1. health and fitness

NHS LIVERPOOL CLINICAL COMMISSIONING GROUP
GOVERNING BODY
TUESDAY 11 NOVEMBER 2014 AT 1PM
BOARDROOM ARTHOUSE SQUARE
(lunch to be provided at 12.30pm)
AGENDA
Part 1:
Introductions and Apologies
1.1
Declarations of Interest
All
1.2
Minutes and action points from the meeting
held on 14th October 2014
Attached
All
1.3
Matters Arising
All
Part 2:
2.1
Updates
Feedback from Committees:
 Healthy Liverpool Programme Leads Board –
14 October 2014
 Approvals Panel – 15 October & 22 October
2014
 Quality Safety & Outcomes Committee –
21 October 2014
 Finance Procurement & Contracting
Committee – 23 October 2014
 Primary Care Committee – 28 October 2014
Report no: GB 80-14
Dr Nadim Fazlani
Prof Maureen Williams
Dave Antrobus
Dr Nadim Fazlani
Dr Rosie Kaur
2.2
Feedback from CCG Network –5th November 2014 Report no: GB 81-14
Katherine Sheerin
2.3
Feedback from Joint Commissioning Group 20th October 2014
1
Report no: GB 82-14
Katherine Sheerin
Page 1 of 2
2.4
Chief Officer’s Update
Verbal
Katherine Sheerin
2.5
NHS England Update
Verbal
Clare Duggan
2.6
Public Health Update
Verbal
Dr Sandra Davies
Part 3:
3.1
Strategy & Commissioning
Healthy Liverpool Prospectus for Change
Part 4:
4.1
Report no: GB 83-14
Carole Hill
Governance
Corporate Risk Register
Part 5:
Report no: GB 84-14
Ian Davies
Performance
5.1
CCG Performance Report
Report no: GB 85-14
Ian Davies
6.
Questions from the Public
7.
Date and time of next meeting:
Tuesday 9th December 2014 at 1pm - Boardroom, Arthouse Square
For Noting:
 Healthy Liverpool Programme Leads Board – 9th September 2014
 Quality Safety & Outcomes Committee 19th August 2014
th
th
 Approvals Panel – 7 and 15 October 2014
th
 Primary Care Committee – 30 September 2014
 Finance Procurement & Contracting Committee – 23rd September 2014
Exclusion of Press and Public: that in view of the confidential nature of the business to be
transacted, members of the public, press and non voting members be excluded from the
meeting at this point.
2
Page 2 of 2
Report no: GB 80-14
NHS LIVERPOOL CLINICAL COMMISSIONING GROUP
GOVERNING BODY
TUESDAY 11TH NOVEMBER 2014
Title of Report
Feedback from Committees
Lead Governor
Senior Management
Team Lead
Report Author(s)
Summary
Recommendation
Dr Jude Mahadanaarachchi
Dr Nadim Fazlani
Dr Simon Bowers
Cheryl Mould, Head of Primary Care Quality &
Improvement
Tom Jackson, Chief Finance Officer
Cheryl Mould, Head of Primary Care Quality &
Improvement
Tom Jackson, Chief Finance Officer
The purpose of this paper is to present the key issues
discussed, risks identified and mitigating actions agreed
at the following committees:
 Healthy Liverpool Programme Leads Board – 14
October 2014
 Approvals Panel – 15 October & 22 October
2014
 Quality Safety & Outcomes Committee – 21
October 2014
 Finance Procurement & Contracting
Committee – 23 October 2014
 Primary Care Committee – 28 October 2014
This will ensure that the Governing Body is fully
engaged with the work of committees, and reflects
sound governance and decision making arrangements
for the CCG.
That Liverpool CCG Governing Body:
 Considers the report and recommendations from
the committee
As per each Committee’s Terms of Reference
Impact on improving
health outcomes,
reducing inequalities
and promoting
financial
sustainability
Relevant Standards
Standards of Good Governance
or targets
NHS Operating Framework 2012/13
Page 1 of 14
29
Healthy Liverpool Programme Leads Board
Tuesday 14th October 2014
(Immediately after the Governing Body meeting
Approx 4:30pm – 6:30pm)
Boardroom – Arthouse Square
AGENDA
1. Welcome and Introductions
All
2. Minutes /Actions from 9 September 2014 meeting
All
3. Engagement Activities Update (verbal)
CH
4. HLP Prospectus for Change (Attached)
CH
5. HLP - Investment Approvals (Attached)
DR
6. Phase 3 Discussion
TJ
7. Mayors Health Commission
KS
8. FTI Economic Modelling Update
9. Any Other Business
(Attached)
TJ
All
Date of Next Meeting
Tuesday 11th November 2014
(approx. 4:30pm–6:30pm immediately after the Governing Body)
4th Floor Boardroom, Arthouse Square
Page 2 of 14
30
LIVERPOOL CCG
CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES
Committee:
HLP Leads Board
Meeting Date
14 October 2014
Key issues:
Risks Identified:
1.
HLP Prospectus content and readiness for
Mayoral summit launch on November 3rd
2014
GB need to agree on the level of detail and
what information is and isn’t needed within
the prospectus
2.
Investment proposals
Of the four investment proposals
considered, two proposals were
considered to lack sufficient clarity
Chair:
Dr Nadim Fazlani
Mitigating Actions:
•
GB members were requested to
provide (formally / informally) comment
on content and proposed amendments
in advance of prospectus publication
date
•
Two proposals rejected and a request
that they be resubmitted at next
HLP with more robust information
included
Recommendations to NHS Liverpool CCG Governing Body:
1. To note the above with regard to content of HLP prospectus and publication in readiness for Mayoral summit
2.
To note the above with regard to the status of investment approvals
Page 3 of 14
31
APPROVALS PANEL
WEDNESDAY 15TH OCTOBER 2014 AT 11.15AM – 12.15PM
MEETING ROOM 1, 4TH FLOOR, ARTHOUSE SQUARE
AGENDA
1.
Welcome and apologies
2.
Approval of minutes:
•
Panel held on 7th October 2014
3.
Healthy Ageing Scheme
a) Budget Summary
b) Review of bids
a. Anfield Group Practice
b. Village Medical Centre
c) Social Isolation bids
4.
Winter Resilience Scheme
a. Winter Scheme Applications Summary
b. Review of Bids
5.
Any other business
6.
Date of next meeting:
TBC
Page 4 of 14
32
LIVERPOOL CCG
Committee:
CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES
Approvals Panel
Key issues:
1. Social isolation bids based on
neighbourhood delivery were
considered and a number approved.
Meeting Date: 15.10.14
Risks Identified:
• Neighbourhoods are not statutory
organisations therefore cannot be
commissioned to deliver a service.
•
Chair: Prof Maureen Williams
Mitigating Actions:
• Proposals approved but with conditions to
seek assurance that sub-contracting and
Neighbourhood management arrangements
are in place
Requires one practice to take
responsibility for holding the funding
and managing on behalf of the
neighbourhood
Recommendations to NHS Liverpool CCG Governing Body:
1. To note the risks and issues.
Page 5 of 14
33
APPROVALS PANEL
WEDNESDAY 22nd OCTOBER 2014 AT 1pm – 2pm
MEETING ROOM 1, 4TH FLOOR, ARTHOUSE SQUARE
AGENDA
1.
Welcome and apologies
2.
Approval of minutes:
•
Panel held on 15th October 2014
3.
Healthy Ageing Scheme
d) Healthy Ageing Applications Summary
e) Review of bids
4.
Winter Resilience Scheme
c. Winter Scheme Applications Summary
d. Review of Bids
5.
Validation appeals process (GP specification)
6.
Any other business
7.
Date of next meeting
Page 6 of 14
34
LIVERPOOL CCG
Committee:
CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES
Approvals Panel
Meeting Date: 22.10.14
Key issues:
1. Local Quality Improvement Scheme
validation appeals process
Risks Identified:
• No opportunity for practices to appeal
decision of Primary Care Committee
members following recommendation
from validation committee member
• No process established setting out
grounds for appeal and format of final
appeal
2. Winter scheme additional capacity
• Schemes approved provide funding for
extra 4930 appointments per week.
Chair: Prof Maureen Williams
Mitigating Actions:
• Established final appeal for practices via the
Approvals Panel
• Process detailing grounds for appeal and
format agreed by Approvals Panel and
shared with relevant practices
•
Evaluation of the schemes will consider
the impact and acknowledge the actual
additional capacity made available
during the winter period
Recommendations to NHS Liverpool Shadow CCG Governing Body:
1.To note the risks and issues identified.
Page 7 of 14
35
QUALITY SAFETY AND OUTCOMES COMMITTEE
TUESDAY 21ST OCTOBER 2014 3PM TO 5PM
ROOM 2 4TH FLOOR ARTHOUSE SQUARE
AGENDA
1.
Welcome & Introductions
ALL
2.
Declaration of Interests
ALL
3.
Minutes and Action notes from 19th August 2014
Chair
4.
Ratification of Approvals from non quorate 19th August 2014 meeting:
4.1 Policy for the Performance Management of Serious Incidents/Never
Events
4.2 Revision of Terms of Reference
5.
Risk Register
QSOC 30-14
Jane Lunt
6.
Trust Contract Quality - Early Warning Dashboard
QSOC 31-14
Kellie Connor
7.
CQUIN Performance 2014/15
QSOC 32-14
Kellie Connor
8.
Safeguarding Team Report
QSOC 33-14
Tracy Forshaw
9.
Healthcare Acquired Infection
QSOC 34-14
Denise Roberts
10. Commissioning Policy Review –
Procedures of Low Clinical Priority
QSOC 35-14
Sharon Elliott
11. Update regarding Care Quality Commission (CQC)
Inspections
QSOC 36-14
Denise Roberts
Date & Time of next meeting
Tuesday 16th December 2014 3pm to 5pm Meeting Room 2 Arthouse Square
Page 8 of 14
36
LIVERPOOL CCG
CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES
Meeting Date: 21st October 2014
Committee: Quality, Safety & Outcomes
Committee
Vice Chair: Jane Lunt
Key issues:
1. Supporting a reduction in the incidence
of Healthcare Acquired Infections
(HCAI) across the health economy
Risks Identified:
Mitigating Actions:
• Rates of C Diff and MRSA lower than
• Monthly meetings between CCG & Trusts to
same period last year (13/14) – need to
explore and address specific issues.
reduce further.
• Post Infection Review (PIR) process well
established to determine causes and
• Other HCAIs emerging - concerns
learning.
for Carbapenemase-Producing
• Series of workshops in place to explore
Enterobacteriaceae (CPE) which
whole system issues and solution.
require further work.
• Panel process for appeals being introduced.
2. Currently a high number of reviews
taking place following incidents which
meet criteria for Serious Case Review,
Domestic Homicide Reviews and
Mental Health Homicide.
• Current capacity may be inadequate to
meet demands within timescale.
•
• Effectiveness of review potential
compromised.
•
3. Updated Policy for Performance
Management of Serious Incidents by
Liverpool CCG ratified by Quality Safety
& Outcomes Committee.
•
•
Serious Incidents provide an
opportunity for learning & improvement
for both trusts and CCG/NHS England
– opportunities to maximise this need
to be enhanced
•
•
CCG engaged with the Key Partnership
Boards & NHS England to understand
requirements and timescales.
National review of this issue taking place –
CCG contributing to this.
Monthly internal review meetings well
attended and clinical review of reports well
established.
Learning & improvement supported by
Trusts being required to review incidents on
an annual basis to elicit themes and trends.
Patient Safety Collaborative being reestablished as a Forum for commissioners
and providers to share learning and improve
care.
Recommendations to NHS Liverpool Shadow CCG Governing Body:
1. Note the issues and risks and the action to improve and mitigate risk
2. Note that updates will be provided to assure progress in eliminating or mitigating issues
37
Page 9 of 14
FINANCE, PROCUREMENT AND CONTRACTING COMMITTEE
THURSDAY 23 OCTOBER 2014 AT 10AM – 12:30PM
ROOM 2 – ARTHOUSE SQUARE
AGENDA
1. Welcome and Introductions
All
2. Declaration of Interests (form available)
All
3. Minutes and action notes of previous meeting
held on 23 September 2014
Chair
AGENDA ITEMS
4. Specialised Commissioning Update (Standing Item)
Verbal
Tom Jackson
5. Finance & Contracts Performance Month 6
Report no: FPCC50-14
Alison Ormrod
6. Finance KPI Month 6
Report no: FPCC51-14
Alison Ormrod
7. Mersey Care NHS Trust Redevelopment (TIME)
Report no: FPCC52-14
Derek Rothwell
8. Any Other Business
ALL
Date of next meeting(s):
Tuesday 25 November 2014
10am – 12:30
Tuesday 16 December 2014
9:30am – 12:00pm
Tuesday 27 January 2015
10am – 12:30
Thursday 12 February 2015
10am – 12:30pm
Tuesday 24 March 2015
10am – 12:30pm
38
Room 2 Arthouse Square
Room 2 – Arthouse Square
Room 2 Arthouse Square
Boardroom – Arthouse Square
Room 2 Arthouse Square
Page 10 of 14
LIVERPOOL CCG
CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES
Committee:
Finance, Procurement and Contracting
Committee
Meeting Date
23 October 2014
Key issues:
Risks Identified:
1 Approval of additional funding for
Merseycare Time (Clock View)
•
2 Merseycare funding for Edge Lane
•
Chair:
Dr Nadim Fazlani
Mitigating Actions:
Phase 1 funding was endorsed by
•
Merseyside Cluster Board and was part
of a legacy business case inherited by
Liverpool CCG
Original endorsement was provided by •
Merseyside Cluster Board and
that changing clinical needs may
impact the service originally envisaged
to be provided at Edge Lane.
Approval of £0.29m funding in 14/15
and £1.23m in 15/16. Clock View to be
presented to the December 2014
Governing Body for Approval.
The CCG would require a separate
business case in respect of this project
and would not commit any further
funding.
Recommendations to NHS Liverpool CCG Governing Body:
1. To note the above with regard to investment
2. To note the above with regard to future investment in the TIME project
3. Clock View will be presented to the December 2014 Governing Body for Approval
39
Page 11 of 14
NHS LIVERPOOL CLINICAL COMMISSIONING GROUP
PRIMARY CARE COMMITTEE
TUESDAY 28TH OCTOBER 2014 AT 1PM – 3PM
BOARDROOM – ARTHOUSE SQUARE
AGENDA
Part 1: Introductions and Apologies
1.1
Declarations of Interest
All
1.2
Minutes and action points from the last meeting
held on 30th September 2014
Attached
All
1.3
Matters Arising:
1.3.1
All
Part 2: Updates
2.1
2.2
Feedback from Workstreams October 2014
Report no: PCC 36-14
a)
Localities
PCC 36a-14
North, Central &
Matchworks
b)
Medicines Management Sub-Committee
PCC 36b-14
Shamim Rose
c)
Community Settings of Care
PCC 36c-14
Jude
Mahadanaarachchi/
Paula Finnerty
d)
Stakeholder Engagement
PCC 36d-14
Dave Antrobus
Update from NHS England
- Mersey View
40
Verbal – Tom Knight/
Rose Gorman
Page 12 of 14
Part 3: Service Development/Implementation
3.1
GP IT
PCC 37-14
Simon Bowers/Kate
Warriner
3.2
Community Pain Management
PCC 38-14
Jude Mahadanaarachchi
Part 4: Quality & Performance
4.1
Organisational Development Update
PCC 39-14
Ray Guy/Moira Cain
4.2
Liverpool Quality Improvement Scheme
(GP Specification)
PCC 40-14
Rosie Kaur
4.3
IM&T Update
PCC 41-14
Simon Bowers/Kate
Warriner
5.
Any Other Business
ALL
6.
Date and time of next meeting:
25th November 2014, 1pm to 3pm, Boardroom, Arthouse Square
41
Page 13 of 14
LIVERPOOL CCG
CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES
Committee: Primary Care Committee
Key issues:
1. Community Pain Model
2. General Practice Organisation
Development (Practice Nurses and
Practice Manager/Admin).
3. GP IT Operations Model.
Meeting Date: 28th October 2014
Chair: Dr Nadim Fazlani
Vice Chair: Dr Rosie Kaur
Risks Identified:
Mitigating Actions:
• Proposal did not include self care
element or domiciliary provision.
• To review and discuss with clinical lead
to include these elements.
• That there needs to be strong
evaluation in order to demonstrate
outcomes.
• To develop investment proposal.
• Ensure robust evaluation framework is
in place
• Ambitious programme that will require a •
clear action plan and milestones.
Support from Primary Care Team to put
together one clear action plan.
• That a vehicle to support the
development is not identified.
•
Consideration given to how CCG
supports organisational development in
General Practice
• That funding allocated to CCG 2015/16
will have a detrimental impact to
number of key compoents i.e. COIN,
ICE, Out of Hours Service Desk.
• Primary Care Committee agreed way
forward, investment process now
needs to be followed.
Recommendations to NHS Liverpool CCG Governing Body:
1.
To note the issues and actions
2.
To note that Local Quality Improvement Scheme (GP Specification) end of year report demonstrated improvement in all key
performance indicators from its implementation.
42
Page 14 of 14
Report no: GB 81-14
NHS LIVERPOOL CLINICAL COMMISSIONING GROUP
GOVERNING BODY
Title of Report
Lead Governor
Senior Management
Team Lead
TUESDAY 11TH NOVEMBER 2014
Feedback from Merseyside Clinical Commissioning
Groups Network
Dr Nadim Fazlani, Chair
Dr Fiona Lemmens
Katherine Sheerin, Chief Officer
Report Author
Katherine Sheerin, Chief Officer
Summary
The purpose of this paper is to present the key issues
discussed, risks identified and mitigating actions
agreed at the Merseyside CCG Network on 5th
November 2014.
This will ensure that the Governing Body is fully
engaged with the work of the Merseyside CCG
Network and reflects sound governance and decision
making arrangements for the CCG.
That Liverpool CCG Governing Body:
 Considers the reports and recommendations
from Merseyside CCG Network
Impact on improving
health outcomes,
reducing inequalities
and promoting
financial sustainability
By working collaboratively with CCGs across
Merseyside we will ensure that opportunities are
maximised for Liverpool patients and the
consequence of commissioning services understood
and managed.
Relevant Standards or
targets
Standards of Good Governance
NHS Operating Framework 2012/13
43
Page 1 of 2
MERSEYSIDE CCG NETWORK
WEDNESDAY 5 NOVEMBER 2014, 1.00pm-4.30pm
Conference Rooms A, St Helens Chamber, 1st Floor, Salisbury Street,
off Chalon Way, St Helens WA10 1FY
No
Timing
Item
1.00pm
Lunch / informal pre-meet
141101
1.15pm
Minutes / actions of previous meeting
141102
1.30pm
EPRR Update inc:
- Current status report
- Report on provider development plans
Lead
Roger Booth/
D Johnson
141103
1.45pm
How to access the evidence base to enhance quality of services
and health outcomes achieved through commissioning 15 minutes
David Stewart, Director of Health Libraries North
david.stewart@nhs.net
David Stewart
141104
2.00pm
The North West Coast Academic Health Science Network
- Provide context and consult with clinicians about
views on the regional topics for the Patient Safety
Collaboratives being run on behalf of NHS England.
Lisa Butland,
Director of
Innovation
+ Research
141105
2.15pm
Informatics
K Sheerin
(Kate
Warriner +
Simon
Bowers to
present)
Presentation on North Mersey and Mid Mersey strategies
(requested by KS)
Lunch available from 1pm, meeting to commence at 1.30pm
44
Page 2 of 3
LIVERPOOL CCG
CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES
Committee: CCG NETWORK
Meeting Date: 5 November 2014
Chair: Dr Steve Cox
Key issues:
Risks Identified:
Mitigating Actions:
1. Presentation of the iLinks Strategy for
North Mersey
• Impact of different approaches and
speed of informatics transformation in
Mid Mersey on the North Mersey
system
•
•
•
2. CSU Update
Concerns re ability of Cheshire and
Mersey CSU to deliver required
services
•
3. Maternity Services Review
•
Speed of delivery of the review causing
concerns, with limited commissioning
leadership
•
Mid Mersey CCGs to consider adoption
of principles/approach set out in the
iLinks Strategy and to ensure
informatics support is commissioned to
deliver.
Interim Managing Director to meet with
all Mersey CCGs on 3 December 2014.
Clear approach from Liverpool CCG re
service requirements by Christmas
2014.
Commissioner-led review to be
instigated, subject to agreement by all
CCGs. Paper to Governing Body in
due course.
Recommendations to NHS Liverpool CCG Governing Body:
1. To note the risks and actions from the CCG Network.
45
Page 2 of 2
46
Report no: GB 82-14
NHS LIVERPOOL CLINICAL COMMISSIONING GROUP
GOVERNING BODY
TUESDAY 11TH NOVEMBER 2014
Title of Report
Lead Governor
Feedback from the Joint Commissioning Group of
the Health & Wellbeing Board/Liverpool CCG
Dr Simon Bowers
Senior Management Tony Woods, Head of Strategy and Outcomes
Team Lead
Report Author
Tony Woods, Head of Strategy and Outcomes
Summary
The purpose of this paper is to present the key
issues discussed, risks identified and mitigating
actions agreed at the Joint Commissioning Group
on 20th October 2014.
This will ensure that the Governing Body is fully
engaged with the work of the Joint
Commissioning Group and reflects sound
governance and decision making arrangements
for the CCG.
Recommendation
That Liverpool CCG Governing Body:
 Considers the reports and
recommendations from Joint
Commissioning Group
Impact on
improving health
outcomes, reducing
inequalities and
promoting financial
sustainability
Relevant Standards
or targets
• Reduction of health inequalities in the city
• Improve the physical and mental health and
well-being of the population of residents in
Liverpool
47
Preventing people from dying prematurely
Helping people to recover from episodes of illhealth or following injury
Ensuring that people have a positive experience
of care
Page 1 of 4
JOINT COMMISSIONING GROUP OF THE LIVERPOOL HEALTH AND
WELLBEING BOARD
Monday, 20 October 2014
1.00 P.M.
AGENDA
1.
Welcome and Introductions
For the Chair to welcome all attendees to the meeting and lead introductions.
2.
Declarations of Interest
To provide an opportunity to declare any pecuniary or significant prejudicial
interests they may have in any item on the agenda.
3.
Notes of the Last Meeting
To receive and consider the notes of the last meeting, held on 22
2014.
nd
September
(Pages 1 - 6)
4.
i)
Healthy Liverpool Programme
Prospectus for Settings of Care;
Report and appendices attached.
ii) Mayoral Health Summit
rd
Verbal update on the preparations for the event, to take place on 3
November 2014
(Pages 7 - 82)
5.
Emergency Preparedness
Report to be tabled, to include feedback from a Cheshire and Merseyside Ebola
th
response workshop which took place on 15 October.
6.
Mayoral Health Commission
To receive a verbal update report on the Mayoral Health Commission
recommendations
48
Page 2 of 4
7.
Children's Trust Board - Joint Commissioning Intentions and
Strategy
Draft Joint Commissioning Strategy & Framework for Liverpool’s Children &
Young People attached
(Pages 83 - 94)
8.
Joint Commissioning Group Performance Report
Joint Commissioning Group Performance Report and Commentary Report
attached.
