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EVERYONE COUNTS: PLANNING FOR PATIENTS

NHS KNOWSLEY CLINICAL COMMISSIONING GROUP 2013/14

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1. Introduction .......................................................................................................... 4

About Knowsley ...................................................................................................... 4 Knowsley Clinical Commissioning Group ............................................................... 5 Knowsley CCG’s Strategy and Vision ..................................................................... 6 Improving Outcomes, Reducing Inequalities .......................................................... 7 Preventing People from Dying Prematurely ............................................................ 7 Enhancing the Quality of Life for People with Long-Term Conditions ..................... 8 Helping People to Recover From Episodes of Ill Health or Following Injury ......... 10 Ensuring People Have a Positive Experience of Care .......................................... 11 Treating and Caring for People in a Safe Environment and Protecting Them from Avoidable Harm .................................................................................................... 12 The 3 Local Priorities ............................................................................................ 13 Choice and Transparency ..................................................................................... 13

2. The Basics of Care ............................................................................................. 14

3. Patients’ Rights: The NHS Constitution ........................................................... 14

4. Eliminating Long Waiting Times ....................................................................... 14

Diagnostic Test Waiting Times ............................................................................. 15 More Responsive Care: Urgent & Emergency Care ............................................. 15 Cat A Ambulance Calls ......................................................................................... 15 Cancer Waits – 2 Week Wait ................................................................................ 16 Keeping Our Promises: Eliminating Mixed-Sex Accommodation .......................... 17 Keeping Our Promises: Reducing Cancellations .................................................. 17 Mental Health........................................................................................................ 17 Keeping Our Promises: Choice and the Information to Exercise it ....................... 18 Dementia / IAPT ................................................................................................... 18

5. Patient Centred, Customer Focused ................................................................ 19

NHS Services, 7 Days a Week ............................................................................. 19 Healthcare Quality Improvement Partnership (HQIP) ........................................... 19 Choice in 2013/14 at all Points of the Pathway ..................................................... 20 Listening to Patients and Increasing Their Participation ....................................... 20 Acting on Feedback .............................................................................................. 21 Informing Patients ................................................................................................. 22 Better Data, Informed Commissioning, Driving Improved Outcomes .................... 22 NHS Standard Contract Sanctions........................................................................ 22 Commissioning the Appropriate GP Information Services to Provide Clinical Assurance and Safety. .......................................................................................... 23 Higher Standards, Safer Care ............................................................................... 24 Compassion in Practice standards and application of the 6 C’s. .......................... 24 Innovation ............................................................................................................. 25 Academic Health Science Network (AHSN). ........................................................ 25 Innovation, Health and Wealth: Accelerating Adoption and Diffusion in the NHS. 25

6. Transforming Health and Social Care at CCG Level ....................................... 26

Joined up Local Planning ...................................................................................... 26 Healthier Together Public Service Reform ............................................................ 27 QIPP 2013/14 ....................................................................................................... 27

7. Financial Planning ............................................................................................. 27

Managing Risk ...................................................................................................... 27

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Planning Assumptions .......................................................................................... 28 Tariff ...................................................................................................................... 28 Integrated Care Plans ........................................................................................... 28 Contracting for Quality .......................................................................................... 28 CQUIN .................................................................................................................. 28 KPIs ...................................................................................................................... 29 Continuity of Care ................................................................................................. 29

Knowsley CCG Plan on a Page………………………………………………………...35

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1. Introduction 1.01 The vision for the NHS in England is to secure better outcomes for patients as defined by the 5 domains of the NHS Outcomes Framework and uphold the rights and pledges in the NHS Constitution. 1.02 This plan will describe how Knowsley CCG will deliver the outcomes for its population in conjunction with a range of stakeholders from the health economy as defined through the delivery of system reform, quality, performance and financial metrics as defined in:

a) The Mandate for the NHS in England - the strategic framework for the discharge of NHS responsibilities, requiring the NHS to deliver improvements against the NHS Outcomes Framework; ensure patients’ rights and pledges under the NHS Constitution are maintained within allocated resources and meet the QIPP challenge.

b) The NHS Outcomes Framework - the standards for the NHS to achieve to secure better outcomes

c) The NHS Constitution - the rights of and pledges to patients to be upheld. 1.03 Through the delivery of the mandate, the NHS Constitution and the NHS Outcomes Framework Knowsley CCG will guarantee that no community is left behind or disadvantaged; will focus on reducing health inequalities and advancing equality to improve outcomes for patients.

1.1 About Knowsley

1.1.1 Knowsley is a metropolitan borough of Merseyside, England. It comprises the towns and districts of Kirkby, Prescot, Huyton, Whiston, Halewood, Cronton and Stockbridge Village.

1.1.2 Kirkby, Huyton, and Prescot are the major commercial centres of the borough. It takes its name from the village of Knowsley.

1.1.3 Knowsley’s population grew dramatically in the 1950’s and 1960’s as residents were migrated from inner city Liverpool to new housing estates created on the outskirts of the city. With them came existing health challenges, some of which remain present to this day.

1.1.4 Population forecasts predict further increases in the population aged 50 and

over, including a 75% increase in men aged 85 plus in Knowsley. At the same time, it is anticipated that there will be a decrease in younger age groups, notably those aged 35 to 44.

1.1.5 Life expectancy for females in Knowsley in 2006-08 was 79.2 years,

compared to a national average of 82 years, i.e. Almost 3 years lower. Life expectancy for males in Knowsley in 2006-08 was 75.5 years, compared to a national average of 77.9 years, i.e. almost 2½ years lower. There are also differences in life expectancy within the Borough. Male life expectancy

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ranges from 71.0 years in Prescot West ward to 79.5 years in Swanside ward, a difference of over 8 years. Female life expectancy ranges from 74.7 years in Northwood ward to 89.0 years in Halewood North ward, a difference of more than 14 years.

1.1.6 There are a number of other notable characteristics present in the Borough’s

population. Knowsley also has a higher than average proportion of lone parent households (19%) and a higher percentage of carers (11.5%) than the average for England and Wales (9.9%). Comparisons from the 2001 Census also reveal that Knowsley residents are less likely to own their own home, have a car or have qualifications and are more likely to be unemployed or have a limiting long-term illness.

1.1.7 The most deprived areas are often also those with the poorest health.

Physical and mental health and wellbeing can be affected by many factors, including

a) housing conditions, b) the environment, c) work, d) social contact, e) access to leisure and culture opportunities, f) experience or fear of crime and g) transport access to services and facilities

1.1.8 Knowsley is the third most deprived CCG in England; its patients have the

worst health related quality of life outcomes for long term conditions in the country and the highest standardised emergency admission rate in the North West. The challenge for the CCG is therefore at the highest level

1.2 Knowsley Clinical Commissioning Group

1.2.1 Knowsley CCG comprises 33 practices and a registered population of just over 161,000. Each practice has a CCG lead clinician and all leads come together to form the clinical Membership Group (CMG) and this group has determined the scheme of reservation and delegation. The CMG has reserved to itself the approval of group’s commissioning plan and its budget.

1.2.2 Knowsley CCG has seen excellent clinical engagement develop over the

past 12 months with practices coming together regularly to determine commissioning priorities and the Group’s governance structure through a process of discussion and debate often followed by voting where every person is involved in determining the final outcome of the discussion. This approach was also applied to the development of the Group’s draft strategy, vision and values which means that it is owned by the membership as opposed to being perceived as a ‘top down’ approach to developing the CCG.

1.2.3 The CCG commissioning priorities, draft strategy, vision and values were

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then shared with patients, the public and a wide range of stakeholders at a number of events prior to being adopted with the few changes that were requested.

1.3 Knowsley CCG’s Strategy and Vision

1.3.1 The CCG’s vision is that in 5 years-time, the population of Knowsley will be happier and enjoy better health. When they need to access health and wellbeing services, the services will be high quality, have improved access and use the latest evidence based treatments and therapies.

1.3.2 People will live longer, be healthier and enjoy a better quality of life. They will

be safer and there will be a reduction in health inequalities. They will have greater independence through self-care and have more responsibility and greater involvement in decisions about their care.

