNAL AUDIT PLAN:

4.2 Monitoring of Contracts ; 1.4 Clinical Quality – Overview

Work in collaboration

█

CHALLENGING

3x4

12

3x4

12

T

1. Review of CCG Infection Prevention Strategy

Target: May 2015 Completed: May 2015

2. Review of Networks priority focuses

Target: June 2015 Completed:Yes June 2015

3.Annual review of IPC work plan


4. CDI Reduction plan to be reviewed and updated


5. Evidence of best practice to be shared from CDI assessments at IC Network


6. CDI Community Assessment Tool to be piloted (delayed due to training to take place for practice based IP Leads until August)

Target: August 2015 Completed: June 2015

7. CDI Reduction plan out for consultation - delayed until July

by Public Health England with system to implement recommendations from C diff PIRs.

CCG PRIORITY:

To ensure high quality local services

RCA/PIR Quality Standard Tool to monitor data quality in order to ensure learning is captured


8. CDI Reduction plan to be implemented delayed until August

Target: August 2015 Completed:

9. Develop information pack for GP in collaboration with prescribing workstream

Target: August 2015

Completed: on target


RISK NUMBER: 14a DATE RISK ADDED: APRIL 2013

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Failure to comply with NHS continuing Health care Framework

Inability of CCG to provide

Patents with a NHS CHC outcome decision within 28 days

Insufficient staff resources

in place to deliver service/respond to activity

Contractual and financial

support not in place Complex Case Reviews

QIPP Programme delivery

Failure to take action on

risks identified within Feb 2015 Internal Audit Report – limited assurance.

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20

Contracted providers

held to account for process through contracting meetings

Investment in CCG CHC clinical and administration resource as identified in 2014/15 Internal Audit Report

Established process for Complex case reviews

QIPP monitored through CCG CHC Work stream

Develop workforce succession planning

Review of operating processes established to target backlog which will not effect on going business continuity

Update report on actions to address risks identified in Internal Audit Feb 2016

Review reports from Broadcare Stop the Clock function to understand delays in attaining 28 day target

Review performance

at COT and CCG clinical execs and Governing Body, to assess performance to assess within 28 days and performance against trajectory to reduce retrospective claims backlog

Reports to CCG and

clinical execs and integrated care work stream to assess performance to assess within 28 days and performance against trajectory to reduce retrospective claims backlog

Contracted providers

meeting quality and performance standards

Complex case reviews follow process

Vacancy rates below 5%

CCG PRIORITY:

█

CHALLENGING

4x5

20

4x5

20

T

1. Monthly reports to the CCG CHC Work stream for review and action reports

Target: April 2015 Completed: April 2015

2. Resilience test over a six month period - Broadcare ability to provide an integrated activity and finance report

Target: October 2015 Completed:

3. Review all complex cases against care plan

Target: March 2016 Completed:

4. Complete business case to close PUPoC and Back log and move CCG CHC to business as usual


5. CHC Workstream consideration of options/approach for backlog and service/QIPP development


6. Internal Audit Action Plan provided to Internal Audit and ongoing on a monthly basis to CHC workstream (outstanding actions still remain for Contracting and Finance)

Target: May 2015 Completed: YES March 2015

To ensure high quality local services To improve care for frail elderly individuals

7. Presentation of Business Case to Clinical Executives for decision on 2 and 3 June


8.

Target:

9

Target:


RISK NUMBER 14b DATE RISK ADDED February 2014 – Separated existing RISK 14

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Retrospective claims for CHC for September, 2012 and March 2013 cut off dates.

Inability to recruit

qualified staff to review claims

Failure to process ‘retrospective’ claims within financial provision made

Increasing demand for on-going CHC

Reduced timescale for completion of PUPOC cases and access to the pooled NHSE fund

Broadcare is a standalone system with limited capacity to store records

4x5

20

Establish management

and administration process to review and manage the claims

Identify claims applicable WSCCG with indicative cost

Recruitment of personnel to administer and clinically review all claims

Use staff within the entire CHC team flexibly to ensure deadlines are met

Decision panels to

ensure robust CCG decision makingRegular reporting using local spread sheet to inform performance reporting

Claims processed within expected timeframes

█

CHALLENGING

4x5

20

4x5

20

T

1. Regular reporting Monitoring of staffing and performance at Monthly CHC work stream.

Target: April 2015 Completed: April 2015

2.Urgent Business Case approval required

Target: June 2015 Completed: June 2013

3. Appointment of CHC Programme Director

Target: June 2013 Completed: June 2013

4.Development of strategic direction of programme


5. Development of CHC programme implementation plan with defined outcomes

Target: Completed:

6. Regular reporting of progress with CHC implementation plan


7.

Target Completed:

RISK NUMBER: 20 DATE RISK ADDED: MAY 2014

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Failure to redesign and commission services covered by the Urgent Care and Health and Independence reviews within required timescales

Potential for services to

fall out of contract Risk that the full

potential benefits of a transformational redesign are not met leading to patient care being adversely affected and inefficiencies in the system

Reputational damage to

commissioners

4x4

16

Programme structure

put in place for Health and Care Mapping of all existing services to ensure full coverage of newly commissioned services

Regular review with

SCC to ensure smooth running of programmes

COT review

Executive Group review

Health & Wellbeing Board review

Governing Body Review

Area Team Strategic Plan Review

CCG PRIORITY:

Demonstrate excellence in patient experience and patient engagement

Improve the health and care of older people

Improve access to mental health services

Improve health and wellbeing through partnership working

Deliver financial sustainability through quality improvement

█

CHALLENGING

3x4

12

3x4

12

T

1. Contingency plans to be developed and approved

Target: Sept 2014 Completed: Sept 2014

2. Contingency plans to be implemented

Target: Dec 2014 Completed: Yes Dec 2014

3. Complete 1+1 procurement and extensions

Target: June 2015 (on track) Completed:

4. Submit vanguard bid for collaborative arrangements

Target: Feb 2015 Completed: Yes February 2015

5. Agree next steps on vanguard work with system

Target: April 2015 Completed: YES April 2015

6.

Target: Completed:

7.

Target: Completed:

8.

Target: Completed:

RISK NUMBER: 22 DATE RISK ADDED: JULY 2014

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LSP Contract Cessation

The national contract for

the provision of Clinical Systems through an LSP (Local Service Provider) ends in July 2016

Requirement to procure

existing or replacement systems, with a risk that the costs of this change will not be devolved locally, and we will be forced to identify additional resources; currently unclear, expected to be no less than £0.25m per annum

4x5

20

System-wide

coordination of the response to this contractual change is being led by the CCGs

Impacted providers are

evaluating the benefits of the existing systems to enable development of appropriate business case(s)

Investigation of

procurement options

Financial implications

being considered within 2 & 5 year plans, and long term financial outlook

All funding implications

are to be handled locally; cost pressures have been factored into financial planning

█

CHALLENGING

3X4

12

3x4

12

1. System wide coordination action plan to be produced

Target: End Q4 2014/15 Completed: Yes May 2015

2. Meetings with providers with outcomes to be fed into action plan

Target: Completed: Yes October 2014

3. Action plan for procurement options to be produced

Target: End Q4 2014 Completed: June 2015

4. Follow up with the DoH / Cabinet Office

Target: Completed: Yes October 2014

5. implementation of procurement action plan

Target: Q2 2016/2017 Completed:

6.

Target: Completed:

7.

Target: Completed:

8.

Target: Completed:

RISK NUMBER: 24 DATE RISK ADDED: JANUARY 2015

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WT

A&E failing to meet 4 hour standard presenting a potential risk to patient safety and experience.

Clinical risk of patients

not being seen in appropriate timescales or insufficient beds to accommodate appropriate environments.

Risk of patient

experience deterioration due to long waits.

Risk of breaching

constitutional obligations.

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Where required, daily

system wide teleconferences designed to ensure all actions to improve patient flow are taken

Team of escalation

managers in place to support system and directors on call.

Daily performance information monitored, regular discussions and monthly formal contract meetings.

█

CHALLENGING

4x4

16

4x4

16

1. Continued close working across the health system with the intention of improving 95% performance for future months throughout 2015/16 contract year

Target 95% to be met monthly Completed: MTD 96.78 %QTD 94.98%

Completed:

2. Contract Query issues- working to compliance with contractual standards

Target: Remedy daily performance to achieve 95%

Completed:

3. . System wide action plan agreed through SRG

Target: Review monthly

Completed:

4. Target: Completed:

Target: Completed:

5.