(Pages 95 - 108)
9.
Finance Report - Better Care Fund Update
To receive an update report relating to the finances of the Better Care Fund.
(Pages 109 - 115)
10.
Physical Activity Strategy
To receive a report providing an update on the development of the Liverpool
Physical Activity and Sport Strategy and associated Action Plan.
(Pages 116 - 162)
11.
Integrated Personal Commissioning
Integrated Personal Commissioning briefing attached.
(Pages 163 - 177)
12.
Health and Wellbeing Board Items
To note additional items for submission to the next meeting of the Liverpool
Health and Wellbeing Board –
i)
ii)
iii)
13.
Updates on the Joint Strategic Needs Assessment and Joint Health
and Wellbeing Strategy;
Public Health Annual Report; and
Report of the Joint Commissioning Group
Facilitation of the Next Meeting
To discuss the structure of the next meeting of this Group, to take place on
th
Monday 17 November 2014.
49
Page 3 of 4
LIVERPOOL CCG
CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES
Committee:
Joint Commissioning Group
of the Liverpool Health and
Wellbeing Board
Meeting Date
20 October 2014
Chair: Samih Kalakeche and Katherine
Sheerin
Key issues:
Risks Identified:
Mitigating Actions:
1. Joint commissioning intentions
and strategy for Children’s
Services
• That given the local authority
financial pressures, the health of
children is negatively affected, if
an ambitious, aligned children’s
plan is not agreed and delivered
• Children’s Summit to be held,
bringing together commissioners
and providers to develop and
agree the plan.
2. Physical Activity Strategy
• That the ambitions are not
realised given the challenges
facing the people of the city.
• Clear oversight of delivery of the
strategy by the Living Well
Programme Steering Group
Recommendations to NHS Liverpool CCG Governing Body:
1. To note the risks and mitigating actions from the JCG
50
Page 4 of 4
Report no: GB 83-14
NHS LIVERPOOL CLINICAL COMMISSIONING GROUP
GOVERNING BODY
TUESDAY 11TH NOVEMBER 2014
Title of Report
Healthy Liverpool Prospectus for Change
Lead Governor
Dr Nadim Fazlani
Senior Management
Team Lead
Tom Jackson, Director of Finance and Healthy Liverpool
Programme Director
Report Author
Carole Hill, Head of Communications
Summary
The purpose of this paper is to present the final version of
the Healthy Liverpool Prospectus for Change, which was
provided to the CCG Governing Body in draft form in
October 2014.
Recommendation
That Liverpool CCG Governing Body:
 Notes the final version of the Healthy Liverpool
Prospectus for Change;
 Notes the launch of the Prospectus at a Mayoral
Summit on 3rd November;
 Notes that a further report will be presented to the
Governing Body in December on the next phase of
public engagement for Healthy Liverpool, which will
commence in January 2015.
Impact on improving
health outcomes,
reducing inequalities
and promoting
financial
sustainability
The Healthy Liverpool Prospectus for Change sets out
how we will deliver the CCG’s approach to health
outcome improvement, reduction in health inequalities
and delivering financial sustainability for the next five
years.
Relevant Standards
or targets
Delivery of statutory responsibilities for the CCG.
51
Page 1 of 4
HEALTHY LIVERPOOL PROSPECTUS FOR CHANGE
1.
PURPOSE
The purpose of this report is to present the final version of the Healthy
Liverpool Prospectus for Change, following the consideration of the draft
version by the Governing Body in October 2014.
2.
RECOMMENDATIONS
That Liverpool CCG Governing Body:
• Notes the final version of the Healthy Liverpool Programme
Prospectus for Change;
• Notes the launch of the Prospectus at a Mayoral Summit on 3rd
November;
• Notes that a further report will be presented to the Governing Body
in December on the next phase of public engagement for Healthy
Liverpool, which will commence in January 2015.
3.
BACKGROUND
Healthy Liverpool is an ambitious programme to transform Liverpool’s
health and social care system to one that is person-centred, supports
people to stay well and provides the very best in care.
The Healthy Liverpool Prospectus for Change sets out proposals for the
transformation of health and social care in the city over the next five years.
The Prospectus was published a week after the NHS published its 5 Year
Forward View, which sets out how the health service needs to change
over the next five years if it is to close the widening gaps in the health of
the population, quality of care and the funding of services.
The Liverpool vision for the future of our health and social care system
aligns closely with the Five Year Forward View vision. This alignment
provides assurance that the Healthy Liverpool programme proposals
52
Page 2 of 4
contained in the Prospectus are sound and the programme is on the right
track to deliver the transformation that is required.
The launch of the Healthy Liverpool Prospectus for Change will be
followed in the new-year with a city-wide engagement campaign, details of
which will follow in December.
4.
MAYORAL SUMMIT
The Prospectus for Change was launched on 3rd November 2014 at a
Mayoral Summit at Liverpool Town Hall, which provided an opportunity to
present the key elements of the proposals, including:
• The Case for Change
• The Healthy Liverpool Model of Care
• The three settings of care – Living Well, Community Services and
Hospital Services
• The Roadmap – next phases of delivery and engagement
• The Platform to a Healthier Liverpool – how Healthy Liverpool aligns
with the recommendations from the 2013 Mayoral Health Commission
The Summit, which was hosted by Mayor Joe Anderson, had senior
representation from the city’s health providers, Liverpool City Council,
NHS England and other key professional stakeholders. The event
demonstrated a shared consensus and commitment from the health and
social care system to work together in partnership and an agreement that
the Healthy Liverpool programme should be seen to be delivering change
quickly and with continued pace.
The new Healthy Liverpool website went live alongside the launch of the
Prospectus for Change. This will be a primary channel to support the next
phase of communications and public engagement.
www.healthyliverpool.nhs.uk
5.
HEALTHY LIVERPOOL PHASE 3
The launch of the Healthy Liverpool Prospectus marks the beginning of
phase 3 of the programme, which will include a city-wide engagement
programme on the Prospectus for Change, from January-March 2015,
intended to raise awareness of the case for change and proposed
53
Page 3 of 4
solutions that will deliver the ambitious improvements in health outcomes
set out in the document. Detailed proposals for the city-wide engagement
programme will be presented to the Governing Body in December.
A detailed programme plan for phase 3 is being developed for approval by
the Healthy Programme Leads.
6.
CONCLUSION
The Healthy Liverpool Prospectus for Change captures the ambition of the
city’s plans to transform health and social care and to improve health
outcomes for the people of Liverpool.
The contents of the Prospectus provide a framework for the next phase of
engagement with the people of Liverpool.
Liverpool CCG, working with partners in a process led by clinicians,
continues to develop detailed plans for specific Healthy Liverpool projects,
initiatives and investments designed to deliver the transformation in patient
outcomes, quality and sustainability of health and care in Liverpool.
ENDS
54
Page 4 of 4
Healthy Liverpool
Prospectus for change
november 2014
55
My colleagues and I are
absolutely committed
to putting people first
and putting patients
first. We are absolutely
committed to the Healthy
Liverpool Programme’s
success and look
forward to everyone
in Liverpool benefiting
from this challenging
but essential work.
Joe Anderson
Mayor of Liverpool
56
The Healthy Liverpool
programme is truly a
once-in-a-generation
opportunity to transform
health and social care in
Liverpool for the better.
dr nadim fazlani
chair, nhs liverpool clinical commissioning group
Healthy Liverpool prospectus
CONTENTS
Introduction by the Mayor of Liverpool,
Joe Anderson
Foreword by Dr Nadim Fazlani, Chair,
NHS Liverpool Clinical Commissioning Group
2
4
1
The Healthy Liverpool Vision
6
2
The case for change
8
7.5
Proactive approaches
23
7.6
Delivering more specialised care
in community settings
26
7.7
What should people expect from
their community services?
26
Re-aligning hospital services
28
8.1
Sustainability of our hospital services
29
8
2.1
Poor health outcomes and
city-wide health inequalities
8
8.2
Liverpool’s specialist hospital services
30
2.2
Population change
8
8.3
Delivering 7-day hospital services
30
2.3
Sustainability
9
8.4
Clinicians leading change
30
2.4
Service variability
9
8.5
31
2.5
Lifestyle-related health issues
9
Benefits of re-aligning
hospital-based care
2.6
New approaches to care
9
8.6
Scope and approach
31
2.7
Empowering patients
9
8.7
Urgent and emergency care
31
8.8
Improving cancer services
32
Women’s and maternity services
35
3
The Liverpool Health Journey
10
8.9
4
Our ambition – a new model of care
12
9
Technological innovation
37
4.1
Healthy Liverpool settings of care
12
10
How we will deliver transformation
38
4.2
Prioritising to achieve
the best outcomes
13
5
Delivering person-centred care
14
6
How we will support people in
living well
16
6.1
Improving physical activity
17
6.2
Reducing alcohol misuse
18
6.3
Reducing smoking levels
18
6.4
Better self-care for people
with long-term conditions
19
7
Transforming community services
20
7.1
Better links between health,
social care and voluntary services
22
7.2
Neighbourhoods
22
7.3
Transforming primary care
23
7.4
Integration of health and social care
23
57
10.1 Transforming mental health services
38
10.2 Supporting healthy ageing
41
10.3 Tackling cancer
44
10.4
Transforming care for children
and young people
47
10.5
Delivering joined-up care for people
with long-term conditions
50
10.6
Better care for people with
learning disabilities
53
11
Investing for long-term sustainability
56
12
The Healthy Liverpool Roadmap
57
13
References and additional sources
59
14
Glossary
60
1
2
introduction
A
CLEAR
VISION…
for health improvement for the people of
Liverpool, the outcomes we aim to deliver
and how we plan to achieve our vision.
Joe Anderson Mayor of Liverpool
Two years ago I instigated a Commission to determine how best to support and improve
the health and well-being of the people of Liverpool. The findings of the Mayoral Health
Commission concluded that such is the extent of the poor health outcomes of the people
of Liverpool, and the relentless drive on budgets and resources, that only a wholesale
comprehensive approach to transformation would be likely to succeed.
The Commission’s vision is for an Integrated
Health and Social Care System for Liverpool,
with prevention and self-care at its core.
To achieve this a 10-point plan was identified
to which all partners were asked to sign up
to and then to sustain their commitment by
collaborating to achieve this vision.
The programme is critical to the city’s future.
We need healthy communities to engender
economic success. Economic success will
improve the quality of life for all our families.
And we must do everything we can to ensure
taxpayer’s money is being spent in the most
effective way.
The newly established NHS Liverpool Clinical
Commissioning Group, as the body responsible
for the vast majority of health commissioning
within the city, took up the challenge of
delivering the recommendations of the
Mayoral Health Commission.
The vision for a New Health Service for Liverpool
was subject to a formal public consultation in
2007/08, which provided a clear mandate from
the people of Liverpool supporting the principle
of care delivered closer to home and approval
for significant investment in new neighbourhood
health facilities across the city. This vision was
successfully achieved, with the development of
a network of new or refurbished Neighbourhood
Health Centres and an NHS Treatment Centre.
It has set up the Healthy Liverpool Programme
as its response to the Commission and is now
providing the necessary leadership to achieve
this vision of improved health and well-being.
The Healthy Liverpool Programme sets out a
clear vision for health improvement for the
people of Liverpool, the outcomes we aim to
deliver and how we plan to achieve our vision.
58
The Healthy Liverpool Programme represents
a logical continuation of the journey that
commenced with A New Health Service for
Liverpool. Our plans represent a further
step-change in the development of community
care, which aligns with the new hospitals
that are now in development and the hospital
service re-alignment debate which forms
part of the Healthy Liverpool Programme.
Healthy Liverpool prospectus
3
The Mayor’s Health Commission recommended:
All the key partners
in Liverpool formally
sign up to the principle of
seeking to create a pioneering,
high quality, sustainable
Integrated Health and Social
Care System, and undertake
together to lead, manage,
and fund the transformation
of the health outcomes of
the people of Liverpool.
1
Mayor of Liverpool,
Joe Anderson
We have much to be proud of in Liverpool
when we consider the expertise and dedication
of those working in the health and care
services, our innovation and some of our
globally-leading hospitals and clinicians.
This is the city, after all, that had the country’s
very first public health officer in the person of
Dr William Duncan, who delivered widespread
public health improvements more than 160 years
ago. The Healthy Liverpool Programme might be
regarded as yet another chapter in a Liverpool
story which began with his reforms.
My colleagues and I are absolutely committed
to putting people first and putting patients first.
We are absolutely committed to the Healthy
Liverpool Programme’s success and look
forward to everyone in Liverpool benefiting
from this challenging but essential work.
59
Liverpool Health
Partners and the North
West Coast Academic Health
Science Network to play a key
part, through research-based
input, in helping health and
social care to ‘act as one’
and to work together across
traditional boundaries.
6
Prevention and
self-care become
the primary focus in the
transformation of the health
A Neighbourhood Model
7
outcomes, and a focus on
to be the key way of
young people and older people. implementing the proposed
integrated Liverpool Health
The system to be
and Social Care System.
3
stimulated by a major
new initiative to integrate out of
A workforce strategy to
8
hours services across primary,
deliver a high quality,
community, secondary, tertiary, integrated 24/7 service; to
mental health and social care. include the development
of new roles; existing staff
Achieving the vision will
to work differently; giving
require strong operational
young people access to new
over-sight and support.
opportunities and to support
Therefore the Commission
the recommendations of
further recommended:
the Mayor of Liverpool’s
Education Commission.
A single unifying
4
strategic plan, based on
Transformation of the
9
the City’s Joint Strategic Needs
health outcomes of
Assessment, bringing together the people of Liverpool through
the local commissioning plans the Integrated Health and
of the CCG, the City Council,
Social Care System is
the Health and Well-being
research and evidence-based.
Strategy of the joint Health
and Well-being Board, and
The City of Liverpool
10
NHS England (Merseyside).
and all its organisations
commit to the transformation
National bodies to be
of the health outcomes
5
kept fully informed of the by tackling the wider
strategic plan, to allow space
determinants of health and
for the reduction of duplication facilitating healthy choices
and unnecessary competition
in food, alcohol, smoking,
(particularly in secondary care), exercise and transport.
2
More importantly, I believe all people should
have access to the right care at the right time
and in the right place. I believe it is wrong
that the health of people in Liverpool should
be so much poorer than in some other places
in the UK. And I believe it is wrong that there
remain health inequalities within the city itself.
and for the restructuring of
care in all settings to improve
the patient pathway and quality
of care.
4
foreword
We
believE…
we should offer the best care to everyone,
irrespective of where they live in Liverpool,
to a consistently high standard.
dr nadim fazlani chair, NHS liverpool clinical commissioning group
The life expectancy
gap between men
living in Childwall
and Kirkdale.
Healthcare in Liverpool faces major challenges and needs to reform. Issues such as an
ageing population and opportunities such as advances in medical technology means that
care services can and should be organised in a more effective way. A different approach
will enable people to have the very best health and care and will ensure that we spend
taxpayers’ money more efficiently.
We believe we should offer the best care to
everyone, irrespective of where they live in
Liverpool, to a consistently high standard.
This document outlines our vision for the
future of health and care services in the city.
It explains why they need to change and the
broad principles which will underpin that
change. It also explains how we will plan
and deliver change in partnership with
the people of Liverpool and others.
Healthy Liverpool is our response to the
Mayor’s Health Commission so brings with it the
full authority of the city’s elected leadership.
We believe the case to transform health and
social care is overwhelming. Just consider
some of the killer issues in our city. Some
5,000 people in Liverpool have dementia but
only half of them are ever diagnosed.
Lung cancer alone accounts for over 12% of
the gap in life expectancy between Liverpool
and the rest of England. Life expectancy within
Liverpool varies considerably, even between
neighbouring communities.
60
It is wrong, we believe, that people in
Liverpool have significantly poorer health
than elsewhere in the UK and Europe and
that life expectancy within the city is so varied.
Our aim is to change that.
Work to reshape some care is already
underway – integrated health and social care
is an emerging reality and there is work
being done on how we better deliver care
in neighbourhoods and communities.
However, reform needs to go further, with
more improvements in primary care, greater
access to GPs, more support for people to
manage their own care, better illness prevention
and some services moving from hospitals into
the community.
Primary and neighbourhood-based care services,
GPs in particular, are often the gateway to
health and social services and the main source
of advice for patients. So reform of primary
care is the cornerstone of a changed health
and social care system.
Improving primary and neighbourhood care will
enable people to stay healthier and independent
for longer and also reduce demand on hospitals.
Healthy Liverpool prospectus
5
Dr Nadim Fazlani, Chair,
NHS Liverpool Clinical
Commissioning Group
Our hospital services largely continue to operate
in the same way as they did in the last century,
despite the changing face of the population and
technology. We believe some hospital services
would benefit from a fresh approach to the way
they are organised.
The Healthy Liverpool Programme will
undoubtedly be challenging. But we also believe
it will be exciting and that it is essential.
I know through my own experience of being a GP
in Kensington, Liverpool, where our practice has
some 8,500 patients, that some families and
If we reduced emergency admissions to hospitals communities have become almost accustomed
by just 11% we would be able to afford an extra
to ill-health and that their expectations are low.
one and a half GPs in every practice in the city.
I believe we must raise such expectations so
This is the virtuous circle we are aiming to create. that Liverpool people are ambitious for their
own health and for that of their families.
Quality of care has to be foremost, however.
Without quality, we won’t achieve the outcomes
Only days before we published our prospectus,
we are aiming for. All the proposed reforms under NHS England published its Five Year Forward View,
consideration will therefore be underpinned by a which sets out the vision for the future of the NHS,
rigorous approach to standards and quality.
an articulation of why change is needed, what that
change might look like and how we can achieve it
What must also be at the heart of any change
collectively. This Five Year Forward View aligns
programme is a collaborative approach. Our
closely with the Liverpool vision for the future of
commitment is to work in partnership to deliver
our local NHS and reconfirms our belief that the
the necessary reforms. Health and social care
prospective changes we offer in this document
organisations, including Liverpool City Council,
will take us where we need to go.
the Third Sector, patients’ groups, GPs and
individual health trusts will all be involved in
The Healthy Liverpool Programme is truly a
this process.
once-in-a-generation opportunity to transform
health and social care in Liverpool for the
Most importantly, our approach must put people better. Some of the improvements we want to
first. The evidence is overwhelming that taking
see may take a generation. Some are already
a person-centred approach to the delivery of
happening and already improving people’s lives.
care; giving people more say over care plans and Please play your part.
better supporting them to look after themselves
will improve their health and well-being.
61
The number of
additional GPs we
could afford in
every practice in the
city if emergency
hospital admissions
were cut by 11%.
6
the healthy
liverpool vision
1
Our vision is for a healthcare system in
Liverpool that is person-centred, supports people
to stay well and provides the very best in care.
This vision is underpinned by a number of ambitious
outcomes to be achieved by 2020. These include:
Health outcomes
for people within
Liverpool will have
improved relative
to the rest of England,
and health inequalities
within Liverpool will
have narrowed.
62
The quality of
healthcare received
by Liverpool patients
will be consistent
and of high quality.
T here will be a
new model of care
which is clinically
and financially
sustainable for
the long-term.
Healthy Liverpool prospectus
Through the transformation achieved by the
Healthy Liverpool Programme, our goals are:
24.2% 71%
A 24% reduction in
years of life lost.
63
An increase to 71%
in the measurement
of the quality of life
for people with longterm conditions.
15%
A 15% reduction in
avoidable emergency
hospital admissions.
Top 10 Top 5
To deliver a patient
experience in our
hospitals that puts
us in the top 10 of
CCGs nationally.
To provide a
community-based
care experience that
puts us in the top 5
of CCGs nationally.
7
8
the case
for change
2
The case for change is a compelling one. The city’s health economy like many across the
NHS in England faces a series of unique challenges and opportunities in future, that if not
addressed have the potential to impact the sustainability, delivery and outcomes of local
services and therefore adversely affect the health and well-being of Liverpool people.
The gap in life
expectancy between
the ward with the
highest and the
ward with the lowest
life expectancy.
These drivers for change are not necessarily
unique to Liverpool but like every health economy,
local needs, structures and circumstances
can mean that their impact can be potentially
significant if left unaddressed. If we are to
achieve our vision for a Healthy Liverpool we
must first understand these drivers and then
seek to design a system that is able to rise
to the challenges faced and the opportunities
available. For Liverpool there are a significant
range of challenges to be addressed:
Poor health outcomes and
city-wide health inequalities
Residents in the City experience a range of
worse health outcomes in comparison with
similar cities, with significant levels of inequality
Population change
2.2
within parts of the city and with other parts
Despite poor health outcomes, Liverpool’s
of the country. Inevitably with such variation,
population is living longer, with an expected 9%
positive progress and outcomes are harder
growth in the numbers of people aged 65+ years
to achieve. What we need is an approach to
by 2021 and significant growth in those aged
change that is strongly clinically led, sustainable 70-75 and 85+. Although the total population is
and appropriately resourced. In essence,
not expected to significantly change, changes in
the ‘prescription’ is the Healthy Liverpool
the age profile within the population will impact
Programme with its whole-system emphasis.
upon health and health service delivery. As the
population ages there will be more people living
with health conditions and often multiple needs,
placing greater demands upon our health system,
both in community and in hospital care settings.
2.1
The increased
likelihood of dying
of cancer when living
in Kirkdale compared
to Woolton.
64
Inequalities within the city are shocking:
the gap in life expectancy between the ward
with the highest (Woolton) and the ward
with the lowest (Kirkdale) life expectancy
is 10.5 years;
people in Woolton on average live
10.5 years longer than people in Kirkdale;
for cancer, people in Kirkdale are 3 times
more likely to die of cancer than in Woolton;
for cardio-vascular disease (CVD), people living
in Picton ward are 2.5 times more likely to die
of CVD than Mossley Hill;
for respiratory disease, people living in Princes
Park are 6.5 times more likely to die of this
disease than Mossley Hill.
Healthy Liverpool prospectus
Sustainability
Liverpool is fortunate to have a robust
infrastructure of neighbourhood health facilities
delivering primary and community services,
as well as a unique range of hospitals; with
eight NHS trusts serving the city’s population.
Like all health systems Liverpool is subject to
a variety of challenges, including financial,
operational, quality, workforce and regulatory
issues. If we are to realise the vision for Healthy
Liverpool, we will have to ensure that all our
health services across all settings of care are
able to meet the future needs of the city and
that we are able to develop and sustain the
best health system in the country, which will
be necessary in order to achieve our ambitions
for significant improvement in health outcomes.
2.3
The increased
likelihood of dying
of Cardio-Vascular
Disease in Picton
ward than in
Mossley Hill.
Predicted growth
in the number of
Liverpool people
aged 65+ years
by 2021.
Service variability
Outcomes across the city for local
people are unacceptably variable; this is being
experienced in primary care, community care
and in our hospitals. This can manifest itself
in a variety of ways, including differing referral
rates for cancer, high admission or conversion
rates in hospitals, variances in hospital length
of stay and clinical outcomes. Similarly patient
experience and quality of service delivery across
the city can vary significantly. Such variations
have to be tackled; we will work to a future
where services are delivered consistently to
the highest standards in a fair, sustainable and
equitable manner.
