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Led by clinicians, accountable to local people NHS EAST LANCASHIRE CCG GOVERNING BODY 27 January 2014 1 3:00pm in Meeting Room 1, Walshaw House AGENDA Item Lead Strategic Objective Report Category Timing Patient Story Veterans in Communities 1:00pm 1 Welcome, Introductions & Chair’s Update Chair 1:30pm 2 Apologies 3 Regular Items: 3.1 Governance: Declarations of Interest Quoracy Chair 1:35pm 3.2 Declarations of Other Business 3.3 Public Questions 3.4 Minutes of the meeting held on 25 November 2013 Action Matrix: Chair Attached Receipt 3.5 Matters Arising 4 Key Topic for Discussion: 4.1 Three Year Delivery Plans MY/TM All Attached Action 1:45pm 5 Business: 5.1 Chief Clinical Officers Report MI All Attached Receipt 2:15pm 5.2 Keogh Review into ELHT Position Statement JH 1, 4 Attached Receipt 2:20pm 5.3 Finance & Performance Update MY 2 Attached Receipt 2:30pm 5.4 Communications Progress Report AB All Attached Receipt 2:40pm 5.5 Equality & Inclusion Annual Report AB 2, 3 Attached Receipt 2:50pm 6 Governance: 6.1 Sub Committee Summary AB All Attached Receipt 2:55pm 7 Any Other Business 7.1 Items for inclusion on the Corporate Risk Register 3:00pm 8 Date & Time of Next Meeting Monday, 24 March 2014, 1pm at Walshaw House RESOLUTION: “That representatives of the press and other members of the public be excluded from the remainder 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. PART 2 9 Minutes of the closed meeting held on 25.11.13 Chair Attached 3:05pm 10 Remuneration Committee Minutes : 28.10.13 Chair Attached 3:10pm 11 Cases for Change : Business Cases Financial Details MY/TM Attached 3:15pm

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27 January 2014 1 – 3:00pm in Meeting Room 1, Walshaw House
1 Welcome, Introductions & Chair’s Update Chair 1:30pm
2 Apologies
3.3 Public Questions
3.4 Minutes of the meeting held on 25 November 2013 Action Matrix:
Chair Attached Receipt
3.5 Matters Arising
4.1 Three Year Delivery Plans MY/TM All Attached Action 1:45pm
5 Business:
5.1 Chief Clinical Officers Report MI All Attached Receipt 2:15pm
5.2 Keogh Review into ELHT – Position Statement JH 1, 4 Attached Receipt 2:20pm
5.3 Finance & Performance Update MY 2 Attached Receipt 2:30pm
5.4 Communications Progress Report AB All Attached Receipt 2:40pm
5.5 Equality & Inclusion Annual Report AB 2, 3 Attached Receipt 2:50pm
6 Governance:
7 Any Other Business
7.1 Items for inclusion on the Corporate Risk Register 3:00pm
8 Date & Time of Next Meeting
Monday, 24 March 2014, 1pm at Walshaw House
“That representatives of the press and other members of the public be excluded from the remainder 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.
9 Minutes of the closed meeting held on 25.11.13 Chair Attached 3:05pm
10 Remuneration Committee Minutes : 28.10.13 Chair Attached 3:10pm
11 Cases for Change : Business Cases Financial Details
MY/TM Attached 3:15pm
Agenda Item: 3.4
East Lancashire CCG Governing Body Minutes of the meeting held on Monday, 25 November 2013
1pm, James Hargreaves Suite, Burnley Football Club PRESENT: Di van Ruitenbeek Chair / Lay Advisor - Patient Engagement Steve Allcock Secondary Care Consultant
Dr Fiona Ford GP Lead - Primary Care Development Dr Paul Hartley GP Lead - Acute Commissioning & Contracting Dr Phil Huxley GP Clinical Lead – Pendle Dr Mike Ions Chief Clinical Officer Dr Murthy Motupalli GP Clinical Lead - Hyndburn Dr David White GP Clinical Lead - Burnley
Dr Peter Williams GP Clinical Lead - Rossendale Tom Wolstencroft Lay Advisor - Governance Mark Youlton Chief Finance Officer In Attendance: Steve Dean Director, Healthwatch Lancashire Tim Mansfield Chief Operating Officer
Anne Pietrzak Board Services Manager
Min Ref:
13.135 Welcome, Introductions & Chairs Update The Chair welcomed everyone to the meeting and advised the change of venue was to allow more people to attend in relation to the HAC discussion. She reminded attendees this was not a public meeting, but a Governing Body meeting held in public. Any questions would be welcome following the meeting and the Chair would be happy to speak to those individually. Introductions were made. It was with regret that Dr Ions announced that a GP colleague had died. Dr Michael Barsby, GP at Kiddrow Lane, died suddenly following complications. Dr Barsby had been a GP for 16 years and was well respected. He was 43 years old, married with three children. His funeral was taking place that day and Dr Ian Whyte was attending and representing the CCG. Dr Ions wished to record official condolences from the Board and our thoughts are with his family.
13.136 Apologies Apologies were received from Olive Carroll, Dr Ian Whyte and Mike Leaf.
13.137 Governance Issues Declarations of Interest:
- Dr Motupalli, as a Hyndburn GP & employee for ELMS working 2 sessions per month at the HAC.
- Dr White provided ad-hoc occupational health service for ELMS.
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- Dr Ford, as a Hyndburn GP and many patients use the facility which would impact on the practice, should the facility close.
- Dr Huxley, as a Pendle GP – the HAC was a significant resource.
It was considered that all GPs should declare an interest in the item relating to the HAC as any decision would impact on all GPs in all 5 localities. The Chair pointed out that if a decision is made regarding the HAC, the issue would be referred to the Remuneration Committee for a final decision. The Chair also highlighted that those declaring an interest would not be involved in the final decision making process. Legal advice had been sought which clarified that this arrangement would deal with any conflict of interest issues as the membership of the Remuneration Committee does not include GP members. Declarations of Other Business: There was no further business
declared. Quoracy: The meeting was quorate.
13.138 Public Questions The Chair advised that one public question had been received from Mr Colin Wills relating to a Specialist Parkinson’s Nurse. Q: If it is decided to appoint a Parkinson’s Nurse:
What will happen next, what will the timetable be, and How long will it be before an appointment is made and the person
appointed starts work? A: Mr Mansfield advised that it was his understanding that recruitment would
be dependent on the Parkinson’s Society releasing the funding for the post and on the length of time to recruit. The item was listed on the agenda and a decision would be made during the meeting.
13.138.1 Petition The CCG had received a petition from Councillor Claire Pritchard relating to services currently provided at the Health Access Centre in Accrington and contained approximately 4665 signatures. The Governing Body were asked to receive the Petition and respond. The Chair formally received the petition on behalf of the CCG. ACTION: Review the policy regarding Petitions.
13.139 Minutes of the meeting held on 28 October 2013 The minutes of the meeting held on 28 October 2013 were presented. 13.120 : Lancashire Health & Wellbeing Board - It was noted there was a missing word in the second paragraph ….. discussions at the last meeting. RESOLVED: that subject to the above amendment, the minutes were approved as an accurate record.
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13.140 Action Matrix The Action Matrix was presented and discussed: 13.65 – Integrated Business Report : there were ongoing discussions with the CSU to review the format of the detailed report. More of the detail would be considered when the Head of Quality was in post. 13.96 – Performance : The CSU had advised Ambulance response time data was not available by locality and the CCG was in discussion with Blackpool CCG to consider this going forward. Remain on matrix until data is available. It was reported that Mental Health readmission data was included in the IBR. 13.116 – Towards Transformation : Plans were in place to invite the Area Team to meet with the Governing Body. 13.126 – Lancashire CCG Network – Proposed Governance Arrangements : It was noted the CCG was limited to two amendments each year as required by NHS E. The next opportunity would be June 2014 and with a reminder to the May GB meeting regarding any proposed changes. GB comments had been fed back to Chorley & South Ribble CCG as lead CCG and the final paper would be approved by the CCG network.