Target: Completed:

RISK NUMBER: 26 DATE RISK ADDED: June 2015

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Failure to successfully implement e-care system at West Suffolk Hospital (November 2015), the impact of which destabilizes the system for a period of time

Existing (external) information flows become disconnected during / post deployment

Existing (external) information flows require business change outside WSH, which is not addressed in a timely manner

New (external) information flows are established without appropriate training / business change

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CCG ICT & Informatics Lead is member of WSH eCare Programme Board

Information Sharing Lead is on eCare Stakeholder Group

WSH has introduced Clinical Safety Officer

eCare Programme Lead will present to WS Strategic IT Programme Board in July

Wider stakeholder engagement will occur following July

█

MANAGEABLE

3x5

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3x5

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1. Membership of eCare Programme Board

Target: Q4 14/15 Completed: Q4 14/15

2. Membership of eCare Stakeholder Board

Target: Q1 15/16 Completed: Q1 15/16

3. Mapping & assurance of external information flows

Target: Q2 15/16 Completed:

4. Stakeholder briefing plans implemented

Target: Q2-Q3 15/16 Completed:

RISK NUMBER: 27 DATE RISK ADDED: July 2015

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Potential impact of service quality delivered by NSFT

CQC Inspection report February 2015 highlighted serious concerns in service quality and rated the Trust inadequate overall

Monitor concluded investigation into Trust finances in June 2015 and notes breach of license – Potential for actions to address presenting compromise to quality of services

Reduction in quality of

service and inability to meet performance and clinical quality targets

Maintaining safer staffing levels in accordance with NICE & NQB guidance

Adverse financial position may impact adversely of the quality of care delivered

Potential increase in contract issue log referrals

4x4

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Monthly meetings

to review / challenge quality performance

On-going development of quality dashboard

Attendance at

monthly stakeholder assurance meetings led by Monitor / CQC

Oversight of

quality improvement plans (trust / local) and monthly monitoring of progress by quality team and workstream

Support for NSFT

mock CQC inspections and feedback

Unannounced

quality improvement visits

Sign off provider

CIPs and associated QIAs

Monitor primary

care contract issues and Trust response

Demonstrated

improvement against identified contractual key performance indicators evidenced through quality dashboard escalation of issues via SLA meetings

Confidence that NSFT have structures in place to deliver the required quality improvements

Assurance that actions detailed in the quality improvement plan have been implemented

Test that actions

detailed in the quality improvement plan have resulted in changes at an operational level

Test that actions

detailed in the quality improvement plan have resulted in changes at an operational level

█

CHALLENGING

4x4

16

1. Regular quality review meetings to review performance against defined key performance indicators

Target Monthly updates

Completed:

2. Support NSFT to develop a visual quality dashboard promoting visual assessment of performance against agreed thresholds and allowing trends to be identified.

Target: : Monthly with template finalized in September 2015

Completed:

3. . CCG attendance at monthly stakeholder assurance meetings to review and challenge progress to deliver quality improvements

Target: Ongoing

Completed:

4. Review of progress against quality improvement plans (Trust / Local) prior to each quality review meeting

Target: Ongoing Completed:

5. Schedule quality improvement visits to Suffolk based NSFT services

To ensure that CIP schemes do not have an adverse impact on quality

Timely response to

contract issues with effective learning reducing numbers

Target: August 2015 Completed:

6. Schedule meeting to gain assurance of robust process to sign off CIPs and to review QIAs associated with the CIPs to assess potential negative impact on quality

Target: August 2015

Completed:

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Agenda Item No. 14 Reference No. WSCCG 15-44 From: Amanda Lyes, Chief Corporate Services Officer

REVISED REMUNERATION AND HR COMMITTEE TERMS OF REFERENCE

1. Purpose

1.1 To present to the Governing Body for approval revised terms of reference for the Remuneration and HR Committee, as revised by the Committee at its meeting held on 5 May 2015.

2. Background

2.1 In line with its current terms of reference, at its meeting held on 5 May 2015, the Remuneration and HR Committee carried out an annual review of its terms of reference.

3. Current Position

3.1 Having reviewed its terms of reference at its meeting, the Remuneration and HR Committee asked that the Chief Corporate Services Officer discuss the following comments with the CCG’s Governance Advisor prior to circulating revised terms of reference for agreement by the Committee and recommendation to the Governing Body for approval.

That reference to the Shared Management Advisory Group should be removed from the terms of reference as the Group was thought to no longer be necessary.

That the implication on the CCG’s Constitution of removing the Shared Management Advisor Group from the terms of reference be explored and steps put in place to alter the Constitution if required.

That paragraph 3.5 should be revised to take account of the fact that minutes reported to the next Governing Body were often ‘unconfirmed’ and not ‘approved.

That paragraphs 4.1/4.2 be reviewed to clarify the correct membership of the Committee and ensure consistency. That the sentence ‘membership may include individuals who are not on the Governing Body’ should be retained.

To consider whether there was a necessity for ‘running costs’ to continue to be included in section 8.

3.2 As a result of the recommendation of the Remuneration and HR Committee the attached

terms of reference, showing revisions as tracked changes, were subsequently agreed for recommendation to the Governing Body for approval

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4. Recommendation

4.1 The Governing Body is recommended to approve the Remuneration and HR Committee

revised terms of reference as appended to the report.

Author: Jo Mael Corporate and Governance Officer

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WEST SUFFOLK CLINICAL COMMISSIONING GROUP

REMUNERATION AND HUMAN RESOURCES COMMITTEE

TERMS OF REFERENCE

1 INTRODUCTION

The Committee is established in accordance with the NHS West Suffolk Clinical Commissioning Group’s constitution and shall advise the Governing Body about the appropriate remuneration and terms of service for the senior officers, managers and staff of the Clinical Commissioning Group. The Terms of Reference are based on the former NHS Commissioning Board template and are approved by the NHS West Suffolk Clinical Commissioning Group Governing Body. They are reviewed on an annual basis.

2 REMIT AND RESPONSIBILITIES OF THE COMMITTEE 2.1 The Committee shall make recommendations to the Governing Body on

determinations about pay and remuneration for employees of the Clinical Commissioning Group and people who provide services to it and allowances under any pension scheme it might establish as an alternative to the NHS pension scheme.

2.2 The Committee shall determine and recommend as required, the allowances

payable to GPs and other members of the Governing Body not employed by the Clinical Commissioning Group.

2.3 The Committee shall review and approve, as required, recommendations made by

the Shared Management Remuneration and Human Resources Advisory Group in regard to the Accountable Officer’s performance.

2.4 The Committee shall review and approve, as required, recommendations made by

the Shared Management Remuneration and Human Resources Advisory Group in regard to the Accountable Officer and other Chief Officer’s remuneration and conditions of employment.

2.5 The Committee shall determine on behalf of the Governing Body the terms of

service (pay and non-pay benefits) of senior officers and managers. 2.6 The Committee shall establish arrangements for monitoring and evaluating the

performance of individual senior officers and managers, as approved by the Governing Body.

2.7 The Committee shall determine and approve the application of Clinical Excellence

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Awards. 2.78 The Committee shall advise on and oversee contractual arrangements for staff by

developing policies for recommendation to the Governing Body, to ensure an equitable and consistent approach.

2.89 The Committee shall receive and approve HR, Organisational Development and

Learning and Development policies and procedures. 2.910 The Committee shall receive and approve reports and have oversight of the work

of the Health and Safety Committee. 2.101 The Committee shall determine and oversee contractual arrangements with staff

and any termination payments. 2.112 The Committee shall receive the minutes of any sub groups that may be formed

and receive and approve reports on Organisational Development and Learning and Development.

2.123 By reference to the Governing Body Assurance Framework, the Committee shall

monitor allocated risks and satisfy itself and assure the Audit Committee that the mitigating actions proposed for each allocated risk are reasonable and that each mitigating action is being undertaken.

2.134 In making its recommendations and decisions the Committee will take into

account: (i) Provisions of any national guidance and arrangements

(ii) Relevant legislation (in particular anti-discrimination and equal pay

legislation)

(iii) Best practice and affordability

(iv) Employee relations and relevant staffing matters within the Clinical Commissioning Group

(v) Remuneration levels elsewhere within the NHS and other relevant

labour markets

(vi) Trends and development in non-pay benefits and terms and conditions

(vii) Organisational performance

(viii) Auditor requirements

(ix) Existing terms and conditions of service

(x) Statutory health and safety legislation and best practice

2.145 The Committee will retain the right to place specific reports, on an exception basis

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and with the agreement of the Chair, in a closed agenda whereby the content of the report and subsequent discussion, will not be accessed under the Freedom of Information Act 2000. Reports placed in a closed agenda will be returned to the Governing Body Secretary or nominated deputy at the meeting for shredding. Committee members will be responsible for deleting the relevant electronic records from their own computer systems.