2.4
Lifestyle-related health issues
True transformation of health in Liverpool
will be dependent upon people taking more
responsibility for their own health. Obesity,
2.5
alcohol misuse and smoking-related ill-health
are all significant factors affecting the health
of Liverpool people. The Healthy Liverpool
Programme will incorporate evidence-based
approaches, working with our partners, to
support people to take control of their own
well-being, and live healthier lifestyles. The
challenges impacting on our local NHS services
now and into the future can be tackled most
effectively by helping people to remain healthy
for longer.
New approaches to care
Against the backdrop of significant
health and care challenges, we are improving
our understanding of the best approaches to
maintain health and provide better treatment for
people who need care. There is strong evidence
that for some conditions, developing more
specialised hospital care can result in better
outcomes for patients through the concentration
of highly-effective technology along with the
most highly trained and specialist staff.
2.6
Empowering patients
It is clear that significant opportunities
exist to improve health outcomes through
empowering patients to get involved in
decision-making about their and their loved
ones’ care. In this way we can improve
outcomes by addressing the whole person,
rather than focusing on single facets of their
health. Too many people report negative or
unsatisfactory experiences and for too many
people there are barriers to accessing care
in a straightforward fashion. Putting people
first will therefore underpin our approach to
achieving a healthy Liverpool.
2.7
The challenges impacting on our
local NHS services now and into
the future can be tackled most
effectively by helping people to
remain healthy for longer.
Councillor roz gladden
deputy mayor and cabinet member for health and adult
social care, liverpool city council
65
9
10
66
Healthy Liverpool prospectus
3
11
the liverpool
health journey
We have a legacy in Liverpool
of taking bold decisions to
improve health.
Katherine Sheerin CHIEF OFFICER, nhs LIVERPOOL CCG
Liverpool has a strong legacy of strategic and proactive investment in physical
health infrastructure and ambitious re-design of health and health services.
Between 2008-2013 the former commissioners
of health services, Liverpool Primary Care Trust,
invested many millions into new and improved
community health facilities and an expansion
of community-based healthcare to enable
more services to be delivered closer to people’s
home. This programme complemented and
was a necessary precursor for the new Royal
Liverpool and Alder Hey hospitals which are
now being developed.
The vision for a New Health Service for Liverpool
was subject to a formal public consultation
in 2007/08, which provided a clear mandate
from the people of Liverpool for the principle
of care delivered closer to home.
67
This vision was successfully achieved, with
the development of a network of new or
refurbished Neighbourhood Health Centres
and an NHS Treatment Centre across the city.
The Healthy Liverpool Programme represents
a logical continuation of the journey that
commenced with A New Health Service for
Liverpool. Our plans represent a further
step-change in the development of community
care, which aligns with the new hospitals
that are now in development and the hospital
service re-alignment debate which forms part
of the Healthy Liverpool Programme.
12
our ambition – a
new model of care
4
In order to achieve the Healthy Liverpool vision we need to identify new ways of
working and to design services that support our ambitions. Healthy Liverpool will
deliver a new model of care – person-centred care. So the health and care system
must take into account the needs of the entire person, rather than addressing just
one particular element of what may be a complex range of health and social needs.
In reality, this means being prepared to set
aside traditional approaches which may suit
the health and care system’s traditional
organisational needs but do not best serve
the needs of the individual.
This new model of care means that the
different tiers of the health and care system
must connect better. In practical terms,
specialists and other staff will break traditional
organisational boundaries and work in different
locations and different settings, centred on the
needs of people and communities.
4.1
Healthy Liverpool settings of care
The Healthy Liverpool Model is built around three ‘settings’ of care:
Supporting people
to self-care and
equipping them with
the knowledge and
resources to take healthy
lifestyle decisions.
DELIVERING care in
communities across
the city, including GP
practices, schools, health
and community centres,
pharmacies, people’s
homes and residential
care facilities. Our
intention is to bring as
much care as possible
closer to people’s homes.
68
ensuring that, in future,
our hospitals will be
used for only those
services which absolutely
must be delivered in this
setting, because of the
complexity of the service
or the seriousness of a
person’s illness.
Healthy Liverpool prospectus
We have to manage competing priorities
and make decisions that will give us the
best chance to achieve the ambitious
improvements in health outcomes of
Liverpool people.
Prioritising to achieve
the best outcomes
The multiple demands on our NHS mean that
in planning for the future we have to manage
competing priorities and make decisions that
will give us the best chance to achieve the
ambitious improvements in health outcomes
of Liverpool people.
4.2
We have examined a wide evidence-base,
including the findings of the Mayor’s Health
Commission and the Liverpool Joint Strategic
Needs Assessment, to identify six priority
areas which, through effective re-design
and focused investment, will drive improved
health outcomes.
This does not mean that other areas will be
neglected; we will continue to improve all
health services, but we are prioritising these
key areas, as evidence indicates that we can
achieve the biggest improvement in health
outcomes by transforming the way that these
areas are designed and delivered.
THE SIX PRIORITY AREAS:
69
MENTAL HEALTH
HEALTHY AGEING
LONG-TERM CONDITIONS
CHILDREN
LEARNING DISABILITIES
CANCER
13
14
Delivering personcentred care
5
National research tells us what people want from their health and care services.
We took that research and asked people in Liverpool about their needs. What they told
us is represented in the following statement:
“We want to live the most independent lives possible.
We want services that are easier to navigate and
access; services that are organised around, and
responsive to, our human needs. We want the care
system to recognise that one size does not fit all;
we each have our own definitions of independence
and services should be able to flex to this.”
The vast majority of contacts in healthcare and
social care take place in community settings
rather than in hospitals – in GP practices, with
health visitors, midwives, district nurses,
community matrons, social workers, mental
health workers, therapists and pharmacists.
Achieving person-centred, joined-up care could
transform the way these services are offered
“We want our families and carers to be identified
and make an enormous contribution to improved
and involved in our care. We want to plan our care experience of care for Liverpool people.
with people who work together to understand
us and our carers, allow us control, and bring
The Liverpool way to joined-up care will not be
together services to achieve the outcomes
led by a focus on structures and organisations.
important to us. The care system can feel like
Our focus will be on people and communities
a maze so we want primary and community
having a better experience of care and support,
healthcare, social care, hospital care, voluntary,
experiencing less inequality and achieving
charity and housing organisations to work
better outcomes. This will be the guiding light in
together to help us succeed in maintaining our
everything we do. So for us, success will be judged
independence for as long as possible.”1
by whether a Liverpool patient is able to say:
I can plan my care with people who work together
to understand me and my carers, allow me
control of that care, and bring together services
to achieve the outcomes important to me.
1. ‘National Voices’ patient
narrative for integration.
70
Healthy Liverpool prospectus
15
Person-centred,
joined up care can
transform quality
of service.
Fundamentally, joined-up care will deliver better
outcomes for patients, meaning:
fewer people require hospital and long-term care;
more people are supported to live independently
at home for longer;
reduced health inequalities, as a result
of delivering the right services in response
to the specific needs of communities and
neighbourhoods;
more people living well for longer, through
better self-care and self-management of
their conditions.
services in our city. By enabling partners to
collaborate and be guided by the needs of people
rather than systems and organisations, we will
avoid duplication, intervene more quickly to prevent
ill-health or manage conditions better and we will
benefit from shared expertise and resources.
Making this vision a reality will require all local
NHS organisations and partners to unite around
shared core values that are led first by what is
best for people – person-centred care. This journey
has challenges. However, the recent reforms to
the health and care system have created the right
This model of care also provides a more financially conditions for change, by empowering doctors and
sustainable future for health and social care
other health professionals to lead this process.
Innovative approaches to delivering person-centred care
Advice on Prescription
‘Sue’, a mum of 3, was referred
to the Advice on Prescription
programme with a long-standing
diagnosis of anxiety and depression.
She was referred by her GP for
counselling because she was
worried about her increasing
debt, particularly rent arrears.
The counsellor was able to refer
her to the Liverpool Advice
on Prescription Programme
for practical assistance.
In 2013, Sue had been assessed as
being fit for work; she was taken off
Incapacity Benefit onto Job Seeker’s
71
Allowance (JSA). However, due to her
health problems, she was unable to
meet the conditions of JSA, which
resulted in her benefits being stopped.
Her rent and council tax arrears
increased considerably and she
became very worried about losing
her home. The Advice on Prescription
service assisted Sue by securing
an award of Employment Support
Allowance and a backdate of
suspended payments. All court
action relating to rent and council
tax arrears was also stopped. Sue’s
weekly income has increased by
over £200 and she has returned to
counselling to support her recovery,
without the added worries about debt.
16
Just 30 minutes
activity each day
will save hundreds
of lives.
72
Healthy Liverpool prospectus
6
The number of
deaths per year that
could be prevented
by 30 minutes of
activity per day.
17
how we will
support people
in living well
Our ambition is for Liverpool
to become the most physically
active city in the country.
dr maurice smith GP, nhs LIVERPOOL CCG
Liverpool has a strong legacy of strategic and proactive investment in physical
health infrastructure and ambitious re-design of health and health services.
The decreased
likelyhood of heart
disease related death
for a diabetes patient
who is active (3 hours
walking per week).
Living Well is built upon two workstreams – one focusing on activity
which will help to prevent ill-health in
the population and another focusing on
how we ensure people with long-term
health conditions are able to look after
and care for themselves.
Liverpool has a long tradition of
partnership working across a wide range
of health improvement and lifestyles
agendas, resulting in better outcomes
in key areas such as smoking and
alcohol-related admissions to hospital.
73
for cancer, cardio-vascular disease
and respiratory disease.
Improving Physical Activity
We have a bold ambition to transform
the health of Liverpool people. Our goal:
6.1
Liverpool will be the most
physically active city in
the country by 2021.
Liverpool City Council and Liverpool CCG
believe that partnership approaches to
prevention are essential to success.
There is clear evidence of the health
benefits of undertaking at least 30 minutes
physical activity a day. When we say
physical activity this does not need to be
overly strenuous, it can be simple activities
such as walking and gentle cycling.
We have prioritised three areas of
prevention where we will focus our
attention: physical activity, smoking and
alcohol. These areas have been identified
as key health issues in Liverpool,
particularly influencing high mortality
Currently in Liverpool about half of the
adult population does not participate
in any form of physical activity. Around
86% of adults in Liverpool are not
active enough to maintain good health,
compared to 70% nationally.
6
18
how we will support people in living well, continued
If we were able to get every adult in the city
to undertake 30 minutes of activity per day
for at least 5 days per week we estimate that
would prevent:
424 deaths per year;
146 CHD emergency admissions per year;
2,452 new Diabetes cases;
55 cases of Breast Cancer;
43 Colorectal Cancer cases.
How much a daily
gentle walk will
reduce the risk of an
emergency admission
for a COPD patient.
The percentage of
all deaths that are
due to heart disease.
The percentage
of breast cancer
deaths that are
due to inactivity.
For people with long-term health conditions
there are significant benefits from being active:
an active patient with diabetes (who walks
3 hours a week) is 2½ times less likely to
die of heart disease than an inactive person
without diabetes;
patients with COPD who walk gently for
half an hour per day halve their risk of an
emergency admission;
10% of all deaths from heart disease and 18%
of all breast cancer deaths are due to inactivity;
physical activity reduces blood pressure in
patients with hypertension, far greater than
prescribed medication;
the National Institute of Clinical Evidence
(NICE) recommends physical activity as
an effective treatment for depression,
particularly when undertaken in groups.
We will work with Liverpool City Council and
other key organisations with expertise, including
our professional sports clubs and Sport England,
to focus significant investment to achieve our
ambition, through the jointly agreed Liverpool
Physical Activity and Sport Strategy.
The city has a wealth of assets, including some
of the best green spaces in the country, which
we will harness to make physical activity
opportunities available to all, regardless of
where people live or how fit they are. We will
be developing large scale programmes which
will be informed by insight into the particular
needs of our city, reaching the whole population;
from pre-school to older people, people living
with, or at risk of developing, long-term health
conditions, and people with a disability.
Our intention is to create a social movement;
mobilising people of all ages, backgrounds
and abilities to improve their health through
activity. We will recruit champions who will
promote the benefits of activity and offer
support to people who want to get started.
Alongside this, we will invest in weight
management and healthy eating programmes.
74
Reducing alcohol misuse
An estimated 11,300 people in Liverpool
drink at high risk levels and approximately 10%
of all admissions in the city are estimated to be
alcohol-related – the 4th highest in the country.
Alcohol-related mortality is amongst the highest
in the country.
6.2
Our aim is to create effective partnership working
to prevent and reduce alcohol-related problems to
improve the quality of life for people who live in,
work in and visit our city.
Using the best evidence available we will put in
place programmes that target specific groups that
are often difficult to influence in terms of behaviour
change; including young people and middle-aged
women. We will use insight data and social marketing
approaches to reach and influence these groups.
We will also continue to lead the drive for minimum
pricing for alcohol at national level and use local
powers and influence with local businesses.
We aim, over the next five years to significantly
reduce the under-75 death rate for liver disease
and reduce the impact on our health services of
alcohol-related problems.
Reducing smoking levels
Smoking is the single biggest behavioural
risk factor for premature death and has a
significant impact on Lung Cancer, COPD and
CVD, which are the major killers in Liverpool.
6.3
If we were able to increase numbers of people
on smoking cessation setting quit dates to a level
of 15%, we estimate we would avoid 114 deaths
per year.
Our vision is for the city to be a place where children
are not exposed to tobacco smoke; smoking levels
are decreasing and smoking is not seen as the norm.
Providing a comprehensive tobacco control
programme including a specialist stop smoking
service has already helped to reduce Liverpool’s
smoking prevalence from 35% in 2005 to 25% in
2013. However we need to reduce this even further;
our plan is to deliver a further 5% reduction by 2020.
Working with partners we will put in place a
number of specialist programmes aimed at
supporting individuals to stop smoking, including
targeted interventions for key groups such as
young people and pregnant women; increasing
the range of brief interventions advice and
specialist stop smoking services.
Healthy Liverpool prospectus
Better self-care for people
with long-term conditions
The self-care model for people with long-term
conditions in Liverpool encompasses a range
of activities, actions and ideas that individuals,
families and communities can undertake to
better manage their own condition.
6.4
The number of
lives that could
be saved each
year by increasing
participation in
smoking cessation
programmes.
The percentage of all
city admissions that
are estimated to be
alcohol-related.
The model is also designed to empower people
to take care of their own health and to have
a high degree of self-reliance and, therefore,
less reliance on health and care services.
19
involving people in decision-making,
encouraging problem-solving and goal-setting;
developing care plans in partnership with
professionals;
promoting healthy lifestyles and offering
practical tools to achieve this;
providing the tools for people to monitor their
symptoms and to know when to take action;
supporting people to understand and manage
the emotional, social and physical impact of
their conditions;
harnessing the power of digital tools and
assistive technology to support the adoption
of self-care at scale.
The priority areas identified for self-care for
long-term conditions are:
people with diabetes,
people with respiratory problems, including
chronic obstructive pulmonary disease (COPD)
and asthma,
those with coronary heart disease,
frail elderly people.
We intend to develop a menu of services with
patients who suffer from one or more of these
conditions and to create a toolkit for healthcare
professionals that can help them initiate and
support the self-care journey, in partnership
with patients.
Some 24,000 people registered with a GP in
Liverpool have diabetes; 14,000 with COPD;
28,000 with asthma and 18,500 with coronary
heart disease.
There will also be a unified self-care portal
accessible via all GP practices in Liverpool
so that healthcare professionals can access
information on all services in a simple fashion.
Through this approach, we aim to create an
Our approach to self-care is to offer a range
education and cultural shift towards a
of support for people to live well and have a
high degree of self-reliance. Our focus will be on: collaborative partnership between health
professionals and patients.
Supporting Self Care
Tony Coulter
61-year old former painter and
decorator, Tony Coulter’s life
changed completed when he was
diagnosed with a brain tumour at
just 48. A series of operations then
left Tony totally blind and epileptic.
Care technology has allowed
him to regain his independence and
live by himself, whereas previously
he was heavily reliant on his sister.
Tony now lives in a Riverside Independent
Living Housing community, where he
is supported by care technology made
available through Mi – More Independent,
a NHS Liverpool CCG programme which
deploys technology to support self-care.
Tony uses technology to improve his
quality of life. This includes a talking
75
microwave, a talking computer and a
talking watch that tells him the time.
He also has a special device that
detects if he suffers a fall, a Lifeline
pendant around his neck that he can
press for help, and sensors in his bed
that raise an alarm if he suffers a fit.
Tony says: “I can’t say that life isn’t
a challenge, but the technology has
helped a lot – it gives you reassurance
and peace of mind that someone is
always looking out for you.
“The last straw would be losing my
independence. I have a supportive
family, but don’t want to rely on
them all the time. The technology
has allowed me to stay in my own
home, living alone, and being as
independent as I can possibly be.”
20
We want to be
able to answer yes
to; are we putting
people first? Is the
experience of care
good? Are services centred
around people’s needs?
This is person-centred care.
Dr Paula Finnerty gp, NHS Liverpool CCG
76
Healthy Liverpool prospectus
7
21
transforming
community
services
We will provide excellent 7-day
services in all our communities.
Dr Jude Mahadanaarachchi gp, nhs Liverpool CCG
The improvement
in the number of
people with COPD
and breathlessness
who have been
offered a pulmonary
rehab programme.
77
The Mayor’s Health Commission recommended that the City of Liverpool and
all its organisations commit to the transformation of health outcomes by
tackling the wider determinants of health. This reflects the fact that health
is not just the physical well-being of an individual, but includes the social,
emotional and cultural well-being of the whole community.
Working together, all local organisations
should enable each individual to achieve
their full potential as a person, which
will contribute to the total well-being of
their community.
Liverpool aims to have fantastic
community services to serve its population.
The aim is to deliver excellent health
and social care outcomes, services
that prevent illness and improve physical
and emotional well-being for the local
community. People will experience
co-ordinated and integrated health
and social care using evidence
based pathways, where care is truly
personalised and actively supported
to ensure the best possible outcomes.
When we say community services we
mean those that provide healthcare,
social care and voluntary care services
outside of hospital.
Liverpool has a history of working together
and our intention is for the City to come
together as a whole and make better use
of all its assets, services, staff and patient
experiences to ensure that we transform
community services to improve the health
and well-being of the people of the City.
For the population as a whole, we
recognise that the vast majority of
citizens in Liverpool maintain and
manage their own health and well-being
close to home. People do this through
their own motivation, through their
families, friends, carers and faith groups,
through local amenities such as parks
and gyms, libraries, schools, community
organisations and transport systems,
or through their dentists, pharmacists
or employers, amongst many others.
7
22
The increase in
60-75 year olds
receiving bowel
cancer screening in
the last two years.
transforming community services, continued
The next largest group of people to access
health and social care services will be those
who require routine care from their GP or who
require specific support to enable them to
remain as healthy as possible and to live as
independent a life as possible. In the scheme
of things it is a small minority of people who
go on to require specialist care or have more
complex conditions. It is an even smaller
group of people who go on to require
hospital based care.
At present Liverpool has many excellent services
and staff but as we know services can be
disjointed and fragmented. For people this can
mean that access to health, social care and
other community services is not joined-up which
can lead to delays and multiple assessments.
We recognise that Liverpool has a fantastic
opportunity now to bring together all our
resources which includes health and social
care, patient expertise and the Voluntary Sector.
We aim to work in a joined-up way so that
people get excellent care and support in a
timely manner in the right place from the right
professional. This needs to involve all those who
provide care and support so that the care an
individual receives is person-centred and has
a greater emphasis on supporting them to care
for themselves. We want to place a real focus
on people living well and having healthier lives
but also to ensure that when required services
are accessible, responsive and work together
to meet individual need. People tell us that
this is what they want and this is what we aim
to deliver.
Our intention is that everyone in Liverpool can
expect to receive joined-up care from services
located close to the community where they
live. This will provide people for example with
improved access to GPs, community nurses,
social workers, health visitors, simple
diagnostic tests, pharmacies and voluntary
services. At the heart of this will be the way
these services work together to provide care.
Better Links between Health,
Social Care and Voluntary Services
Liverpool has a wealth of voluntary, community
and social enterprise (VCSE) partners. We
recognise that our ambitions for health and
well-being are more likely to succeed if our
7.1
78
models of health, care and support services
reflect all aspects of health and well-being and
operate as a strong and integrated part of our
health and care system.
Many voluntary organisations have a detailed
understanding of specific local needs, high levels
of trust and engagement with local communities
and the ability to work across multiple services
to provide care for individuals. For example,
within the context of an ageing population, the
Voluntary Sector has a crucial role to play in
addressing social isolation as well as harnessing
the power of the local community.
Evidence demonstrates that social determinants
of health have a defining impact on health
outcomes. More preventive and less intensive
interventions for health will be needed to
make the system sustainable. Consequently
we need to understand the challenges and
opportunities in this area and to plan how
to build such approaches into the Healthy
Liverpool Programme.
Health, Social Care and Voluntary Care
services will be provided in a variety of settings,
for example:
for the person at the centre – this may
mean adopting a healthier lifestyle,
and being a proactive partner in treatment;
at the GP Practice – this may mean proactive
prevention and partnering with Voluntary
Care Services throughout pathways;
in the neighbourhood – this may mean
voluntary care services supporting
healthy communities, health promoting
neighbourhoods, and training and development.
We will ensure we know which voluntary care
services are in our communities to enable us
to signpost people appropriately to get the
support they need when they need it.
Neighbourhoods
The Mayor’s Health Commission
recommended that a neighbourhood model
should be the key way of implementing the
proposed integrated Liverpool Health and
Social Care System.
7.2
Healthy Liverpool prospectus
the liverpool model of care
HOSPITAL SERVICES
SPECIALIST COMMUNITY
SERVICES – CVD/RESPIRATORY/DIABETES/TB,
COMMUNITY CHILD HEALTH - PAEDIATRICIAN,
OUTPATIENT SERVICES – DERMATOLOGY/UROLOGY,
DIAGNOSTIC SUITE – IMAGING/DVT SERVICE, SEXUAL HEALTH SUITE,
MENTAL HEALTH RECOVERY, SOCIAL CARE, REABLEMENT HUBS
NEIGHBOURHOOD
WOMEN AND
CHILDREN
– Community
Child Health
– Midwives
– Health Visitors
– Planned Care
SPECIALIST
NURSING
DIABETES
HEART
FAILURE
COPD
HIGH QUALITY
GENERAL PRACTICE
LOCAL QUALITY
IMPROVEMENT SCHEMES
PREVENTION
AND SELF CARE
PEER SUPPORT,
HEALTH TRAINERS, HEALTH LITERACY,
COMMUNITY-LED NON-CLINICAL SERVICES,
ADVICE ON PRESCRIPTION
EMPOWERED
PEOPLE
79
COMMUNITY
NURSING
DIAGNOSTICS
MEDS MANAGEMENT
SOCIAL CARE
THERAPIES
(OT/PHYSIO/SALT)
MENTAL HEALTH
ADDITIONAl SUPPORT
(DRUGS/ALCOHOL)
SEXUAL HEALTH
LERNING
DISABILITIES
END OF LIFE
23
7
24
transforming primary care
Primary and neighbourhood based
care services, GPs in particular, are often
the gateway to health and social services
and the main source of advice for people,
so improvements in primary care will be the
cornerstone of a transformed health and social
care system. It’s clear therefore that Liverpool
needs a General Practice Service that’s fit for
the future. This means we will look at ways in
which we can deliver 7-day services, which will
improve access and the experience of care.