13.141 Matters Arising There were no matters arising from the minutes.
13.142 Accrington Victoria Health Access Centre Tim Mansfield, Chief Operating Officer gave a presentation highlighting key issues that the CCG needed to take into consideration when making a decision regarding the future of the Health Access Centre (HAC) in Accrington. An engagement exercise had taken place with patients, the public and local organisations, including Hyndburn Borough Council about the services provided by the HAC. The CCG was very aware of the public interest and emotion associated with the HAC and have been actively listening to the views expressed. The CCG was committed to openness and transparency and it was noted that the level of detail would not have been made available by the previous organisation. The HAC was successful in offering wider access to patients outside GP core hours. The presentation outlined concerns raised by local people and highlighted key challenges for the CCG, particularly the need to deliver the required cost savings of £33m over the next few years, whilst ensuring fairness in GP access across all 5 CCG localities. The contract was initially procured by EL Primary Care Trust and awarded to East Lancashire Medical Services (ELMS), an independently run social enterprise. There were two elements to the Health Access Centre which included access for unregistered patients on a walk-in basis, together with a GP Practice with a list size of 1358. Commissioning responsibility for the GP Practice sat with NHS E and it was expected that a decision regarding this facility would be made in February 2014.
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It was reported that the number of attendances at the facility was significantly more than originally anticipated with increased costs and details of locality attendance rates were outlined. A number of options were outlined in the report together with issues that need to be taken into consideration when making a decision regarding the future of the Walk In Centre. It was also recognised that when the engagement exercise commenced, a change to the GP Contract had not been anticipated. Members were asked to express an initial view on the options presented and to consider if there was enough evidence for a final decision to be made at the meeting or defer a decision until the New Year. As Chair, Dr van Ruitenbeek wanted to be confident that sufficient evidence was available to the Governing Body to make a well informed decision at the meeting. Members discussed the options at length and the following points were made:
The majority of members considered there was insufficient information to make an informed decision. [MM & FF felt there was enough evidence to make a decision.]
GP Practices are under pressure, highlighting the need to strengthen primary care to provide a better service. This was an opportunity to improve access for primary care across the patch. Primary care responsibility sits with NHS E and options as they are now could make issues more complicated in terms of access.
It was considered the APMS Practice should be involved in discussions to inform the decision. It was noted this was a separate discussion and there was a need to ensure the CCG is sufficiently engaged with NHS E to ensure decisions are not taken independently.
There was also a need to consider the proposed alternatives outlined in the recent Monitor report, whilst at the same time considering these against the Primary Care Development Strategy.
Options 4 & 5 were identified as being funded at a fixed price. However, a detailed business case was not available outlining costs and benefits of the alternatives.
Healthwatch strongly believed in the need to listen to patients and respond in a positive way. Soft intelligence was consistent with the spirit behind the petition. Consideration should be given to looking wider than the HAC in terms of provision of primary care across the whole of East Lancashire.
There were increasing demands on primary care across all localities with relatively low funding being received within East Lancashire. Winter pressures money had enabled the CCG to pilot different ways of working and build on the quality improvement work ongoing.
The decision would have a direct effect on service users in the Hyndburn area and it was important to work with Hyndburn practices to improve access.
It was also important to have a clinically appropriate model that offers value for money.
There was a request for specific information relating to the percentage of frequent visits and people attending the HAC for a second opinion. It was important to provide the best possible care, balancing want with need and affordability.
Financial consequences associated with deferral of a final decision were considered, noting this could result in 6 months additional activity, creating a potential overspend of £1m which would be managed by non-recurrent funding. Members were advised that details of the
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financial allocations for the next two years were expected w/c 16 December and whatever decision is taken, the organisation must be in a sustainable financial position.
Following debate, it was agreed to eliminate the following three options which were amongst those initially being considered:
Keep the status quo and tender a service in its current format; Let the current contract expire without a replacement service; Decommission the GP walk-in service and extend the contract for the
Minor Injuries Unit to include minor illness. Once a decision is made, there would be a need to discuss the impact with the Overview & Scrutiny Committee and if there was likely to be a significant change in service, it would be necessary to go out to formal consultation. In conclusion the Chair thanked everyone for their contributions which highlighted that the majority of members felt there was not enough information to make a decision. It was recognised that in order to make the best decision, greater clarity was required outlining how future models would fit into the whole system, whilst taking account of the financial implications. It was important to have a clear understanding of the primary care development strategy and to ensure the final decision fits with the decisions of NHS E regarding the contract for the GP Practice. It was also important to consider the knock-on effect of this decision on AVCH as a health facility and the wider implications on A&E and Urgent Care Centres. Dr Ions felt the debate was a very accurate summary of the current position. The Chair thanked members of the public for their contributing views to inform this decision, pointing out that the CCG listens to public opinion. She highlighted the importance of understanding that the CCG was making a well considered decision in deciding to defer a final decision until early 2014. RESOLVED: that following in-depth debate, the Governing Body agreed to defer a final decision on the future of the GP walk-in Centre at Accrington Victoria Hospital until early in the new year, to allow more detailed options to be developed.
13.143 Specialist Parkinson’s Nurse for EL Following concerns raised by local people regarding the lack of a Parkinson’s Nurse in East Lancashire, a detailed business case had been developed for a primary care based Parkinson’s Nurse. The post would be pump primed by Parkinson’s UK for two years, on the understanding that this would be mainstreamed by NHS funding thereafter. The nurse would be hosted in primary care and support all five localities, offering home visits and symptom management, therefore reducing the number of emergency admissions and increased length of hospital stay. The Business Case had been considered by the Local Delivery Group with a recommendation to the Governing Body that the CCG support the proposal, which highlighted a good example of responding to patient feedback. Following consideration of the report it was recognised there were a large number of patients with Parkinsons Disease in East Lancashire which was
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considered a significant workload for one nurse. This raised the question as to whether the CCG should be commissioning a service rather than a nurse for the number of patients identified. The Chief Nurse was pleased to see the report and agreed with the capacity issues. However, it was important to demonstrate that this role will have an impact on patient experience in terms of reducing the number of admissions and length of stay. It was important to ensure robust support systems are in place together with connectivity with secondary care locally and obtain peer support from neighbouring CCGs. It was considered this was the first step towards helping a group of people improve their quality of life which would produce great benefits. Over the next two years the service should be audited to support the development of a business case for a wider service. The nurse would sit within a Practice in primary care and provide support all five localities. RESOLVED: that the Governing Body support the Business Case and Letter of Intent for submission to Parkinson’s UK by the deadline of 30 November 2013.
In view of timings, the Chair requested precise discussions going forward.
13.144 Keogh Review into ELHT The report provided a position statement relating to the Keogh Assurance Framework in respect of ELHT and the assessment of progress made in the delivery of actions and submission of evidence. Jackie Hanson, Chief Nurse confirmed that the delivery of evidence was now being managed as an on- going process through regular meetings with the Trust and progress was being made in respect of Section 4. It was acknowledged that significant work was underway within the Trust to ensure robust evidence is delivered in a timely manner which is then analysed with further feedback to the Trust. This was an active piece of work, with the aim of having a document that is fully populated before the next Risk Summit, when there would be formal discussion with the TDA and the Trust and progress against the Keogh review would be monitored. Tom Wolstencroft requested significant discussion time at the next meeting to devote to this issue and to ensure there was capacity within the CCGs resource to manage. Dr Ions confirmed the Quality Assurance Framework was the CCGs response to Francis. It was confirmed that concerns regarding the pace of change and embedding of issues throughout the organisation had been articulated with the Trust. More information had been received and it was important to meet the challenge to support the Trust to embed the required changes to improve outcomes and develop a culture demonstrating more care and compassion. It was also reported there had been a number of changes of appointment at ELHT with Interim HR and Communications & Engagement Directors now in post. ACTION:
Allow time for indepth discussion at the next meeting.
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Individual points to be raised with Jackie Hanson & Mike Ions outside the meeting.
RESOLVED: that the Governing Body receive the report.
13.145 Finance & Performance Update Mark Youlton, Chief Finance Officer presented the financial position statement for the seven month period to 31 October 2013, confirming the forecast outturn position for the organisation remained robust. He reported a slight worsening in the position at ELHT and activity data for other providers identified over-performance at Lancashire Teaching Hospital Hospital and significant under-performance at Pennine Acute. An increase in costs associated with continuing healthcare had resulted in a forecast £3m overspend, noting that a contingency held for this purpose had now been deployed. Prescribing data also identified a £3m overspend against plan. The CCG was in a position to achieve the £10m required surplus, which would be banked for use in the next financial year to support any additional expenditure. However there was non recurrent funding that must be spent in year, the first call on which would be the unidentified QIPP gap, noting that the organisation must not be in this position year on year. Members referred to the challenges of QIPP, the Winter Plan and the Integration Fund and the challenge to work with other organisations. Information was awaited from colleagues in Oldham relating to Affordable Warmth which would lead to reduced admissions at A&E particularly for the frail elderly group and support the CCG to get ready for future years challenges. Concerns were expressed relating to the QIPP £2.9m gap highlighting the need to understand why the target had not been met and to ensure the CCG does not fall into the same position next year. There was a need to change the way services are delivered, highlighting the importance of clinical leadership to support people to keep themselves well at home. The Chair considered it was the responsibility of the whole Governing Body to look for more transformational ways of working to ensure a quality service can be offered in more community based ways. In conclusion the Chair emphasised the need for transformation and creative thinking, recognising that next year will be more financially challenging. RESOLVED: that the Governing Body receive the report.