3 RELATIONSHIP WITH THE GOVERNING BODY 3.1 The Committee has authority from the NHS West Suffolk Clinical Commissioning

Group Governing Body to determine matters in respect of the remuneration and terms of service of senior officers and staff, where issues of confidentiality and possible conflicts of interest are concerned. The Committee is accountable to the NHS West Suffolk Clinical Commissioning Group Governing Body

3.2 The Chair of the Committee in consultation with colleagues on the Committee and

senior officers of the Clinical Commissioning Group will make decisions that are required urgently.

3.3 The Committee has delegated powers from the Governing Body for all Human

Resources policies and procedures and issues that may impact on the terms and conditions of employment for all staff, for instance lease cars and travel policies.

3.4 The Committee has delegated powers from the Governing Body for all matters of

health and safety. 3.5 Formal minutes shall be kept of the proceedings and approved by members of the

Committee prior to submission which will be submitted to the next meeting of the NHS West Suffolk Clinical Commissioning Group Governing Body.

3.6 The Chair of the Committee shall draw to the attention of the Governing Body any

issues that require disclosure to the full Governing Body, or require executive action.

4 MEMBERSHIP OF COMMITTEE 4.1 The Committee shall consist of the Chair of the NHS West Suffolk Clinical

Commissioning Group Governing Body and a minimum of two members appointed by the Clinical Commissioning Group Governing Body as set out in the Constitution, one of whom will be the Chair of the Audit Committee Lay Member for Governance. Membership may include individuals who are not on the Governing Body.

4.2 The Lay Member for Governance will chair the Committee.

In the event of the Chair being unable to attend all or part of a Committee meeting, he or she will nominate a replacement from within the membership to deputise for that meeting.

4.3 The Chair will be a member of the Shared Management Remuneration and HR

Advisory Group that advises the Committee and through this, the Governing Body, about the appropriate remuneration, terms of service and performance

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management of the Accountable Officer and other Chief Officers shared by the Clinical Commissioning Group.

4.34 Senior Officers of the Clinical Commissioning Group are not eligible for

membership of the Committee. A senior representative for HR and the Accountable Officer are invited to attend in an advisory capacity. It is acknowledged that HR advice should be sought to assist the Committee in reaching decisions and it would be expected for the HR representative to be present throughout the meeting, unless the majority of the Committee and the Chair considered otherwise. Other Senior Officers will be invited to attend as appropriate.

4.45 Full time employees or individuals who claim a significant proportion of their

income from the Clinical Commissioning Group will not be Members of the Committee and the Member Practices should not be in the majority.

5 SECRETARY The Corporate Services Office will provide the secretariat to the

Committee.Governing Body Secretary shall be secretary to the Committee and he/she, or their nominee, shall attend to take minutes. The Governance AdvisorGoverning Body Secretary shall provide appropriate support to the Chair and committee members when necessary by drawing their attention to best practice, national guidance and other relevant issues as appropriate.

6 QUORUM A quorum shall be two members. 7 FREQUENCY OF MEETINGS 7.1 Meetings shall be held bi-monthly or as appropriate. 7.2 The agenda and supporting papers will be sent out at least 5 days in advance of

the meetings to allow time for due consideration of issues. 7.3 Meetings will be timetabled and agreed in advance. 8 CONDUCT OF THE COMMITTEE The Committee will review on an annual basis its own performance and

effectiveness including running costs and membership and terms of reference. The Governing Body will approve any resulting changes to the terms of reference or membership.

Date Approved: July 2012

Last Review: May 2015

Next Review: April 2016

From: Amanda Lyes, Chief Corporate Services Officer WEST SUFFOLK CCG GOVERNING BODY SELF-ASSESSMENT FEEDBACK 1. Purpose 1.1 To present to the Governing Body feedback from its recent self-assessment exercise. 2. Background 2.1 In line with the annual self–assessment process carried out by other Committee’s,

the CCG’s Clinical Scrutiny Committee, at its meeting held on 29 April 2015 agreed that, other Committees to include the Governing Body, may benefit from carrying out a similar exercise.

2.2 To that end a self-assessment questionnaire was developed and distributed to

members of the Governing Body on 6 May 2015 for completion and return by 29 May 2015.

3. Current Position 3.1 A total of 6 responses were received. The detail of those responses is set out within

Appendix 1. 3.2 Review of the content of the responses indicates that, in the main, members feel the

Governing Body achieves its overall aims and working principles. 3.3 As discussed at the CCG’s Clinical Scrutiny Committee held on 24 June 2015, it is

intended that an action plan be developed from the feedback associated to self-assessment carried out by the CCG’s Clinical Executive Committee, Clinical Scrutiny Committee and Governing Body for review at the next meeting of the Clinical Scrutiny Committee.

4 Recommendation 4.1 The Governing Body is asked to consider feedback from the self-assessment

exercise as presented and whether any further action might be required. Author: Jo Mael Corporate Governance Officer

Agenda Item No. 15


GOVERNING BODY - SELF ASSESSMENT QUESTIONNAIRE

Number of responses:

Issue Yes No Partially N/A Comments/Action

1. OVERALL AIMS - Do you think that the Governing Body:

Is correctly constituted with relevant sub-committees that enable it to carry out its role effectively

6 Having just joined the board this is my impression so far.

Includes clinical leaders who can demonstrate commitment to partnership working and have the necessary skill set to lead commissioning and drive transformational change

5 1 Some clinical leaders still on the learning curve as would be expected, others don’t provide enough inspiration or drive.

Membership includes the right balance of experience, knowledge and skills

6

Upholds the seven Nolan principles of Standards in Public Life

6

Effectively carries out its statutory duties

6

Gives equal prominence to both quality and financial matters

5 1 There are pressures that could lead to reduce from gold standard to keep within financial ‘straight jacket’. Increasingly the driving force has been finance and less of quality

Has proper constitutional and governance arrangements with the capacity and capability to deliver all of its duties and responsibilities

6

Secures effective participation by each member of the CCG in the exercise of the groups’ functions

4

2 Although participation is sought and encouraged there are some to seem unwilling to participate.

Has significant engagement with its constituent practices

5 1 However engagement is not in consistent across the patch, but is geared to practice ‘wants’. Not all practices engage with the CCG as you might expect

Effectively manages risk 6

Has effective processes in place for dealing with conflicts of interests of members or employees of the group

6

Facilitates transparency in its decision making

6

Has clear and credible plans to deliver quality and productivity improvements within financial resources

5 1 One of the greatest challenges we have. Some QIPP plans are very ambitious and could be seen to be unachievable from the outset

6


Reviews assurance and regulatory compliance reporting processes

6 Incorporated within agenda items

Has mechanisms to keep it aware of topical legal and regulatory issues

6 Incorporated within agenda items

2. WORKING PRINCIPLES – Do you think that the Governing Body achieves:

Trust and mutual respect 5 1 Building trust and mutual respect could be improved.

Openness, honesty and transparency

6

Top level commitment 6

A positive and constructive approach

5 1 I think it can be too guarded at times. There is a practical approach taken when necessary which is essential.

A commitment to work with and learn from each other

6

Appropriate confidentiality when needed

6

Everyone is aware that this is essential for a board member.

3. INTENDED BENEFITS - Do you think that the Governing Body:

Has regard to the need to reduce inequalities between patients with respect to both their ability to access health services and the outcomes achieved

5 1 Needs more focus

Has a clinical focus in everything it does, with quality at its heart

5 1 With the higher balance of GPs it is naturally at the core of the CCG. Some QIPP schemes may reduce the quality but make savings

Ensures inclusion of patients, carers, public, Health and Wellbeing Boards, local authorities and other relevant stakeholders

6 Actively encouraged. Most of the time. Benefits enormously from Jo Finn

Communicates a clear vision of the improvements it is seeking to make locally, including population health improvements and reducing health inequalities

5 1 No clear vision for health inequalities or population health

Achieves the involvement of other clinical colleagues providing health services locally

6 Unfortunately not all Practices have clinicians who participate.

Identifies and prepares for future developments in patient need, and changes in the healthcare provider market

6 CCG does embrace the need to adapt and prepare for future changes.

Analyses and acts on information from communication and engagement activities to translate priorities for improvement in services, access and outcomes

6 The volume of communicated information seems to be neverending.

Effectively works in partnership with local authorities and other relevant organisations

6 The difficulties are that other organisations also have their restrictions and financial restraints. This does sometimes limit progress and fully be able to work together.

Has credible plans for how the CCGs will continue to deliver the local QIPP challenge for the local health system

3 3 Plans are not delivering the necessary QIPP. Concentration has been focused on current years, but has been acknowledged a longer term


view/plans need to be developed. Some plans look too ambitious

Encourages innovation and implementation of evidence based practices.