1.3.3 In order to make these aspirations a reality, the services that we commission

will be:

a) Patient centred b) Safe c) High quality d) Cost effective e) Outcome focussed f) Closer to home g) Affordable

1.3.4 From the patient’s perspective, all services will be integrated and appear

seamless. Where appropriate, the CCG will seek to foster greater integration of services across secondary care, primary care, community care, the local authority and the 3rd sector.

1.3.5 The CCG recognises the importance of the wider determinants of health and how social care, employment, economic prosperity, housing, sport and leisure, education, the environment and public health all help to promote health and wellbeing.

1.3.6 The CCG aims to take a leadership role in the whole health economy, in

particular in shaping how it is organised, in order to make it fit for purpose and ensure that patients will be at the heart of everything it does.

1.3.7 In order to deliver the CCG’s vision a number of vehicles for change were

identified;

a) Engaging patients and the public b) Moving from unplanned care to planned care c) Improving the quality of primary care d) Bringing services closer to home e) Quality assurance

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f) Patient education g) Professional education

1.3.8 The CCG has also worked collaboratively with the Local Authority to develop

and establish a strong Health & Wellbeing Board and developed a joint strategy that has a clear line of sight across all organisations and in particular the CCG’s commissioning plan. The Health & Wellbeing Board has agreed 4 priority areas for action in 2013/14, each area has a champion and the CCG is champion for 2 of the 4 areas; Respiratory Disease and Appropriate Use of Services.

1.3.9 It is from this platform that the CCG’s plan for 2013/14 has been developed

1.4 Improving Outcomes, Reducing Inequalities

1.4.1 Knowsley CCG has been an active partner in the establishment of the Knowsley Health & Wellbeing Board and in developing effective working relationships with the LA, Public Health and Direct Commissioners. The CCG recognises the importance of effective partnerships and co-commissioning relationships in reducing inequalities across the borough and has prioritised this within its engagement plan. The Joint Health and Wellbeing Strategy details a life course approach to improving outcomes and reducing inequalities which takes into account the NHS Outcomes Framework.

1.5 Preventing People from Dying Prematurely

1.5.1 Knowsley CCG has inherited a strong legacy of integration between community services and social care and is committed to building upon this foundation to further improve integration in primary, secondary, community and social care across whole pathways.

1.5.2 Health checks have been in place within Knowsley for a number of years and

whilst uptake has been good it can be improved. The CCG will work with partners to assess the potential to expand the scope of the health check from being one broadly focussed on cardiovascular risk to one which encompasses other key areas where Knowsley has high levels of disease such as COPD and mental health.

1.5.3 The CCG has innovative integrated consultant led community services in

place for CVD, COPD and from April 2013, a newly commissioned Diabetes service. These services provide rapid access to diagnostics, assessment, treatment and management within the community. The services also include rehabilitation and palliative support within their outcomes and the CCG will continue to ensure its plans are delivered in respect of improved outcomes and improved access to diagnostics.

1.5.4 During 2013/14 the Community CVD service will be re-specified as it enters

the final year of contract. The plan is to develop further improvements in access to early diagnosis and management and continue to reduce years of

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life lost from causes amenable to healthcare. 1.5.5 The CCG will continue to work collaboratively to improve health outcomes

through; a) Prevention - Increased uptake of Health checks across the borough in

locations easily accessible to the population at a time that suits them b) Earlier diagnosis – access to local timely diagnostics and screening

programmes c) Improved access to all services delivered closer to home within

community settings d) The use of robust evidence to ensure the maximum health, wellbeing

and social benefits and impacts from strategies, policies and commissioning decisions

1.6 Enhancing the Quality of Life for People with Long-Term Conditions

1.6.1 The Joint Health & Wellbeing Strategy takes a life course approach to addressing the needs of the local population. Following public and patient consultation and engagement, underpinned by a sound needs analysis, a list of measures were agreed to determine how success would be measured in achieving each life course outcome. These will draw upon the information available from partners including co-commissioners at NHS England;

a) Life expectancy continues to increase b) More people with long term conditions experience a good quality of life c) Fewer unplanned hospital admissions particularly for Respiratory related

conditions like COPD and childhood Asthma, delivered by specialist services commissioned by the CCG

d) Improved quality of life and experience for carers e) More people living in the community independently for longer – through

re-ablement, assistive technologies and joint working with LA and commissioning partners.

f) Improved quality of life for individuals with progressive conditions g) Fewer children and families negatively impacted by poverty h) Reduction in harmful lifestyle choices (adults and children) i) Improve life expectancy in the neighbourhoods or groups of people most

likely to die at an early age faster than other areas of the borough j) Preventing re-admissions – Improved intermediate care pathways and

discharge into the community

1.6.2 To achieve these outcomes the CCG plan focuses upon; 1.7 Person-Centred Care for People with LTC

1.7.1 Knowsley has the worst health related quality of life outcomes for people with long term conditions in England coupled with the highest standardised emergency admission rate in the North West.

1.7.2 There has been a significant reduction in emergency admissions and length

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of stay over the past 3 years mainly associated with the commissioning and implementation of high specification integrated community delivered services which include diagnosis, treatment, management, rehabilitation and palliation for CVD and COPD. In addition the CCG has re-designed community nursing services to complete the community care campus model.

1.7.3 This Intensive Support Team model has been designed to maximise the

advantages of having a joined up primary health and social care team focussed upon a practice population. Personalised care plans and the move towards budgets are within the key quality outcomes of the service. The CCG will make further progress with the LA to fully integrate health & social care teams and embed them within primary care.

1.7.4 During 2013/14 the Intensive Support Team model will be fully implemented

and the community COPD service will deliver its year 2 outcomes. Finally the CCG’s newly commissioned Community Diabetes Service will be implemented. The overall impact of this will be to improve health related quality of life indicators, improve outcomes and reduce emergency admissions.

1.7.5 A key aspect of all services is to support self- management and increase

use of telehealth and assistive technology. 1.8 Unplanned Hospitalisation for Asthma in the Under 19s

1.8.1 Knowsley has seen a significant increase in the number of A&E attendances within this group and a correlating increase in unplanned admissions. The CCG will address this area of concern within its plan through gaining an understanding of the situation in more depth in respect of the number of families accessing services and any common factors across the borough.

1.8.2 During 2012/13 the CCG’s practices identified this area of concern through

their work on the Quality Outcomes Framework (QOF) where practices highlighted this group of patients when reviewing A&E admissions. Subsequent more detailed reviews through the practice peer groups has led to a number of recommendations which will be put in place such as Asthma Nurses in walk in centres to whom practices could refer patients and where patients can be seen rather than attending A&E. Knowsley will utilise its excellent relationship with local providers to ‘brand’ these services e.g. Alder Hey @ as this will help to reassure parents about the quality of the service.

1.9 Dementia

1.9.1 The CCG has lower levels of dementia than would be expected which is due in part to a high mortality rate and low life expectancy. However as life expectancy increases it is anticipated that the prevalence of dementia will increase to the levels seen in less deprived populations. Dementia is a high

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priority for the CCG and plans are in place to increase diagnosis and subsequent timely access to treatment year on year in line with its QIPP plan.

1.9.2 The CCG will also continue to work with LA colleagues, carers groups and

the third sector to raise the profile of the disease and the fact that earlier diagnosis and treatment leads to improved outcomes.

1.10 Helping People to Recover From Episodes of Ill Health or Following Injury

1.10.1 In Knowsley, there is an ageing population, high prevalence rates of disease

and premature mortality, higher than average prescribing costs and high use of the three acute hospitals that are easy to access from any part of the borough.

1.10.2 One of the 4 priority areas for action in 2013/14 within the Joint Health &

Wellbeing Strategy is appropriate use of services and the CCG is the champion across the economy for this area. The aim is to ensure local people access quality services, at the right time, in the right place so they are used appropriately and efficiently. This work will continue throughout 2013/14 through engagement with the local population and publicity campaigns.

1.10.3 As the CCG’s population flows into three main acute hospitals it works

collaboratively with a number of CCGs to reduce avoidable hospital admissions.