13.146 Winter Plan Tim Mansfield provided a detailed update in terms of current activities relating to Annual Resilience Planning, specifically relating to winter developments, finances and planning. The system had been under pressure for a long time highlighting a risk if robust services are not in place. It was also recognised that ELHT had received £1.4m to support the winter plan. Tim outlined key points, particularly the strategies and plans that are integral to the overall plan
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A Pennine Lancashire Information Campaign had been developed in partnership with the Communications and Engagement Team to provide reassurance to the public and other stakeholders about the ability of the NHS to cope during the winter months. The communications plan was also designed to avoid confusion and help patients to use the most appropriate services. Members received assurance that the organisation was doing as much as possible to ensure robust plans are in place to be confident that services will be available to the public. It was noted there was lengthy discussion at the Senior Clinicians meeting regarding the detail of the ambulatory care pathway, with further discussion at the December meeting. RESOLVED: that the Governing Body receive the report and support the work ongoing to deliver the Annual Resilience Plan 2013/14, confirming there would be further discussion at the Senior Clinicians Meeting in December.
13.147 Integration Transformation Fund Members received correspondence from NHS England outlining the details of the Integration Transformation Fund which confirmed that 3% of the CCGs budget would be made available to promote the development of integrated health and social care services. The budget would sit within the governance arrangements of the Health & Wellbeing Board and details of the funding transfer and how this would impact on East Lancashire was expected on 19 December. The CCG was working with LCC and the Health & Wellbeing Board to develop plans outlining how the funding will be used and submit to NHS E by 15 February 2014, demonstrating engagement with stakeholders and the public, with funding transferring in 2015/16. An Integrated Transformation Board was to be created to take this work forward and a stakeholder event was planned in January 2014 for members of the Patient Participation Groups, together with more detailed discussion at the Health & Wellbeing Partnership in January to sign off the initial plan. Dr Ions reiterated that these were unrealistic timescales to respond to the planning process. The CCG supported the principle of integration and it was important to identify ideas highlighting how we best do this. The Chair requested that voluntary and community group representation was included in the planned events, to influence discussion and priorities and share creative ideas. She also confirmed this was an opportunity to do things differently and demonstrate partnership working. RESOLVED: that the Governing Body receive the report and note the content.
13.148 Procurement Policy The policy was recommended for approval by the Wider Management Team and presented to the Governing Body for ratification. It was an important document to have as an organisation which outlined the procurement process in line with Standing Orders and Prime Financial Policies.
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The Chief Finance Officer confirmed the policy was based on a CCG standard and had a clear link with the Conflict of Interest Policy to ensure a robust process was in place. RESOLVED: that the Governing Body ratify the Procurement Policy as presented.
13.149 Sub Committee Summary The report summarised the work of each of the sub-committees of the Governing Body, reporting key decisions and highlighting items for approval. Members attention was drawn to the Audit Committee Terms of Reference which had been revised to clarify the role of the Audit Committee in terms of Emergency Planning and Resilience. Clinicians requested assurance that organisations are working collaboratively and Practices fit in with the arrangements. It was clarified that the CCG was a Category 2 responder and important to ensure the appropriate plans are in place. The sub-committee summary was based on approved minutes of the relevant committees and it was felt that a number of the items listed had been superseded by further discussion. It was also considered that non LDG members would not fully understand the basis of discussions from the summary and that consideration be given to a full set of minutes being included as an appendix. RESOLVED: that the Governing Body receive the report, endorse the decisions taken by the Committees and accept the Audit Committee Terms of Reference.
13.150 Stakeholder Committee Minutes RESOLVED: that the Governing Body receive the following Stakeholder Committee Minutes for information:
Pennine Lancashire Clinical Transformation Board – 2.10.13
13.151 Any Other Business 13.151.1 Corporate Risk Register It was suggested the Health Access Centre be included on the Register in relation to the financial risk from the decision made and organisational reputation risk. 13.151.2 Keogh Review Dr Williams referred to the latest SHMI report for ELHT which identified that mortality rates are as expected, which acknowledged that there had been some progress. It was confirmed that the SHMI rate was in line, however there were some anomalies regarding the HSMR, pointing out that the Keogh concern was not the number of deaths, but the number of deaths not reported.
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13.152 Date & Time of Next Meeting The next meeting of the Governing Body would take place on Monday, 27 January 2014, 1pm at Walshaw House. The Chair thanked members of the public for attending.
“That representatives of the press and other members of the public be excluded from the remainder 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).
Version 14
24 June 2013
13.65 Integrated Business Report QSC to highlight areas where further data is required to provide assurance to the
GB. Report to include timely, locality level information.
Ongoing discussions with the CSU to revise the format of the IBR.
19 August 2013
13.96 Performance Presentation Check if MH data includes readmission figures – separate information to be
provided regarding readmission data. Ambulance Performance – request for response time data to be broken down to
Borough level and to explore further in respect of inappropriate 111 ambulance requests.
MH readmission data is included in the IBR. CSU had advised response time data was not available by locality. Discussions ongoing with Blackpool to consider going forward – remain on matrix until data is available.
28 October 2013
13.116 Towards Transformation Area Team to be invited to a Governing Body meeting to outline their role and
develop relationships across the Board.
13.126 Lancashire CCG Network – Proposed Governance Arrangements Potential implications to the Constitution to be raised with the Council of Members. Statement to be incorporated regarding exit arrangements, including wording that
does not prevent the CCG from working in other geographical areas for the benefit of our population.
Consideration to be given to the CCG having more than one vote. Report to be revised before a final decision is made.
CCG limited to two amendments each year as required by NHS E. Next opportunity is June 2014. Reminder to April 2014 GB re any proposed changes. Comments fed back to Chorley & South Ribble CCG as lead CCG – final paper to be approved by the CCG Network.
25 November 2013
13.144 Health Access Centre Revised options to be considered at the Governing Body meeting in February
[13.12.13] Additional funding was being made available to GP Practices across the country to establish 9 pilots relating to 7 day working. There was an opportunity to bid for this funding, however the view was the pilots had already commenced. TM to check the position.
13.144 Keogh Review into ELHT Allow time for indepth discussion at the January 2014 meeting.
January Agenda
Version 14
Individual points to be raised with Jackie Hanson & Mike Ions outside the mtg. MI/JH
13 December 2013
13.146 Winter Plan Notes of joint visit with the TDA and Area Team to Urgent Care and the
Medical Assessment Unit to be circulated.
This report outlines the position on the Business Cases and Delivery Plans for the workstreams for Scheduled Care, Unscheduled Care, Integrated Care, Mental Health and Dementia following detailed discussion and recommendations from the LDG
REPORT CATEGORY: Formally Receipt
Debate the content of the report
Receive the report for information

2 Optimise appropriate use of resources and remove inefficiencies.

1. Introduction 1.1 This report outlines the position on the Business Cases and Delivery Plans for the
workstreams for Scheduled Care, Unscheduled Care, Integrated Care, Mental Health and Dementia following detailed discussion and recommendations from the LDG.
2. Purpose
2.1 Cases for Change have been circulated widely throughout the CCG for the key work-
streams of the CCG. They have been agreed by CCG Members at a QP event, the LDG and the Governing Body. Associated Business Cases and Delivery Plans were agreed at the LDG meeting on 20th January 2014 for recommendation to the Governing Body. We are confident that these will enable the CCG to deliver its QIPP targets in 2014/15 and 2015/16, and the requirements within the planning guidance, Everyone Counts. More detail will be presented to the Governing Body as part of the final planning submission in March.
3. Conclusion
3.1 Scheduled care The recommendations of the LDG are to commission:
- An integrated Skin Service - A consultant led Community Ophthalmology Service - A Community Integrated Rheumatology, MSK and Chronic Pain Management
3.2 Unscheduled Care
The recommendations of the LDG are to commission: – Co-located primary care services within UCC – Ambulatory care pathway within East Lancashire Hospital Trust – Early Action Accident and Emergency Police Liaison Role Pilot – Paediatrics – redesign of Children’s Observation Assessment Unit – Children’s community respiratory service – Children’s physiotherapy service – A review of Bespoke Patient Transport Services
– Health Access Centre review – NWAS Intermediate Tier Vehicle Review – Develop a NHS 111 local interface model – Improving access in primary care 3.3 Integrated Transformation
The development of the Business Cases and the Delivery Plan for integrated care is closely aligned with the development of the Better Care Fund and the additional modelling work that the Health economy has commissioned to inform and test the assumptions we have made about the development of community health and care services to facilitate the shift in spending from acute to community services.