6 It is acknowledged we can learn from each other locally, but also further afield.

Established a track record of delivering service transformation

5 2 Some good examples but not widespread. This has been a learning curve and developed since CCG inception.

4. CONDUCT OF MEETINGS - Do you think that for meetings of the Governing Body:

The quality of papers received allows members to perform their roles effectively

5

1 Papers could be shorter and punchier. But the volume is sometimes a limiting factor

Agendas and papers are circulated in good time for members to adequately prepare for meetings

5

1 But sometimes short notice updates ‘invalidates’ the ‘reading’ already done.

Minutes are circulated no more than 10 days after the meeting

5 1 By necessity the weekly board meetings are, some committees do live up to this need.

Each agenda item is ‘closed off’ appropriately so that members are clear as to what the conclusion is; who is doing what, when and how and how it is being monitored

5 1 Not always. Seems to work well

Debate is allowed to flow and conclusions reached without being cut short or stifled due to time constraints etc

6 Debate and ideas are encouraged

Meetings are chaired effectively and with clarity of purpose and outcome

5 1 Well managed

The Chair is visible within the organisation and is considered approachable

6

Members contribute regularly across the range of issues discussed

6 There is participation from all – with the varying board make up it does seem to give added value by views from different perspectives.

Members feel sufficiently comfortable in meetings to be able to express their views and opinions

5 1 Can be guarded. And this is encouraged

Members provide real and genuine challenge – they do not just seek clarification and/or reassurance

4 2 The challenge is all too often from the lay members. Members come across as there to make a difference not to just ‘rubber stamp’ changes

When a decision has been made or action agreed, there is confidence that it will be implemented as agreed and in line with the timescale set down

6 Realistic timings are essential to achieve the required outcomes

of 23

Agenda Item No. 16


From: Bill Banks, Lay Member for Governance, Vice Chair MINUTES OF MEETINGS 1. Purpose

1.1 This report incorporates for endorsement, minutes of recent meetings of the Audit Committee, Remuneration and HR Committee, Clinical Scrutiny Committee, CCG Collaborative Group and Commissioning Governance Committee.

(i) Audit Committee The unconfirmed minutes of an extraordinary meeting held on 18 May 2015 and meeting held on 2 June 2015.

(ii) Remuneration and HR Committee The unconfirmed minutes of a meeting held on 16 June 2015

(iii) Clinical Scrutiny Committee The unconfirmed minutes of a meeting held on 24 June 2015

(iv) CCG Collaborative Group The unconfirmed minutes of a meeting held on 18 June 2015

(v) Commissioning Governance Committee

Decisions from a meeting held on 20 May 2015 2. Recommendation 2.1 The Governing Body is asked to endorse the minutes as attached to the report whilst noting

that ‘unconfirmed’ minutes remain subject to change by the relevant Committee/Group. Author: Jo Mael Corporate and Governance Officer

Unconfirmed Minutes of an Extraordinary Meeting of the West Suffolk Clinical

Commissioning Group Audit Committee held on Monday 18 May 2015 PRESENT Bill Banks - Lay Member for Governance (Chair) Peter Knights - Governing Body Member IN ATTENDANCE Colin Boakes - Governance Advisor Dan Daley - Management Trainee Mark Game - Head of Accounting and Control Carl Goulton - Chief Finance Officer Mark Hodgson - Ernst and Young – External Audit Roger Holt - Financial Accounting Manager Jo Mael - Corporate and Governance Officer Ruth Pritchard-Wooles - Ernst and Young - External Audit 15/042 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were noted from: Lisa George - Local Counter Fraud Specialist, Tiaa Amanda Lyes - Chief Corporate Services Officer



15/044 AUDIT RESULTS REPORT

Whilst in receipt of the Audit Results Report, the Committee was advised by External Audit that its conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in the use of resources had been revised since distribution of the agenda. A revised version was circulated and it was explained, that Members were required to reflect on the Audit Results Report provided and consider the appropriateness of the proposed management response. Key messages as outlined within the Audit Results Report included; Financial Statements

The financial statements were good with their being nothing to report. The CCG’s finance directorate was thanked for assistance it had provided to the Auditors.

There had been no significant audit risks to report in respect of financial statements.

Other risks were identified as being in relation to addressing the backlog of continuing healthcare cases and deadline pressures as a result of bringing the audit completion date forward which could have impacted on the timeliness and quality of the financial statements and supporting working papers.

The Annual Report had improved on that of 2013/2014 with their being nothing

significant to report.

The report outlined that the Auditors had identified one misstatement within the draft financial statements which management had chosen not to adjust. The CCG was required to either correct the statement or provide a rationale as to why it would not be corrected for consideration and approval by the Audit Committee and inclusion within the Letter of Representation.

Internal control – the report highlighted that a number of ex-gratia payments had been made during the financial year that, contrary to the CCG’s constitution, had not been reviewed by the Audit Committee. Whilst it was noted that the payments had gone through the Remuneration and HR Committee, there was a need for tighter governance procedures going forward.

Value for Money Criteria 1 – arrangements for securing financial resilience Since issue of the Audit Plan, the Auditors advised that they had identified a new significant risk to Criteria 1, that being the CCG’s ability to achieve its forecast outturn position in 2015/16 dependent upon delivery of its Quality, Innovation, Productivity and Prevention (QIPP) plan. The auditors reported that they had gained sufficient assurance about the financial resilience of the CCG. They also commented that the CCG needed to monitor the delivery of the QIPP programme throughout the year, as the track record of delivery remained a significant challenge. Criteria 2 – arrangements for securing economy, efficiency and effectiveness As previously mentioned, whilst paperwork distributed with the agenda had indicated a report by exception in relation to economy, efficiency and effectiveness in the use of resources in respect of the CCG’s arrangements for addressing the backlog of continuing healthcare cases, that conclusion had since been revised to qualification. It was explained that following discussion with the Regulator, the Auditors had been advised that a report by exception was not appropriate and, as such, the conclusion was revised to that of qualification. The CCG was required to review arrangements it had in place to assess continuing healthcare claims in order to clear the significant backlog of cases and achieve the 28 day framework target, with its Governing Body being required to consider the recommendation within the next three months and respond formally to the External Auditors. Having questioned the implications of a qualified conclusion, the Committee was advised that it was possible the Regulator might publicise CCG performance. In the event that there was no improvement next year a public interest report would need to be undertaken and most likely referred to the Secretary of State for Health. The Committee noted the content of the reports and thanked the External Auditors.

15/045 ANNUAL REPORT AND ACCOUNTS

The Committee was in receipt of a report from the Chief Finance Officer which

provided an updated version of the Annual Report and Accounts. Key points included;

That at the date of the report the audit of the CCG's accounts was on-going and therefore could result in further amendments to the accounts. Any

amendments, if any, would be minor in nature and discussed outside of the meeting. No significant amendments were expected.

Management had made various amendments to the Annual Report and Accounts since the drafts that were presented to Members on 22 April 2015. In respect of the Governance Statement and Accounts those amendments had been relatively minor in nature and agreed with audit colleagues during the audit process. None of the amendments had resulted in a change to the previously reported surplus of £2,775k.

Management had decided not to amend a misstatement identified during the audit process. The reason for not amending the misstatement was given in appendix one and was included in the draft Letter of Representation.

Appendix two addressed the agreed actions from the Informal Audit Committee meeting on 22 April 2015.

Having considered the latest version of the Annual Report and Accounts and reviewed the appropriateness of the management response to the Audit Results Report, the Audit Committee recommended that the CCG Governing Body approve the Annual Report and Accounts and Letter of Representation.

15/046 DATES OF FUTURE MEETINGS

The next meeting of the West Suffolk CCG Audit Committee was to be on Tuesday 2 June 2015 at 2.00pm in the Paddock Meeting Room at Rushbrook House. Future meetings:

Date Venue Time

2015

02 June 2015 Paddock Meeting Room 2.00pm

01 September 2015 Paddock Meeting Room 2.00pm

06 October 2015 Paddock Meeting Room 2.00pm

01 December 2015 Paddock Meeting Room 2.00pm

2016

02 February 2016 Paddock Meeting Room 2.00pm

_____________________________ ______________________ Chairman (Bill Banks) Date

Unconfirmed Minutes of a Meeting of the West Suffolk Clinical Commissioning

Group Audit Committee held on Tuesday 2 June 2015 PRESENT Bill Banks - Lay Member for Governance (Chair) Peter Knights - Governing Body Member IN ATTENDANCE Neil Abbott - Head of Internal Audit

Dan Daley - Management Trainee Mark Game - Head of Accounting and Control Lisa George - Local Counter Fraud Specialist, Tiaa Mike Gooch - Emergency Planning & Resilience Manager (Item 15/046 only) Mark Hodgson - Ernst and Young, External Audit Jo Mael - Corporate Governance Officer Norman Pottinger - Information Governance and Risk Manager 15/042 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were noted from: Colin Boakes - Governance Advisor Carl Goulton - Chief Finance Officer Kevin Limn - Director, Tiaa Amanda Lyes - Chief Corporate Services Officer Ruth Pritchard-Wooles - Ernst and Young - External Audit



15/044 MINUTES OF THE PREVIOUS MEETING

The minutes of the West Suffolk CCG Audit Committee meeting held on 7 April 2015 were reviewed and confirmed as a correct record.