7.3
The improvement in
people who have had
a stroke or TIA having
lower cholesterol.
transforming community services, continued
NHS England has invited CCGs to come forward
to take on an increased role in the commissioning
of primary care services. This could lead to
co-commissioning arrangements between the
CCG and NHS England from 2015. We welcome
this change, which would accelerate our ability
to improve quality and access to a broader range
of services in primary care and empower us to
improve primary care services in line with the
vision for Healthy Liverpool.
Integration of Health
and Social Care
Liverpool people must have access to consistent The Mayor’s Health Commission recommended
GP services which are delivered to an agreed
that a neighbourhood model is the best way of
level of quality and to ensure that people are
achieving an integrated Liverpool Health and
treated outside of hospital whenever appropriate. Social Care system, and that transformation
This is what every person registered with a
of health outcomes should be research and
Liverpool General Practice will expect. To drive
evidence based.
this endeavour in 2011, Liverpool established
the “GP Specification” to improve the quality and In the same way as the neighbourhood model
consistency of General Practice across the city,
has supported GP practices to work together
improve the health of people, reduce variation
it is also crucial to enable the coming together
and health inequalities and ensure most cost
of these GP practice groups with other health
effective use of resources. Target areas for this
and social care professionals voluntary,
“GP Specification” include:
community and social enterprise partners.
improving access to General Practice;
All of these organisations need to work together
to shape and deliver joined-up local services
increasing screening;
in order to ensure real person-centred care.
increasing vaccinations and immunisations;
increasing Health Checks;
To enable this more joined-up working, a number
Chronic Disease Management.
of modern models for integration will be
considered and tested in the local health and
Examples of improvements achieved so far,
social care economy. We have already begun
and expected to continue, include:
to establish integrated health and social care
7.2% more patients aged 60-75 years old have
had bowel cancer screening in the last 24 months; services and teams, organised around GP
practices in neighbourhoods. In addition to this,
5% improvement in people with coronary
we are exploring innovative models of integration
heart disease having lower cholesterol;
between some organisations in our system.
3.9% improvement in people who have had
a stroke or TIA having lower cholesterol;
One approach is the use of joint agreements;
7.6% improvement in people with diabetes
to purchase health and social care services.
who have had all nine key care processes
Similar arrangements have been developed to
that are known to improve their conditions;
deliver a range of services for adults.
38.1% improvement in the number of newly
diagnosed diabetics aged 17+ who have
Proactive Approaches
7.5
been offered structured education in the
For people with the most complex health
last 12 months;
and social care needs, communities need a
11% improvement in the number of people
proactive approach to delivery of services which
with COPD and breathlessness who have been
at their core are about providing the right local
offered a pulmonary rehab programme;
services in the right place for all. This means
5.4% improvement in the number of people
working together across health and social care
with severe mental illness who have a
to systemically identify vulnerable people at risk
record of five key physical health checks
of a crisis or hospitalisation and working with
in the previous 12 months.
them earlier to help them self-care and prevent
this happening where possible.
80
7.4
Healthy Liverpool prospectus
25
We’re proactively
working with
people to help
them self-care and
prevent the risk of
hospitalisation.
The improvement in the
number of newly diagnosed
diabetics, aged 17+,
who have been offered
structured education
in the last 12 months.
81
7
26
transforming community services, continued
Delivering More Specialised Care
in Community Settings
We will also move more specialist health
services that are currently offered from local
hospitals. We want to do this because some
specialist services that are traditionally
provided in hospital can be safely and effectively
provided in our communities. In future we will
see more hospital consultants leading integrated
teams in community locations and they will
work more closely with General Practice and
neighbourhood teams to show them how to
provide more specialist support to those with
highly complex conditions, without the person
at the centre having to go into hospital. We are
planning for specialist diabetes care, heart
failure and COPD to be provided in this way.
7.6
The improvement in
people with diabetes
who have had all nine
key care processes.
Liverpool has prioritised six areas to improve
health outcomes for the city – Mental Health,
Healthy Ageing, Long-Term Conditions, Children,
learning disabilities and Cancer. Each of these
areas will have a community focus to ensure we
achieve our goals for improvement. For example:
a Community Reablement Team will provide
a city-wide falls service as an alternative to
hospital admissions;
a new model of diabetes care will provide a
one-stop shop for newly diagnosed people;
children and family health hubs will provide
joined-up care for children with complex needs;
hospital doctors will work from community
settings to provide more convenient clinics
for people.
What Should People Expect
from their Community Services?
We have identified a clear set of standards
and anticipated benefits that demonstrate how
this new model for community services will
transform the experience of care for people
and contribute to our outcome ambitions:
7.7
Access
The improvement
in the number of
people with severe
mental illness who
have a record of
five key physical
health checks.
Between 8am and 6.30pm, Monday to Friday, everyone will have access to telephone triage with
a GP within one hour in case of an urgent health need and an appointment on the same day.
Everyone with an urgent social care need will have access to social care within 2 hours,
those with a less urgent need will be contacted within two days;
All health and social care partners will provide the same high standard of service in the day,
night or at the weekend.
Quality and Safety
Reduction in variation and health inequalities across the City.
People working in the service are recruited, organised, developed and supported so that
they have the skills, competencies and knowledge to enable the delivery of high quality,
safe and reliable care.
Identification of patients who are at risk of developing illnesses, and offering proactive
prevention/management of conditions.
Identification of patients who are already ill and at risk of being admitted to hospital
as an emergency, and offering proactive treatment to avoid unnecessary admissions.
All people who would benefit from a care plan will have one.
Delivering care to people so that they can die in their own homes with respect.
Implementation of the Care Act 2014
Social Care Services will have a duty to promote a person’s well-being.
People’s access to personal budgets will be formalised.
Counselling and advocacy will become Social Care services; funding will be available
to provide these services for those who do not have anyone else to do this for them.
The whole family will be entitled to an assessment when assessing an adult’s needs.
Carers will have the same rights to assessment and support as those they care for.
82
Young carers aged 16-18 years old who are transitioning to adulthood will have a new right to
have their specific needs assessed in light of how their role might change.
Healthy Liverpool prospectus
27
Transforming Community Services
Sarah-Jane Daley Community Diabetes Specialist Nurse
People newly diagnosed with
Type II Diabetes have the
opportunity to participate in
a six-week ‘X-Pert’ Diabetes
Programme, which enables
people to develop a good
understanding of their condition,
supports them to self-care and
encourages them to share their
experiences. As it is a group
session, it facilitates individuals
to learn and support one another.
83
People often attend the sessions
with misconceptions, myths and
little understanding of what diabetes
is and what the possible complications
may be if it is not well controlled.
One such patient sent a letter to
Sarah-Jane Daley, Community
Diabetes Specialist Nurse, telling her
that the X-Pert Programme provided
them with the “confidence to discuss
their treatment with healthcare
professionals, family and friends
in an open and informed manner”.
Following on from attending the
course the patient had lost weight
and as a result achieved a healthy
BMI and improved their overall
glycaemic control.
“Having just completed a six-week
X-Pert programme, I had to write and
say what a wonderful job you are doing.
I have to give particular praise to the
educator who delivered the course
with great professionalism but also
humour, understanding and patience,
which not only helped the group to
relax and gel together, but to
participate, share experiences and
build trust in each other. I hope the
work of the Diabetes Team is extended
into schools, the workplace and GPs
where your X-Pert knowledge could
help so many people appreciate the
value of a healthier lifestyle and avoid
the pitfalls of diabetes.”
28
Our hospitals are already good.
We will ensure they are excellent
7 days a week.
dr fiona lemmens gp, nhs Liverpool CCG
Artist’s impression
of the new Royal
Liverpool Hospital.
84
Healthy Liverpool prospectus
8
29
Re-aligning
Hospital Services
Doctors, nurses and other
professionals are leading
on the proposals for change.
professor donal o’donoghue secondary care doctor,
nhs Liverpool CCG governing body
A key element of the Healthy Liverpool vision is for the city to have the best hospital
services in the country. In determining the shape and content of hospital services we will
be guided by the following principles:
all patients will receive the right care in
the right place first time;
services must be of high quality and
delivered to best practice quality standards;
continuity and co-ordination of care will be
maximised and any necessary transfer of
care across hospitals optimised to reduce
risks and improve the experience of patients;
a safe healthcare system that provides a quality
service and is sustainable financially and
operationally into the future;
equality for all, delivering safe care
seven days a week.
85
The ambition of this vision must be set against
the backdrop of a Liverpool health economy
which, like many across the NHS in England,
faces both challenges and opportunities.
If we are to achieve our vision and design
the best hospital-based care system in the
country, we must first understand these
drivers and then seek to design a system that
is able to rise to the challenges faced and the
opportunities available.
Sustainability of our hospital services
Liverpool’s health economy has a unique
mix of hospitals, with eight NHS or NHS
Foundation Trusts serving the city’s population.
Like all hospitals they are subject to a variety
of challenges including financial, operational,
quality, workforce and regulatory.
8.1
The Liverpool hospital service landscape has
largely evolved over time, rather than to a plan,
which has resulted in duplication of services and a
focus upon individual organisational performance
and delivery rather than a co-ordinated and
integrated whole system approach. Without change
we believe our current hospital system is not best
placed to respond to the future needs of local
people or the wider health and social care system.
Achieving a sustainable, financially stable
hospital provider landscape going forward is a
key objective of the Healthy Liverpool Programme,
as without such a foundation it is difficult to see
how services can change and develop for the
long-term benefit of patients.
8
30
re-aligning hospital services, continued
Liverpool’s specialist
hospital services
Liverpool, unlike many cities, benefits
significantly from having a high concentration
of specialist trusts – Alder Hey, The Walton
Centre, Liverpool Heart & Chest and the
Clatterbridge Cancer Centre; with specialist
services also provided in our two main acute
providers the Royal Liverpool & Broadgreen
University Hospital and Aintree University
Hospital, and at Liverpool Women’s Hospital.
8.2
Liverpool is served
by no fewer than
eight NHS Trusts.
In planning for the future it is essential
that we safeguard, nurture and develop the
city’s role as a ‘centre of excellence’ for
specialist services, which are not just for
the people of Liverpool but also for residents
of Merseyside and the region.
essential if we are to reduce variations in
quality and improve patient experience and
outcomes. The national agenda makes it
clear; to quote NHS England Medical Director
Sir Bruce Keogh:
We have got to stop
talking about ‘seven
day working’, where
the emphasis is on
the people delivering
the service. We have
to talk about ‘seven
day services’ and
focus on the people
receiving the services.
This is about how
and not about why.
Liverpool CCG plays an active role in supporting
current co-working arrangements to support the
commissioning of specialised services, which is
the responsibility of NHS England. The majority
of specialist hospitals located in Liverpool
provide services for people across the whole
of Merseyside and further. As such, any options
proposed by the Healthy Liverpool Programme
for redesign of specialised commissioned
sir bruce keogh
services will be developed in partnership with
medical director, nhs england
neighbouring CCGs, NHS England and people
from both within and outside the city who depend
upon these services. Future option development
Our approach is not just about addressing
will also be informed by nationally determined
issues surrounding weekend working, but
specifications for specialised services.
rather improving access to high quality services
on every day of the week, in all our hospitals.
NHS England is exploring options for CCGs to
This implies change in provider behaviours and
take on an increased role in the commissioning
organisation, informed by engaging with and
of specialised services. We welcome the
listening to patients and the public. Our hospitals
opportunity to co-commission higher volume
have begun the journey to improve collaboration
specialised services in the city, as local
and innovation to better sustain services across
decision-making will facilitate the process
the city, with staff potentially in the future
for improving hospital services in Liverpool.
working across and between sites to deliver
For example, to improve outcomes for cancer,
services to patients in an effective and efficient
our biggest killer, it makes sense to align
manner every day of the week.
the commissioning of high volume cancer
treatments, such as chemotherapy, with
Clinicians leading change
other ‘non-specialised’ cancer services and
8.4
The development of the vision for a
priorities, to deliver improved cancer outcomes.
sustainable and deliverable system of hospital
care has been led by local clinicians – doctors,
Delivering 7-day hospital services
8.3
consultants, nurses and other healthcare
The delivery of safe, effective and
practitioners. As Liverpool’s hospitals frequently
appropriate 7-day hospital services is a
care for people who live outside the city
development which we are committed to
boundaries, we have also engaged from the
achieve in a sustainable and affordable
outset with colleagues from elsewhere in the
manner. Delivery of the national clinical
Liverpool City region and beyond.
standards across all of our hospitals is
86
Healthy Liverpool prospectus
Benefits of re-aligning
hospital-based care
In achieving the best hospital care in the country
we would expect to see the following benefits:
enhanced patient experience and outcomes;
first class general and specialist
hospital services;
reduced variation in service delivery quality,
performance and outcomes;
a safe healthcare system that provides a quality
centred service for patients;
a sustainable provider landscape for the future;
a service delivery model that promotes a
workforce that is sustainable, motivated
and champions service quality and improved
patient outcomes;
a hospital care system that is complementary
and supportive of the wider Healthy Liverpool
Programme and other settings of care;
a system that enables Liverpool to keep
specialist hospital-based services in the city.
8.5
Re-aligning hospitalbased care will
enhance the patient
experience and
improve outcomes.
Scope and approach
The work being done currently to identify
the optimal shape for hospital services in the
future has included the following NHS trusts
within its scope:
Royal Liverpool and Broadgreen
University Hospitals
Aintree University Hospital
Liverpool Women’s Hospital
Clatterbridge Cancer Centre
Liverpool Heart and Chest Hospital
The Walton Centre
Liverpool Community Health
North West Ambulance Service
8.6
Other local trusts and stakeholders will also
play a crucial role in supporting the delivery
of effective hospital services, including Mersey
Care NHS Trust, which delivers mental health
services, children’s services at Alder Hey
Hospital, Liverpool City Council and of course
community and primary care services.
Any future proposed hospital realignment
changes could therefore be far reaching in
their influence and impact, across the whole
of the Liverpool health economy.
This work is informed by the complex
inter-dependencies and relationships between
services. We have also examined and defined
the quality and operational standards of
services we aspire to, based upon national,
regional and local best practice and guidance.
87
31
The outcome of this clinically-led work is to
develop a series of profiles or descriptions
as to how services might be configured and
delivered in the future. In developing the
work we have initially prioritised a review
of the following areas:
urgent and emergency care;
cancer;
women’s health and maternity services.
It has become apparent in discussion with
clinicians that when considering the future
of hospital services we will also need to
examine the future shape of cardiology and
stroke services. Both services are closely
linked to the delivery of urgent and emergency
care, the future landscape for community and
acute services, prevention and rehabilitation.
Therefore work will soon begin to consider
the future direction for cardiology and stroke
services, as well as the future delivery of
elective care.
Urgent and emergency care
The future delivery of urgent and
emergency care is being considered as part of a
national review of major trauma services and
also because of the challenges being experienced
due to current service pressures across the city.
8.7
Our approach to determining the future shape
of urgent and emergency care in the city has
been informed by a number of individuals and
organisations. A series of workshops with leading
clinicians involved in the delivery of urgent and
emergency care have been held to explore the
current delivery and configuration of services;
explore and develop the clinical standards for
the future delivery of care; and to shape what
the provider landscape in the city could look like.
We have not at this stage sought to identify
individual options for future provider sites in
detail, but instead have focused on the clinical
standards we expect patients in the city should
expect to receive to deliver the best urgent and
emergency care.
The scope of our review has not specifically
looked at the delivery of urgent and emergency
care for children, as there is a separate
programme looking at the future needs and
provision of services for children, and because the
city already benefits from the delivery of excellent
paediatric urgent and emergency services provided
by the Alder Hey Children’s NHS Foundation Trust.
8
32
Our aim is to deliver
the best care 7 days a
week, 24 hours a day,
with maximum staff
resilience, enhanced
training, and improved
recruitment and
retention.
The proposal for a
single major trauma
service would offer
specialist facilities
that receive patients
who have suffered
trauma from other
emergency centres
or directly from an
emergency ambulance.
re-aligning hospital services, continued
We believe urgent and emergency care will be
best served in future by a delivery model that
sees patients benefit from services delivered
from two adult emergency centres, one of which
would provide Major Trauma services.
In essence, an emergency centre comprises
hospital-based facilities that are able to receive
the full range of emergency patients and which
provide for resuscitation, diagnosis and onward
referral where appropriate. Importantly, this
service is under the continuous supervision of
one or more consultants in emergency medicine,
who have clinical accountability for this care.
Liverpool currently has two emergency centres
and the proposed continuation of access to
our two emergency centres in the city reflects
the current and anticipated future demand
for such care. It also takes into account the
geography and needs of people from neighbouring
areas, particularly South Sefton and the Kirkby
area of Knowsley.
The proposal for a single major trauma service
would offer specialist facilities that receive
patients who have suffered trauma from
other emergency centres or directly from an
emergency ambulance, which in this case
would include adult major trauma cases for
Cheshire & Merseyside. There are other elements
of specialist emergency care, such as hyperacute stroke, which could be delivered from
either or both emergency centres. Designations
for other specialist emergency services will be
the subject of further exploration by clinicians
over the coming months.
In determining the shape of urgent and
emergency care for the city we have taken into
consideration issues such as patient activity,
access, workforce, deliverability, service
sustainability, clinical interdependencies
and estate. Clinicians have also developed a
schedule of minimum standards which outline
the quality of care and service delivery that
patients in the city expect.
Our aim is that services across the two
emergency centres would be delivered on a
collaborative staffing model basis, with staff
working and interchanging across the two
sites to deliver the best care 7 days a week,
24 hours a day, with maximum staff resilience,
enhanced training, and improved recruitment
and retention.
88
Improving cancer services
Liverpool has the highest rate of deaths
from cancer in the UK, so it is important that
any review considers how outcomes could be
improved in the context of cancer services
provided by local hospitals.
8.8
Cancer services across the city are currently
provided by multiple providers across multiple
sites, including the specialist medical oncology,
diagnostic and radiotherapy resources of the
Clatterbridge Cancer Centre (CCC) located on
the Wirral.
A public consultation has been conducted by the
CCC to seek to develop a new Cancer Centre on
the Royal Liverpool Hospital campus site to serve
the Merseyside and Cheshire Cancer Network
(MCCN). This new cancer centre would provide
all inpatient oncology beds for the Merseyside
and Cheshire network, together with outpatient
oncology services for those patients for whom
the Liverpool site is the most accessible.
The proposed new cancer centre would operate
as the hub, supporting a network of cancer
services which would include a satellite centre
at Aintree Hospital offering radiotherapy and
other services, the existing cancer centre at
Clatterbridge - which would continue to deliver
outpatient cancer care to its local population
on the Wirral and in West Cheshire – and
the distributed network of outpatient and
chemotherapy clinics operated in partner
hospitals throughout the area. We strongly
support the proposed development.
The specific service changes include:
the creation of a new cancer centre on the
Royal Liverpool campus, bringing together
inpatient cancer services with critical care,
other support facilities and a wide range of
medical and surgical experts;
the establishment of a new radiotherapy
service in Liverpool and an overall increase
in radiotherapy capacity;
the relocation of complex outpatient
radiotherapy from Wirral to Liverpool,
representing about 6% of treatments given;
an increase in the capacity of chemotherapy
and outpatient services in Liverpool.
Healthy Liverpool prospectus
Above: an artist’s
impression of the
proposed Liverpool
Cancer Centre.
Closer integration
between the NHS
and research teams
within the University
of Liverpool and other
key research partners
is one benefit of the
new Cancer Centre.
89
33
Whilst the new centre would provide a
closer integration between the NHS and
concentration of the majority of cancer services,
research teams within the University of
cancer surgery is currently provided across
Liverpool and other key research partners;
the city in the Royal Liverpool, Aintree University
location of specialist services in one
Hospital, Liverpool Women’s, Liverpool Heart &
place, more easily accessible to the majority
Chest, The Walton Centre and Alder Hey Hospitals. of patients;
If the city’s ambition is to truly become a
best use of NHS resources by enabling
world class centre of excellence for cancer care,
clinical teams to work more effectively and
treatment and research it is appropriate to
efficiently together;
consider the case for the relocation of surgical
maintenance of other cancer services which are
cancer services onto the new central campus
best delivered in more local settings, including
at the Royal Liverpool Hospital site, bringing
other local hospitals and the community.
together cancer services through a collaborative
and integrated delivery model for the benefit of
As with any proposed major service change, it is
patients and their families.
essential that a thorough and comprehensive
analysis of the case for change is carried out
It is however recognised that there is a strong
involving all stakeholders and partners.
clinical case to retain certain cancer surgery on
other specialist sites where this delivers the best This would involve the clinicians who deliver
possible outcomes for patients. Examples include services across all local providers; the multiple
cancer surgery carried out at The Walton Centre commissioners involved including local Clinical
and at Alder Hey Hospital.
Commissioning Groups; NHS England in its role
as a commissioner of specialised services; the
The case for the development of the new
Merseyside & Cheshire Cancer Network; patients,
Clatterbridge Cancer Centre, articulated below,
voluntary and community groups associated
mirrors the case for concentrating the delivery
with cancer care and the wider population of
of the majority of cancer surgery on the
Liverpool and Merseyside.
Royal Liverpool Hospital site:
better co-ordination of pathways of care
Our intention is to facilitate a detailed
for cancer patients by bringing together
examination of the case for change in the
key specialist services on a single health
way in which surgical cancer interventions are
delivered, in light of the proposed development
campus which will host the majority of
of the new Clatterbridge Cancer Centre on the
Specialist Cancer Multi-Disciplinary Teams;
Royal Liverpool Hospital site that is scheduled
improved access to specialists from
to open in 2018. The work to develop a detailed
other clinical disciplines and to specialist
case for change will take place over the latter
clinical facilities;
half of 2014/15.
8
34
90
re-aligning hospital services, continued
Healthy Liverpool prospectus
Women’s and
maternity services
The city is unique in having a specialist
women’s hospital, which the people of
Liverpool view with great affection and
pride. Currently the majority of births
in the city, around 8,000 per year, take
place in Liverpool Women’s hospital.
8.9
The number of births,
per year, which take
place in the Liverpool
Women’s Hospital.
Women’s health services in Liverpool are
good. However, if we aspire to have the
best hospital based care in the system
we need to consider how we can address
the challenges of effectively delivering
national clinical standards for 7-day
services; meeting revised national service
specifications for specialist services;
dealing with changes in the training
of doctors, all of which is putting pressure
on acute hospital services.
Clinicians at the Liverpool Women’s
Hospital are leading a review to explore
how services for women could be
improved to deliver even better outcomes.
One of the challenges to be addressed
in this review is about access to general
adult and paediatric services. There are
a growing number of pregnant women
with more complex health needs who
need to be safely transferred by
ambulance for treatment at a local
acute hospital, often to the Royal
Liverpool Hospital. This multi-disciplinary
support by clinicians from other
organisations includes haematology,
cardiology, neurology, endocrinology
and renal medicine. Support is also
required from other trusts for complex
diagnostic services, interventional and
diagnostic radiology.