The recommendations of the LDG are to commission: – Integrated neighbourhood teams – Safer Transfers of Care – Transitional System redesign – 7 day working in primary and community services – Lead clinician for over 75s 3.4 Mental Health and Dementia The recommendations of the LDG are to commission: - A redesigned Single Point of Access - Further development and expansion of the Counselling programme within IAPT to
widen the numbers of IAPT compliant counsellors and to broaden access to the Primary care MH system.
- A 24/7 A&E MH response through the full year 2014-2015 to allow for re-design of the A&E and Crisis MH system.
- Delivering the Dementia diagnosis gap project and improving management of Dementia within Primary care.
- Local intermediate residential services for people with dementia 4. Recommendations 4.1 Governing Body Members are requested to approve the recommendations
of the LDG as outlined above. 4.2 To note that confirmation of any investment into these work-streams is dependent upon the CCG being able to deliver all its financial targets. Mark Youlton Tim Mansfield Chief Finance Officer Chief Operating Officer
MEETING DATE: 27 January 2014
This report provides an update on both strategic and operational issues of interest to Governing Body members which have taken place since my last update in October 2013.
REPORT CATEGORY: Formally Receipt
Debate the content of the report
Receive the report for information

2 Optimise appropriate use of resources and remove inefficiencies. √

27 January 2014
Chief Clinical Officer’s Report
1. Introduction 1.1 This report provides an update on both strategic and operational issues of interest
to Governing Body members which have taken place since my last update in October 2013. In this report I will refer to the following:
Keogh Review
Planning Guidance
Personal Health Budgets
Tobacco Free Lancashire: Revised Tobacco Free Strategy and Terms of
Rossendale Steering Group Elections
Policies and Procedures
2 Keogh Review
2.1 The second CCG listening event was held in Pendle on 16th January at Colne Library. The event was well attended with approximately 60 people attending, all conveying their views on the services provided to the Pendle residents. There was representation from the CCG, East Lancashire Hospitals NHS Trust, Airedale Foundation Trust, Pendle Overview and Scrutiny Committee and Health Watch. 2.2 The listening event was positive and feedback from the public suggests that future events would be welcomed. Themes and comments have been collated and these will be used to identify and address any issues and inform the commissioning of services going forward.
2.3 A date has also been set for the Burnley listening event, and this will be held on Saturday 1st February.
3 Planning Guidance 3.1 NHS England has published its framework within which commissioners will need to
work with providers and partners in local government to develop strong, robust and ambitious five year plans to secure the continuity of sustainable high quality care for all, now and for future generations.
3.2 Everyone Counts: Planning for Patients 2014/15 to 2018/19 describes NHS
England’s ambition for the years ahead and its ongoing commitment to focus on better outcomes for patients. It describes the vision for transformed, integrated and more convenient services, set within the context of significant financial challenge. The planning guidance is accompanied by a suite of support tools intended to assist commissioners with their planning considerations to maximise the best possible outcomes for their local communities.
3.3 The planning guidance seeks:-
Strategic plans covering a five year period, with first two years at operating plan level
An outcomes focused approach, with stretching local ambitions expected of commissioners, alongside credible and costed plans to deliver them
Citizen inclusion and empowerment to focus on what patients want and need
More integration between providers and commissioners
More integration with social care – cooperation with Local Authorities on Better Care Fund planning
Plans to be explicit in dealing with the financial gap and risk and mitigation strategies. No change not an option
3.4 NHS England has also published the funding allocations that Clinical
Commissioning Groups (CCGs) will receive over the next two years (2014/15 and 2015/16). The allocations contain a new funding formula that will more accurately reflect population changes and include a specific deprivation measure.
3.5 Funding for NHS commissioners will rise from £96bn to £100bn over the next two
years so, despite wider public sector budget cuts, the NHS is being protected from inflation. The changes follow an extensive review into funding allocations and all CCGs will receive a funding increase matching inflation in the next two years while the most underfunded areas, and those with fast-growing populations, will receive even more.
3.6 work is underway within the CCG to develop and populate the required
documentation. 3.7 The framework and funding allocations can be accessed at: Everyone Counts: Planning for Patients 2014/15 to 2018/19 Funding Allocations for CCGs 4 NHS Choices: Publication of GP Outcomes Data 4.1 As part of NHS England’s drive for more transparency and public participation,
increased information about the standards and performance of primary care was published on the NHS Choices website on 6th December.
4.2 The information, which is a data set of GP outcome standards and high level
indicators, includes screening rates, Quality Outcomes Framework measures, prescribing items and patient survey data. The new ‘accountability view’ published
via the NHS Choices Website at: http://www.nhs.uk/Service-Search/Accountability
5 Personal Health Budgets – April 2014 Right to Ask
5.1 From April 2014 people who are have a long term condition or are in receipt of continuing health care will have the right to ask for a personal health budget; this will then move to a right to have a Personal Health budget by October 2014. 5.2 The CCG has made the following progress towards achieving this NHS Mandate:
The CCG have begun to develop systems and processes with the Lancashire CSU to ensure that people can access Personal Health Budgets by April 2014
The CCG is working with the Local Authority to scope out the potential for joint health and social care budgets, and this may be as part of the Integrated Transformation Fund.
6 Tobacco Free Lancashire: Revised Tobacco Free Strategy and Terms of Reference 6.1 Tobacco Free Lancashire (TFL) is a collaborative programme which has been in place in Lancashire since 2002, when it was known as the Smokefree Cumbria and Lancashire Partnership. A revised Tobacco Free Strategy and Terms of Reference
have been developed in partnership with a wide range of stakeholder organisations and agencies interested in working together to reduce the devastating impact that tobacco has in Lancashire. The strategy has been endorsed by Tobacco Free Lancashire. 6.2 The final versions will be signed off at the next Tobacco Free Lancashire Alliance Meeting on 5th February 2014, and members of the Governing Body are asked to support this work.
Tobacco Free Lancashire Strategy v2 (revised at 19 12 2013).pdf
Tobacco Free Lancashire Terms of Reference (revised at 19 12 2013).pdf
7 CCG Assurance 7.1 Further to my last update, East Lancashire Clinical Commissioning Group has had its second checkpoint meeting with NHS England on Tuesday 3rd December. Following the meeting, the CCG submitted a populated Quarter 2 action plan on 10th December which detailed the actions required for each domain. These will be continually monitored and progress reported to the NHS England Local Area Team (LAT).
8 East Lancashire Hospitals Trust 8.1 On 6th December 13, Mark Brearley stood down from his post as Chief Executive of
East Lancashire Hospitals NHS Trust. Jonathan Wood, Director of Finance has been acting Chief Executive and the Trust has since announced the appointment of Jim Birrell as interim Chief Executive from 6th January 2014.
The Trust Development Agency (NHS TDA) has also confirmed the appointment of
Professor Eileen Fairhurst as the new Chair of ELHT from 1st February 2014. 9 Governing Body Members 9.1 At its meeting in October 13 the Governing Body supported the proposal to appoint an additional Lay Advisor with an interest in Patient Engagement and Quality. The appointment process is now underway and interviews will take place on 4th February. 10 Rossendale Steering Group Elections 10.1 The election of GP Member representatives on the Rossendale Locality Steering Group has now concluded. A total of 29 responses were received out of a distribution of 39 ballot papers, representing a 74% response rate. 10.2 All five of the candidates listed below have been elected to serve on the Steering Group formally from 1 March 2014, and our congratulations go to those individuals. Dr J. Cowdery Dr A. Mannan – re elected Dr T. Mackenzie – re elected Dr J. O’Malley Dr Z. Sykes – re elected 11 Stakeholder Engagement 11.1 As part of the CCG’s proactive programme of engagement with our key
stakeholders, the following meetings have taken place since my last update:
11th November – Meeting with Gordon Birtwistle MP for Burnley
12th November – Meeting with Mark Hindle, CEO Calderstones
14th November - Lancashire Health & Wellbeing Board Development Day
23rd December – Meeting with Mike Leaf, Director of Public Health
21st January – Meeting with Airedale Executive Team
11.2 Actions from these meetings will be handled through the embedded CCG business
12 Policies and Procedures 12.1 The following policies have been approved and disseminated in line with the policy ‘An Organisation wide Policy for the Development and Management of Policy and Procedural Documents’:
13 Recommendations 13.1 Members are requested to:
Support the work of Tobacco Free Lancashire
Note the updates within the report
Dr Mike Ions Chief Clinical Officer
This report is provided to the Governing Body, as a position statement, in relation to the evidence submitted by East Lancashire Hospitals Trust (ELHT) and the wider Health Economy against the CCG Keogh Quality Assurance Framework (QAF).