1.10.4 At one hospital the 3 CCGs are collaborating with the acute trust and the 3

LAs to implement a new model of care following guidance and advice from the Emergency Services Intensive Support Team (ECIST). This will see a new model where consultants will be at the front end and patients will be discharged into the community more quickly to avoid admission where appropriate. This will require services to be in place within the community to receive the patients. The CCG will ensure this is the case as required.

1.10.5 However, Knowsley CCG believes that the solution is to put community

services in place and/or redesign services so that patients do not attend A&E in the first place where that is not the correct place for them to be. This work will support the H&WB priority of Appropriate Use of Services.

1.10.6 As part of this culture change the CCG plans to implement a truly integrated

model into the Kirkby area which will see an acute trust, the community provider, the local authority and other partners such as out of hours, 111 and the ambulance service work together to deliver agreed quality outcomes for the local population in respect of urgent care. The outcome should be a shift from unplanned to planned care.

1.10.7 This excellent opportunity has been identified by the clinicians as a new 3

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storey clinical facility opened on 1st April 2013 in the town centre. Rather than decant existing services as is into the building the CCG has worked with all partners to devise a new model for ‘walk in centre plus’ and also a dedicated long term conditions wing. Investment in diagnostics including X-ray, near patient testing, ultra sound and the existing diagnostics available via the COPD/CVD/Diabetes services (echocardiography and spirometry) means that the community and practices will have improved access to diagnostics locally.

1.10.8 Integrating these services with the local authority in respect of social care,

re-ablement, increased intermediate care provision, mental health support and wider council services on the one site means that patient focussed services can be developed that ensure the patients do not go to hospital unless that is the right place for them to be. The model will see services in place and accessible 7 days a week in one easy to reach place making care co-ordination smoother and reducing barriers to integration. This model will be transferable across the CCG and will take the use of primary care resource centres to another level where they can be community hubs with access to prevention as well as health and social care.

1.10.6 This work links into other domains covered within this planning template as

the CCG strives to ensure quality services are delivered within the community thus reducing the need for costly hospital appointments and delays, and that a focus on prevention of poor health or reduced wellbeing is at the forefront of everything we do.

1.10.10 The measures we will use are;

a) Reduction in harmful lifestyle choices (adults and children) b) Fewer unplanned hospital admissions and re-admissions c) Improved quality of life for individuals with progressive conditions d) Influencing public choices on when and where to access specific

specialist services e) Preventing re-admissions – Improved discharge and intermediate care

pathways into the community

1.11 Ensuring People Have a Positive Experience of Care

1.11.1 The CCG ensures the services it commissions, whether delivered locally within the community or via an acute setting have good engagement with the patients who use them, at both the pathway design stage and continually throughout the contract. This has helped to tailor the way in which the care and services are delivered and ensure that feedback is used to improve the quality and outcomes for Knowsley patients.

1.11.2 The Outcomes Framework has included a new metric, the friends and

families test which aims to capture rapid feedback from Secondary care providers in a timely fashion to enable patients to make informed choices about where they choose to go for their care as well as informing commissioners and providers of where changes need to be made and this

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will further enhance local intelligence to support commissioning and improvements in the patient experience.

1.11.3 The CCG has in place a Quality & Safety Committee which is delegated to

monitor and promote quality and safety across all commissioned services. It is this committee which will receive all provider quality performance data including friends and family tests. The committee has established a patient experience sub group which provides a forum for receiving borough wide views of patient experience of services. This group will also conduct forums for each of the CCG’s commissioning areas so that more specific service area patient experience information can be obtained e.g. mothers and newborns; mental health etc.

1.11.4 The CCG has designed and implemented a patient feedback system which

is used in the practices to enable patients to tell us, anonymously if desired, about their experiences of any service or group of services and any provider including the GP practice. This information is collated and stored on a data base which is monitored and reviewed for trends so that the CCG has rapid access to soft intelligence about the quality of services and the experience of those who access them. This is a key component of the CCGs patient experience and feedback system.

1.11.5 The CCG has a strong patient participation group structure which also

serves to provide feedback along with close working with the wider networks of patient groups including those for learning disabilities, physical disabilities and mental health services. The CCG supports a number of community engagement groups to carry out specific pieces of work.

1.11.6 The CCG has a Primary Care Quality network which plans to develop a

friends and family type test for practices in advance of any national requirement as this will inform the development of practices within the CCG and support improvements in primary care quality.

1.12 Treating and Caring for People in a Safe Environment and Protecting Them from Avoidable Harm

1.12.1 The CCG has systems in place to identify potential safety failures in providers both at health economy and at CCG level including an early warning system which uses patient feedback as well as the National Quality Dashboard and other provider based quality metrics including locally determined quality and safety schemes.

1.12.2 The CCG is assured that the reduction in the trajectories for HCAI C-Diff for

its providers as set out in the Everyone Counts: Planning for patients 2013/14 guidance will be met. There have been some issues this year at catchment level for one or two of the CCG’s providers, but this has not negatively impacted upon the CCG’s performance.

1.12.3 Achievement and maintenance of a zero tolerance on MRSA incidents will

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be much more challenging particularly within the community. The CCG is working closely with providers (practices and nursing/residential homes) and Public Health colleagues using lessons learned in hospitals and best practice evidence to develop a comprehensive plan to deliver this significant quality improvement.

1.13 The 3 Local Priorities

1.13.1 The three local priorities have been agreed by both the Health & Wellbeing board within the overall Joint Health and Wellbeing Strategy and by the CCG’s Clinical Membership Group;

1.13.2 Improving the experience of care for people with mental illness The CCG has seen an increase in emergency admissions for mental health

related events and a lower than anticipated uptake of psychological therapies. This is one of the four key areas for action within the borough in 2013/14 and a whole system approach will be taken.

1.13.3 Reducing emergency respiratory related admissions for adults with

COPD The CCG has high levels of COPD within the population and comparatively

high levels of hospital admissions for the condition. The CCG will build upon the recent reduction in admissions to achieve further planned reductions and improving overall health outcomes through increased uptake and completion of rehabilitation programmes.

1.13.4 This will be achieved through the planned delivery of the year 2 quality

outcomes detailed within the Community COPD Service specification.

1.14 Choice and Transparency

1.14.1 Knowsley has low levels of educational attainment and if the CCG’s strategy is to be realised it will be important to ensure the population understand what services are available to them, where those services are, the quality of those services and what information they should use to make choices.

1.14.2 The CCG inherits lower than average performance in respect of use of

Choose and Book and so there will also be a need to support and educate practices to offer choice including how they can access comparative data about providers in order to support their patients to make choices.

1.14.3 The CCG is keen to improve the use of Choose and Book as it is an

effective way of supporting patients to choose where they wish to be treated based on quality outcomes. Within Knowsley there is a wide variation in use of the system and improvement plans to improve use of the system and ensure the CCG population is able to make informed choices

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about healthcare.

2. The Basics of Care 2.1 The CCG will, through effective contracting, ensure all of the services it commissions are fit for purpose and deliver quality outcomes, this is underpinned by the introduction of the national CQUIN scheme to secure improvements in the quality of services and better outcomes for all patients, whilst ensuring that strong financial management is maintained. 2.2 A Clinical Quality & Performance Board has been established at each of the CCG’s providers which enables commissioners to maintain a close oversight of the basics of care as well as all aspects of quality and safety. The CCG takes an active role in all of these groups and the notes are submitted to the CCG’s Quality & Safety Committee 2.3 The cost Improvement plans for all of the CCG’s providers have been requested and once received will require formal evaluation via collaborative commissioning arrangements and at the CCG level through the Quality & Safety Committee where the clinical leaders of the CCG will take a view as to the assurance provided through use of the range of national support tools.