The Liverpool Women’s Hospital has a
specialist (level 3) neonatal critical care
unit which cares for 1,100 babies per year,
some of whom are transferred from other
units across Cheshire, Merseyside and
beyond. Access to specialist paediatric
services presents similar challenges to
adult services. A review by clinicians from
both the Women’s and Alder Hey Hospitals
91
35
is developing proposals to address this
challenge and to recommend a new
approach to improve care for these
patients. Despite some of the clinical
challenges at Liverpool Women’s the
Neonatal Unit continues to deliver high
quality care for a high risk population.
Gynaecology services, including for
cancer, are concentrated on the Liverpool
Women’s Hospital site. As with maternity
services, they are not co-located with
other key specialties such as urology,
general surgery, colorectal and specialist
diagnostic services and level 3 critical
care beds, which means that women have
to be safely transported between different
hospital sites, most often to the Royal
Liverpool Hospital, although in some cases
consultant staff from other hospitals will
travel to support patient care. The planned
relocation of the Clatterbridge Cancer
Centre onto the Royal Liverpool site and
the opportunity to develop a centre of
excellence for cancer care presents a
compelling case to consider a different
model of care, which would improve
outcomes for cancer patients.
The clinically-led work done to date
has sought to describe the clinical
challenges to the current delivery model
for maternity and gynaecology services
at Liverpool Women’s Hospital and
how we might move forward to deliver
the best care in a sustainable way for
patients in the future. Work is ongoing
to explore options for any proposed
changes, informed by the interdependencies of women’s and maternity
services with emergency medical care
and the care of babies who require
specialist hospital services.
Despite these challenges, evidence shows
that patient outcomes are better than
the national average in most indicators.
Our aim is to achieve the best outcomes
in the country.
36
Harnessing technology to deliver Joined-up care
Karen Brogan Liverpool Community Health Matron, based in Walton
Liverpool Community Health, which
provides community services in Liverpool,
are now able to access and share patient
information with GPs using a platform
called EMIS Web.
treatment are better informed due to access
to the same information across Primary,
Community, Secondary and Out of Hours
settings. Karen Brogan Liverpool Community
Health (LCH) Matron in Aintree has experienced
how much of a difference this has made.
This has enabled Community Matrons to have
full access to the GP’s Patient record. Previously,
Matrons would have spent a lot of time either
phoning GP surgeries or driving to the surgery
to access information in patient notes.
“I value EMIS Web sharing as it enables me
to see everything relevant in the GP patient
record in addition to other community
services involved with the patient. I can
see any recent changes to the patient’s
medication, recent problems and known
allergies. This helps me to make a more
informed decision regarding the patient’s
care. It is enabling us to spend more time
with patients as I have the information I
need at my fingertips!”
This more efficient way of sharing information
has benefited patients in a number of ways,
including quicker diagnosis, which has helped
reduce hospital admissions and improved
patient safety, as clinical decisions on
92
Healthy Liverpool prospectus
9
37
technological
innovation
Liverpool will be the first place in the
country to give our professionals, and
the people they care for, access to the
information they need, when they need it.
dr simon bowers gp, nhs liverpool ccg
Our vision for joined-up, people-centred care will only be achieved by
having access to high quality information, available in the right place,
at the right time. One of the key enablers for this will be through the
use of technology to share information and work collaboratively across
settings of care and organisations.
Liverpool CCG will be investing to:
create and deliver an information
exchange across health and
social care;
ensure system-wide strategic
leadership and alignment in
informatics across the whole system;
fully exploit the benefits and
investment in existing technologies
and processes.
Working with our
partners, we will jointly
deliver a Merseyside
iLinks strategy.
Working with partners, including
Informatics Merseyside and
neighbouring CCGs, we will jointly
deliver a Merseyside iLinks strategy
to achieve a number of outcomes
that will enable this transformation:
electronic information will be
available 24/7;
information is relevant and available
at the point of care in real-time;
individuals can access and contribute
to their own electronic record;
working towards a ‘paper-light’
local health system.
Why can’t we?
One of the outcomes will
ensure 24/7 availability
of electronic information.
93
There is a shared ambition and enthusiasm amongst health professionals to achieve
an effective information exchange, to support improved, person-centred care and
to support a culture where we share, moving to a focus on how do we? rather than
why can’t we? Sharing information in this way will take us closer to the goal of a
person only having to tell their story once.
38
How We Will
Deliver
Transformation
10
We have set out six programmes which, through effective
re-design and focused investment, will drive the ambitious
improvements in health outcomes that are so needed for the city.
10.1
transforming mental
health services
the Challenges
More than 93,000 people in
Liverpool are affected by mental
health issues.
50,900 adults (16-74) living in
the city will experience anxiety
or depressive disorders in any
given year.
5,923 patients registered with
Liverpool GPs in Aug 2014
had been diagnosed with
schizophrenia, bipolar affective
disorder or other psychoses.
94
Healthy Liverpool prospectus
We want to see person-centred,
mental healthcare, with an
emphasis on prevention, more
community services and a focus
on recovery.
39
Mental health services will operate as a seamless
system of health and social care across the
spectrum of severity, offering care which is holistic,
timely and equitable, shifting the balance towards
community based prevention and recovery.
We have embarked upon a transformation
of support and service provision, working
collaboratively with major stakeholders in
dr nadim fazlani chair, nhs liverpool ccg
the city, including Liverpool City Council;
Mersey Care NHS Trust; the Voluntary Sector
and the Police Commissioners Office. The key
characteristics of a transformed mental
health and well-being system will include:
access to essential advice, assessment and
treatment in a straightforward and timely way.
Liverpool has amongst the highest levels of
There will be ‘no wrong door’ for mental
mental health need in the country. The prevalence
health services for those in need. People with
of Severe Mental Illness (SMI) such as
multiple needs, and their carers, will receive
schizophrenia and bipolar disorder is the highest
a ‘joined-up’ response from services;
33% of GP consultations
of the major cities outside London and significantly mental health will be integrated into long-term
are related to mental
above national and regional levels. Estimates
condition management and there will be
health issues. In the
future mental health
suggest Liverpool experiences the second highest
greater mental health input alongside physical
services will be a
prevalence of common mental illness in England.
health support;
seamless system of
effective and seamless collaboration between
health and social care.
Most mental health problems relate to
the NHS, social care and criminal justice
depression and anxiety and can be predominantly
system at the ‘front door’ of the crisis system;
managed in primary care. Smaller numbers
high quality mental health inpatient and
of people experience more severe forms of
specialist mental healthcare, available with
mental illness which may require specialist
capacity to meet the needs of the local
input from mental health professionals and
population. There will be planned, adequate
sometimes hospital based care.
bed spaces delivered in modern, fit for purpose
facilities, supported by multidisciplinary teams.
The impact of mental illness on our healthcare
Care will extend to integrated community based
system is significant. Liverpool has the highest
mental health support providing rapid diagnosis
rate of hospital admissions for mental health
and treatment;
there will be a focus on supporting families
problems amongst the core cities of England
and 1 in 3 consultations in general practice is
and social networks; building upon family and
related to mental health.
community support;
improved supported accommodation and living
Service users and carers report that the system
services, enabling people experiencing mental
can often feel disjointed, lacking clear pathways
distress to remain within their community and
and a lack of focus on supporting recovery – it
close to family and friends networks;
can be hard to access services and then hard to
greater focus on supporting people to move
on from specialist residential and nursing
exit services once in the mental health system.
environments into supported living environments
(step down services) where it is safe and
We have established a clear vision for what
appropriate to do so.
we wish to achieve for people in Liverpool
who experience a mental health problem:
95
10
40
Over 400 students
enrolled since the
launch of Recovery
College at Mersey
Care NHS Trust.
how we will deliver transformation, continued
Significant progress is already being made with
key developments across the system including:
Benefits on Advice Service covering the
whole of the city, focused on supporting the
management of debt and income for people
with mental health issues;
delivery of a new model for psychological
therapies;
the opening of a new inpatient facility
‘Clock View’ providing a new assessment suite,
expanded psychiatric intensive care unit and
recovery wards;
improved communication through better
liaison across services;
launch of Recovery College at Mersey Care
NHS Trust, with over 400 students enrolled
providing education and training as a route
to recovery, and further plans for increasing
provision across community based services.
mental health services – What would success look like?
Reducing excess
under 75 mortality rate
in adults with serious
mental illness.
Increasing the number of
people with severe mental
illness who have received
a list of physical checks.
I ncreasing the proportion
of people Mental Health
Care programme approach
to 95%.
Decrease the number
of delayed discharges
from hospital because
of mental health.
Increase employment
for people with mental
health conditions.
Decrease admissions to
hospital for self-harm.
Increase the proportion
of people who have
entered psychological
therapy treatment against
expected from 11.8% to
15% by the end of 14/15.
Increase the proportion
of people moving to
recovery from 32% to
50% by the end of 14/15.
Increase the proportion
of adults in contact with
mental health services
living independently,
with or without support.
Increase employment
for people with mental
health conditions.
96
Healthy Liverpool prospectus
41
10.2
supporting healthy ageing
the Challenges
Liverpool’s population is living longer with
an expected 9% growth in the number of
people aged 65+ years by 2021, and particular
growth in those aged 70-75 and 85+.
The estimated number of people living
with dementia in Liverpool is predicted
to rise by 10.7% by 2021. Nationally, it is
estimated that each dementia patient
costs the economy £27,647 per year;
55% of which is met by unpaid carers,
40% by social care and 5% by healthcare.
Liverpool has the second highest mortality
rate for falls aged 65+.
Liverpool has the greatest level of unpaid
carers among the core cities.
Older people are more likely to stay
a long time in hospital, to experience
delayed discharge, and to be readmitted
within a month as an emergency.
Liverpool has a higher proportion of
people dying in hospital compared to
the national average.
Our aim is for
people to be able to
retain independence
and live at home
for longer, with the
right support.
97
Whilst the number of older people is expected
to increase, the number of people of working
age is expected to decline so there will be
fewer people to provide informal care and
economic support to the ageing population.
dr jim cuthbert gp, nhs liverpool ccg
It is expected that more people will be living with
one or more long-term condition, ill-health or
disability; there will be increased demand for
health provision and long-term care and a rise
in the number of people entering a caring role.
Liverpool’s population, like that of every city in
the UK, is living longer. As the population ages
there will be more people living with health
conditions that place increasing demands on
health and social care.
Our vision for our older citizens in Liverpool
is to keep them living at home for longer by
helping them retain their independence with
the support of care professionals and families.
When people do need care, this will be of high
quality, based on personal needs and delivered
seamlessly across health and social care.
10
42
how we will deliver transformation, continued
Jointly, Liverpool CCG and Liverpool City Council
spend about £232m each year on health and
social care for older people. Analysis shows that
two-thirds of this expenditure is for care provided
by ‘specialist’ providers such as hospitals and
nursing or residential long-term care.
The amount spent
annually by Liverpool
CCG and Liverpool
City Council on health
and social care for
older people.
The health and care system is therefore
skewed towards hospital and long-term care,
so providing care reactively when people are in
crisis and experiencing high levels of need with
limited opportunities to increase independence.
We need to shift focus so that we identify
issues and intervene earlier, before people
enter crisis. That way, greater impact on
health and care outcomes can be achieved.
Focussing on interventions which promote
prevention, early identification, proactive care
and self-management will be less costly and
more effective. It will also, most crucially,
improve the quality of life for older people.
Our reform of health and care for the elderly
will focus on the following areas: improving
care home provision and the clinical support
which care homes receive; ensuring services
are in place to support those with dementia;
helping older people get better quickly, for
instance after a fall; supporting carers of the
older people; and providing end-of-life care in the
best possible way, for instance in people’s homes.
We will ensure a successful and stable
care home sector by creating clearly defined
and specific service specifications including
a quality and capability framework for care
homes to ensure delivery of expected outcomes
for residents.
There will also be a new clinical model to
support care homes with dedicated care home
community matrons and redesigned working
arrangements so that homes are working
closely with allied health professionals.
The proposed reforms of intermediate care and
reablement services are designed to reduce the
number of people being admitted unnecessarily
to hospitals, reduce length of stay and delayed
discharges in acute care, enable independent
living in the community and prevent long-term
placements in nursing care homes.
98
To do this, we are establishing frailty units at the
Royal Liverpool University and Aintree Hospitals.
These units will be staffed by a geriatrician-led
multi-disciplinary team. Dedicated staff will
work across the unit and the community to
manage the discharge of patients from hospital
and their onward care needs, providing continuity
of care for patients leaving hospital.
There will also be a redesigned community
reablement service to create a modern,
integrated service that reduces the current
over-reliance on hospital beds, providing care
to more people in their own homes.
The Community Reablement Team will be
commissioned to deliver a city-wide falls service
within the community as a step up for general
practice and an alternative to hospital for
ambulance services.
To tackle dementia, we will create joined-up,
high quality specialist services with the
introduction of new working practices between
secondary care specialist providers and GPs
to create a clinical network for dementia.
This will assure high quality care, seamless
provision across organisational boundaries
and standardised practice which will reduce
variation in services.
We will also implement a comprehensive range
of post-diagnostic support tailored to the needs
of the person with dementia and their carers.
For those requiring hospital stay or long-term
residential needs, there will be increased
assisted housing provision, excellent hospital
care and high quality nursing care in care homes.
Good quality supportive and end-of-life care
is important in ensuring that those people, and
their families, approaching the end of their life
are treated to optimise their quality of life with
dignity and respect. One of the aims is to enable
people to be supported and die in a location of
their own choosing; research suggests many
people would prefer to die in their home rather
than in hospital.
Our reforms will ensure everyone has equal
access to services that provide care at the end
of life, supported by the provision of specialist
palliative care consultants in the community.
Healthy Liverpool prospectus
43
healthy ageing – What would success look like?
I ncreasing the proportion
of people who are still at
home after 91 days after
hospital discharge, from
79.7% to 82% in 2014/15.
This would be the
equivalent to keeping
580 people at home.
Reduction in permanent
admissions for over 65s
to residential and nursing
homes, from 737.3 (13/14)
to 612.9 (15/16). This
would be the equivalent
of keeping 87 people at
home for longer.
Reduction in emergency
admissions for vertebral
and hip fractures of
25.6% (167) by 2018/19
amongst those aged
65-79/80-plus.
Measurable improvements
in patients’ experience of
primary care/hospital
care/integrated care.
An increase in the
estimated diagnosis
rate for people with
dementia from 58% to
64% by March 2015 and
70% by March 2016.
A reduction in emergency
admissions to hospital for
people from care homes
by 40% (985 admissions)
by 2018/19.
A reduction in emergency
admissions for people at
the end of life of 29.3%
(738) by 2018/19.
Reduction in people dying
in hospital from 56.5%
to 40% by 2018/19 and
increase in those dying
at home from 22.9%.
There will be a new
clinical model to
support care homes
with dedicated care
home community
matrons and
redesigned working
arrangements.
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44
how we will deliver transformation, continued
10.3
Tackling cancer
the Challenges
Cancer mortality rates have fallen by 10%
in Liverpool since 1993 but nationally they
have fallen by 20%. Liverpool has one of the
highest cancer mortality rates in the country.
In 2010 there were 2,584 new cases of cancer
in Liverpool – an 8% increase on the number
recorded in 2001. The main causes were lung,
colon, prostate and breast cancer.
L ung cancer accounts for 12% of the gap in
life expectancy for both males and females.
New cases of malignant melanoma of skin
have more than doubled over the last decade
from 48 to 99 in Liverpool, whilst nationally
there has been just a 65% increase.
In 2010, 78% of female patients in
Liverpool who were diagnosed with breast
cancer had survived the disease after
5 years but nationally that figure was 84%.
Research suggests that up to half of all
cancers could be prevented by changes to
lifestyle behaviours.
Early diagnosis and people living
well are how we will reduce deaths
from cancer.
dr ed gaynor gp, nhs liverpool ccg
Cancer has now
replaced cardiovascular
disease as the biggest
killer in Liverpool.
100
Over our lifetimes it is estimated that one in
three of us will develop some form of cancer.
As the population lives longer, this figure is
expected to increase further. It is a major
contributor to the gap in life expectancy
between Liverpool and England. Latest analysis
suggests that lung cancer alone accounts for
over 12% of the gap in life expectancy for both
males and females.
Cancer has now replaced cardiovascular disease
as the biggest killer in Liverpool, with more than
three out of 10 deaths in 2011 being attributed to
the disease, equating to 1,297 residents. Against
many measures, the city does not compare well
with the rest of the UK when it comes to the
incidence of cancer and the survival rates.
Healthy Liverpool prospectus
Systematic cancer
screening will be
expanded to support a
public education and
information drive.
The number of deaths
in Liverpool attributed
to cancer in 2011.
Our approach to addressing Liverpool’s biggest
killer is built upon two fundamental principles.
One is that early diagnosis of cancer is the
best way of improving patient outcomes - the
quicker the disease can be treated, the better
the chances of survival. The other is that up
to half of all cancers could be prevented by
changes to lifestyle behaviour.
So we must put in place the measures which
encourage and assist people to live healthier
lifestyles and ensure people are educated
about the signs and symptoms of cancer.
This public education and information drive
will be supported by systematic and expanded
screening for cancer and the right services and
support for patients as they undergo diagnosis,
treatment and recovery. This includes bringing
cancer treatments closer to home.
So our vision is that Liverpool residents will
understand and appreciate the risk factors
associated with cancer and know the signs
and symptoms of the disease. They will feel
confident to approach their GP early and we
will have the right systems in place so that
they are seen quickly by high quality staff.
Patients will also have support around lifestyle
and recovery issues no matter what kind of
cancer they have or where they live in the city.
Screening is key in Liverpool for diagnosing
cancer, although uptake remains low. Through
increased uptake for screening programmes and
availability of screening, the aim is to reach
national targets for breast, cervical and bowel
cancer screening. We will also ensure flexible
sigmoidoscopy is available to detect upper
gastro-intestinal cancers in patients most at risk.
We also intend to launch a major lung cancer
campaign – ‘Liverpool Fights Lung Cancer’.
CT scans to screen for lung cancer will be
proactively offered to those at highest risk in
deprived areas, therefore targeting inequalities.
Currently about 2,700 people have been
identified who will be invited to take part in
the lung cancer screening programme.
Populations at high risk of lung cancer will be
targeted for stop smoking campaigns and raising
awareness of signs and symptoms of lung cancer.
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45
These initiatives will lead to an increase in
people being diagnosed at an earlier stage of
disease; increased one and five year cancer
survival rates; a decrease in under 75 mortality
and a reduction in inequalities and gap in life
expectancy across the city.
A range of campaigns for the public and primary
care health professionals will raise awareness
of the lifestyle risks which can cause cancer
and the signs and symptoms of different types of
the disease. We will improve the tools available
to primary care professionals so that they are
supported to help diagnose cancer earlier.
A key element of future cancer care in the city
will be ensuring patients are able to access the
best cancer care and most advanced treatment,
facilities and equipment as close to home as
possible. The Clatterbridge Cancer Centre has
proposed developing a new site alongside the
Royal Liverpool University Hospital to deliver
more services close to Liverpool patients.
This co-location will mean patients being
treated closer to home, better integration with
the Royal’s services and access to world class
specialist and expertise.
Work is also underway to ensure improved
pathways and access to diagnostic tests for
lung, colorectal, upper gastro-intestinal and
ovarian cancers which will ensure that patients
receive the correct test first time and that they
are seen more quickly, diagnosed faster, and
treated quicker.
10
46
how we will deliver transformation, continued
tackling cancer – What would success look like?
Seeing less than 90% of
patients waiting 62 days
from referral from
screening service to first
definitive treatment.
Seeing less than 85% of
people waiting 62 days
from urgent GP referral to
first definitive treatment.
Seeing less than 93%
of people waiting 2
weeks from urgent
GP referral to first
outpatient appointment.
Reducing the under-75
mortality rate for cancer.
Increasing bowel cancer
screening rate to 60%.
Increasing breast cancer
screening rate to 70%.
Increasing cervical cancer
screening rate to 80%.
Increasing 1 and 5 year
survival rates for breast,
bowel and lung cancer.
Reducing smoking
prevalence from
25.2 to 20.2 by 2020.
Increasing the number of
people who stop smoking.
A key element of future
cancer care in the
city will be ensuring
patients are able to
access the best cancer
care and most advanced
treatment, facilities
and equipment as close
to home as possible.
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Healthy Liverpool prospectus
47
10.4
Transforming care
for children and
young people
the Challenges
33.6% of children under 16 years
live in poverty in Liverpool and,
in the poorest ward, some 64%
of children live in poverty.
Barnardo’s estimate that
there are 3,000 young carers
in the city.
Liverpool has one of the highest
emergency admission rates for
asthma and epilepsy (patients
0-17yrs) and also one of the
highest rates of A&E attendances
in children under 5 years.
There are 3,756 children in
Liverpool with “children in need
plans” and 2,105 families which
are classified as ‘troubled’.
A family-centred approach is the
only way to address Liverpool
children’s needs. We will enable
families to access help early
and on their terms.
dr simon bowers gp, nhs liverpool ccg
Managing the health and well-being of children
is complex and challenging, requiring a
patient-centred approach and close working
between multiple parties, including education,
health and social services professionals.
Child health and well-being is closely related
to poverty and to societal issues. Outcomes for
103
children and young people in Liverpool are poor,
with the health and well-being of children in the
city generally worse than the England average
and the level of child poverty, though improving,
also worse than the England average.
There are also particular challenges which
must be addressed. For instance, Liverpool
has one of the highest emergency admission
rates for asthma and epilepsy (patients 0-17yrs)
and also one of the highest rates of A&E
attendances in children under five years.
Currently there are inconsistencies in the way
care is planned, commissioned and delivered
across the many partners involved. Patients
and their families tell us that they experience
fragmentation, duplication, lack of clarity
and uncertainty.
10
48
Liverpool has one of the
highest rates of A&E
attendances of children
under five years.
Three children’s and
family neighbourhood
health and care hubs
will be established,
delivering joined up
services close to home.
how we will deliver transformation, continued
With growing demand and rising expectations,
the current system is unsustainable and unfit
for purpose. We need to develop a co-ordinated
and integrated approach to maternity and
children’s health and social care services,
which will result in improved experiences
and better outcomes. This approach will
encompass a cohesive, holistic, family-based
model so that, where necessary, we address
an entire family’s needs rather than just an
individual child’s needs.
We also need to ensure systems are in place
so that young people requiring ongoing care
are supported during the transition to adulthood
and beyond and do not ‘fall off’ the health and
care system radar.
Access to uptake of universal services needs to
be optimised. Our objectives are to intervene as
early as possible where a child has needs and
to take a multi-agency co-ordinated approach
to preventative and early intervention services.
Designated teams with identified lead
professionals will manage a child’s care and we
will deliver care in neighbourhood and community
settings when that is most appropriate.
One of the key initiatives that will enable the
identification of children with health and care
needs is through the establishment of a
common assessment framework so that all
public service professionals in the city –
including health, social services, police, fire and
education professionals – are using the same
criteria and tool to assess a child’s potential
needs. The ‘early help assessment tool’ was
launched across the city in October 2014.
This initiative, alongside the development of
the early help locality hubs in January 2015,
will support earlier intervention.