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1 Commission the right services for patients to be seen at the right time, in the right place, by the right professional.
2 Optimise appropriate use of resources and remove inefficiencies.
3 Improve access, quality and choice of service provision within Primary Care
4 Work with colleagues from Secondary Care and Local Authorities to develop seamless care pathways
Keogh Review – CCG Quality Assurance Framework positional update
1. Introduction 1.1 This report is provided to the Governing Body, as a position statement, in relation to the
evidence submitted by East Lancashire Hospitals Trust (ELHT) and the wider Health Economy against the CCG Keogh Quality Assurance Framework (QAF).
1.2 Following the publication of the Keogh Review Report in July 2013, East Lancashire
Clinical Commissioning Group (CCG), as lead commissioner for ELHT, along with colleagues from Blackburn with Darwen Clinical CCG, NHS England Lancashire Area Team and ELHT have worked in close collaboration to develop a CCG QAF.
1.3 This Framework is designed to provide Commissioners with the level of assurance
required to be confident that appropriate action is being taken by the Trust to address the issues and concerns raised by the Keogh Team.
2. Purpose of the Quality Assurance Framework. 2.1 As previously reported the Keogh report highlighted a number of areas where
improvements can be made and the CCGs have been committed to working with ELHT to ensure that these are implemented so that all services provided by ELHT become highly regarded and trusted by the people of East Lancashire and beyond
2.2 The framework focuses on 4 key themes identified in the Keogh review report which
Alignment of Strategies Organisational Development, Values & behaviours Patient Experience
2.3 Within each of these areas the specific key lines of enquiry (KLOE) have been
identified from the Keogh review report and then best practice outcomes have been described against each area in order to articulate the expected level of attainment to be achieved by ELHT.
2.4 Furthermore, the framework specifies the overarching and detailed evidence required
to give assurance to the CCG that the appropriate action is being taken, with clear timescales and underpinning key performance indicators that will be monitored to provide further information on progress and impact.
3. Delivery of Evidence
3.1 The scrutiny of evidence submitted by ELHT in line with the QAF requirements is currently being managed across the CCGs and the Lancashire Commissioning Support Unit (LCSU) with a collaborative approach with ELHT adopted.
3.2 Whilst it was noted and reported that initial evidence submitted by ELHT provided very
limited assurance, significant work has taken place within the Trust to ensure robust evidence is delivered to the CCG in a timely manner. It has been noted that the quantity of the evidence provided has increased over the last month, but there are concerns about the quality of the evidence in some areas, leading to an ability to provide full assurance.
3.3 Following the submission of evidence colleagues from LSCU and the CCG have
undertaken an intensive review to establish a positional update on the level of assurance obtained and progress made by ELHT against the best practice outcomes.
3.4 The positional update summary as of December 2013 was discussed and agreed at
the CCG Quality and Safety Committee held on the 15th January 2014 and is available at member’s request.
3.5 The positional update has been shared with East Lancashire NHS Hospital Trust and they have confirmed that they agreed with the assessment provided
4. Quality Surveillance Group 4.1 The information attached was provided to the Quality Surveillance Group (ELHT),
organised by Lancashire Area Team which was held on the 11th December 2013. East Lancashire CCG and Blackburn with Darwen CCG were represented alongside the Care Quality Commission, Trust Development Authority and the Area team.
4.2 The Clinical Commissioning Groups have not received the formal minutes from this
meeting yet, however the following points were identified within the discussion:
a) The Trust had engaged with the Quality Assurance Framework process and there was evidence of change in all areas identified. There was agreement by all agencies that progress had been made in addressing all the areas identified, but in some areas pace of change was still slow and the impact on patient experience could not yet be fully demonstrated therefore the level of assurance in all four key areas with judged as being limited.
b) The areas identified within the Quality Surveillance Group for priority action by ELHT were identified as;
Complaints handling – in particular understanding the impact on patient experience from the changes to the complaints handling system,
Safeguarding – particularly in relation to the training rates across all divisions.
Performance in key areas such as A&E, Cancer and Stroke pathways
Quality and Governance leadership. Concern was expressed in relation to the lack of capacity in the current structure due to staff vacancies, which could lead to the organisation not being sighted on the key risks and issues.
4.3 The key points identified above have all been discussed through with the Trust and action has been initiated or enhanced to address the issues in a timely fashion. The impact of these changes will be included in the next update of the Quality Assurance Framework, which will take place at the end of January 2014.
4.4 It has been noted by all agencies concerned that the Trust is completing multiple
evidence submissions to both the Trust Development Agency and the Clinical commissioning Group as well as responding the regulatory requirements from the CQC, and although there has been some progress in aligning the information, there are opportunities to do this further, therefore reducing the burden on the Trust and ensuring that the analysis of this is done collaboratively with key agencies.
4.5 The CCG Chief Clinical Officer and Chief Nurse have had brief discussions with the
Improvement Director appointed by the Trust Development Authority(TDA) to work with East Lancashire NHS Hospitals Trust,-(Mrs Marie-Noelle Orzell) The discussion centred on streamlining the TDA and CCG reporting requirements in relation to Keogh. Where possible it was envisaged that the Trust would provide evidence against one framework that focussed on priority actions for the next 30, 60 and 90 day periods, shows impact on patient & staff experience and identifies where monitoring arrangements can now be included in the usual quality meetings within the CCG. These discussions are at an early stage and further reports will be provided to the Governing Body at future meetings on the feasibility of achieving this joint approach that is able to maintain a focus on providing the level of assurance to the CCG as detailed in the current Quality Assurance Framework
5. Recommendations 5.1 Members are asked to:
- Receive the report - Note the current position in relation to evidence submitted and discuss the
subsequent assessment of assurance provided. - Note the potential changes to the Assurance Framework process and discuss the
potential impact on gaining the required assurance.
Mrs Jackie Hanson Chief Nurse
Agenda Item 5.3 Appendix 1
NHS East Lancashire CCG Governing Body
27 January 2014
1. Purpose
The purpose of this briefing is to update the governing body on the current performance for East Lancashire hospitals Trust against the national 95% 4 hour standard for Accident and Emergency patients 2. Background The operational standard for A&E (95% of patients admitted transferred or discharged within 4hours).is a national operational standard and is designed to deliver patients’ rights’ under the NHS constitution. 3. Current Position East Lancashire Hospitals Trust (ELHT) has only achieved the 95% in the first quarter of the year to date and has failed to meet the standard in Quarter 2 and Quarter 3 (93.23 and 91.89% respectively). The current year to date position is 93.15%. Using the daily situation report figures up to and including the 31st December 2013 it would appear that the 2013-14 4hr target maximum number of breaches has been surpassed and ELHT will be unable to recover the position to meet the standard by 31st March 2014. A Performance Trajectory for Quarter 4 is currently being reviewed and will be shared and monitored weekly, ELHT report to the National Trust Development Authority (NTDA) on a weekly basis and provide a Root Cause Analysis for any week where the 95% standard isn’t achieved this is supported by an action plan. 4. Health Economy Actions Since April 2013, the Clinical Commissioning Groups (CCG) and ELHT have worked together to support the achievement of the standard by revising the role, membership and function of the Pennine Lancashire Unscheduled Care Group in line with national recommendations – this group is now known as the Pennine Lancashire Access and Flow Group and has key links with the Integrated Care Agenda. Close liaison with the Lancashire Area Team has also been a key feature with the Director of Operations and Delivery attending the meeting monthly. To support the delivery and subsequent achievement of the 4 hour standard a Health Economy Action plan has been developed and this is monitored through the Pennine
Lancashire Access and Flow Group this is also reported to both East Lancashire and Blackburn CCG’s. The Annual Resilience Plan has been reviewed and a joint Health and Social Care Economy winter plan has been developed with a clear Trigger and Escalation plan in place which identifies clear responsibilities and agreed action from all organisations. Central Winter Investment funds were made available to the Health Economy and these have been utilised in 4 key areas:
Primary Care Access – including the extension of a Primary Care Pathway in Urgent Care.
Ambulatory Care Pathway Pilot
Increased capacity across Health and social Care for 7 day provision of support services, to improve weekend and bank holiday discharges.