3. Patients’ Rights: The NHS Constitution 3.1 The CCG’s plans are informed via robust data warehousing containing many disparate and historic levels of data and information – these are used to inform the CCG of its performance across many National and local indicators. The intelligence gained from this process is utilised in setting plans and trajectories to inform commissioning and contracting. 3.2 The CCG uses these to ensure that its registered population has access to the services they need in a timely and cost effective manner whilst ensuring the overall performance of the organisation and the services it commissions are performing well and that all key tenants of the NHS constitution and NHS Mandate are delivered. 3.3 The CCG employs various modelling techniques that incorporate the use of the latest evidence base and horizon scanning scenarios to ensure that the capacity of the services it commissions meets expected planning demand trajectories, and that they are delivered to the standard required, evidenced via contracted deliverables (KPI’s) and where underperforming – that contract levers are used appropriately to ensure recovery is achieved

4. Eliminating Long Waiting Times 4.1 The CCG monitors RTT waiting times at all of its providers down to speciality

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level for its registered population and ensures that early warning of potentially failing performance is escalated via contract review and appropriate levers are used to ensure patients receive their constitutional right to treatment, where clinically appropriate, within the time frame specified. The CCG will continue this close monitoring and operates a zero tolerance approach to excessively long waiting times e.g. 52 week waits. The CCG is committed to using contractual fines where required to ensure that its patients receive care in line with their rights as detailed in the NHS Constitution. 4.2 Incomplete pathways and long waiters are identified early via PTL at provider level and detailed information is fed back to the CCG about these exceptions and what recovery plans are in place to ensure these patients are treated appropriately including the offer of treatment at an alternative provider in line with their constitutional rights.

4.3 Diagnostic Test Waiting Times

4.3.1 Diagnostic waits for Knowsley registered patients are monitored in much the same as RTT waiters, currently performance is high with very few patients having waits longer than 6 weeks for any one of the 15 key diagnostic procedures. Increases in demand for programmes such as national screening initiatives are taken into consideration when setting and agreeing planned levels of activity.

4.3.2 This performance is at provider / patient level and ensures the CCG is

upstream of any increase in demand in the overall RTT waiting times. The impact of poor performance on the overall RTT indicators is monitored and raised with the appropriate providers in a timely manner through contractual processes.

4.4 More Responsive Care: Urgent & Emergency Care

4.5 Cat A Ambulance Calls

4.5.1 Current NWAS performance for Knowsley is good, the targets are challenging and with the increases in red1 and red2 calls, the provider is constantly at or near tipping point.

4.4.1 Unplanned and Urgent care is a major issue for the CCG with increased demand for emergency services across a host of disease areas; this is being tackled in a number of ways, not least contractually with the providers and the use of marginal rates for reimbursement – but also in demand management techniques, QIPP, redesign / re-procurement of out of hours provision, 111 provision and primary care quality programmes to impact upon frequent flyers. This will have the result that pressure in the system is reduced and will ensure that all patients are seen, treated, admitted, or discharged within four hours of attendance of the department.

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4.5.2 The use of 111 and primary care initiatives are expected to have some impact

upon this demand, but increased use of specialist community services and the integrated rapid response nursing will be key to delivering a reduction in demand for emergency transportation services to secondary and acute care providers.

4.5.3 Commissioners have agreed revised North West reciprocal handover penalty

clauses (in addition to those nationally specified) for inclusion in both Ambulance and Acute Trusts contracts for 2013/14 and for monitoring handover at local hospitals. The revised clauses are designed to be equitable for both Ambulance and Acute Trusts and follow in the spirit of ensuring that handover problems are detected and resolved early at a local level through joint working.

4.6 Cancer Waits – 2 Week Wait

4.6.1 Cancer is the biggest killer within Knowsley, with particularly high levels of lung cancer, lower than national screening uptake rates and generally late access to treatment and support. This late presentation has the impact that the cases are often more complex, due to this and the subsequent shared care arrangements that often arise there is the real possibility of breaches of one of more of the national standards.

4.6.2 Current gaps exist around understanding which groups of people are not

accepting the offers of screening and why. The CCG needs more information on staging of cancers to help it to understand at what stage in the disease process people are presenting with symptoms and the impact this is having on survival rates. Staging data has improved in Knowsley and the CCG will continue work to further improve the quality of data.

4.6.3 The CCG will be looking to improve diagnostics access and uptake and also

increase awareness within Primary Care. 4.6.4 Direct Access to Diagnostic Tests for Cancer (Level 2 QIPP, working with

local CCGs). Along with partners across Merseyside we will commission improved direct access to diagnostic tests In line with 'Improving Outcomes: A Strategy for Cancer'

4.6.5 MacMillan Cancer GP role (Level 1 QIPP, local delivery) The CCG developed

a MacMillan GP role during 2012/13 to deliver medical leadership for delivery of the Cancer Strategy in Knowsley and this work will be progressed as per plan in 2013/14.

4.6.6 Cancer Centre for Cheshire & Merseyside (Level 3 QIPP, working across

Merseyside) Development of a comprehensive Cancer Centre for Cheshire & Merseyside

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4.6.7 The CCG will also a) Promote the HPV vaccination to young girls. b) Commission community focussed social marketing work to understand the

barriers to cancer screening. c) Work with co-commissioners to improve cancer treatment services –

balancing concentration of specialist skills with improved access. d) Conduct health equity audits on bowel cancer and breast cancer uptake.

4.7 Keeping Our Promises: Eliminating Mixed-Sex Accommodation

4.7.1 Through its contractual arrangements with its providers the CCG will ensure that this indicator is adhered to.

4.7.2 Currently, Knowsley performs well and has few mixed sex accommodation

breaches - there are instances though where due to either the patient condition (ITU / HDU) or the age / construction of some provider accommodation that breaches have occurred – these are minimal but the CCG understands the distress this can cause to patients and their families at a time when they feel most vulnerable and is committed to eliminating breaches.

4.8 Keeping Our Promises: Reducing Cancellations

4.8.1 It is not in the patient’s interest to have their operations cancelled, and is particularly distressing when it happens. The CCG will ensure that the constitutional right of patients to have a binding date for their operation within 28 days of cancellation for non-clinical reasons is upheld and if this proves difficult for the provider that the patient’s care is funded under the NHS at a hospital of the patients choosing.

4.8.2 The CCG obtains reports on these and all other quality measures on a

monthly basis and is an active member of Quality review boards at all of its providers and is assured that there are robust systems in place and that exceptions are reported and escalated in a timely fashion to meet requirements and patient’s rights.

4.9 Mental Health

4.9.1 With the multifactorial impact of downturn in the economy, increasing rates of unemployment across all demographics and age groups, poor educational attainment and other wider determinants of health the CCG has seen increase in demand for mental health services and of particular concern is early evidence of an increase in suicides across all age groups.

4.9.2 The CCG will work with all partners and contracted providers to ensure that

Mental Health Liaison nurses / practitioners are available in AEDs and Wards

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and that patients can access these services to ensure the maximum throughput possible, and they are followed up within the appropriate timeframe.

Uptake and completion of psychological therapy services is lower than planned within Knowsley and the CCG is working within the H&WB Mental Health priority action work plan to identify the reasons for this so that the additional capacity that is being commissioned is fully utilised and valued by those who will benefit from this intervention.

4.9.3 The CCG has led a review of CAHMS within Knowsley and expects the

report to be received in May. Following consideration of recommendations in conjunction with partners a plan will be developed to improve the experience of patients and their families through the delivery of improved services.

4.10 Keeping Our Promises: Choice and the Information to Exercise it

4.10.1 The CCG will ensure its providers publish patient access policies and that the information relating to patient appointments are stated clearly in all communication with patients in relation to the constitutional right to treatment within 18 weeks under the choice and openness agenda.

4.10.2 Patient choice is at the heart of the CCG’s ethos, the CCG has an action

plan which will be implemented in 2013/14 to ensure the current inequalities evidenced via national systems like Choose & Book are improved and the CCG can evidence that patients are informed of their full entitlement under the NHS constitution.

4.11 Dementia / IAPT

4.11.2 Dementia The CCG’s intentions and trajectories in respect of dementia diagnosis rates in 2013/14 and 2014/15 are detailed within the planning template; sheet 2 qu. 2i

4.11.3 IAPT Knowsley has higher levels of need than other local CCGs as a result of the deprivation, unemployment and general poor health leading to higher incidence of mental health problems and increasing suicide rates. In addition the borough is a major recruiting area for the armed forces and therefore has and will have a high proportion of returning military veterans.