We also plan to establish three children’s and
family neighbourhood health and care hubs in
Liverpool, from which child healthcare needs
will be co-ordinated across different agencies,
delivering services close to home. A “virtual”
team will be created within each hub and this will
reflect the specialties and services that are able
to support and manage care delivery closer to
home, where appropriate and safe. The team will
incorporate services such as those provided by
health visitors, social workers, school nurses,
therapy services, community midwives,
community paediatrics and others.
104
Where a child has serious health and social care
needs, a dedicated lead professional will be
responsible for ensuring they receive joined-up
care from the various bodies and professionals
concerned in that child’s well-being.
Another initiative which is being developed is
the establishment of a comprehensive database
of every child in the city who is likely to require
care into adulthood. That database will be used
to ensure those individuals continue to receive
the right care after they reach the age of 16.
We are also conducting a pilot around paediatric
asthma in the community which would bring
care and education professionals together to
help families manage the illness and, ultimately,
reduce the number of emergency admissions to
hospital of children experiencing asthma attacks.
Another priority is to ensure children with
complex neurodevelopmental needs and
mental health problems are properly cared
for. Addressing such needs at the earliest
possible opportunity can prevent them
worsening as the child grows older.
An integrated and comprehensive pathway for
young patients with mental health issues is
already being commissioned in partnership with
schools, Alder Hey NHS Foundation Trust and the
Voluntary Sector. This focuses on self-care and
early intervention. This new approach is delivering
much improved outcomes and will be expanded
so that it has more capacity in the future.
Using the Royal College of Paediatrics and
Child Health Invited Reviews Programme,
plans are being developed to define a model
of integrated care delivery. The model will
focus on optimising safeguarding functions
whilst improving the interface with other
clinical services, so that the journey between
primary and secondary care is seamless.
Healthy Liverpool prospectus
49
caring for children and young people – What would success look like?
A reduction in children’s
admissions for Asthma
by 28.8% by 16/17.
A reduction in
emergency attendances
in secondary care.
A reduction in waiting
times for children’s
community equipment
services from 6 months
to days.
A reduction in waiting
times for neurological
development services
from 14 months to
18 weeks.
90% service satisfaction
maintained for child
and adolescent mental
health services.
A reduction in excess
weight in children aged
4-5 and a reduction in
excess weight in children
ages 10-11.
An increase in the number
of women breast feeding
at 6-8 weeks.
A reduction in the number
of women smoking at time
of delivery.
Transforming care for children and young people
Advice and Guidance (IAG) Service
“I am a 16 year old male. I first
came to YPAS when I was 15,
I have attended the anger
management group and
received counselling and had
support from the IAG service.
105
“I was having a bad time with my
family, having arguments all the time
and fighting at school and where I
live. I couldn’t concentrate at school
and wouldn’t do any of the work.
The IAG service and the anger group
helped me build my confidence back
and it felt OK being in a group for
the anger course and looking at
my bereavement in counselling.
“My family have noticed a positive
change in my behaviour and I
can concentrate more at school.
My angry outbursts have got less
and not as bad as they used to be.
I used IAG and Counselling to help
me cope better without making
everyone feel distressed.”
10
50
how we will deliver transformation, continued
10.5
Delivering joined-up care for
people with long-term conditions
the Challenges
30% of people in Liverpool (141,000 people) live
with one or more long-term condition. Of these,
12% (16,000) live with 3 or more conditions.
T he incidence of diabetes is predicted to grow
by as much as 23% by 2030.
Over 10,000 people are living with long-term
conditions in Liverpool that are undiagnosed
and unmanaged.
The cost of emergency admissions for longterm conditions in Liverpool is over £21m.
In 2012-13 Liverpool was in the bottom 25%
of CCGs nationally for avoidable emergency
admissions. Highest admitting conditions
include COPD and angina.
There are currently 14,499 people over
40 diagnosed with chronic obstructive
pulmonary disease in Liverpool and 26,952
people with asthma.
There are 18,464 people over 40 diagnosed with
coronary heart disease in Liverpool, 3,936 with
heart failure, 8,914 who have had a stroke and
7,848 who have atrial fibrillation.
We need radically new approaches to
support the 30% of people in the city who
live with long-term conditions.
dr janet bliss gp, nhs liverpool ccg
As Liverpool’s population lives longer there will
be more people living with long-term conditions –
often two or more conditions at the same time –
which require ongoing treatment and care.
106
And, whilst there has been improvement in line
with national trends, cardio-vascular disease
(CVD) and respiratory disease remain two of
the biggest causes of premature mortality in
Liverpool. Emergency admissions rates for
angina, chronic obstructive pulmonary disease
(COPD) and diabetic complications remain some
of the highest in the country.
So there remains room for improvement in the
management of outcomes related to long-term
Healthy Liverpool prospectus
The number of COPD
patients offered
rehabilitation varies
between 24% and 79%
depending on the
neighbourhood.
One of the main
initiatives being
developed to improve
diabetes care is the
establishment of 11
neighbourhood centres
where patients can
access specialist
consultants.
conditions such as management of blood
pressure and cholesterol in CVD-related
conditions and severity testing in COPD.
outcomes-based contract which has now been
implemented and incentivises providers to work
together more closely.
There is also wide variation in performance across
the city. For instance, the number of people with
diabetes receiving the nine care processes
required to manage their condition varies between
20%-80% depending on what neighbourhood they
live in. Cholesterol management of people with
coronary heart disease varies between 61%
and 73% and the number of COPD patients
offered rehabilitation varies between 24%
and 79% depending on the neighbourhood.
One of the main initiatives being developed to
improve diabetes care is the establishment of 11
neighbourhood centres where patients can access
specialist consultants and the range of other
health professionals who might be concerned
in their care, such as dietary or podiatry experts.
This way, patients will be able to access a
‘cluster’ of care more easily and care plans will
take a people-centred approach and be designed
with an individual’s needs in mind.
We want to reduce the variation in management
of long-term conditions at primary care level and
ensure patients can be supported by specialist
community-based teams and access care much
closer to their homes. We also aim to increase
the number of patients using rehabilitation
services, improve access to testing and
diagnostics and improve the way patients are
advised and educated about their conditions so
they can better care for themselves.
These specialist consultants will also play a
role in educating other health professionals
about diabetes issues and take a lead role in
helping to support and advise people who are
able to self-manage their condition. There will
be an enhanced set of tools available to people
with diabetes to assist in self-management
including information packs and structured
education programmes.
New methods of commissioning services are
being considered as a way of ensuring payment
for services is linked to patient outcomes and
to incentivise different service providers such
as health trusts and GPs to ensure they work
together more closely in the patients’ interests.
Evidence tells us that one of the keys to
successfully managing long-term conditions
is to ensure care is properly integrated so
that primary care, community-based care and
specialist care services are working together
to support patients.
We also know that supporting people to look
after themselves – through education and access
to care close to home – is critical if people are
to stay independent and successfully manage
their conditions.
Diabetes, respiratory disease and cardio-vascular
disease (including stroke) are priority areas for
reorganisation and work is already underway to
better structure services across these areas.
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51
Planned care of diabetic patients is shared
between primary, secondary and specialist
community care. Services are commissioned
separately for activity based contracts, rather
than commissioned jointly for population health
outcomes. Work has started on an integrated
Routine management of COPD and asthma is
undertaken in general practice. In 2012 a
Respiratory Nurses Crisis Response Team was
launched so that it could visit patients in the
community and assist them before their conditions
got so worse that they had to attend hospital.
That service is to be expanded to weekends
and evenings so that even more patients can be
helped, not just to prevent episodes getting so
bad that an emergency admission is required,
but also to give ongoing advice so patients can
better look after themselves. It is expected that
an extra 85 people would avoid emergency
admission by expanding these opening times.
We will also be increasing the capacity of our
pulmonary rehabilitation service, increasing
the referrals it receives and making it more
accessible for patients. This service helps people
manage their COPD and reduces emergency
admissions and deaths from the disease.
Our spirometry service – which diagnoses the
effectiveness of a patient’s breathing – is to be
made more accessible so we can make diagnosis
and monitoring more accessible. The service,
which is currently available in eight sites in the city,
will be made available in a minimum of 18 sites.
To manage asthma better, we will be focusing on
reducing the number of severe asthma attacks
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52
how we will deliver transformation, continued
experienced by sufferers. This will reduce
emergency admissions and help keep patients
well as each attack causes further lung
damage. We’ll do this by instigating a systematic
outreach campaign using methods such as text
messaging to persuade patients to receive care
and advice from a new specialist-led, asthma
nurse and GP service.
For cardio-vascular disease, a range of
improvements are being explored.
There is to be improved screening and prevention
of stroke for patients with atrial fibrillation
(irregular heartbeat) and high blood pressure.
Through simple pulse checks, we predict an
increase in the percentage of over-65s who have
received a pulse check in the last 12 months
from 67% to 82.3% by 2018/19 so these patients
can get care which will help to prevent strokes
This is the equivalent of screening an extra
11,249 people.
Using a new risk assessment tool, we also aim
to increase the percentage of patients with atrial
fibrillation being prescribed an anticoagulant
(clot-busting drug) from 81.7% to 90.9% by
18/19. This is an extra 297 people, which could
prevent nine strokes. We believe there are 4,338
patients eligible for anticoagulation who are
currently not receiving it.
There will also be improved access to and
expansion of a community cardiac rehabilitation
service so that the number of patients receiving
cardiac rehab will increase from 881 to 1,800
per year by 2018-19.
long-term conditions – What would success look like?
Reducing potential years
of life lost by 24.2% by
18/19.
Reducing avoidable
emergency admissions by
15.3% by 18/19.
Improving quality of life
in patients with long-term
conditions by 8.4% by
18/19.
Increasing the number
of people being offered
cardiac rehabilitation
from 881 to 1,800 by 18/19.
Increasing the cardiac
rehabilitation completion
rate from 57% to 80%
by 17/18.
Reducing coronary heart
disease emergency
admissions by 18.3% by
18/19.
Increasing the number of
people with CHD who are
on a statin from 85.1% to
88.8% by 18/19.
Increasing the number of
patients on the pulmonary
rehabilitation programme
from 238 to 700 by year
18/19 and improving the
completion rate to 76%.
I ncreasing the percentage
of patients receiving
spirometry diagnosis for
COPD and Asthma.
Reducing COPD emergency
admissions by 26.9% by
18/19.
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Healthy Liverpool prospectus
10.6
Better care for
people with
learning disabilities
the Challenges
Only 36.6% of adults with a
learning disability known
to Liverpool GPs receive an
annual health check.
Some 2,000 adults with
learning disabilities are
identified on GP registers in
Liverpool, although this may
not reflect the true numbers.
The typical cost of a hospital
bed for someone with a learning
disability and challenging
behaviour in specialist, out of
area placements is between
£150,000-£200,000 per year.
We are challenging
the unacceptable
inequalities faced
by people with
learning disabilities.
jane lunt Chief Nurse, nhs Liverpool CCG
additional and very complex needs such
as challenging behaviour or profound and
multiple learning disabilities.
It is estimated that as much as 2% of the
population are people who have a learning
disability, although some will not be known
to health and social services. In Liverpool,
just over 2,000 adults are identified on
GP registers with a learning disability.
The Healthy Liverpool Programme is
giving particular consideration to services
for people with learning disabilities because
they tend to die younger and experience
poorer health than the general population.
109
People with learning disabilities have poorer
health, die younger and do not receive the
same quality of healthcare as those without such
disabilities.
We believe these differences are to a
large extent avoidable so represent a
In addition, some may have a range of
fundamental health inequality.
53
10
54
The number of adults
in Liverpool identified
on GP registers with a
learning disability.
how we will deliver transformation, continued
Our vision is therefore that people with learning
This will help us improve the number and
disabilities have the same access to the same
quality of annual health checks which are
quality healthcare as the rest of the population,
delivered, with clear links to an updated
that they have a positive experience of treatment health action plan for each individual.
and care, with better health outcomes, and when
the need for specialist services arises that the
There will also be specific learning disability
need is recognised and met promptly.
liaison posts within each of the NHS Trusts
whose role is to ensure that there are systems
We also want people with learning disabilities
and processes in place which enable the
who display challenging behaviour to receive
identification of people with learning difficulties
skilled, sensitive and competent support to
as they enter either hospital and community
maintain them in their local communities
services so that any reasonable adjustments
wherever possible, with less need for hospital
that need to be made to enable the person to
admission or costly out of area placements.
access care are undertaken.
Evidence suggests the health needs of people
with learning disabilities are overlooked by
mainstream services.
Mortality rates for people with learning
disabilities are three times higher than the rest
of the population with the cause of premature
deaths not to lifestyle related illnesses but to
inequality in healthcare.
Access to health checks, screening programmes
and subsequent care planning can be poor
and we have found that awareness is limited
amongst health professionals of issues relating
to decision-making, treatment and consent for
patients with learning disabilities.
It is also the case that people with learning
disabilities who have challenging behaviour
can spend far longer as in-patients than
necessary because of a lack of appropriate
local preventative and skilled communitybased support services.
In the future, mainstream health services
in Liverpool will be better equipped to meet
the needs of people with learning disabilities
through understanding how to make
reasonable adjustments to take into account
a learning difficulty.
We will also invest in more Learning Disability
Primary Healthcare Facilitator resource to
support GP practices identify patients with
learning disabilities and ensure they have
access to health checks and screening.
110
These measures will help us ensure improved
access to the full range of health services,
including health promotion and advice, so
reducing health inequalities experienced by
people with learning disabilities and helping
them live longer.
The needs and rights of patients with learning
disabilities will be better understood and
respected by health professionals and there
will be better care co-ordination and better
planning of hospital discharges.
For those with challenging behaviour who need
secure accommodation and care we will enable
investment in local support services. This will
be aligned with additional focus on preventative
and positive behavioural support teams to work
alongside families and care providers dealing
with challenging behaviour.
There will be fewer breakdowns of care packages
for people in supported accommodation and a
marked reduction in the use of costly out of area
hospital placements.
People with learning disabilities and/or autism
who have challenging behaviour will receive
more timely support from local services and,
critically, will experience greater continuity
and less disruption and be able to maintain
links with their home, family and neighbourhood.
Healthy Liverpool prospectus
55
learning disabilities – What would success look like?
Improved accuracy of
the learning disabilities
register in general
practice, evidenced by an
increase in the prevalence
of learning disabilities.
Increased percentage
of people with learning
disabilities receiving
an annual health check.
Supporting people with learning disabilities
Suzanne Robinson Learning Disability Healthcare Facilitator, Mersey Care
Suzanne, a trained nurse,
decided to work with people who
can sometimes face exceptional
difficulties. Her role revolves
around improving access to
healthcare for those with
learning disabilities.
111
She says: “It’s a sad fact that people
with learning disabilities die sooner
and face barriers, which make it harder
for them to access support. They can
often be the first to ‘fall between the
cracks’ in the health system.”
She says: “There is a strategic role to
be undertaken to ensure that training
and education is given to healthcare
workers so that they know how to
recognise and respond to the needs
of people with learning disabilities.”
The important thing in her view is
that the health professionals who
treat people with learning disabilities
understand and therefore overcome
those barriers to good care.
Whilst staff like Suzanne can and often
are powerful voices in this regard,
‘self-advocates’ have some of the most
lasting impact on professionals. Inviting
someone who is experiencing learning
disabilities to talk to trainee medics
can make a difference that endures
throughout those medics’ careers.
56
Investing for LongTerm Sustainability
11
We have resources now to
invest in this transformation.
tom jackson director of finance, nhs liverpool ccg
Liverpool, along with most health systems, is anticipating a future strain on finances if
future growth in resources does not match the expected increase in demand arising from
an ageing population and other pressures which have been described in this document. By
2020 this gap in funding is estimated to be £120m, based on an assumed need of £1.3billion.
The CCG Governing
Body has created a
Healthy Liverpool
Transformation Fund
of £90m to be made
available during
the two year period
2014/15 and 2015/16.
Although Liverpool is likely to face future
financial challenges, Liverpool Clinical
Commissioning Group, and the Primary Care
Trust before it, has a good track record of
delivering efficiency savings through effective
redesign and robust financial management.
For 2014/15, the CCG has the second
highest efficiency target in the country at
£27.1 million, which represents 3.6% of its
budget. We are on track to deliver these
efficiency savings this year and our target
for 2015/16 is £25.8 million. This successful
drive to achieve efficiencies, whilst continuing
to improve local services means that these
savings can be invested to support the
transformation ambitions of the Healthy
Liverpool Programme.
112
made available during the two year period
2014/15 and 2015/16. Informed by the
comprehensive engagement we will have with
Liverpool people and stakeholders, we will
develop a detailed financial plan that will target
these additional resources in order to maximise
the impact of our transformational programmes.
Liverpool health economy
outlook: Resources Vs
expenditure (flatline)
Expenditure Resources
£1,300,000
£1,280,000
£1,260,000
£1,240,000
£1,220,000
Liverpool CCG is planning to invest at
least 10% (£70m) of its annual budget in
transformation programmes across the
health economy, between 2014/15 to 2018/19.
£1,200,000
To kick-start this programme of investment,
the CCG Governing Body has created a Healthy
Liverpool Transformation Fund of £90m to be
£1,120,000
£1,180,000
£1,160,000
£1,140,000
£1,100,000
2014/15 2015/16 2016/17 2017/18 2018/19
Healthy Liverpool prospectus
12
57
the healthy
liverpool roadmap
We want people in Liverpool to get involved
at every level; helping to shape our plans and
telling us about their experiences of care.
Dave antrobus governing body member, nhs liverpool ccg
The Healthy Liverpool Programme has undertaken substantial engagement with a wide range
of stakeholders, including clinicians, patients and the public, in the last 12 months. This early
phase engagement was intended to support and influence the development of the case
for change and to begin considering future models of care for health and care services.
113
12
58
the healthy liverpool roadmap, continued
We will soon commence a further, intensive
period of engagement with patients, people
who live and work in Liverpool, with NHS and
partner organisations and other groups with
a general or specialist interest in the future of
health and care services in the city. Over the
latter part of 2014/15 we will be facilitating a
city-wide debate about the Healthy Liverpool
case for change and asking for detailed
feedback about what you think about:
the ambition of our proposals;
the proposals for transforming our local
system around the three settings of care;
living well, community services and
hospital services;
the priorities we have proposed to transform
mental health; to support healthy ageing,
long-term conditions, care for children and
young people, people with learning disabilities
and cancer.
This next phase of engagement will be
supported by an awareness-raising campaign
to ensure that everyone with an interest in the
future of Liverpool’s health and care system
is equipped with the information they need to
provide informed feedback.
The winter 2014/15 Healthy Liverpool
Engagement Programme will inform the
ongoing development of options which
will come together in a detailed business
case which will be published next year.
Depending on the nature of the proposals
there may be a formal public consultation
on elements of these proposals, which
would take during the second part of 2015.
In order to achieve our vision, the people
of Liverpool have to be at the centre of
decisions made about their own health
and well-being; this is the essence of
person-centred care.
We will assess all service change
proposals to ensure they pass four stringent
tests, to ensure:
there is strong public and patient
engagement in relation to the proposals;
they are consistent with current and
prospective need for patient choice;
there is a clear clinical evidence base
to instigate the changes;
there is support for the proposals from
clinical commissioners.
Everything we do will contribute to social value and
sustainability for health and the local economy.
professor Maureen Williams deputy chair, nhs liverpool ccg
Have your say
We want to speak to as many people as
possible in the coming months to understand
their experiences of health and care services
in Liverpool and to get their views on what our
priorities should be. A dedicated website has
been set up – www.healthyliverpool.nhs.uk –
where people can find further information
and you can get in touch with us in a number
of ways:
114
Write: H
ealthy Liverpool,
Liverpool CCG,
1 Arthouse Square,
Seel Street,
Liverpool L1 4AZ
Email: healthy.liverpool@liverpoolccg.nhs.uk
Phone: 0151 296 7000
Twitter: @HealthyLvpool
Healthy Liverpool prospectus
13
references and
additional sources
Statistics and data
1. 2011 Census for England
and Wales. Office of National
Statistics (online). Available here:
www.ons.gov.uk/ons/guide-method/
census/2011/index.html
13.1
2. English Indices of Multiple
Deprivation 2010 (online). Available
here: http://data.gov.uk/dataset/
index-of-multiple-deprivation
3. Health and Social Care Information
Centre Indicator Portal (online).
Available here: https://indicators.ic.nhs.
uk/webview/ Accessed Sept 2014.
4. The Public Health Outcomes
Framework (online). Available here:
http://www.phoutcomes.info/publichealth-outcomes-framework#gid/
1000049/par/E12000004
Accessed Sept 2014.
5. NHS Statistics (online). Available here:
http://www.statistics.gov.uk/hub/
index.html Accessed September 2014.
6. Adult Social Care Outcomes
Framework (online). Available here:
http://ascof.hscic.gov.uk/Outcome
Accessed August 2014.
9. Child health profiles (online). Available
here: http://www.chimat.org.uk/profiles
Accessed September 2014.
10. Local prevalence data, extracted
from GP Practice Systems August 2014.
11. National prevalence models (online).
Available here: http://datagateway.
phe.org.uk/ Accessed August 2014.
12. National prevalence data from
Quality and outcomes framework
(online). Available here: http://www.
hscic.gov.uk/qof Accessed August 2014.
Policies
1. Health and Social Care Act 2012.
Department of Health. London 2012.
13.2
additional sources
The Liverpool City-region Health
is Wealth Commission. Final Report.
September 2008 (online). Available here:
http://www.liv.ac.uk/ihia/IMPACT%20
Reports/HIW_Final_Report_sml.pdf
13.3
Liverpool Joint Strategic Needs
Assessment 2013/14: (online).
Available here: http://liverpool.gov.uk/
council/strategies-plans-and-policies/
adult-services-and-health/
joint-strategic-needs-assessment/
Mental Health is Everyone’s Business.
The Joint Strategic Framework for Public
Mental Health 2009-11. Liverpool City
Council 2009.
2. Equity and Excellence. Liberating the
NHS. Department of Health. London 2010.
Laying the Foundations. Liverpool Health
and Well-being Strategy 2012-15.
Liverpool City Council 2012.
3. Fair Society, Healthy Lives. A strategic
review of health inequalities in England
post-2010. London February 2010.
Be Active: be Healthy – creating a moving
culture. Liverpool Active City. Strategy
2012-2017. Liverpool City Council 2012.
4. Smoke Free Liverpool 2004-6
(online). Available here:
www.smokefreeliverpool.com
Taste for Health. Liverpool Food and
Health Strategy 2010-14. Liverpool City
Council 2010.
5. Lose a Million Pounds – Liverpool’s
Challenge 2009 (online). Available here:
7. End of Life Care profiles (online).
www.hsj.co.uk/resource-centre/
Available here: http://www.endoflifecare- your-ideas-and-suggestions/
intelligence.org.uk/end_of_life_care_
obesitychallenge/5006052.article
profiles/ Accessed September 2014.
6. Liverpool 2020 Decade of Health
and Well-being (online). Available here:
8. Cancer profiles (online). Available
http://www.2010healthandwellbeing.
here: http://www.ncin.org.uk/cancer_
org.uk/index.php
information_tools/profiles/pctprofiles
Accessed September 2014.
7. Five Year Forward View, NHS England:
http://www.england.nhs.uk/wp-content/
uploads/2014/10/5yfv-web.pdf
115
59
Natural Choices for Health and
Well-being. A report for Liverpool PCT
and Mersey Forest. C Woods, R Bragg
and J Barton. University of Essex 2013.