Review of the pathway for Continuing Health Care. The impact of these schemes are being monitored and reported to NHS England Local Area team on a monthly basis. Weekly Teleconferences are held with the Director of Operations ELHT, Chief Operating Officer East Lancashire CCG, Head of Unscheduled Care Pennine Lancashire CCG’s and Director of Operations and Deliver NHS England Lancashire Area Team. The teleconference reviews weekly performance, reviews the action plan and also the Performance Trajectory. 5. Next Steps The CCG and key partners from across the health economy will work with EHLT to deliver sustainable improvement on current performance for the Accident and Emergency 4 hour standard. The CCG will liaise with NHS England in relation to the next steps and how the recognition that failure to achieve the 4 hour standard at year end will impact on the health economy. 6. Recommendation The East Lancashire Governing Body is requested to:
Note the contents of this briefing
Acknowledge the actions undertaken
Agree to receive a further update Tim Mansfield Chief Operation Officer
Revenue Resource Limit
1% Surplus
QIPP Performance – delivery against identified schemes
Main Provider Performance
QIPP position stabalised with a recurrent forecast gap of £2.9m
PbR position particularly on ELHT has returned to being volatile
Uncertainty regarding the CCG cash allocation. Further guidance awaited from NHS England
Statutory Duties • Revenue Resource Limit (RRL)
– Expenditure MUST stay within the limits set for the financial year
• Cash Limit (CL)
– Cash spending must stay within the cash limit set for the financial year
Limit £’000 On Target Notes
Commissioning Budgets 493,089 P
The CCG has been notified of the return of £76k from South Yorkshire and Bassetlaw AT in relation to Airedale specialised commissioned services
Running Costs 8,880 P
Commissioning Budgets 447,363 P
The CCG has been notified of its maximum cash draw down for 2013/14 – due to national constraints this is significantly less than had been anticipated. Officers are working to prioritise cash payments to ensure that we stay within our cash limit
Running Costs 8,880
Value 95% 99.6% P Performance in volume has continued to improve
Volume 95% 84.5% O
Value 95% 86.9% O Performance in both value and volume have again improved in month and whilst the target may be unachievable against value, volume, if current performance continues, will be met.
Volume 95% 94.5% O
• Better Payment Practice Code (BPPC)
– The target is to pay ALL invoices within 30 days of receipt of a valid invoice
Performance Measures • 1% Surplus
– The CCG has to plan to deliver a 1% surplus
Annual Surplus £’000
YTD Surplus £’000
Confidence Dial Notes
10,000 2,700 2,950
Confidence remains at 90% of delivery of overall surplus of £10m. Cumulative YTD performance is better than planned due to underspend on the CCG running cost allowance
Cumulative Plan £'000
Actual Achieved £'000
• 2% Recurrent Surplus
– The CCG has to keep in reserves 2% of its recurrent resource. This is to be invested non-recurrently
• 2% Non-recurrent investment – The CCG has to invest its 2% recurrent reserve on a non-recurrent basis in
order to lever transformational change and deliver the QIPP programme
2% Surplus £’000 Confidence Dial Notes
The 2% has to be retained on a recurrent basis and is used as a performance measure of organisational sustainability. Recurrent pressures can be absorbed without utilising the 2% reserve
Annual budget £’000
9,740 6,390 6,390
The uncommitted balance forms part of the CCGs current planning to invest non-recurrent funding to pump prime delivery of 2014/15 QIPP
• Total QIPP Schemes – Achievement of target
• QIPP Scheme Delivery
– Analysis of identified QIPP schemes and delivery against savings plans to date
Identified Schemes
Confidence Dial Notes
7,137 4,870 4,870
The confidence level of achieving the £7.1m QIPP savings through identified schemes has improved further this month
Total QIPP
Target £’000
Identified schemes
10,000 7,100 2,900
There is very little confidence that tthe gap of £2.9m will be met by ssavings schemes. The gap will be ccovered by contingencies, slippage aand reserves from elsewhere in the CCG budget
• Main Provider Activity (ELHT) Acute Services ONLY
Annual Budget £’000
Plan YTD £’000
Activity data as at month 08 has been used to forecast the out-turn position. Whilst activity did show some improvement in months 6 and 7, there is still some volatility in the forecasting. Therefore a prudent position showing the higher end forecast out-turn has been included particularly with the uncertainty of performance during the winter months to be reported. Confidence remains high that this level of forecast out-turn will not be breached.
Summary Financial Information
£’000 Best £’000
Forecast £’000
Provider Activity
ELHT Performance at month 08, based on month 07 activity data is forecasting £7,000k over-performance. The nature of the activity in the first 5 months of the financial year led to a conservative forecast being previously reported. Activity has now returned to being volatile with a big swing between months 08 and the provisional month 09 Activity data for other providers as at month 07 has been received and this shows over performance at Lancashire Teaching Hospital (£1,329k) and Airedale (£279k) , but a significant under-trade with Pennine Acute (- £1,196k). Performance within the independent sector has been verified and is at present reporting and forecast over performance of £257k
8,000 4,000 7,278
QIPP Target
There is still a £2.9m gap in the overall QIPP target. This will have to be the first call on any recurrent contingency that is held by the CCG 2,900 0 2,900
Prescribing Month 07 prescribing data is available and continues to suggest an overspend against plan. It should be noted that this forecast is based on a national formula which does not take into account local schemes and it is therefore anticipated that the prescribing position will improve further as the impact of local QIPP schemes start to be reflected in the actual prescribing figures.
2,100 0 2,100
Best £’000
Forecast £’000
IPA Up to date figures from the Broadcare system suggest an over performance of £5m, this is a significant worsening of the position over the previously reported out-turn. This would represent a 28% increase in expenditure on CHC, IFR, Complex cases and nursing homes. It excludes the impact of any retrospective restitution cases which are for accounted for on balance sheet. Colleagues are working with members of the CSU to understand this swing in position and to ensure that the database is accurately reflecting the financial position. For prudence the whole of the estimated overspend has been included in the forecast position.
5,000 0 5,000
Reserves & contingencies
As directed, the CCG is holding a 1% recurrent contingency. The first call on this would need to be the unidentified QIPP gap, followed by over-performance 0 (2,368) 0
Allocation issues
There are no outstanding allocation issues at present 0 0 0
Calculating the Quality Premium : 2013-14
Measure % of Quality
Premium Achieved Eligible Funding
Potential years of life lost from causes considered amenable to healthcare 12.50% UNKNOWN £231,875
Reducing avoidable emergency admissions 25.00% UNKNOWN £463,750
Improving patient experience of hospital services 12.50% ON TARGET £231,875
Preventing Healthcare Associated Infections 12.50% FAILED £0
LP1 : % of patients offered a place on a programme of Pulmonary Rehabilitation who complete
the full PR programme 12.50% OFF TARGET £0
LP2 : % of items for metformin / sulphonylurea as a proportion of all prescription items for anti-
diabetic drugs (excluding insulin) 12.50% ON TARGET £231,875
LP3 : Demand Management through Advice and Navigation 12.50% ON TARGET £231,875
100.00% £1,391,250
Measure % Adjustment
Referral to Treatment times (18 weeks) 25.00% ON TARGET £0
A&E Waits 25.00% FAILED -£347,813
Cancer Waits - 62 Days 25.00% OFF TARGET -£347,813
Category A - Red 1 Ambulance Calls 25.00% ON TARGET £0
100.00% -£695,625
UNSCHEDULED CARE : Accident & Emergency Attendances
• Fewer Accident and Emergency Attendances than planned in contracts to M08.
• Reductions against plan at ELHT and Pennine but increase in activity against plan at
Airedale. Net effect is a 3.1% decrease in A&E attendances against contract plan.
• Accrington Victoria MIU also undertrading against contract plan / Rossendale MIU still
above original planning assumptions.
• Despite the reduction in A&E attenders , ELHT continues to struggle to meet the 4 hour
A&E target. It is thought that this position cannot be recovered by year end and as such
this constitution measure (for Quality Premium purposes) has been failed.
• Q1 = 95.13%
• Q2 = 93.23%
• Q3 = 91.89%
• Year to date = 93.31% [01/04/2013 – 06/01/2014]
• 76.2% of all Category A - Red 1 ambulance calls that result in an emergency response
arrive within 8 minutes. [NWAS Performance April – October 2013 : TARGET = 75%]
Red 1 calls are the most time critical and cover cardiac arrest patients who are not breathing and do not have a pulse, and other severe conditions.
% 4 hours Target Cumulative % in 4Hrs
UNSCHEDULED CARE : Emergency Admissions [1]
• Volume of emergency admissions (contracted providers) is lower than planned levels to
November 2013 (-650 spells)
• Most providers are reporting fewer emergency admissions than planned for, including
ELHT and Pennine Acute.