The CCG is working with its current provider to increase uptake and completion of psychological therapies and the trajectories for this are detailed in the planning template sheet 2 qu.2 ii.

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5. Patient Centred, Customer Focused The CCG will continue to work with all stakeholders to reform the health and social care system to deliver the five offers of the NHS Commissioning Board

5.1 NHS Services, 7 Days a Week

5.1.1 With the increasing demand for elective procedures and the negative impact that unplanned care has upon the ability of providers to cater for this demand, there is the growing need to operate NHS services throughout the week, whether this be extending outpatients clinics or increased capacity and throughput for day case procedures.

5.1.2 The CCG’s new development in Kirkby, described in detail earlier in this

plan will see more diagnostics within the community with direct access for practices and community services. Access to community diagnostics would also reduce demand on secondary care out-patient services and reduce non elective activity as people could be diagnosed and treated earlier.

5.1.3 One major improvement will be to have open access to diagnostic imaging

at weekends, as these services underpin the diagnostic elements of the vast majority of secondary care patient pathways, they also utilise extremely expensive equipment that is not used to capacity during the traditional out of hours period.

5.1.4 The CCG will be working with other CCGs and the NCB Area Team over the

next few months to develop a strategic approach to delivering this key element of reform.

5.2 Healthcare Quality Improvement Partnership (HQIP)

5.2.1 The NHS standard contract requires all organisations providing NHS funded care must be registered with the CQC and produce an annual quality account. This quality account has a requirement that providers participate in all relevant NCAPOP audits and enquiries, these are commissioned by the Health Quality Improvement Partnership (HQIP).

5.2.2 If providers do not participate in relevant NCAPOP audits they will be in

breach of their contract with the CCG, therefore any non-participation would need to be agreed with the CCG and CQC as the regulator.

5.2.3 All health service providers have to submit their “Quality Accounts” to the

LINk(s) in the local authority area in which the provider has its registered or principal office located by the 30 April each year. This gives the provider up

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to 30 days following the end of the financial year to finalise its Quality Account, ready for review by its stakeholders. The LINk then has the opportunity to provide a statement of no more than 1000 words indicating whether they believe, based on the knowledge they have of the provider, that the report is a fair reflection of the healthcare services provided report by June each year detailing the quality of their services in the previous financial year. These are then to be submitted to the Secretary of State and published on the NHS Choices website so that they are available to the public.

5.2.4 As part of the mandate to share quality measures and survival rates with

patients across an as yet to be determined list of specialities the HQIP will ensure that these form part of the audit to be reported via these same mechanisms, this national benchmark will give assurance to both CCGs and providers that there is equity in the report. The CCG will monitor compliance through its contractual arrangements.

5.3 Choice in 2013/14 at all Points of the Pathway

5.3.1 The CCG has inherited a strong background of local integration and working in conjunction with its Health & Wellbeing Boards has sought patient, carer and public involvement in all of its commissioning plans.

5.3.2 High volume elective pathways best lend themselves to choice at points on

a pathway and the CCG will be review a number of specialities to deliver increased choice e.g. diabetes, rheumatology and musculoskeletal services.

5.3.3 Knowsley CCG is well placed to deliver this in a relatively short timeframe

as it benefits from existing access to multiple providers as a result of patient flows. The CCG will ensure advice is obtained from a range of health and social care professionals to achieve a process where choice is offered at appropriate points within a pathway without compromising the clinical care and safety of the patient.

5.4 Listening to Patients and Increasing Their Participation

5.4.1 There are good levels of patient participation within Knowsley and the CCG intends building upon this to further develop patient participation across all areas of healthcare. The CCG puts patients at the heart of everything it does and will continue to promote active participation.

5.4.2 Patients are able to give feedback on all services via the CCG’s anonymous

practice based system and this in conjunction with feedback from all providers, the boroughs Health & Wellbeing Engagement Board and LINk’s will be a powerful tool for improving services. The CCG will continue to involve patients in all aspects of commissioning, including service design and procurement and will ensure this happens consistently in all service

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areas. 5.4.3 The CCG will also use the NHS Standard contract and the mandate to

deliver against the outcomes expected across the 5 domains of the outcomes indicator set which is inclusive of the Friends and families test. The feedback received must be published by the providers and be used to drive forward improvements in pathways including how and where healthcare is delivered.

5.4.4 NHS funded patients will be able to leave feedback in real time on any service by 2015 through the use of tools such as the Friends and Family test (acute inpatients and A&E patients from April 2013 and maternity services from October 2013).

The CCG will ensure that via the mechanisms at its disposal either through local community based systems, the NHS Standard contract or via national or locally derived CQUIN / improving quality schemes that patients are able to leave feedback in “real time” on the care they receive in such a way as to not impact negatively on those results.

5.4.5 In conjunction with co-commissioners the CCG will ensure the Family and

Friends test is implemented, on time, at all providers in line with the outcomes framework. It will be important to ensure that the test delivers its intended outcome as patients have told the CCG that they feel vulnerable answering questionnaires given them whilst receiving treatment within hospital. They have concerns that it will negatively impact their care and feel compelled to answer in a more positive light. This does not serve to highlight quality and/experience concerns as intended, therefore the CCG will explore ways to overcome this issue to ensure an accurate picture is obtained.

5.5 Acting on Feedback

5.5.1 Improving patient experience is a key priority for the government’s vision as is set out in the white paper ‘Equity and Excellence’. The CCG will use its contractual arrangements with providers to ensure that they deliver against the mandate to provide and publish feedback from the friends and families test.

5.5.2 Through the Quality Boards at provider level the CCG will require providers

to detail the actions they have taken as a result of feedback and also that those actions have led to an improvement in feedback from the test.

5.5.3 The CCG is committed to putting and keeping patients at the heart of all it

does and therefore has developed an internal feedback system at practice level as described earlier, a patient experience sub group and a Quality & Safety Committee to ensure it is able to gather feedback and act upon it.

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5.6 Informing Patients

5.6.1 The CCG is an active member of the H&W Board within Knowsley and will jointly assess population need through the JSNA.

5.6.2 The H&W Board has established an engagement board to ensure local

people have a strong say in plans and services throughout the borough. Representatives from various networks and patient groups are involved to help the H&W Board to listen and act on people’s views and help shape the Health and Wellbeing strategy. Health watch is a member of the H&W Board and is in attendance at the CCG’s Governing body and is included in all activity including informal meetings and Governing Body development

5.6.3 The H&W Board has identified local needs through the Joint Strategic Needs

Assessment which was subsequently prioritised by all stakeholders and the resulting H&W Strategy includes socio-economic measures to evaluate the impact of all activity including involvement and engagement.

5.7 Better Data, Informed Commissioning, Driving Improved Outcomes

5.7.1 All providers are required to use the unique identifying NHS number in all communications with patients, this forms part of the information standards schedule and is continually assured and reported.

5.8 NHS Standard Contract Sanctions

5.8.1 To ensure the CCG has the information it needs to make informed decisions about the care its patients receive from providers of NHS Funded care, and to enable it to commission integrated care pathways, it needs timely high quality data.

5.8.2 The completeness and quality of SUS data will be monitored via the CCGs

contractual arrangements with its providers in conjunction with its Commissioning Support function to ensure that via schedule 5 of the standard contract, all aspects relating to data will be monitored and reported via the various health economy providers’ information / Activity groups on a monthly basis.

5.8.3 The appropriate contract levers and sanctions within the standard contract

will be utilised as appropriate.

5.8.4 The CCG will ensure that Patient outcomes will be monitored against the indicators set out in the Outcomes framework for 2013/14. These metrics, fed by data entered into various recording systems that are compliant with

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NPfIT are covered by Information governance arrangements which not only ensure confidentiality but that the appropriate data standards are adhered to. The framework outcomes metrics in conjunction with patient feedback via PROMs and the Friends and Families Test returns will form part of the overarching methodology in which the CCG will assure itself that high quality outcomes are commissioned and provided as well as delivered.