15/045 MATTERS ARISING AND REVIEW OF ACTION LOG

The Committee was advised that, as yet, there had been no further information issued in respect of the attestation related to primary care co-commissioning. Whilst the Audit Committee had previously requested that it receive regular updates in respect of continuing healthcare, there was no such update on today’s agenda, although it was noted that progress against audit recommendations was reported under agenda item 8. The action log was reviewed and updated with comment as follows: 15/031 – Internal Audit Reports – Commissioning Minor Contracts – following discussion with the Deputy Chief Contracts Officer it had been confirmed that the

CCG’s Procurement Policy contained a section on contracts although a forthcoming review of the policy might result in identification of the need for a separate policy. The Audit Committee asked that the action be kept open for review in six months’ time.

The Chair agreed that Item 12 (Business Continuity – Final Update) be taken next. 15/046 BUSINESS CONTINUITY – FINAL UPDATE

The Emergency Planning and Resilience Manager introduced a report from the Chief Nursing Officer which provided feedback on the business continuity exercise carried out on 7 April 2015. The report detailed the aims and objectives of the exercise, its outcome together with actions identified following its completion. The Committee was advised that the exercise had demonstrated that the business continuity plan was fit for purpose and work continued to facilitate the carrying out of a similar exercise at West Suffolk House. The Audit Committee noted the content of the report.

15/047 ANNUAL REVIEW OF TERMS OF REFERENCE

The Committee was presented with its current terms of reference for annual review, which it felt remained relevant. As no revisions were made there would be no need for the terms of reference to be presented to the Governing Body for approval. The Committee approved its current terms of reference for continued use.

15/048 ANNUAL FEE LETTER

The Committee was in receipt of the Annual Audit Fee letter for 2015/16 from Ernst and Young, External Auditors. The Committee was advised that fees for 2015/16 as set out within the letter were in line with expectation. The Committee noted the content of the Annual Audit Fee letter and accepted the fees as detailed within it.

15/049 ANNUAL INTERNAL AUDIT REPORT

The Committee was in receipt of the Internal Audit Annual Report which summarised work carried out by internal audit during 2014/15. The report contained the Head of Internal Audit’s opinion on the effectiveness of the system of internal control at West Suffolk CCG for the year ended 31 March 2015, which was noted as being an overall opinion of ‘reasonable’ assurance. Internal audit had carried out 21 assurance reviews throughout the year, with eight having been ‘substantial’, 12 ‘reasonable’ and 1 ‘limited’ as previously reported in relation to continuing healthcare. An audit carried out in respect of shared management arrangements remained incomplete due to difficulties in obtaining benchmarking information.

The Committee noted the content of the report and that the Head of Internal Audit would be meeting with the CCG’s Chief Finance Officer to discuss use of the shortfall of audit days.

15/050

INTERNAL AUDIT REPORTS The Committee received the following reports from internal audit with comment in respect of each as follows; Assurance Review of the Commissioners – New Services – Providers Arrangements The assurance review of the Commissioners – New Services – Providers Arrangements had resulted in a ‘reasonable’ assurance level having been achieved. The Committee accepted the report. Review of Section 136 Mental Health Act The assurance review of Section 136 Mental Health Act had resulted in a ‘substantial’ assurance level having been achieved. The Committee accepted the report. Internal Audit Recommendations The Committee was in receipt of a report from the Head of Internal Audit which set out current progress against internal audit recommendations. It was reported that there were currently 25 recommendations outstanding, with 14 of those 25 having slipped into the 0-3 month period for completion and three into the 4-6 month period. There had been no response from the nursing directorate in relation to actions associated with the Individual Funding Request audit and, at the request of the Committee, the Head of Internal Audit agreed to highlight the matter to the Chief Officer. The Committee noted the report and thanked the Head of Internal Audit for work carried out during 2014/15.

15/051 LOCAL COUNTER FRAUD REPORT

The Committee was in receipt of the Counter Fraud Annual Report for 2014/15 which, it was explained, had been developed in line with NHS Protect guidance. Points highlighted included;

The local counter fraud specialist had carried out bribery awareness training on 20 February 2015 which had been attended by 10 CCG employees.

A number of fraud bulletins had been issued and policies reviewed.

The results of a counter fraud survey were attached to the report.

There had been no referrals to the local counter fraud specialist since the previous meeting.

A review of continuing healthcare payments was to be undertaken. The scope and objectives of the review were currently being agreed with the Chief Finance Officer, although in line with work elsewhere, it was likely to focus on evidencing the content of packages and associated payments.

The Committee was disappointed to note the low response rate in respect of the

counter fraud survey and, it was explained, that work to encourage increased participation in future surveys would be incorporated within training sessions. Whilst it was questioned whether the response rate per CCG could be identified, it was reported that due to anonymity associated with the survey that would not be possible. From the responses received to a question on the CCG’s Whistleblowing Policy, there was concern that 50% had not felt confident that, by raising a concern, they would not be at risk of losing their job or suffering any form of retribution. As requested by the Committee, the Local Counter Fraud Specialist agreed to advise the Chief Corporate Services Officer of the statistic and provide opportunity for response. The Committee noted the report and thanked the Local Counter Fraud Specialist for work carried out during 2014/15.

15/052 MANAGING CONFLICTS OF INTEREST – GP DECLARATIONS OF INTEREST

The Committee was in receipt of a report from the Chief Corporate Services Officer on the need to ensure that the CCG complied with revised statutory guidance in respect of managing conflicts of interest (published by NHS England on 18 December 2014) In order to comply with the principles of the guidance, whilst not requesting that virtually all GPs complete a declaration of interests form, it was now proposed to only seek declarations of interest from CCG Member Practice Representatives. That would however be on the basis that other GP partners within a practice would be required to make a declaration in the event of commissioning processes and decisions where they might be seen to potentially benefit financially. Having questioned how the recommendations sat in relation to central guidance, the Committee concluded that whilst it was happy to agree the recommendations ‘in principle’ the Governance Advisor should be asked to provide the Chair with sight of the relevant section of the guidance for clarification. The Audit Committee subsequent ‘approved in principle’ the following recommendations, subject to the Governance Advisor providing the Chair with sight of the relevant section of the guidance, and the Chair being satisfied there was no inconsistency;

The requirement for CCG Member Practice Representatives to complete a declaration of interests and that they would be expected to do that by the end of July 2015. In line with all others completing declarations, they would be updated quarterly by exception.

The requirement that other partner GPs in a practice be required to make a declaration of interests in the event of a commissioning process and/or resultant decision where they might be seen to potentially benefit financially whether or not that was real or perceived.

(Post Meeting Note: following provision of the requested information, the Chair confirmed his endorsement of the decision of the Audit Committee)

15/053 SELF-ASSESSMENT

The Committee was in receipt of a draft self-assessment questionnaire which it was being asked to review and approve for circulation and completion by Committee members. The Committee approved the self-assessment questionnaire as appended to the

report for circulation to Committee members, Officers and representatives from internal audit and counter fraud. Members requiring clarification on questions contained within the audit could forward queries to the Corporate Governance Officer for a response to be obtained.

15/054 GOVERNING BODY ASSURANCE FRAMEWORK (GBAF)

The Committee was in recent of the current version of the GBAF for review. Amendments and additions to the GBAF were detailed within Section 3 of the report. The Committee was advised that the risk associated with existing information sharing flows across the health system being destabilised by the deployment of Lorenzo Regional Care creating a risk to patient care, was likely to be downgraded for inclusion on the Corporate Services risk register in the near future as the risk was not as high as had originally been thought. The appropriateness of downgrading the MRSA risk in light of a ‘0’ occurrence target was questioned. The Committee noted the content of the GBAF

15/055 WAIVERS OF COMPETITIVE TENDERING

No waivers of competitive tendering were received.

15/056 REVIEW OF ANNUAL PLAN OF WORK

The Committee reviewed the annual plan of work.