• It is important to note that in most instances the plan for emergency admissions was set
at last years outturn levels. National benchmarking identifies that the CCG has higher
than expected emergency admissions in several specialties, especially Paediatrics.
• Excess Bed Day costs for patients admitted as an emergency are significantly higher
than planned (+£807k). The majority of this is being reported @ ELHT.
• The seasonal activity increase starting in October has started to be observed but at
levels lower than those seen in 2012-13.
UNSCHEDULED CARE : Emergency Admissions [2]
• Quality Premium target around emergency admissions (25% of total) –The target is for no
growth on 2012-13 outturn for 4 specific categories of admissions . Latest figures
available nationally suggest slightly reduced admission rates in the latest 12 month
period against the baseline :-
Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) DSR per 100,000
1203.1 1191.4
Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s DSR per 100,000
664.1 633.2
Emergency admissions for acute conditions that should not usually require hospital admission DSR per 100,000
1672.5 1665.7
Emergency admissions for children with lower respiratory tract infections DSR per 100,000
641.4 616.2
1 2 3 4 5 6 7 8 9 10 11 12
A ct
iv it
UNSCHEDULED CARE : Emergency Admissions [3]
• The Local Quality Premium target on Pulmonary Rehabilitation (12.5% of total) is currently
off target. A recovery action plan has been supplied by ELHT and performance in Q2
improved above the Q1 position but remains below our target ambition of 75% of
patients who were offered a place successfully completed the PR programme
• Q1 = 57.1% | Q2 = 67.6%
SCHEDULED CARE : Referrals & Outpatients [1]
• GP referrals to ELHT are slightly lower than last year (based on working days in the month –
approx. 0.6 fewer referrals per day)
• There have been reductions in ‘Urgent’ GP referrals and an increase in ‘2-week rule’
suspected cancer referrals.
• ELHT have reported increases in first OP attendances across several specialties including
Cardiology, Surgery, Orthopaedics and ENT.
• Pennine Acute is reporting fewer first OP attendances in Orthopaedics.
• Non-Admitted 18 week referral to treatment times are being maintained well within
threshold levels. Neurology poses the greatest challenge (YTD position= 89.73% against
a 95% target) and this is mainly through activity at Lancashire Teaching Hospitals.
SCHEDULED CARE : Referrals & Outpatients [2]
• Advice and Navigation scheme now available to all localities . This is focused on the key
specialties of Orthopaedics, Dermatology and General Surgery. Utilisation of this
scheme and anticipated ‘deflection’ activity is currently ‘On Target’ to deliver against
the local Quality Premium measure (12.5% of total) .
• Outpatient procedures are significantly overtrading against plan, particularly at ELHT.
• Dermatology OPPROCs are 39% higher than planned (+2,867 attendances / +£351k)
across all providers with the bulk of this being driven by HRG : JC14Z – Skin Therapies
Level 2.
• Dermatology Outpatient follow-ups have reduced by a similar volume (but at a lower
unit price) (-2,755 attendances / -£196k)
• Elective and Daycase admissions are higher than planned +£716k to M08
• Activity overtrade being reported across all main provider sites. With the exception of Pennine Acute
• Main activity overtrade reported in :-
• Orthopaedics (though cheaper casemix of activity so reduced costs)
• Urology
• Surgical Specialties
• Pain Management undertrade @ ELHT is more than offset by the Anaesthetics overtrade at BMI sites
• The 18 week admitted referral to treatment performance is just above the 90%
threshold in November 2013. Year to date performance is below threshold in key
specialties :-
• Orthopaedics (89.95%)
• Neurosurgery (76.5%) - mainly at LTHT
• General Surgery @ ELHT is also just below 90%
SCHEDULED CARE : Elective Admissions [1]
1 2 3 4 5 6 7 8 9 10 11 12
A ct
iv it
SCHEDULED CARE : Elective Admissions [2]
• ENT activity is running slightly above plan @ ELHT yet the waiting list position and
delivery of 18 weeks continues to be challenging. It is worth noting that there is an
increasing undertrade against this specialty @ BMI Gisburne Park which would suggest
there is some capacity in the system to support managing these patients
• Delivery against the 18 week Incomplete Pathways measure is currently at 95.12% (YTD)
against a target of 92% and is therefore ‘on target’ for Quality Premium payments.
• 30 patients have been waiting longer than 36 weeks at the end of November 2013.
• 9 of these are at LTHT for Plastic Surgery (5) and Neurosurgery(3)
• 14 patients are waiting at Central Manchester, the majority for Specialist Paediatrics
April 2013 May 2013 June 2013 July 2013 August 2013 September 2013
October 2013
November 2013
ELHT - Net Promoter Score National - Net Promoter Score
ELHT - Response Rate National - Response Rate
April 2013 May 2013 June 2013 July 2013 August 2013 September 2013
October 2013
November 2013
ELHT - Net Promoter Score National - Net Promoter Score
ELHT - Response Rate National - Response Rate
Friends and Family Test
• The Friends and Family Test Q1 Baseline position is now available (12.5% of total).
INPATIENTS ELHT Net Promoter Score higher than national average and increased above Q1 baseline
ELHT - High response rate (2 x national average)
A&E ELHT Net Promoter Score above Q1 baseline but still below national average and some reduction recently
ELHT Response rate below national average / 15% and decreased from October 2013
ELHT Above National Average
• The Healthcare Acquired infections aspect of the Quality Premium has been failed (12.5%
of total) . Although the number of C.Diff cases is within the profiled annual trajectory,
there have been 6 reported MRSA cases against a zero case threshold.
• The latest update on the local quality premium metric around anti-diabetic drug
prescribing (12.5% of total) shows that we are edging very close to the national position
which we had set as the aspirational target.
• The year-to-to date position against the 62-day wait from urgent GP referral to first
definitive treatment for cancer is lower than the required threshold (84.77% against a
target of 85%). Performance has been improving over the past few months .
• More patients are being reported with rehabilitation bed days than planned for.
Agenda Item No: 5.4
The report outlines progress against the communication and engagement agenda during the period April – December 2013.
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2 Optimise appropriate use of resources and remove inefficiencies.

27 January 2014
1. Introduction
This report provides a summary of communication and engagement activity over the period April – December 2013. Communication and engagement refers to activities, which seek to build the relationships and reputation of the CCG and to use the intelligence from such activities to inform clinical commissioning and quality monitoring. The purpose of this report is to evidence progress and inform activity for the coming three to six months.
The report provides information concerning key aspects of communication support to the CCG: PR, media relations and marketing, Freedom of Information (FoI) requests, social media and web based communication. It also provides information concerning key aspects of engagement support to the CCG including: complaints, compliments, concerns and comments, as well as engagement, market research and insight undertaken. The CCG has lead officers responsible for specific areas covered in this report, namely the Head of Corporate Affairs, Corporate Communications (including staff, stakeholder, FOI’s, website). Chief Operating Officer– Patient and member engagement. An agreed CCG communication and engagement strategy and work plan are the key drivers for most of the activity described.
A forward look highlighting main areas of activity and development is also included.
2. Overall assessment
Since April 2013, the CCG has steadily built its communications and engagement activities and raised its profile within the East Lancashire area. The focus of communications and engagement activity has been around:
- The gathering of qualitative information and soft intelligence about service provision and quality, including the development of the ‘Connect’ initiative and listening events.
- Communications and engagement/patient education on a range of strategically important issues, including urgent care demand management
- Engagement and, where required, formal consultation on developments including the review of the Rossendale Minor Injuries Unit (MIU) contract, the review of the service at the Accrington GP walk-in centre and Lancashire-wide dementia services review.
- Media relations to support operational objectives, such as the winter campaign and minor illnesses and self-care.
- Support for GP engagement through production of the corporate brief and building links to locality groupings through locality managers and steering
groups. - Support for stakeholder engagement via health summits and planning for
engagement in relation to service changes. Media relations has been increased, with additional opportunities identified and
additional proactive work, in addition to reactive responses to major issues such as East Lancashire Hospitals NHS Trust being in special measures and reactions to the review of the provision of the Accrington GP walk-in centre.