5.8.5 All Providers of healthcare, funded via a standard NHS contract are

mandated to comply with information standards and DSCN’s as stipulated by the NHS data dictionary and National Commissioning Board or other national body, this is monitored both locally via contracting / Finance and Information sub groups at all of the CCG’s providers, and nationally via NHSIC reporting, with the appropriate contract levers used to secure delivery.

5.8.6 Certain compatibility issues with provider systems ability to effect any new

changes may arise from time to time, where this is evident the providers will have to submit an escalation and recovery plan via contracting / quality boards to highlight potential risks to delivery and contingencies put in place.

5.8.7 The Department of Health Mandate for 2013/2015 to the NHS

Commissioning Board has given the absolute assurance that patients will be engaged with clinicians and have a say and choice in where their treatment is delivered. It has also confirmed that by 2015 all referrals for NHS funded care will be paperless.

5.8.8 The planning guidance confirms this and says that it will support a move to

paperless referrals in the NHS by March 2015 so that patients and carers can easily book appointments in primary and secondary care.

5.8.9 This will be achieved through the re-launch of the Choose and Book

electronic booking service, which the Department of Health is in the process of re-procuring.

5.8.10 To this end, and to support patient choice in where they receive their care,

the CCG will adopt best practice across the health economy and facilitate the method for increasing the utilisation of the Choose & Book within general practice.

5.8.11 This will include referrals to all primary care commissioned services as well

as providers of acute care by 2015 and will involve a CQUIN within primary care to be developed early in 2013/14.

5.9 Commissioning the Appropriate GP Information Services to Provide Clinical Assurance and Safety.

5.9.1 The Information Services of constituent member practices of the CCG are

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GPSoC compliant and are currently supported via a Service Level Agreement with St Helens & Knowsley hospitals Trust Health informatics Service.

5.9.2 This service level agreement conforms to, and complies with, all of the

CCG’s and national information governance arrangements that make allowance for backup, resilience, failover, continuity and quality of Service. This agreement is monitored by the provider against a range of national indicators and these are supplied to the CCG via Local Information systems team board meetings.

5.10 Higher Standards, Safer Care

5.10.1 The NHS Commissioning Board’s objective is to ensure that CCG’s work with local authorities to ensure that vulnerable people, particularly those with learning disabilities and autism, receive safe, appropriate high quality care. The presumption should always be that services are local and that people remain in their communities; we expect to see a substantial reduction in reliance on inpatient care for these groups of people:

a) The CCG will, via its integrated commissioning teams within the Local

Authority (through section 75), review all current hospital placements and will support everyone inappropriately placed in hospital to move to community-based support as quickly as possible.

b) The CCG will ensure that a register of all people with learning disabilities or autism and who have mental health conditions or behaviour that challenges in NHS-funded care are set up by 1st April 2013

c) The CCG will review individuals’ care in collaboration with various stakeholders and the Local Authority, to identify who should be the first point of contact for each individual concerned.

d) The CCG working with service providers and the people who use services and their families review the care of all people in learning disability or autism inpatient beds and agree a personal care plan for each individual, based on their and their families’ needs and agreed outcomes

5.10.2 The CCG will ensure via its integrated commissioning arrangements with

the local authority, that all individuals have the information, advice and advocacy support they need to understand and have the opportunity to express their views. This support will include self-advocacy and independent advocacy where appropriate for the person and their family. The strong presumption will be in favour of supporting this through existing pooled budget arrangements.

5.11 Compassion in Practice standards and application of the 6 C’s.

5.11.1 The CCG, through collaborative working with other local CCG’s and stakeholders has incentivised providers via a Quality / Nursing CQUIN

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scheme that will ensure all patients, their carers and families experience compassion, competence, communication, courage and commitment at all stages of their treatment and will use the contracting process to ensure this is in monitored but more importantly that it is embedded with the culture of provider organisations.

5.11.2 Direct commissioners and CCGs - to outline how their Responsible

officers will ensure quality of appraisal and clinical governance systems in their organisations (including reference to the revalidation process

5.11.3 This is not yet clear although the CCG is working closely with NCB AT

colleagues and in particular the medical director to establish appropriate arrangements.

All NHS organisations will need to demonstrate in their plans a commitment to implementation of the Comply or Explain regime and ensure compliance through the NHS Standard Contract.

5.11.4 The CCG will use contracting processes and the NHS Standard contract to ensure this is implemented.

5.12 Innovation

5.12.1 The CCG has put in place a medicines management function; a local formulary will be developed and published and will include positive NICE Technology Appraisals. The innovation scorecard will be implemented and monitored through the CCG’s Medicines Management Sub Committee.

5.13 Academic Health Science Network (AHSN).

5.13.1 The CCG can confirm that it is a member of an Academic Health Science Network to help ensure that medical research breakthroughs lead to direct clinical benefits for patients. The CCG has a lead officer and lay champion for research and innovation to spread innovation at pace throughout its commissioning plans and contracts.

5.14 Innovation, Health and Wealth: Accelerating Adoption and Diffusion in the NHS.

5.14.1 The Department of Health (DH) states that at least three million people with long term conditions and/or social care needs could benefit from the use of telehealth and telecare services.

5.14.2 Implemented effectively as part of a whole system redesign of care,

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telehealth and telecare can alleviate pressure on long term NHS costs and improve people's quality of life through better self-care in the home setting, elective admissions, bed days and tariff costs.

5.14.3 The CCG has already made effective use of telehealth throughout the

borough and in its community and social care services. Technology been used successfully to help people to remain in their own homes through supported living and many technological advances such as floor sensors.

5.14.4 The CCG will continue to promote the benefits of technology as part of its

strategy to support people in the community in particular through its newly commissioned community nursing service to support and proactively manage patients with long term conditions to become more responsible for their care and stay in their own homes.

6. Transforming Health and Social Care at CCG Level

6.1 Joined up Local Planning

6.1.1 The Joint Health and Wellbeing Strategy sets out a single vision, a set of priorities and agreed ways of improving health and wellbeing in the borough. The delivery of the Joint Health and Wellbeing Strategy should lead to improvements in health and wellbeing across all population groups in Knowsley and in particular to the most vulnerable residents

6.1.2 To this end, the CCG, through its collaborative arrangements and working

partnership with the Local Authority and other stakeholders through the Health and Wellbeing board had identified via patient & public consultation and engagement and thorough analysis of the Joint Strategic Needs Assessment (JSNA) for Knowsley, that incidence of children’s disability, both physical and mental was increasing.

6.1.3 The Aiming High for Disabled Children programme, rolled out in 2008, built

on this foundation and firmly established disabled children as a priority in Knowsley. The National Service Framework for Children, Young People and Maternity Services (2004) clearly established the significance of improving health services for children and young people with disabilities and introduced the imperative to improve pathways through models like Early Support.

6.1.4 The CCG will continue to work with its partners to maintain this high quality

approach to joint planning and delivery of personalised care including budgets. The CCG through its section 75 agreement works closely with the LA Children and families team.

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6.2 Healthier Together Public Service Reform

QIPP 2013/14

6.2.1 Merseyside has benefitted from a strong QIPP programme over the past 3 years and the CCGs are actively engaged in the transition to leading level 3 QIPP into the future.

6.2.2 As well as the strong relationship between public health, local authorities,

LINks and the CCG through the Health and Wellbeing Board, a collaborative approach is being taken to ensure there is full involvement in the development and transition of programmes to the NCB.

6.2.3 The CCG’s providers Cost Improvement Plans have been requested and

will need to be assurance checked, via both the Quality & Safety and Finance & Performance committees, of their ability to deliver the services to patients without any impact on contracted demand, quality or safety for patients. National tools such as the safety thermometer will be used to assess the plans.

6.2.4 Plans are in place for all of the CCGs QIPP areas that are cash releasing

(demand management areas – predominantly COPD, CVD and Diabetes ) and high level monitoring will be in place for the “Transformational” areas like Integrated front end initiatives (primary / secondary care), Alcohol, Cancer and Dementia. Monitoring arrangements are currently being implemented via the CMCSU portal which will then be reported on a monthly basis to the CCG’s performance management group, which will in turn and as appropriate, feed up to either the Finance & Performance or Quality & Safety sub committees.