Reducing Harm: Improving Care.
Liverpool Alcohol Strategy 2011-14.
Liverpool City Council 2011.
Shaping our Options. Liverpool Clinical
Commissioning Group Healthy Liverpool
Programme. July 2013.
60
glossary
14
A&E - Accident & Emergency - where people receive
treatment for medical and surgical emergencies,
which are likely to need admission to hospital.
A
Acute hospital - these are hospitals that usually
provide short-term treatment, for patients with any kind
of illness or injury that requires urgent attention.
Cardio-vascular disease - is a class of diseases
that involves the heart, the blood vessels (arteries,
capillaries, and veins) or both.
C
Care plan - a care plan is an agreement between a
patient and their health or care professional to help them
to manage their health, day-to-day. It can be a written
document or something recorded in a patient’s notes.
Chronic Obstructive Pulmonary Disease (COPD) – is the name
for a collection of lung diseases including chronic bronchitis,
emphysema and chronic obstructive airways disease.
Clinical Commissioning Group - these are the organisations,
led by GPs, set up by the Health and Social Care Act 2012,
to plan and design local health services. They do this by
“commissioning” or buying health services including:
planned hospital care
urgent and emergency care
rehabilitation care
community health services
mental health and learning disability services
Clinician - a health professional, such as a doctor, or nurse,
involved in clinical practice.
Commissioner - organisations or individuals authorised
to buy health services for the benefit of patients accessing
the NHS. Commissioning is about getting the best possible
health outcomes for the local population by assessing local
needs and then buying services on behalf of the population
from hospitals, clinics, community health services etc.
Clinical Commissioning Groups are commissioners for
certain types of care.
116
Core Cities – England’s 9 largest cities outside of London,
including Liverpool, joined together to give a united voice
for the importance of cities in delivering the country’s full
economic potential, creating more jobs and improving
people’s lives.
Critical care - the specialised care given to patients who
are critically ill and whose conditions are life threatening.
Dementia - a broad category of brain diseases that
cause long-term loss of the ability to think and reason
clearly that is severe enough to affect a person’s daily life.
D
Determinants of Health - the different social, economic
and personal factors determine a person’s quality of health.
This could include education, housing and income.
Diagnostics - tests which patients undergo to help doctors
find out what’s wrong e.g. a blood test.
District nurse - provide care within the community to service
users such as wound management, medication advice,
palliative care and catheter and continence care.
Evidence-based - emphasises the use of evidence from
well-designed and conducted research in healthcare
decision-making.
E
General Practice - part of primary care services;
general practice includes your family doctor (a General
Practitioner GP) and other health services including nurses
that care for you often in GP surgeries and in your home.
G
H
Health Inequalities - avoidable inequalities in health
between groups of people.
Health outcome - a change in the health of an individual or
group of people which can be attributed to an intervention.
For example, the survival of a patient treated for cancer.
Healthy Liverpool Programme - the city-wide programme
which aims to transform health and care services over the
next 5 years.
Healthy Liverpool prospectus
Health and Well-Being Board - a forum where key leaders from
the health and care system work together to improve the
health and well-being of their local population and reduce
health inequalities.
I
Integrated care - a term also used to mean ‘joined-up
care’ (see below).
Intermediate care services – the range of services provided by
the NHS and Local Authorities to help people, generally older
people, to avoid going into hospital unnecessarily and help
them be as independent as possible after leaving hospital.
Joined-up care – the whole range of health and social
care services working together to meet people’s needs.
For example, caring for elderly people in their homes.
J
Joint Strategic Needs Assessment - the Joint Strategic Needs
Assessment is developed jointly by Local Authorities and
CCGs. It looks at the wider determinants of health to establish
current and future health needs of the local population.
Liverpool Health Partners (LHP) - LHP is the organisation
responsible for planning the services, research
programmes and teaching activities carried out by the
University of Liverpool with its NHS health partners.
L
Long-term conditions - are conditions for which there is
currently no cure, and which are managed with drugs and
other treatment, for example: diabetes or dementia.
Multi-disciplinary team - a team of health professionals
with different areas of expertise who meet to determine
the care plan for an individual service user or patient.
M
NHS England - NHS England is an executive nonN
departmental public body of the Department of Health.
NHS England oversees the budget, planning, delivery and
day-to-day operation of the NHS in England as set out in the
Health and Social Care Act 2012.
North West Coast Academic Health Science Network - one of
15 academic health science networks in England. It works as
part of the NHS to enable innovative products to spread quickly
and successfully through the health and social care system.
117
P
61
Paediatric services - this refers to healthcare services
for babies, children and adolescents.
Palliative care - an approach that improves the quality
of life of patients and their families facing problems
associated with serious illness and care at the end of life.
Primary care - services which are normally the main or first
point of contact for a patient. For example: GP surgeries,
dentists, pharmacists, and optometrists.
Portal – a website that serves as a gateway or a main entry
point to IT systems.
Provider - individuals and/or organisations who provide
a service to the NHS e.g. hospitals, clinics, community
health bodies.
Social Care - the provision of social work, personal care,
protection or social support services to children or
adults in need or at risk, or adults with needs arising from
illness, disability, old age or poverty.
S
Specialised services - services that are provided in
relatively few hospitals, accessed by comparatively small
numbers of patients but with catchment populations of
usually more than one million. These services tend to be
located in specialised hospital trusts that can recruit a
team of staff with the appropriate expertise and enable
them to develop their skills. Specialised services account
for approximately 14% of the total NHS budget. The
commissioning of specialised services is a prescribed
direct commissioning responsibility of NHS England.
Telecare – use of technology to enable care to be
provided remotely for patients. For example, a
consultation with a GP by video or by telephone, or where
patients are monitored remotely such as when a fall sensor
in a patient’s home triggers an alert to a central team.
T
U
Urology - surgical specialty that investigates and
treats the urinary tract system.
This prospectus is printed on
Cocoon Silk 100 from 100%
de-inked post-consumer waste.
118
Report no: GB 84-14
NHS LIVERPOOL CLINICAL COMMISSIONING GROUP
GOVERNING BODY
TUESDAY 11th NOVEMBER 2014
Title of Report
Corporate Risk Register
Lead Governor
Maureen Williams
Senior Management
Team Lead
Ian Davies, Head of Operations & Corporate Performance
Report Author
Ian Davies, Head of Operations & Corporate Performance
Summary
The purpose of this paper is to present to the Governing
Body the Corporate Risk Register as part of the
governance and assurance process for the organisation
Recommendation
That Liverpool CCG Governing Body:
 Note the revised and updated risk register and the
actions underway to mitigate the risks identified
Impact on improving
health outcomes,
reducing inequalities
and promoting
financial
sustainability
Relevant Standards
or targets
119
The risk register provides the Governing Body with
assurances on the key risks that impact upon the delivery
of the organisations key objectives and financial stability.
Organisational and corporate governance requirements
Page 1 of 1
120
LIVERPOOL CCG: CORPORATE Risk Register NOVEMBER 2014
Ref
Organisational
Values &
Objectives
Date
Entered
Objective
Version FINAL 4th NOV 14
Description of Risks Current Controls Assurance in Controls L
Current Current
Risk
risk
Management Actions re gaps in controls
C (score) accepted and assurance or unacceptable risk rating
C004
HRR
We will act with
honesty and
transparency in all
our actions. We are
committed to a
teamwork
environment, where
every member of the
CCG is valued,
encouraged to
contribute and
recognised for their
efforts.
14/05/2013 Compliance with
Employment law
and NHS
Employers
guidance
Failure to ensure
that all policies and
procedures are up
to date, compliant
and communicated
to staff
Programme of
Monitored by HR &
policy review and Remuneration
updating
Committee
underway, with
'priority' policies
addressed first
and default to
where required
use of previous
PCT policies as an
interim measure
2 4
8Y
C008
FPCC
We will act with
honesty and
transparency in all
our actions. We are
committed to a
teamwork
environment, where
every member of the
CCG is valued,
encouraged to
contribute and
recognised for their
efforts.
28/05/2013 Effective
governance and
staffing
arrangements in
place for the
management of
the DALLAS / MI
programme
Current governance
arrangements
unacceptable and
leave the CCG open
to a high level of
financial,
operational and
reputational risk.
Inability to
implement final
staff structures.
Governing Body
Programme lead
in place, initial
programme
structures and
staffing in place
Monitoring by Chief
Finance Officer and
Audit, Risk and
Scrutiny Committee
4 4
16 N
C009
FPCC
To maximise value
from our financial
resources and focus
on interventions that
will make a major
difference
28/05/2013 Effective
management of
specialist
commissioning
financial risk
Risk to CCG financial
allocations from
specialist
commissioning
allocations and
management by
NHS England
Collaborative
Commissioning
Agreement
entered into with
NHS England
Monitoring by Chief
Finance Officer and
Audit, Risk and
Scrutiny Committee
3 3
9N
121
Priority policies approved by the HR &
Remuneration Committee. Annual review of
policies to be completed by the end of
Quarter 1. Review of policies ongoing. All
Policies have been reviewed/refreshed
(next review April 2015); new policies for
flexible working, maternity leave, parental
leave and paternity leave issued; further
polices covering the areas of social media,
study leave and recruitment & selection will
be presented to the next meeting of the HR
Committee for approval.
Programme and staff transferred into the
CCG with effect from the 1st Nov 2013.
Review of activities and staffing
commenced. Meetings with staff and their
representatives continue. Resolution
ongoing.. A positive project delivery report
was presented to the meeting of the
Governing Body held on the 14th October
2014 and provided assurance on the
delivery and current performance of the
project. Staff consultation continues,
alongside HR due process to seek a
resolution for the staffing structure for the
project.
Monthly mechanism and controls
established to assess in year spend and
agree appropriate action.
Standing item on the Audit and Finance,
Contracts and Procurement Committees.
Contact made with individual Trusts where
growth in activity is judged to have arisen
due to specialist commissioned services,
negotiations continue. CCG has submitted
expression of interest to NHS England for
the CCG to assume responsibility for key
elements of specialist commissioning in the
city, outcome awaited. Outcome of national
review and redesignation awaited.
L
Residual
Risk
Lead
Completion Review
C (score) Officer Date
Date
Progress
1 4
4 ID
on-going
Dec-14
▼
2 4
8 TW
Ongoing
Dec-14
►
3 3
9 TJ
on-going
Dec-14
►
Ref
Organisational
Values &
Objectives
C011G
B
To hold providers of
commissioned
services to account
for the quality of
services delivered
C012
To hold providers of
commissioned
services to account
for the quality of
services delivered
CO14
We will act with
honesty and
transparency in all
our actions. We are
committed to a
teamwork
environment, where
every member of the
CCG is valued,
encouraged to
contribute and
recognised for their
efforts.
122
Date
Entered
Objective
11/06/2013 Delivery of
commissioned
services to
patients by
Aintree
University
Hospital NHS FT
meets
commissioning
requirements
(service and
quality) and
compliance with
Monitor
'operating
licence'
Description of Risks Current Controls Assurance in Controls L
Quality review
completed in
April 2013; NHS
contract
collaborative
commissioning
arrangements in
place with South
Sefton and
Knowsley CCGs;
CPQG;Monitor
investigation
commenced with
regards to
provider
performance in
AED, HCAI, RTT
and mortality
01/05/2013 Delivery of
Concerns raised as CCG led and cocommissioned to the safe and
ordinated
services to
effective delivery of investigations
patients by
services to local
underway;
Liverpool
residents
Quality review
Women's
completed in
Hospital NHS FT
March 2013.
meets
commissioning
requirements
(service and
quality) and
compliance with
29/07/2013 Resolution of all
outstanding
Continuing
Health Care
restitution,
review and
appeals cases
Patient care and
service delivery
falling below an
acceptable and safe
standard and
commissioner
expectations
/standards. Trust in
potential breach of
Monitor 'operating
licence'
Financial risk from
cases (financial
settlements and
interest);
reputational risk
due to significant
delays to resolution;
Formal Ombudsman
investigation into
delays
Current Current
Risk
risk
Management Actions re gaps in controls
C (score) accepted and assurance or unacceptable risk rating
Monthly reporting to
Governing Body; CPQG
on-going monitoring
and assessment of
provider service
delivery;Monitor
investigation
completed and
sanctions applied;
regular reporting
through Regional
Quality Surveillance
arrangements
4 5
20 N
CPQG, reporting to
Governing Body and
Chief Officer; regular
reporting through
Regional Quality
Surveillance
arrangements
4 5
20 N
4 5
20 N
CSU
Monthly progress
commissioned to reports from CSU,
manage all
complaints monitoring
outstanding cases
and to clear the
backlog with a
target date of
March 2014
L
Residual
Risk
Lead
Completion Review
C (score) Officer Date
Date
Progress
CPQG monitoring and holding the provider
to account for service delivery; Monitor
investigation into Provider performance
completed: licence breached action plan in
place; details posted on Trust website. CQC
Report published on the 6th December
2013, including a warning notice to be met
by 28th February 2014. Matter raised in
Part 2 of the Governing Body meeting held
on the 10th December 2013 and way
forward agreed. Liverpool CCG formal
position communicated to Knowsley and
South Sefton CCGs. Actions continue to seek
sustainable improvements. CQC reinspection has demonstrated a significant
level of improvement, sustainable delivery
to be monitored closely. Routine provider
surveillance now underway
CQC Report of visits undertaken on the 7th
and 8th July 2014 now received and a
follow up Quality Review meeting is
scheduled. A follow up inspection took
place on the 30th September and the CQC
report was published in October. The CQC
found that further action was needed with
regards to staffing and assessing and
monitoring the quality of service provision.
This will now be reviewed by the CPQG
alongside the Trust action plan with a
report back to the Quality Safety &
Outcomes Committee.
2 5
10 KS
on-going
Monthly
review
via
CPQG/
QSG
▼
3 5
15 KS
on-going
Monthly
review
via
CPQG/
QSG
►
The CSU has been commissioned to
continue the management of claims
through to the end of March 2014, although
the inherited backlog will not be cleared by
the end of the financial year. CSU
contracted for a further twelve months to
manage restitution cases on behalf of the
CCG. There has been a significant increase
in the numbers of legacy claims progressing
to the latter stages of the process. A
subsequent remodelling has led to an
increase of 52% in likely 'panel' cases and a
potential increase in financial liability from
£2.4M to £4M. (under the current rules CCG
liaibility under the 'national pool' is limited
to £2.8M, although this is subject to
change). It is now expected that all claims
will not be cleared before 2016/17,
continuing a reputational risk to the CCG.
5 4
20 JL / ID
Mar-15
Dec-14
►
Ref
Organisational
Values &
Objectives
Date
Entered
Objective
Description of Risks Current Controls Assurance in Controls L
CO15
To hold providers of
commissioned
services to account
for the quality of
services delivered
06/08/2013 CCG use and
reliance upon
quality and
timely
performance
data
Poor quality data
leading to
inaccurate
monitoring and
assessment of
providers,
operational and
financial risk
CSU is
commissioned to
provide business
intelligence
support including
data processing
and validation.
CO18
We accept
responsibility for our
actions. We make
and support business
decisions through
experience, evidence
and good judgement,
and we will deliver
against our promises
01/10/2013 Deliver the
transformation
of health and
health & care
services across
the city through
the Healthy
Liverpool
Programme
Failure to agree
model of care;
establishment of
programme leads
and infrastructure;
delivery of the
transformational
programme; failure
to communicate and
engage with
stakeholders and to
gain understanding
and support for the
programme;
reputational risk
due to high profile
of NHS change and
reconfiguration
programmes.
Programme
CCG Governing Body,
Advisory Board
Programme Advisory
established;
Board
Governing Body
commitment to
HLP; officer-led
delivery group in
place; Additional
senior resource
sourced to
manage
communications,
stakeholder
management and
engagement.
Clinically-led
settings and
programme
groups; assurance
process identified
and commenced.
123
Monthly performance
meetings with CSU, 'in
house' analyst capacity
to review data
accuracy and assess
risk
Current Current
Risk
risk
Management Actions re gaps in controls
C (score) accepted and assurance or unacceptable risk rating
L
Residual
Risk
Lead
Completion Review
C (score) Officer Date
Date
Progress
4 5
20 N
CSU being held to account for the delivery
of data to the required standard and
quality, matters raised at monthly
performance meeting with CSU leadership;
some recent improvement in data quality
seen; issues with individual providers being
taken up via contract meetings. Inconsistent
improvements in data quality and
timeliness seen. Robust arrangements in
place for monitoring, significant review
planned for Quarter 1 2014/15. The review
has concluded that whilst the controls put
into place have had an impact, issues
remain that continue to require CCG staff
intervention. A further review of the whole
of Business Intelligence is planned that will
inform our future commissioning intentions.
4 3
12 TJ/ID/T on-going
W
Dec-14
►
2 5
10 Y
Healthy Liverpool governance infrastructure
formally approved by Governing body and
all groups established. Additional
communications and engagement support
sourced. The programme is on the NHS
England service change and reconfiguration
tracker which marks the commencement of
the NHS assurance process. The Case for
Change document is in development and
will be shared externally in October 2014. A
new round of stakeholder engagement is
taking place in September 2014 with MPs,
Councillors, Select Committee, groups that
have been involved in earlier engagement
activity, GPs and local NHS providers. The
Prospectus for Change was agreed at the
meeting of the Governing Body held on the
13th October. A public launch will take
place at the Mayoral Health Summit to be
held on the 3rd November, which sees
Phase 3 of the work commence.
2 5
10 NF, KS
Dec-14
▼
On-going
Ref
Organisational
Values &
Objectives
Date
Entered
Objective
Description of Risks Current Controls Assurance in Controls L
Current Current
Risk
risk
Management Actions re gaps in controls
C (score) accepted and assurance or unacceptable risk rating
L
Residual
Risk
Lead
Completion Review
C (score) Officer Date
Date
Progress
CO19
To maximise value
from our financial
resources and focus
on interventions that
will make a major
difference
01/12/2013 To agree with
Liverpool City
Council the
'Better Care
Fund' (formally
Integration
Transformation
Fund) for 201416, including
individual
schemes,
outcomes and
performance.
Failure to agree with
the City Council the
investment schedule
and associated
outcomes, including
the performance
element of the
Fund, threatening:
'retention' of the
BCF resources in the
City; service delivery
and continuity; and
relations with the
City Council
Initial principles
discussed at the
Joint
Commissioning
Group meeting in
December;
further national
guidance now
published.
Negotiations led by
the Chief Finance
Officer, regular
updates to SMT,
briefings to Governing
Body.
2 5
10 Y
Final submission now made to NHS England
following agreement by the Health & Well
Being Board and CCG Governing Body.
Continued work on performance
arrangements and scheme developments
underway. Subsequently changes to the
national approach have been introduced
and the original submission
reviewed/revised; Liverpool BCF identified
by NHSE/LGA for 'fast track' submission in
July 2014. After a review of the benefits and
changes to the process, Liverpool has now
withdrawn from the fast track process. A
final submission will now be made in line
with the national deadline of the 19th Sept.
The CCG final submission was made and
feedback has been received. The CCG plan
has been assessed as "Approved with
Support", the plan was judged to be
"strong" with a number of areas for
improvement. Actions are underway and
timescales for delivery are to be agreed
1 5
5 KS, TJ & On going
TW
Dec-14
►
CO23
We accept
responsibility for our
actions. We make
and support business
decisions through
experience, evidence
and good judgement,
and we will deliver
against our promises
06/01/2014 To deliver
effective
information
governance
processes
Failure to comply
with requirements
of the Information
Governance Toolkit
leading to
restrictions placed
on the CCG on the
handling of weekly
psuedomynised
data, adversely
affecting key
business functions
MIAA is
supporting the
CCG in meeting
the level 2
requirements of
the Toolkit.
CCG declared selfdeclaration with
Toolkit in March 2013
and subsequently
supported by an
Internal Audit opinion
of "significant
assurance".
1 4
4Y
Declaration of compliance at Level 2 of all
Information Governance Toolkit
requirements made by the 31st March 2014
deadline and supported by MIAA Internal
Audit. Actions continue to move towards
goal of Level 3 compliance by the end of
March 2015. Additional dedicated IG
support post to be recruited to in Quarter 1
2014/15. Recruitment of post delayed into
Quarter 2. Awaiting publication of the IG
Toolkit for 2014/15. Continue to work to
improve current systems. Additional
support to be recruited to ensure ongoing
compliance
1 4
4 TW
Dec-14
▼
124
Mar-15
Ref
Organisational
Values &
Objectives
Date
Entered
Objective
Description of Risks Current Controls Assurance in Controls L
Current Current
Management Actions re gaps in controls
Risk
risk
C (score) accepted and assurance or unacceptable risk rating
L
Residual
Lead
Completion Review
Risk
C (score) Officer Date
Date
Progress
CO24
To hold providers of
commissioned
services to account
for the quality of
services delivered
01/03/2014 Delivery of
commissioned
services to
patients by
Liverpool
Community
Health meets
commissioning
requirements
(service and
quality)
Concerns raised as
to the safe and
effective delivery of
services to local
residents
CCG led and coordinated
investigations
underway.
CPQG, reporting to
Governing Body and
Chief Officer; regular
reporting through
Regional Quality
Surveillance
arrangements
4 5
20 N
CQC inspections took place in November
and December 2013; Single item Quality
Surveillance Group held on the 11th
February; Quality Review Meeting held on
the 18th February; Trust remedial actions to
be monitored and followed up through the
regular Clinical Quality and Performance
meetings. SUI monitoring process has
identified under reporting of pressure
ulcers by the Trust and non compliance with
expected processes (six monthly review
underway with non reported incidents now
shown on STEIS). Interim Chief Executive
appointed. Interim appointments made to
Director of Nursing and Operations posts.
LCH collaborative commissioning forum
established and led by LCCG to provide
oversight and scrutiny of the recovery plans.
CQC inspection report (visits 12th -15th
May) published 15th August. Overall the
Trust was found to "require improvement".
The report has been received and reviewed
by the CPQG (Chair Dr Jim Cuthbert) who
have oversight of the remedial action plan.
NHSE are supporting the Trust regarding
governance matters. Meetings of the
Collaborative Commissioning Forum
4 5
20 KS
on-going
Monthly
review
via
CPQG/
QSG
►
CO26
QSOC
To hold providers of
commissioned
services to account
for the quality of
services delivered
12/03/2014 Delivery of
commissioned
services to
patients by Alder
Hey NHS FT
meets
commissioning
requirements
(service and
quality) and
compliance with
Monitor
i
Concerns raised as
to the safe and
effective delivery of
services to local
residents from
Whistleblowing
allegations
regarding theatre
staffing and sickness
levels and from
recent CQC
inspection.
Specialist
Commissioners
and CCGs working
together to
understand the
concerns raised
and determine
with the Trust a
sustainable
improvement
plan.
Single item QSG held
23rd April 14 to review
action plans with the
Trust. LCCG tasked
with establishing a
collaborative
commissioning forum
to oversee work to
address quality and
safety concerns
4 4
16 Y
Collaborative commissioning forum will
provide needed oversight of Trust recovery
and mitigation plans.CQC inspection report
(visits 21st - 22nd May) published 20th
August. The findings are currently under
review by commissioners. Overall the Trust
was found to "require improvement". The
report has been received and reviewed by
the CPQG (Chair Dr Shamin Rose) who have
oversight of the remedial action plan.