3 4 5
Context This report provides information concerning communication and engagement activities supported by the communication and engagement team of NHS Staffordshire and Lancashire Commissioning Support Unit (CSU). Communication activities include: media management, marketing, website and social media, and FOI management. Engagement activities include insight and market research, complaints management, patient and public involvement and membership. Communications: overview This has been a period of positioning the CCG to achieve more prominence in the media and building relationships with stakeholders. One of the challenges for the CCG has been the scale of media interest and coverage of the acute trust with significant issues, particularly around Keogh. This has clouded perceptions of the NHS in Pennine Lancashire. The positioning of the CCG in this environment has been to convey leadership, reassurance and assurance of scrutiny and stewardship. In recognition of this environment, a significant amount of work has been done in relation to reputation and issues management. Communications and engagement links across Pennine Lancashire, in particular between both CCGs have been developed. A Pennine Lancashire communications group has been established, led by the head of locality for communication and engagement for East Lancashire and BwD CCGs. Membership includes the council, county council, acute trust and mental health trust. This is helping to ensure co-ordinated, consistent and coherent communication occurs. As a result of this additional strategic activity, there has been a notable increase in print and radio coverage. Web and social media: overview The CCG now has a vibrant and actively functioning website which is building a regular following of users. Similarly the number of followers to the CCG Twitter account is growing. These channels will be actively promoted to build a larger following and encourage these platforms as a means to engage with the CCG further. The CCG has agreed that the website and an extranet/intranet will be hosted in- house from April 2014. Work is ongoing to design a process for developing this work.
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Campaigns and marketing: overview There has been a steady development of campaigns in support of key business objectives during 2013. It is intended to build on this and focus work during 2014 on strategic business priorities, including urgent care demand management, integrated care, cases for change and local priorities. Design and marketing: overview The Think! campaign is now well established and it is planned to develop this concept further in the coming 12 months to create a rolling programme of communications and engagement related to urgent care and demand management. The Connect branding has been successful and will also be developed further. Further design and marketing communications work will be aligned to strategic business objectives. Existing and future campaigns will be evaluated by the engagement/market research team. FOI: overview The FOI process has been successfully managed by the CSU on behalf of the CCG, including negotiating extensions to timescales where appropriate. No FOI requests have been escalated to the Information Commissioner in this time. Complaints: overview The majority of complaints have been dealt with within the statutory timescales. The status of complaints (RAG rated) is now highlighted to the CCG on a weekly basis. Concerns, comments and compliments are being fed into the soft intelligence system. Engagement: overview The CCG is making good use of the CSU’s engagement support and aligning this to strategic objectives. More work is needed to ensure that hard to reach groups are also effectively engaged. This will be developed further in plans moving forward. Forward look Work is currently being undertaken to agree communications and engagement priorities for the CCG moving forward in line with the two and five-year strategic and operational plans currently being developed. The likely focus on this work will be on:
- Urgent care and demand management (year-round); - Integrated care, including the Better Care Fund – initial focus on frail elderly
and long-term conditions; - Cases for change; - Locality-based priorities; and - Hard to reach groups.
A draft plan for discussion and agreement is currently being produced.
Conclusion There has been a solid and steady programme of communications and engagement work from April 2013 onwards. Aligning this work with strategic and operational priorities moving forward will enable the CCG to build on this foundation and provide increased evidence of effective communications and engagement to inform commissioning decisions, service quality monitoring and service review and development.
13 Recommendations The Governing Body is asked to:
- Note the content of the report. - Note the work completed from April to December 2013
David Rogers Senior Executive – Communication and Engagement, SLCSU Colette Booth Head of Locality Communications and Engagement, East Lancashire CCG/ SLCSU
The CCG has a growing media presence in local print and radio.
There were a total of 107 stories in print media in the first six months of the year, the majority
of these were favourable (see Figure 1, below)
Of the 107 articles, 68 were positive, 25 neutral and 14 negative.
Media interest has been focused on: (1) Changes to services/commissioning decisions and
discussions (e.g. Accrington and Rossendale) (2) General proactive health messages, e.g.
winter and self-care. (3) Issues at East Lancashire Hospitals NHS Trust, of which ELCCG is
the lead commissioner.
The CCG has achieved a significant level of broadcast media interest. In particular, there
has been radio and TV interest in the Health Access Centre developments, and dementia
services, as well as the Keogh review. All have been potentially contentious issues, but the
CCG position was presented well, in a balanced way.
Over the last six months, the balance of media engagement has shifted towards more
proactive media responses as the CCG has evolved and developed its plans. This in turn
has led to more proactive media engagement.
A total of 47 media releases have been researched, written and issued and 34 reactive
media enquiries dealt with. In addition to this, working relationships with key journalists,
notably on the Lancashire Telegraph, BBC Radio Lancashire and the Rossendale Observer
have been developed and strengthened.
Media and stakeholder briefings and support
A considerable amount of support has been provided in the form of advice and briefings to
support the Keogh and post-Keogh interest in the acute trust. Close liaison with the acute
trust communications team has ensured that the CCG has been fully informed and involved
in the Trust’s media and stakeholder communication. A Pennine Lancashire Communication
group was established to ensure consistency and coherence of communication across the
health economy. This has proved useful in planning for winter messages and anticipated
pressures in urgent care.
Media briefings and/or statements have been prepared and distributed in relation to several
major issues in addition to queries around ELHT, including CQC involvement in
Calderstones, reactions to national announcements and other areas.
Weekly reporting and Horizon Scanning
The CSU communication and engagement team have provided the CCG with a weekly
‘reputation and relationship’ tracker which provides data and regular analysis of
communication and engagement metrics. This also provides the CCG with a high level
analysis of ‘hot issues’, and an update of work that the communication and engagement
team have undertaken for the CCG in the last week, with plans for the following week. In
addition to this, the communication and engagement team provide the core team with a
weekly horizon scanning document which brings together important policy, guidance, news
and information.
Web and social media
The communication and engagement team built and content managed the website for the
new CCG. Over the last six months the website has been reviewed, given a refresh and
updated. The newly revised content can be viewed here:
http://www.eastlancsccg.nhs.uk/ The website includes a carousel of prominent news features,
and contacts for all GP practices. It also includes an updated news section. Twitter is
integrated with the website.
Since the website was launched in April 2013, it has attracted 15,074 visitors, including
9,340 unique visitors. There have been almost 60,000 page views (59,786) and the average
number of pages viewed by each visitor was just under 4 (3.97).
The top 5 website pages viewed are (1) Who we are (2) Contact us (3) Key documents (4)
Governing body: member profiles; and (5) What we do.
The CCG Twitter account is integrated with the CCG website. The CCG has 1028 followers
– a significant and growing following. We have tweeted more than 300 health and related
messages. There were 185 retweets – where Twitter messages are sent to others with
similar or larger followings, and the CCG was mentioned in the tweets of 198 other Twitter
followers. This reflects a growing penetration of the Twitter ‘sphere’ enabling the CCG to
bypass traditional media and convey its messages to residents and stakeholders in a more
direct way.
The communication and engagement team have tweeted about a wide range of topics,
including amplification of national campaigns (such as dementia awareness week, world
diabetes week and self-care week), and more localised tweets (such as promoting local
Think! messages and demand management and supporting local authority public health
initiatives). There has been a significant increase in localised tweets towards the end of the
year, with the support of the CSU digital team.
Approval of the social media policy (to be discussed, January 2014) will enable the CCG to
further develop its social media presence, including on Facebook.
The “Think!” campaign was developed using patient engagement for use in urgent care
demand management and successfully launched in September 2013. The aim of this
ongoing campaign is to encourage residents, patients and public to think about how they
access health care. It includes a focus on minor illnesses and self-care and a range of
channels to deliver messages about how, where and when to access appropriate care.
The campaign was developed using focus groups and insight from the experiences of
patients, and was created in partnership with both Pennine Lancashire CCGs and East
Lancashire Hospitals NHS Trust. Materials included posters, leaflets and banners.
Feedback from the public has been positive, particularly in relation to the newsletter which
gave details of health care access points and the distribution of forehead thermometers
designed to be used for children. It is clear, however, that communications to support
demand management needs to be developed into a year-round campaign which can be
delivered on an ongoing basis.
Minor illnesses
In line with the Think! campaign, a series of 10 leaflets, plus posters and other materials
were developed aimed at directing patients to self-care and pharmacies where they were
suffering from routine minor illnesses. Patient information was designed to be handed out by
GPs and practice staff in preference to a prescription. The material was also distributed to
pharmacies. In East Lancashire, this will be further developed to cover the Minor Ailments
Scheme in due course.
Team Winter
Building on the Think! campaign, a Team Winter campaign was developed to reinforce and
make seasonal demand management and urgent care messages. The campaign was
launched in December and included radio advertisements across the Pennine Lancashire
area, including 2BR, print media advertisements, posters and a proactive schedule of media
releases on key healthcare topics.
The daily teleconference on winter pressures is supported by the CSU, as is out of hours
communications cover to deal with urgent issues as winter pressures increase.
Design and marketing support
Team Winter Campaign – Logo/Newspaper adverts/Web banners/Posters