15/058 DATES OF FUTURE MEETINGS

The next meeting of the West Suffolk CCG Audit Committee was scheduled to take place on Tuesday 8 September 2015 at 2.00pm in the Paddock Meeting Room at Rushbrook House. Future meetings:

Date Venue Time

2015

06 October 2015 Paddock Meeting Room 2.00pm

01 December 2015 Paddock Meeting Room 2.00pm

2016

02 February 2016 Paddock Meeting Room 2.00pm


Unconfirmed Minutes of a meeting of the West Suffolk Clinical Commissioning

Group Remuneration and Human Resources Committee Meeting held on Tuesday, 16 June 2015

PRESENT: Bill Banks Lay Member for Governance (Chair) Dr Christopher Browning GP Member IN ATTENDANCE: Amanda Lyes Chief Corporate Services Officer Jo Mael Corporate and Governance Officer

15/031 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were

noted from Jo Finn, Lay Member for Patient and Public Involvement 15/032 DECLARATIONS OF INTEREST

No declarations of interest were received. 15/033 MINUTES OF THE PREVIOUS MEETING

The minutes of the West Suffolk CCG Remuneration and Human Resources

Committee meeting held on 5 May 2015 were reviewed and confirmed as a correct record subject to a minor revision to paragraph 3 of minute 15/019 to change ‘and’ to ‘had’ in respect of the revision of policies.

15/034 MATTERS ARISING AND REVIEW OF THE ACTION LOG

There were no matters arising from the previous meeting and the action log

was reviewed and updated. 15/035 DIRECTORATE UPDATE

The Committee was in receipt of a written general overview of the key

headlines of activity within each directorate with key points highlighted from the report including; Corporate Services

The IT service management procurement continued, with a report to be presented to the CCG’s Governing Body in July 2015.

In light of the challenges being faced by the continuing healthcare team the Chief Corporate Services Officer had loaned a member of the Corporate Services team to assist.

The Human Resource team was to launch a data cleanse of staff information in the near future.

A Property Services User Group, Chaired by the Chief Corporate Services Officer had been set up.

The Chief Corporate Services Officer confirmed that, in order to remain within contractual requirements, the CCG was obliged to comply with NHS

Part One

Jobs request that the CCG cease advertising for other organisations such as GP practices.

Nursing Directorate

The restructure of the Individual Funding Request team had been concluded and the Committee was to receive a more detailed report later on the agenda.

The business case for additional staff within the continuing healthcare team had been approved by the CCG’s Clinical Executive and was now being implemented. Interviews for additional nursing posts were due to take place on 19 June 2015.

Finance One of the Deputy Chief Finance Officer’s (with primary responsibility for Ipswich and East Suffolk CCG) would be leaving the organisation and a recruitment campaign to find a replacement was to commence in the near future. Contracts

Work on the community services procurement continued with expectation that the contract would be signed at the end of June 2015.

A meeting was scheduled to take place on 17 June 2015 with trade union representatives in relation to the TUPE of staff in respect of the community services contract.

One of the Deputy Chief Contract Officer’s would be leaving the organisation and a recruitment campaign to find a replacement was to commence in the near future.

Chief Operating Office and Redesign

The CCG’s new tele-dermatology service had been shortlisted for the Health Service Journal Value in Healthcare Awards 2015.

15/036 WORKFORCE PLANNING AND DEVELOPMENT UPDATE

The Committee was in receipt of a report from the Chief Corporate Services

Officer which provided an update on how the Transformational Lead for Workforce Planning and Development was supporting the health workforce in Suffolk. It was explained that the Transformational Lead for Workforce Planning and Development role had been funded by the Local Education and Training Board (LETB) for a 12 month period from December 2014 in order to focus on health and social care workforce profiling and integrated workforce development. Work carried out since December 2014 was detailed within Section 3 of the report and included;

Facilitation of a Suffolk Executive Away Day to establish trust and build relationships to support integrated workforce planning and development at executive level

Development and agreement by the System Leaders Partnership Board of a memorandum of understanding in respect of the sharing of workforce data across Suffolk organisations.

Development of ‘Think Big!’ an integrated real time project support programme for piloting with the early adopter sites, and development of an integrated re-ablement and rehabilitation service in September 2015.

Roll out of a worker shadowing pilot programme for the Sudbury integrated neighbourhood team.

The sharing of over 50 different pieces of work and projects across the health and social care system in Suffolk and Norfolk from networks established through the role.

Whilst progress of work had previously been reported through the System Leaders Partnership Board, regular updates were now being provided to the Health and Wellbeing Board. Work was taking place with Suffolk County Council in an attempt to secure funding for continuation of the role after December 2015. The Chief Corporate Services Officer agreed to provide a further progress update once plans had been finalised. The Committee noted the report and confirmed its support for attempts to seek continuation of the role of Transformational Lead for Workforce Planning and Development post December 2015.

15/037 WORKER SHADOWING

The Committee was in receipt of a report which provided information on the

implementation of a pilot worker shadowing programme in Sudbury and the potential for its wider roll out across Norfolk and Suffolk. It had been identified through the Sudbury Integrated Neighbourhood Team (INT) workshops that there was a lack of knowledge about the roles and responsibilities of different teams and their members and hence the Sudbury Task and Finish Group had agreed that a worker shadowing programme be developed. Worker shadowing for implementation included ‘fly on the wall’ observation and observation with some active involvement. The programme consisted of a minimum placement of two half days with a host organisation and individuals were able to apply for more than one placement. 10 staff across both CCGs had expressed an interest in the programme to date, with work now taking place to define areas of focus and ensure linkage to personal development programmes. The Committee advised of the need to ensure that there was benefit for both individuals and the organisation and welcomed further information at a later date. The Committee noted the content of the report and requested that it receive further information on evaluation of the pilot at a later date, together with a breakdown of take up by staff per CCG.

15/038 HEALTH AND SAFETY AND RISK COMMITTEE

The Committee received a report from the Chief Corporate Services Officer

which provided an update on health and safety matters. Key issues highlighted within the report included;

Safetyboss the CCG’s Health and Safety Advisor had continued to provide training sessions for staff covering manual handling, fire safety and general health and safety awareness. The content of the training had been refreshed in January 2015 with increased emphasis on health and safety within the office environment.

The Health and Safety and Risk Committee had developed a set of ‘housekeeping’ guidelines for Rushbrook House in line with those already in existence and developed by the Council in respect of West Suffolk House.

The Health and Safety and Risk Committee had addressed issues associated with the farm car park at Rushbrook House which included improving the quality of the surface and lighting.

Two fire evacuation exercises had been carried out with the most recent having included the staging of an emergency planning exercise.

The Committee noted the content of the report.

15/039 RISK ASSESSMENT – ‘LOCK DOWN’ PROCEDURES

The Chief Corporate Services Officer reminded the Committee that at a

previous meeting it had questioned the necessity for ‘lock down’ procedures and asked that the Health and Safety and Risk Committee consider the matter at a forthcoming meeting. To that end, the Committee was now in receipt of a report and draft risk assessment which had been presented to the Health and Safety and Risk Committee at its meeting held on 15 June 2015. The report considered ‘lock down’ procedures in conjunction with security arrangements at Rushbrook House. The Chief Corporate Services Officer advised that, at its meeting on 15 June 2015, the Health and Safety and Risk Committee had invited comment from its members on the draft risk assessment by 19 June 2015 and, as such, the outcome would be reported to the Remuneration and HR Committee in September 2015. The Committee noted the content of the report and that it was to receive a further update in September 2015. The Committee requested that the update also include confirmation in respect of arrangements in place at West Suffolk House.

15/040 POLICIES FOR APPROVAL

There were no policies received for approval. 15/041 JOINT STAFF PARTNERSHIP COMMITTEE

The Committee was in receipt of a report from the Chief Corporate Services

Officer which summarised the main issues discussed and outcomes to emerge, from the Joint Staff Partnership Committee meeting held on 8 May 2015. The Committee noted the content of the report.

15/042 DEPARTMENT OF HEALTH LETTER REGARDING EXECUTIVE PAY

The Committee was in receipt of a recent letter received from Jeremy Hunt,

MP in respect of executive pay, together with a proposed response from the CCG Chair. The letter from the Department of Health had been issued to Chairs of NHS Trusts, NHS Foundation Trusts and Clinical Commissioning Groups, with a request that CCGs respond to the points outlined within the letter by the end of June 2015. The Chief Corporate Services Officer advised that both CCG Chairs had seen and approved the draft prior to its presentation to the Committee for consideration and endorsement. The Committee questioned whether responses contained within the letter


should be bullet pointed in line with the questions asked, and asked that exploration of the correct salutation be undertaken. Having reviewed the draft response and been assured by the Chief Corporate Services Officer that there was nothing deficient in the CCG’s controls, the Committee endorsed the draft response subject to inclusion of the correct salutation and revision of the letter to bullet point format.