7. Financial Planning 7.1 The CCG’s financial plans are expected to deliver a 1% surplus of 2.4m which is inclusive of 2% headroom (£4.2m) allocated for non-recurrent expenditure. Plans are currently being developed to invest the 2% non-recurrently in 2013-14 to ensure delivery of the NHS Outcomes Framework.

7.2 Managing Risk

7.2.1 The CCGs financial plans include a 0.5% contingency to mitigate the risk of any unplanned financial pressures arising in 2013-14 across the local health economy.

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7.3 Planning Assumptions

7.3.1 Knowsley CCG’s financial plans include an assumption of 1% growth within Secondary Care and Continuing Care based on historic projections. The CCG plans to purchase forecast out-turn from its Acute contract providers which includes an element of underlying growth. CCG contracts will include 4% inflationary uplift offset against an efficiency of 2.7% or 2.9% in the case of PbR activity.

7.4 Tariff

7.4.1 The CCG has agreed activity plans with provider for NEL activity as required and budgeted for all admissions at 100% tariff. Any activity above plan will be paid at the marginal rate of 30% with the remaining 70% paid to the Area Team for investment in demand management schemes. The CCG’s financial plans include an estimate of the 70% payment based on 2012/13 out-turn.

7.5 Integrated Care Plans

7.5.1 Knowsley CCG will continue with existing pooled budget arrangements in place for Continuing Healthcare, Learning Disabilities and a range of other integrated services through its section 75 agreement. This will be reviewed during 2013/14 to ensure the pooled arrangements deliver value for money for the CCG and continue to improve health outcomes for the local population.

7.5.2 Knowsley CCG has included £1.015m of reablement money in its financial

plans and will work through the Finance & Performance Committee to administer this budget in conjunction with the LA.s to improve outcomes in Knowsley.

Contracting for Quality Guidance note – Commissioners should use this section to outline their plans as regards the 2013/14 contracts.

7.6 CQUIN

7.6.1 Knowsley CCG has through collaborative commissioning arrangements with other local CCGs, agreed CQUIN measures for 2013/14 which include the national goals;

a) Friends and Family test

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b) Improvement against the NHS safety Thermometer (excluding VTE) c) Improving dementia care (FAIR) d) Venous Thromboembolism – 95% patients being risk assessed and

achieve locally agreed goal for no. of VTE admissions that are reviewed through RCA.

7.6.2 In addition a number of locally agreed schemes have been agreed and

included in contracts.

7.6.3 The CCG can give assurance that its CQUIN schemes will be focused on supporting Everyone Counts/CCG Outcomes framework – which in turn will support achievement of CCG Quality premium, these will cover

a) Communications b) Effective safe discharge c) Nursing Quality d) Dementia + e) Patient Experience f) Unplanned admissions g) CAMHS Transition

7.7 KPIs

7.7.1 The CCG will use the levers at its disposal within the NHS Standard contract to ensure delivery of the outcomes its commissions from its providers via the standard NHS Contract and will enforce the terms of the contract. Key performance indicators will be actively monitored including any locally developed KPIs.

7.8 Continuity of Care

7.8.1 The National Standard NHS Contract will detail the requirement for all providers to ensure Continuity of Care in the event of serious financial difficulty. This has been addressed through the 2013/14 contract negotiation process.

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Clinical Commissioning Groups - Planning Template for 2013-14

31

92

Data Validation Tests

Complete data entered

Whole numbers entered

No negative numbers entered

Measure is valid

Within character limit?

0 0

Planning Round 2013/14 Every clinical commissioning group (CCG) will need to complete and upload to Unify2 this planning template, as part of their formal planning submission to the NHS Commissioning Board.

To complete this template: • Read the detailed information given in Everyone Counts: Planning for Patients 2013/14 Technical definitions and the Supporting Planning 13/14 for CCGs documents found at: http://www.commissioningboard.nhs.uk/everyonecounts/ • Select your organisation from the dropdown box below • Answer all sections on pages 1& 2 (you may need to scroll down to see all sections) • Complete drop-down boxes and yellow boxes • Green boxes contain automated calculations, you should not try to fill these in • Where boxes are ‘greyed out’ you should not complete them • The ‘Data Validation Tests’ table further down this page tells you if the data you have entered into the yellow boxes are valid. If they are, boxes will be green and Unify2 will accept your template. If not, boxes will turn red. If any boxes are red Unify2 will not accept your template • You will then need to submit your completed template to the Unify2 system • To do this you will need a Unify2 account for your CCG/CSU • Please see instructions at the bottom of this page on how to get a Unify2 account • Please see box below ‘How to Upload this Template’ for instructions on how to submit this template to Unify2 For queries related to this Planning Template and its submission to Unify2 please email PAT@dh.gsi.gov.uk or telephone 0113 825 0523

How to upload this template:

Once you have completed this workbook, save it on your hard drive as a .xls file (NOT a .xlsx file, as this will not upload to Unify2). Please upload your data into Unify2. To do this, login to Unify2 (see hyperlink in the 'guidance' section, at the bottom of this page)

[If you are a CSU acting on behalf of a CCG, and have logged in using a CSU account you will now need to follow an extra step before continuing, see end of this section. If logged in as a CCG, continue to step below]

Once logged in, click on Data collection & management

…..then NON DCT Home Page ...and select the Upload option for the return referenced Plan2013

Then click Browse and point to the location of this workbook…

C:\Documents and Settings\andrea.kelly\Local Settings\Temporary Internet Files\Content.Outlook\VUFQ0M5M\[CCG_Planning template_201314_final (2).xlsx] ...before ticking Auto Sign Off and then clicking Upload.

You will then be able to view your data through the Extraction Viewer menu, but please be aware that it can take a few hours for your data to filter through.

Extra step for CSUs: If you are a CSU acting on behalf of a CCG, and have logged in using a CSU account you will first need to ‘impersonate’ the CCG for whom you are uploading the template before you can continue. To do this: • In the top right corner of the screen, click where it reads You are signed in as xxx as XXX COMMISSIONING SUPPORT UNIT • Select the correct CCG from the organisation dropdown list • Click ‘Impersonate’ • Follow remaining steps above, from 'Click on Data collection and management'

Please choose your organisation:

Selected organisation details:

Code: 01J Name: NHS Knowsley CCG

Template questions menu:

1. i) Self Certification - NHS Constitution

32

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

1. ii) 1. iii) 1. iv) 2. i) 2. ii) 2. iii) 3. i) 3. ii) 3. iii) 3. iv)

Self Certification - Mandate Self Certification - Provider CIPs Self Certification - HCAIs Trajectories - Dementia Diagnosis Rate Trajectories - Improved Access to Psychological Services Trajectories - Local Priorities Activity Trajectories - Elective FFCEs Activity Trajectories - Non-elective FFCEs Activity Trajectories - First Outpatient Attendances Activity Trajectories - A&E Attendances

Guidance:

In order to upload a template for a CCG, colleagues will need a Unify2 account for their CCG/CSU To request a new account - please go to the Unify2 homepage http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx - under ‘System Links’ click ‘Request a Unify account’, - select domain ‘Knowledge and Intelligence’, and - select Organisation Type ‘CLINICAL COMMISSIONING GROUP (PROPOSED)’ or 'COMMISSIONING SUPPORT UNIT' as required

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Number of people

diagnosed

Prevalence of dementia

% diagnosis

rate

2013/14 996 1604 62.1%

2014/15 1049 1636 64.1%

The number of people who

receive psychological therapies

The number of people who have depression and/or anxiety disorders (local estimate based on Psychiatric

Morbidity Survey)

Proportion

2013/14 3240 27050 12.0%

01J Name: NHS Knowsley CCG

Before completing this template read the detailed information given in Everyone Counts: Planning for Patients 2013/14 Technical definitions and the Supporting Planning 13/14 for CCGs documents found at:

http://www.commissioningboard.nhs.uk/everyonecounts/ 1. Self Certification

i) Do your plans ensure that the performance standards in the NHS Constitution will be delivered throughout 2013/14? Yes/No

ii) Do your plans ensure that the performance commitments in the Mandate will be delivered throughout 2013/14? Yes/No

iii) Have you assured provider CIPs are deliverable without impacting on the quality and safety of patient care? Yes/No