15/043 NHS CONSULTANCY SPENDING CONTROLS

The Committee was presented, for information, with a recently received letter

from the Chief financial Officer of NHS England in respect of NHS consultancy spending controls. The letter dated 2 June 2015 outlined a number of actions in respect of controlling NHS consultancy expenditure, which although were mainly applicable to providers, also applied to CCGs in some instances. The Committee noted the content of the letter and that there were mechanisms in place to control such expenditure with monitoring via the relevant Committee such as Remuneration and HR Committee, Audit Committee and Collaborative Group.

15/044 INDIVIDUAL FUNDING REQUEST TEAM RESTRUCTURE

The Committee was presented with a report which provided information on the

recent individual funding request team restructuring process. The report included documentation in respect of the consultation exercise, questions raised and responses given, together with detailing the final structure which had now been implemented. It was explained that the restructuring process had been difficult and taken six months to complete. The restructure had seen a refocus on job descriptions and roles and responsibilities with there being no staff redundancies. Recruitment was still to take place to the Band 7 position with the role due to be advertised in the near future. Operating procedures had been revised to reflect the new structure. The Committee noted the content of the report.

15/045 ANNUAL PLAN OF WORK

The Committee noted the annual plan of work and that any changes could be

notified to the Corporate Governance Officer. 15/046 ANY OTHER BUSINESS

The Chief Corporate Services Officer reported that the CCG was to be

inspected by HM Revenue and Customs on 5 August 2015. 14/047

DATE AND TIME OF NEXT MEETING

The next meeting of the West Suffolk CCG Remuneration and Human Resources Committee was scheduled to take place on Tuesday, 15 September 2015 at 10.00am, in the Paddock, Rushbrook House, Paper Mill Lane, Bramford, Ipswich, Suffolk, IP8 4DE.

Unconfirmed Minutes of WSCCG Clinical Scrutiny Committee held on Wednesday 24 June 2015 from 0900 – 1100hrs

Room T2, Green Duck, Technology House, Western Way, Bury St Edmunds, IP33 3SP

PRESENT: Bill Banks Lay Member – Governance (Chair) Dr Simon Arthur GP Governing Body Member Kevin Bernard Governing Body Member Dr Ed Garratt Chief Operating Officer Carl Goulton Chief Finance Officer Julian Herbert Chief Officer Dr Crawford Jamieson Secondary Care Lead Dr David Kanka Deputy Director of Public Health Peter Knights Governing Body Member Dr Daniel Knowles GP Governing Body Member Amanda Lyes Chief Corporate Services Officer Barbara McLean Chief Nursing Officer Rakesh Raja GP Governing Body Member Dr Roz Tandy GP Governing Body Member Wendy Tankard Chief Contracts Officer Dr Andrew Yager GP Governing Body Member IN ATTENDANCE: Andy Eley Deputy Chief Operating Officer Hilary Finegan Continuing Healthcare Programme Director Louis Kamfer Deputy Chief Finance Officer Jo Mael Corporate Governance Officer (Minutes) Jo Wyatt Office Manager, West Suffolk CCG 15/027 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and apologies for absence were noted

from; Dr Christopher Browning GP Governing Body Member and CCG Chair Jo Finn Lay Member – Public and Patient Engagement Dr Giles Stevens GP Governing Body Member



15/029 MINUTES OF PREVIOUS MEETING

The minutes of the meeting held on 29 April 2015 were reviewed and agreed as a correct record.

15/030 MATTERS ARISING & REVIEW OF ACTION LOG

There were no matters arising from the previous minutes and the action log was

reviewed and updated.

15/031 INTEGRATED PERFORMANCE REPORT

The Committee received the Integrated Performance Report for June 2015, which

provided members with a summary of performance against national targets, contractual targets, clinical quality and patient safety issues, workstream progress and financial performance and acute activity. Key points highlighted during discussion included; Clinical Quality and Patient Safety

Serious case review – recommendations of the report associated to a childrens safeguarding serious case review had noted incidental learning for those organisations involved. When available, the resultant Suffolk wide action plan would be reported to a future meeting.

The Committee’s attention was brought to improved infection control reporting contained within the report.

The report detailed recent positive visits to the Care Coordination Centre and a nursing home where concerns had previously been raised.

CQC and Monitor work in respect of Norfolk and Suffolk NHS Foundation Trust was detailed within the report. The CCG had worked jointly with Norfolk CCGs to develop a reporting dashboard with the first report having been expected last week. The next Monitor meeting was scheduled to take place on 24 June 2015.

Contracts

West Suffolk Hospital – progress was being made in respect of the remedial action plan associated with acute oncology and staff training was being pursued. The situation continued to be monitored closely. A remedial action plan was now in place with regard to A&E and performance levels were currently being met. Referral to treatment times gave cause for concern across specialties and the Committee was in receipt of a more detailed addendum paper. Remedial action plans had been initiated and whilst delivery was expected in July 2015, recent information was indicating that General Surgery would not be compliant until October 2015. A recent decline in diagnostic performance was also impacting on performance levels and ways to increase capacity and staff resource were being explored. A remedial action plan was in place. A recent decline in cancer two week wait times outside of the CCG area was being investigated

Care UK/111 Service – the 111 service had recently experienced increased

demand. Warm transfer performance continued to be an area of concern and the recruitment of advisors remained challenging. The decline in performance would be escalated contractually.

Finance

The CCG’s financial plan was to be discussed later on the agenda.

Whilst £8m of QIPP schemes had originally been identified, NHS England had requested that activity increase by 1% at a cost of £2m which had necessitated identification of a further £2m of QIPP schemes. In light of that gap NHS England’s Area Team had been unable to assure the plan and advised that it would be undertaking a ‘deep dive’ of the CCG’s finances with the CCG being required to resubmit its plan by the end of June 2015.

Whilst a breakdown of the current position in respect of identified QIPP schemes was detailed within the additional report, it was noted that some such as continuing healthcare were of high risk.

At Month one unvalidated data was indicating over-performance in both acute activity and prescribing. There was increased day case activity with significant variances in trauma and orthopaedics and gynaecology, whilst emergency and

non-elective activity was slightly lower the casemix was higher than plan, which in some cases was due to excess bed days. The situation was being monitored closely. The Committee agreed that activity level information should be considered by the workstreams prior to discussing with the Trust at forthcoming service level agreement meetings, and that under-performance in cardiology and general medicine should also be investigated. Having suggested that coding be reviewed and noted that previously annual clinical audits had taken place, the Committee agreed that, in line with the contract, the CCG should seek to undertake exploration of coding jointly with the Trust. The importance of identifying mutually beneficial schemes with the Trust was emphasized and the Chief Officer agreed to consider the matter with the Trust’s Chief Executive at forthcoming meetings. The need to determine if current identified QIPP schemes were successful and facilitate the identification of further schemes was recognised.

Clinical Workstreams The Chief Operating Officer reported that information contained within the report in respect of workstream progress had been revised and now included RAG ratings. Key points highlighted during discussion included; Integrated Care – whilst work with care homes in Sudbury carried out by the CCG’s Care Homes Coordinator had been successful there was difficulty in recruiting to the team in order to facilitate roll-out of the work across the CCG area. The COPD community service was to be built into the integrated admission prevention service from July 2015. Whilst a paper on frailty was to be presented to the system forum next week which considered how patients might be managed more effectively, a CQUIN associated to the frailty assessment tool had not been agreed and was due to be discussed at the Executive Committee. A clinical lead had been identified for the integrated admission avoidance scheme and the operating model was being developed although key performance indicators were, as yet, to be agreed with the hospital. The Committee agreed that all outstanding issues with the hospital should be discussed within workstream meetings that afternoon prior to considering further action. Planned Care – the Chief Contracts Officer agreed to bring detail in respect of the pain service to a future Executive Committee meeting. Prescribing – focus was on poly pharmacy, tackling wastage and reduced prescribing. The Committee noted the content of the reports.

The Chair agreed that agenda item 10 (Financial Recovery Plan) be taken next.

15/032 FINANCIAL RECOVERY PLAN

As previously discussed, the Committee was in receipt of a financial plan being

developed for submission to NHS England at the end of June 2015.

The need for the plan to contain increased detail on new QIPP schemes was emphasized. The Committee noted the plan and proposals by NHS England to carry out a ‘deep dive’ of the CCG’s finances at the end of June 2015 for discussion at meetings to be held in July 2015.

15/033 CONTINUING HEALTHCARE CURRENT POSITION

The Committee was in receipt of a presentation from the new Continuing Healthcare

Programme Director which detailed workforce planning and reporting in respect of the service going forward. It was reported that, whilst the presentation was focussed on Previously Unassessed Periods of Care (PUPoC) cases, it was intended that the work carried out in respect of such cases could be utilised to address the backlog of normal cases. The presentation detailed the steps required to process a case together with outlining a trajectory reporting template. The Committee was advised that work would shortly take place in an attempt to streamline processes. Whilst work also continued in respect of a procurement process to outsource work the availability of providers was unknown and, as such, focus remained on meeting the November 2015 deadline set by NHS England for the clearance of PUPoC cases. There was an on-going campaign to recruit nurses and a number of appointments had been made from interviews held the previous week with further interviews planned. It was recognised that, in light of the auditor’s report, future consideration would need to be given as to whether to focus resource on PUPoC cases or the backlog. The Committee noted the content of the report and that the CCG’s Executive and Scrutiny Committee would continue to receive regular progress updates.

15/034 CONTRACT RENEWAL LIST

The Committee was in receipt of a report from the Chief Contracts Officer which

detailed progress in respect of contract renewals. The Committee noted the content of the report and that the CCG’s workstreams would continue to receive regular updates on the current contract position.

15/035 GOVERNING BODY ASSURANCE FRAMEWORK (GBAF)

The Committee received the current version of the CCG Governing Body Assurance

Framework (GBAF) which, it was explained, was reviewed by the Chief Officer Team every month and by the Governing Body and Audit Committee at each of their meetings. Amendments and additions to the GBAF were set out with Section 3 of the report with key points highlighted being;

There were nine risks in total.

The removal of Risk 25 (Existing information sharing flows across the health system are destabilised by the deployment of Lorenzo Regional Care creating a risk to patient care). The risk had been removed from the GBAF and incorporated within the Corporate Services departmental risk register.

Risk 26 (Failure to successfully implement e-care system at West Suffolk Hospital (November 2015)) had been added.

The narrative and rating associated to Risk 04 (Failure to evidence the national drive of zero tolerance on MRSA bacteraemia) was questioned and the Chief Nursing Officer agreed to investigate. The Committee noted and approved the content of the report.

15/036 SELF ASSESSMENT FEEDBACK FORM

The Committee was in receipt of a report which contained feedback from its recent

self-assessment exercise. A total of 11 responses had been received and whilst feedback indicated that members felt the Committee achieved its overall aims and working principles, there was concern in respect of openness and transparency and whether members provided real and genuine challenge. The Committee noted the content of the report and requested that the Chief Corporate Services Officer consolidate feedback from self-assessment exercises carried out across Committees into an action plan for consideration at a future meeting.



15/038 DATE OF NEXT MEETING

Wednesday 26 August 2015, 0900-1200 hrs, Ground Floor room 14, West Suffolk House, Bury St Edmunds, IP33 3YU.

Ipswich & East Suffolk Clinical Commissioning Group

West Suffolk Clinical Commissioning Group

Unconfirmed Minutes of the CCG Collaborative Group meeting held on

Thursday, 18 June 2015, 3.00pm in the Pavilion, Rushbrook House

PRESENT Martin Smith (MS) CCG Collaborative Group Chair Dr Christopher Browning (CB) Chair, West Suffolk CCG Governing Body Dr Mark Shenton (MS) Chair, Ipswich and East Suffolk CCG Governing Body Julian Herbert (JH) Chief Officer, Ipswich & East Suffolk and West Suffolk CCGs Bill Banks (BB) Lay Member (Governance) West Suffolk CCG Governing Body Graham Leaf (GL) Lay Member (Governance) Ipswich & East Suffolk CCG Governing Body IN ATTENDANCE Jo Mael (JM) Corporate Governance Officer Minute

Action

15/019 Welcome and apologies The Chairman welcomed everyone to the meeting and no apologies for absence were received.

15/020 Declarations of Interest


15/021 Minutes of meeting held on 16 April 2015

The minutes of a meeting held on 16 April 2015 were considered and agreed as a correct record.

15/022 Matters arising and review of action log

There were no matters arising and the action log was reviewed and updated.

15/023 Service Performance Review Report

The Collaborative Group was in receipt of the Service Review Performance Report which, it was explained contained revised objectives for Chief Officers following commencement of the new financial year. Progress was to be reviewed via regular 1:1 meetings with the Chief Officer, and indicators RAG rated with the individuals concerned, prior to them being discussed within the Chief Officer team as a whole. Key points highlighted included:

As the Chief Contracts Officer, a Deputy Chief Contracts Officer and Deputy Chief Finance Officer were due to leave the organization, there was a potential risk in respect of work associated with the community services contract that was due for sign off by the end of June 2015.

QIPP delivery in 2015/16 was recognised as challenging and the first set of data was currently awaited. NHS England’s Area Team had indicated that it wished to do a ‘deep dive’ into the CCGs QIPP plans and following their submission to the Area Team by the end of June 2015, a visit by the Area Team was anticipated to go through the plans in detail.

Continuing healthcare and individual funding requests continued to be an area of concern for the CCG and was to be discussed later on the agenda.

It was felt that the County Council had been more internally focused recently, which had resulted in some delayed progress within workstreams. It was anticipated that situation would resolve going forward.

The Collaborative Group noted the report and that the next six months would be a challenging period for the CCGs in light of the continuing healthcare situation, increased scrutiny on QIPP and personnel changes.

15/024 Continuing Healthcare

The Chief Officer reported that, in light of the previously reported concerns associated with continuing healthcare as highlighted within internal and external audit reports, he would be taking on direct responsibility for chairing continuing healthcare workstream meetings going forward. An interim programme director had recently been appointed to take over responsibility for the work of the team who would report directly to the Chief Officer and was to attend next week’s Clinical Scrutiny Committee meetings. The outsourcing of work continued to be explored.

15/025 Primary Care Co-Commissioning Update

The Group was in receipt of a briefing note in respect of primary care co-commissioning. The paper set out the scope for co-commissioning, governance and management arrangements and advised that a memorandum of understanding was currently being developed with NHS England to clarify the role and responsibilities of joint committees. CCG’s were able to apply for full delegated arrangements from 1 April 2016 with formal proposals needing to be submitted by 2 October 2015. Co-commissioning could also be extended to include dental, eye health and community pharmacy. Whilst full delegated arrangements might be considered as an opportunity for the CCGs, any agreement to go forward would need to be dependent on facilitation of appropriate support and resource. The CCG Collaborative Group noted the content of the briefing note.

15/026 Election Outcome Implications

The Collaborative Group was in receipt of a paper which set out key commitments contained within the Conservative election manifesto in relation to health and workforce issues. It was reported that the two main messages being received since the election were;

That Government was not keen to undertake any further re-organisation of the health service, although Monitor and the TDA were likely to have one Chief Executive appointed across both organisations.

That there would be increased scrutiny and focus on finances with NHS England taking on an increased assurance approach.

An announcement from Jeremy Hunt, Secretary of State for Health in respect of primary care was expected on 19 June 2015. The CCG Collaborative Group noted the report.

15/027 Any Other Business

No items of other business were received. 15/028 Dates of next meeting

The CCG Collaborative Group agreed that, in light of the absence of a number of members, the 20 August 2015 meeting be cancelled.

Date Venue Time

Dates 2015

20 August 2015 (Cancelled) The Pavilion 11.00am

15 October 2015 The Pavilion 11.00am

17 December 2015 The Pavilion 11.00am

(All meetings to be held in The Pavilion, 1st Floor, Rushbrook House).

JM

WEST SUFFOLK CCG COMMISSIONING GOVERNANCE COMMITTEE

Decision Record

20 May 2015

DIABETES LOCAL ENHANCED SERVICE (LES) To receive and approve a report.

Dr Rakesh Raja Report No:

WSCCG/CGC 15-05

Commissioning Governance Committee Members:

Bill Banks, Lay Member for Governance, Chair

Julian Herbert, Chief Officer Carl Goulton, Chief Finance Officer Wendy Tankard, Chief Contracts Officer Dr Crawford Jamieson, Secondary Care Doctor Decision Having carefully considered information contained within the report, and

advising that further consideration should be given as to how any approved scheme would be monitored throughout the year, the Commissioning Governance Committee subsequently; Agreed ‘in principle’ to development of the diabetes local enhanced scheme (LES) subject to percentages aligned to the payment structure being revised to become more outcome based, as follows: % of Payment Schedule 20% 4 quarterly instalments to all participants 10% Upon submission of completed audit 20% 60- 79% of patients 8 out 9 key care processes met 20% 80% or above of patients 8 out 9 key care processes met 3 x 10% Upon achieving three treatment targets KPIs 1-3

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