If No, please provide commentary (max 4000 characters)

If No, please provide commentary (max 4000 characters)

If No, please provide commentary (max 4000 characters)

Continuing CCG oversight and engagement in the development of provider CIPs will be achieved through CCG leadership of Clinical Quality and Performance groups at each provider. In relation to Knowsley’s five ‘main’ providers, a process of clinical- led quality impact assessment of all CCG relevant cost improvement schemes is being undertaken by a senior clinical team/group (Doctor(s) and Nurse) at each CCG. The impact assessments for each provider are based upon:

iv) Do you plan to manage HCAIs so that your local population have a maximum number of C.Difficile infections as set by your local CDI objective? Yes/No

If No, please provide commentary (max 4000 characters)

2. Trajectories

i) What dementia diagnosis rate are you aiming for in 2013/14 and 2014/15?

ii) The proportion of the people that enter treatment against the level of need in the general population i.e. the proportion of people who have depression and/or anxiety disorders who receive psychological therapies:

34

01J Name: NHS Knowsley CCG

Before completing this template read the detailed information given in Everyone Counts: Planning for Patients 2013/14 Technical definitions and the Supporting Planning 13/14 for CCGs documents found at:

http://www.commissioningboard.nhs.uk/everyonecounts/

iii) Trajectories for Locally Selected priorities1, the three local measures should not duplicate the national measures:

2013/14

Indicator Definition (please specify the local measures chosen) max 4000 characters Numerator Denominator Measure Local Priority 1 -10 % reduction in Eme adms for COPD from 12/13 OT baseline of 591 FFCE's 532 #DIV/0! Local Priority 2 -5% reduction in Eme adms in MH specs for children & adults from baseline of 855 FFCE's 813 #DIV/0! Local Priority 3 Increase referrals via C&B by 30% from 12/13 OT baseline of 17,616 5313 #DIV/0!

3. Activity Trajectories 2013/14:

CB_S3 CB_S1 CB_S2 CB_S4

Activity Trajectories

i) Elective

FFCEs

ii) Non- elective FFCEs

iii) First Outpatient

Attendances

iv) A&E

Attendances2

2013/14 April 1968 1818 4896 May 2140 1886 5002

June 2170 1818 5299 July 2355 1836 5264 August 2116 1841 4776 September 2165 1833 5220 October 2200 1893 5176 November 2255 1853 5197 December 1899 1856 4358 January 2036 1845 4841 February 2237 1785 4920 March 2374 1921 5291

2013/14 Total 25915 22185 60240 63687 2012/13 Forecast Outturn3 25539 22605 63687 64957 Forecast growth in 2013/14 1.5% -1.9% -5.4% -2.0%

Footnotes: 1. If your Local Priority indicator does not need a denominator (i.e. it is not a percentage), please leave the denominator box blank. Please just put the figure for your indicator in the numerator box. 2. We have asked only for an annual A&E figure. This is because we do not have a formal national data source for monthly A&E attendances by commissioner so we have asked only for an annual growth figure to give us an idea of what commissioners are planning for 13/14. 3. The forecast outturn is an estimate of what the activity will be as at the end of the 2012/13 Financial Year. This could be estimated, for example, by projecting forward from the current year-to-date position.

Context Outcome Aspirations Programmes Commissioning Developments

*Maternity Services ‐ Review and pathway redesign to bring services into Community

*Gynae ‐ Pathway review and service model development 

*Safeguarding ‐ Integration across CCG work streams

*Paediatric Neurodisabilities ‐ Collaborative working with partner CCGs to develop integrated pathway

*Children's Community Services ‐ Full review and redesign 

*COPD ‐ Consultant led diagnosis, Management and Rehab in Community

*CVD ‐ Consultant led Community Service review and re‐procurement 

Poor Lifestyles *Improved access to Diagnostics

*Cancer centre for Merseyside

*Improved Uptake of Cancer Screening

*Diabetes Community Service Procurement

*Alcohol Intervention in Acute settings

*Procurement: national 111 Programme

*Reduce emergency admissions for ACS

*Nursing with Reablement services ‐ Respecification & Procurement

*Borough Wide Review of all Unplanned Care Provision for redesign and implementation during 2013/14

*Continuing reductions A&E attendances & admissions

*Implementation of the IST ‐ Risk Stratification & Integrated Case Management WITH Community Nursing

*Learning Disabilities ‐ Inpatient Capacity review and redesign

*Primary Care MH Services ‐ Full review and redesign 

*MH Primary Care Liaison & Single point of Access implementation

*Communication, Discharge & Primary Care Audit ‐ CQUIN development

*CAMHS ‐ Comprehensive review and pathway development

*Acute Pathways ‐ Implementation

*Dementia & Memory Services ‐ Delivery of integrated Medical and Social Care models for Early Diagnosis & Support 

● Increase in proportion at deaths at patients preferred place of care● Improved Primary Care knowledge, management and symptom control at End of Life, in line with G.S.F and ensuring equitable, standardised and consistant 

End of Life *MacMillan GP recruitment 

Alcohol

Diabetes

Knowsley Shadow CCG Plan on a Page 

No £ Growth Expected

Deprivation & wider determinants of Health

Cultural dependence on & High use of Hospitals

Excess Cancer, CVD & Respiratory deaths

Strategies & Vehicles for Change

Growing Elderly Population

Qua

lity Assurance

Profession

al Edu

catio

nPa

tient Edu

catio

n

Maternity & Early years

Wise use of M

oney

Right S

ervices in rig

ht place at right time:

Increased Prod

uctivity

 & Value

Redu

ced Du

plication & W

aste

Improv

ing Qua

lity of Prim

ary Ca

reMov

ing from

 Unp

lann

ed to

 Plann

ed

Patie

nt & Pub

lic Eng

agem

ent

Child Health

CVD

Dementia

Cross Cutting Themes

Wellbeing

 & Prevention 

Vision

High Qua

lity Services

Better Health

Health Promotion & Prevention

Services Closer to Hom

e

A better start in life● Implementation of the  Child Health Promotion Programme:● Increasing breastfeeding initiation by 12% and continuation by 5%● Reducing infant, neonatal mortality and stillbirth rates● Reducing smoking in pregnancy by a further 4% ● Reducing Childhood Obesity at year 6 by 2%

Increasing Life Expectancy● 2.6% increase (males) & 1.9% increase (Female), narrowing the gap with England ● Premature CVD Mortality ‐ narrowing of gap with England by 44% in absolute terms ● Premature Respiratory Mortality ‐ narrowing of gap with England by 14% in absolute terms● Premature Cancer Mortality ‐ narrowing of gap with England by 9% in absolute terms

● Reduction in Alcohol related Hospital admissions of 150 admissions per 100,000 population

● Whole system redesign & Implementation of Unplanned Care Services across the Borough● Increased percentage of services delivered in Community Settings that patients value & choose to use● Reduction in emergency admissions for respiratory conditions in children● Reduction in Hospital admissions for ACS conditions ● Reduction in emergency readmissions within 30 Days of discharge from hospital

An ambitio

n for a

 health

ier, ha

ppier p

opulation, with

 a better q

uality of life. A

 redu

ction in health

 ineq

ualities a

nd im

proved

 access to

 health

 care whe

n requ

ired, as close as possible to th

e pa

tient

Commun

ity Empo

wermen

t

Workforce Develop

men

t

Use of T

echn

olog

y

Partne

rship Working

Maternity & Womens Health 

● Increased provision of Community Services that are responsive to need 24/7 for both Adults & Children● Reductions in Emergency & Crisis admissions to Acute Mental Health Services

● Earlier Diagnosis and intervention in line with QIPP plans● Improved Support to Carers of patients with

High Quality, cost effective services, 

closer to the patient 

Partnership working

Cancer

Respiratory

Mental Health

Urgent Care