Meetings of the Collaborative
Commissioning Forum continue.
3 4
12 JL
Ongoing
Monthly
review
via
CPQG/
QSG
▼
125
Ref
Organisational
Values &
Objectives
CO29
To hold providers of
commissioned
services to account
for the quality of
services delivered
CO30a
To hold providers of
commissioned
services to account
for the quality of
services delivered
126
Date
Entered
Objective
01/06/2014 Delivery of the
commissioned 4
hour target in
AED to patients
by Royal
Liverpool &
Broadgreen
University
Hospitals NHS
Trust meeting
the
commissioning
requirements
(service and
quality) and
compliance with
TDA
requirements
27/06/2014 Delivery of a
safe, effective
and reliable
clinical
laboratory
service for the
benefit of
patients
Description of Risks Current Controls Assurance in Controls L
Failure to meet the
95% 4 hour target in
AED 2014/15,
leading to patients
potentially receiving
delayed care and
treatment.
Remedial Action
Plan in place;
previous 'contract
query' remains
open and subject
to fortnightly
review.
Current remedial
action plan monitored
through the formal
contract query process
and by the TDA.
Unavailability of
test results for
macroprolactin and
prolactin (pituitary
hormones) for
clinical scientists to
review in the
Aintree Laboratory
or report to the
original requester.
(48 test results
identified dating
back to December
2012)
Liverpool Clinical StEIS investigation
Laboratories has outcome awaited.
established an
incident group to
review the
matter; reported
via StEIS;
individual
requesting
clinicians have
been contacted
and where
required clinical
advice provided.
Current Current
Management Actions re gaps in controls
Risk
risk
C (score) accepted and assurance or unacceptable risk rating
L
Residual
Lead
Completion Review
Risk
C (score) Officer Date
Date
Progress
4 4
16 N
CCG internal Trust oversight group and
contract review meeting to discuss recent
significant deterioration in performance and
the use of further contract sanctions. Single
item NHS England QSG held in August and
to be followed up by meetings with the
Trust. Current Trust 'claim' of over activity
and financial spend in non elective care
currently the subject of further exploration
and examination by commissioners. An
external audit of the activity and patient
pathway has been commissioned. Some
improvement has been seen in recent
performance (Quarter 2 met) however this
is not yet being consistently delivered week
on week.
4 4
16 ID
Ongoing
Dec-14
►
5 4
20 N
Measures being put into place to prevent a
similar occurrence in the future. The CCGs
are currently working collaboratively to
review the StEIS investigation report and
findings. Further review meeting scheduled
in early September. Significant progress has
been made, following a review meeting
chaired by NHSE to establish 'learning' from
the incidents. The CCG is assured that
remedial action has been implemented and
operational service delivery will now be
subject to routine monitoring. It is
recommended that this risk is removed
from the register.
1 4
4 JL
Ongoing
Oct-14
▼
Ref
Organisational
Values &
Objectives
Date
Entered
Objective
CO30b
To hold providers of
commissioned
services to account
for the quality of
services delivered
27/06/2014 Delivery of a
safe, effective
and reliable
clinical
laboratory
service for the
benefit of
patients
CO30c
To hold providers of
commissioned
services to account
for the quality of
services delivered
27/06/2014 Delivery of a
safe, effective
and reliable
clinical
laboratory
service for the
benefit of
patients
CO31
To hold providers of
commissioned
services to account
for the quality of
services delivered
127
Description of Risks Current Controls Assurance in Controls L
Failure to report
pathology test
results to requesting
GPs for a range of
nine clinical tests
due to an apparent
intermittent
technical failure
(1,354 test results
identified as
involved).
Loss of laboratory
test result messages
in the GP Practice
EMIS web system as
a consequence of
messages being
rejected by the DTS
mailbox. (initial
analysis shows 36
messages were
'rejected' and
therefore not
received by the
Practices). The
technical system
issues potentially
effects other DTS
messaging.
12/08/2014 Delivery of NHS Failure of the Royal
Constitution
Liverpool &
Waiting time
Broadgreen
targets for
University Hospitals
elective care (52 to meet expected
waiting time targets,
& 18 weeks)
leading to
lengthened patient
waiting times
Current Current
Management Actions re gaps in controls
Risk
risk
C (score) accepted and assurance or unacceptable risk rating
L
Residual
Lead
Completion Review
Risk
C (score) Officer Date
Date
Progress
Liverpool Clinical StEIS investigation
Laboratories has outcome awaited.
established an
incident group to
review the
matter; reported
via StEIS; all
unreported
results have been
reviewed by the
appropriate
internal specialist
clinician; where
there was no
patient follow up
letters have been
sent to all
relevant GPs
commencing
27/05.
5 4
20 N
An internal forensic review checking of all
laboratory test within the Aintree lab
continues to ensure that all unreported test
results are identified and appropriate action
taken on individual cases. StEIS report
received. Interim operational solution put
into place to mitigate risks, with parties
further exploring a permanent solution.
Significant progress has been made,
following a review meeting chaired by NHSE
to establish 'learning' from the incidents.
The CCG is assured that remedial action has
been implemented and operational service
delivery will now be subject to routine
monitoring. It is recommended that this risk
is removed from the register.
1 4
4 JL
Ongoing
Oct-14
▼
Scoping exercise
underway to
assess the scope
and potential
impact of the
issue.
StEIS investigation
outcome awaited.
5 4
20 N
Outcome of urgent scoping exercise
awaited before reassessing the risk severity
and impact. StEIS report received. Interim
software solution put into place to mitigate
risks, with parties further exploring a
permanent solution for implementation by
year end. Significant progress has been
made, following a review meeting chaired
by NHSE to establish 'learning' from the
incidents. The CCG is assured that remedial
action has been implemented and
operational service delivery will now be
subject to routine monitoring. It is
recommended that this risk is removed
from the register.
1 4
4 JL
Ongoing
Oct-14
▼
Audit of waiting
times complete,
remedial action
plan in place and
being monitored.
Current remedial
action plan monitored
through the formal
contract query process
and by the TDA.
5 3
15 Y
Regular 'oversight' and contractual
meetings with the Trust in place. The Trust
have submitted an investment proposal to
NHS England to release additional 'national'
monies to support recovery of waiting
times. Recent improvement in a reduction
in the numbers waiting noted.
3 2
6 DR/CM Ongoing
Dec-14
▼
Ref
Organisational
Values &
Objectives
Date
Entered
Objective
Description of Risks Current Controls Assurance in Controls L
Current Current
Management Actions re gaps in controls
Risk
risk
C (score) accepted and assurance or unacceptable risk rating
L
Residual
Lead
Completion Review
Risk
C (score) Officer Date
Date
Ongoing
Dec-14
►
1 3
3 TW/DR Ongoing
Oct-14
▼
3 3
9 JL/DR
Dec-14
►
CO32
To maximise value
from our financial
resources and focus on
interventions that will
make a major
difference
19/08/2014 To manage
RLBUHT over
performance
against
contracted levels
for 2014/15
The forecast outturn
for RLBUHT is
£11.5m over
performance as at
M3 2014/15, 50% of
over performance
relates to Non
Elective admissions,
25% for diagnostics
and 25% over
planned care and
high cost drugs .
This is significantly
over planned levels
for 2014/15 and
continued
performance at the
current levels will
add pressure to
LCCG finances.
LCCG are utilising
contract levers to
understand the
drivers behind the
over
performance. An
Activity Query
Notice has been
issued and the
Trust are
providing a
response to set
out for the
reasons for the
increase in over
performance.
There has been
clinical
involvement
throughout the
contract query
LCCG utilising NHS
standard contract
levers to manage
performance, a
standard process .
5 4
20 N
Awaiting formal response to AQN. LCCG to
request a quality assurance exercise of the
2014/15 NEL admissions data. Monthly
monitoring of activity and finance plan to
continue. A response to the AQN was
received from the Royal however it was
judged to be 'incomplete'. The CCG has now
commissioned an independent assessment
of counting and coding practices in the
Trust which is expected to report back to
the CCG by the end of December and will
inform the next steps to be taken.
5 4
CO33
To maximise value
from our financial
resources and focus on
interventions that will
make a major
difference
19/08/2014 Agreement to
secure
Information
Management
services for the
CCG from April
2015.
A revision to the
current partnership
agreement and
changes to the
commitment from
previous partners
could threaten
delivery to the CCG.
The CCG will
ensure delivery of
the service is via a
formal Service
Level Agreement.
Current service
delivery subject to
routine monitoring
and review by the
Head of Contracts &
Procurement.
3 3
9N
Further negotiations underway with the
provider to seek to reduce the level of
potential risk to the CCG and allow
completion of a new service level
agreement with the Trust. Following further
discussion with the provider the level of risk
has been reduced to an acceptable and low
level, therefore the risk is recommended to
be removed.
CO34
To hold providers of
commissioned
services to account
for the quality of
services delivered
29/08/2014 Delivery of RTT
waiting times in
line with NHS
Constitution and
contractual
requirements at
Alder Hey NHS
Foundation
Trust
Failure to agree and
implement elective
care operational
resilience and
capacity plan
Elective care
operational
resilience and
capacity plan
submitted to NHS
England by the
Trust as required.
Trust plan has been
subject to external
review by the NHS
IMAS Elective Intensive
Support Team
4 3
12 N
The NHS England Area Team are liaising
with Monitor and the CCG as to the actions
required by the Trust in light of the
concerns expressed by the Intensive
Support Team with the intention of
agreeing a revised acceptable and
deliverable elective care plan.
128
Progress
20 TJ/DR
Ongoing
Ref
Organisational
Values &
Objectives
CO35
To hold providers of
commissioned
services to account
for the quality of
services delivered
Date
Entered
Objective
Description of Risks Current Controls Assurance in Controls L
Current remedial
action plan monitored
through the formal
contract query
process, Collaborative
Commissioning Group
and by Monitor
4 4
16 N
Single item QSG meeting held in October
with the Trust, all commissioners and
Regulator. Current performance trajectory
models year end failure to reach the target
as very likely.
L
Residual
Lead
Completion Review
Risk
C (score) Officer Date
Date
13/10/2014 Delivery of the
commissioned 4
hour target in
AED to patients
by Aintree
University
Hospital NHS
Foundation
Trust meeting
the
commissioning
requirements
(service and
quality) and
compliance with
Monitor
requirements
Failure to meet the
95% 4 hour target in
AED 2014/15,
leading to patients
potentially receiving
delayed care and
treatment.
CO36
To hold providers of
commissioned
services to account
for the quality of
services delivered
13/10/2014 Delivery of
commissioned
services is able
to meet likely
adverse weather
and 'winter'
demands
2014/15
Failure to meet
patient demand
leading to a fall in
performance and a
potential adverse
impact upon service
responsiveness and
quality
Additional
national and local
resources
released to
enhance and
strengthen
service resilience
and capacity.
Oversight of the plans
via the CCG Urgent
Care Team and the
North Mersey System
Resilience Group.
3 4
12 Y
The North Mersey System Resilience Group
has hosted a winter planning review for the
health economy, where provider plans were
reviewed and assessed. Additional service
capacity has been commissioned across
primary care, ambulance, community,
mental health and secondary care services
and will be closely monitored via monthly
'tracker' returns.
3 4
12 ID
Ongoing
Dec-14
CO37
To hold providers of
commissioned
services to account
for the quality of
services delivered
31/10/2014 Delivery of the
commissioned
services to
patients by
Aintree
University
Hospital NHS
Foundation
Trust meets the
commissioning
requirements
(service and
quality).
Higher than
expected number of
deaths in hospital as
measured by SHMI
(Summary Hospitallevel Mortality
Indicator - ratio
between the actual
number of patients
who die following
hospitalisation and
the number that
would be expected
to die on the basis
of average England
figures, given the
characteristics of
the patients treated.
National data
monitoring has
highlighted that
the Trust has a
higher than
expected SHMI
value and is
identified as a
"repeat outlier"
for this key
indicator.
Health & Social Care
Information Centre
(hscic) summary of
SHMI deaths
associated with
hospitilisation April
2013 - March 2014
(published 23rd
October 2014)
3 4
12 N
This recently published data will be subject
to review by the CCG and the matter raised
with the Trust at the next Collaborative
Commissioning Forum / CPQG. The risk will
then be reassessed.
3 4
12 KS/JL
Ongoing
Nov-14
129
Remedial Trust
plans in place;
'contract query'
open and subject
to fortnightly
review.
Current Current
Management Actions re gaps in controls
Risk
risk
C (score) accepted and assurance or unacceptable risk rating
5 4
20 ID
Ongoing
Progress
Dec-14
▲
►
►
KEY:
Updates to
existing risks in
'blue'
new risk
recommend removal from the register
►
▲
▼
130
Risk
Unchanged
Risk
increased
Risk
decreased
Report no: 85-14
NHS LIVERPOOL CLINICAL COMMISSIONING GROUP
GOVERNING BODY
TUESDAY 11th NOVEMBER 2014
Title of Report
CCG Corporate Performance report
Lead Governor
Dr Nadim Fazlani
Senior Management
Team Lead
Ian Davies, Head of Operations & Corporate
Performance
Report Author
Stephen Hendry, Senior Corporate Services
Manager (Performance & Operations)
The purpose of this paper is to report to the
Governing Body key aspects of the CCG’s
performance in delivery of quality, performance and
financial targets for 2014/15.
Summary
Recommendation
Impact on improving
health outcomes,
reducing inequalities
and promoting
financial
sustainability
Relevant Standards
or targets
That Liverpool CCG Governing Body:
 Notes the performance of the CCG in delivery
of key national performance indicators and the
recovery actions taken to improve
performance
The report provides evidence of the progress being
made across the organisation at both an
organisational and individual service provider level.
Everyone Counts: Planning for Patients 2014/15
Page 1 of 29
131
LIVERPOOL CCG PERFORMANCE REPORT
1.
PURPOSE
The purpose of this paper is to report to the Governing Body key aspects of the
CCG’s performance in delivery of quality, performance and financial targets for
the year 2014/15.
2.
RECOMMENDATIONS
That Liverpool CCG Governing Body:
 Notes the performance of the CCG in delivery of key national performance
indicators and the recovery actions taken to improve performance, if
required.
3.
BACKGROUND
The CCG is held to account by the NHS England on its performance in delivery
of key indicators within the CCG Outcome Indicator Set of the NHS Outcomes
Framework 2014/15 and operational standards expected from the NHS
Constitution.
In addition, the CCG has to be assured that the services we commission are
delivering the required quality standards and that any risks and issues relating to
service quality and patient safety are identified and positive action taken to
rectify.
The CCG has established robust governance processes and committee
structures in order to monitor performance and provide assurance to the
Governing Body that key risks to the organisation are being identified and
effectively managed. For example, the Quality, Safety and Outcomes
Committee has responsibility for quality and performance issues within its
commissioned services, whereas the Finance, Procurement and Contracting
Committee has responsibility for financial monitoring and contract activity.
Page 2 of 29
132
Whilst the November 2014 Performance Report provides a summary of CCG
performance in relation to the NHS Outcomes Framework/Everyone Counts
(which has been the primary focus of previous reports) the revised format
introduces performance analysis against key Public Health/local outcomes;
providing the Governing Body with a much more integrated report structure
which maps progress against statutory reporting requirements and across the
priority programme areas of Mental Health; Healthy Ageing; Long Term
Conditions; Children; Learning Disabilities and Cancer.
The quality and accuracy of some data flows still present some issues for the
CCG, although it should be emphasised that any specific problem areas are
dealt with swiftly between NHS Liverpool CCG and North West Commissioning
Support Unit (NWCSU).
The report is based on the published and validated data available as at 2nd
November 2014. As a consequence of the timing of reporting (to meet NHS
Liverpool CCG’s governance timetable) and data schedules, this report updates
the Governing Body with a combination of data up to the end of August and/or
September 2014.
4.
NATIONAL PERFORMANCE MEASURES
NHS Liverpool CCG is committed to ensuring that patient rights under the NHS
Constitution are consistently upheld. National Performance Measures are
reflective of the key priority areas detailed in Everyone Counts: Planning for
Patients 2014/15 and encompass measurements against Quality (including
Safety, Effectiveness and Patient Experience) and Resources (including
Finance, Capability and Capacity). In addition to analysing local performance
against these indicators, CCGs are expected to achieve improvements against
indicators across the five domains detailed in the NHS Outcomes Framework
2014/15 and the high-level national outcomes the NHS is expected to be aiming
to improve.
Headline commentary is provided below on the specific areas of performance:
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4.1 NHS Constitution – Access & Waiting
4.1.1 Good Performance
Indicator
Referral To Treatment (18
Weeks)
Referral to Treatment (52
Weeks)
GREEN
Narrative
The CCG continued to meet ALL 18 week and 52
week targets for Referral to Treatment for the month
of September 2014, maintaining an average 2%
above each threshold for admitted, non-admitted
and incomplete non-emergency pathways. At Trust
catchment level Liverpool Heart & Chest failed to
achieve 90% for the 18 week admitted patient
pathway recording 81.18%; indicating a downward
trend from June (92%) and July (89%). A total of 48
patients missed the 18 week target for August. The
Trust also had one patient waiting over 52 weeks for
the completed non-admitted pathway. (Red). One
patient exceeded the 52 week target for completed
non-admitted pathways following referral to the
Trust.
Assurance on CCG control measures
The Trust has acknowledged the failure to meet National Requirements, with commissioners
and Monitor. Action Plans and recovery plans continue to be reviewed and assured by
commissioners.
Indicator
Cancer Waiting Times (All)
GREEN
Narrative
The CCG met ALL cancer waiting times for
September 2014 and is achieving all cancer targets
year-to-date up to August 2014 (2 weeks, 31 day
and 62 day waits). There were a number of
breaches at Trust catchment level including
Liverpool Heart & Chest, Alder Hey and the Royal
Liverpool (detailed in Appendix 2a – Provider
Dashboard). The Royal Liverpool Trust failed to
achieve 93% in August 2014 for patients referred
urgently by a GP for suspected cancer with 84 out of
877 patients breaching the two week period.
Feedback relating to the context of the Royal’s
performance was not available at the time of writing.
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Indicator
A&E Waits - % of patients who
spend 4 hours or less in A&E
(cumulative) 95% threshold
GREEN
Narrative
For August and September 2014 the CCG has
achieved the 95% threshold with the latest figures
showing 95.43% of patients were admitted,
transferred or discharged within 4 hours of attending
A&E. Both Aintree and the Royal Liverpool Hospitals
failed to achieve the required 95% year to date up to
September for patients waiting over 4 hours in A&E.
Aintree are yet to achieve the target in any month
this year with performance for September 2014 at
94.2%. The Trust describes the causes of
underperformance as ‘multi-factorial’, but are largely
attributed to capacity to assess and make decisions
promptly in AED (either through lack of physical
capacity or inefficient processes), and ability to
maintain flow into assessment areas and through to
wards.
The Royal Liverpool hospital marginally
missed the target for September recording 94.56%
after achieving the target the previous 3 months.
(See Appendix 2 for Weekly & Quarterly A&E
Performance).
Assurance on CCG control measures
The contract query issued to the Royal Liverpool against A&E waiting times remains in place
until there is evidence of sustained recovery. Aintree’s continued underperformance against
the A&E target was the subject of a Single Item Quality Surveillance Group on 21st October
2014. Actions resulting from the meeting are to be fed into the Aintree Collaborative
Commissioning forum for routine surveillance and monitoring.
Indicator
Diagnostics - Percentage of
Patients waiting for more than
6 weeks for a diagnostic test.
GREEN
Narrative
Liverpool CCG continues to demonstrate
improvement for diagnostic waiting times with an
achievement of 0.62% below the 1% threshold for
September 2014. In-month performance analysis at
Trust level shows that Alder Hey exceeded the
target for September with 2.45% (9 out of 368
patients waiting above 6 weeks) whilst Liverpool
Community Health now stands at 5.26%.
Assurance on CCG control measures
Rigorous monitoring of diagnostic times will continue for Royal Liverpool and Liverpool
Community Health. Contract Queries relating to diagnostics remain in place until sustained
performance below 1% is achieved for three consecutive months.
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Indicator
Ambulance Response Times.
GREEN
Narrative
The CCG is achieving against all ambulance
response times; both in-month and year-to-date.
Although continuing rising demand for ‘Red’ calls is
a matter of concern at a North West level the service
is not currently meeting all performance targets.
4.2 NHS Outcomes Framework - Helping People to Recover from Episodes
of Ill Health or following Injury
4.2.1 Good Performance
Indicator
Stroke – (% of patients spend
at least 90% of their time on a
Stroke Unit (Target 80%)
TIA – % assessed and treated
within 24 hours (Target 60%)
Narrative
The CCG has achieved the performance targets for
both Stroke (81.97%) and TIA (80.77%)
measurements. The Royal Liverpool did meet the
September 80% target for Stroke patients spending
90% of their time on a stroke ward - performance of
73.68% equating to 10 out of 38 patients. This is
drop from August 2014 when the Trust did achieve
the target.
GREEN
4.3 NHS Outcomes Framework - Ensuring People Have a Positive
Experience of Care
4.2.1 Areas for Improvement
Indicator
Mixed Sex Accommodation –
zero tolerance of breaches
RED
Narrative
The CCG continues to receive a ‘RED’ rating against
this indicator, again attributed to performance at
Royal Liverpool where there were three mixed sex
accommodation breaches reported for September
2014. The Trust has now recorded at least one
breach per month since April 2014, with a year-todate total of 23 breaches.
Assurance on CCG control measures
The CCG continues to apply appropriate contract sanctions for the breaches which have
occurred at Royal Liverpool. The two units which have been the primary cause of the
breaches have been relocated as at 31st October 2014.
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4.4 Quality Premium – National Indicators (Health Care Acquired Infection)
4.4.1 Areas for improvement
Indicator
Narrative
Incidence of Healthcare Acquired
Infections – MRSA (Plan tolerance
of 0)
Although the CCG is rated as ‘Red’ (year-to-date
cases total 5 against a tolerance of 0 cases), no new
cases have been reported in August 2014 or
September 2014 relating to Liverpool patients. The
Royal Liverpool reported one case in September
and is currently running at 6 cases year-to-date
across the health economy; the Royal Liverpool has
a higher incidence rate of MRSA when compared to
the Trust’s peer group.
RED
Assurance on CCG control measures
Each MRSA case has been subject to robust Post Infection Review (PIR) processes with
appropriate action plans in place to address any gaps in quality or safety.
Indicator
Narrative
Incidence of Healthcare Acquired
Infections – C.difficile (Monthly plan
tolerance of 13)
The CCG rating of ‘Amber’ is due to the monthly and
year-to-date figures reported. Although overall
incidences of C.Difficile have reduced in September
with 9 cases reported, the year-to-date figures now
exceed planned trajectories by one case (80 cases,
plan of 79). This is largely attributable to
performance in July and August 2014 where the 13
case threshold was exceeded (24 and 16
respectively)
AMBER
Assurance on CCG control measures
Liverpool CCG is required to form a C Difficile appeals panel to review any cases where the
Trust concerned considers there to be no ‘lapse in care’ episodes. A panel (separate to the
Clinical Safety and Serious Incident Group) is now being formulated (a CCG Clinical Lead for
the group is also in place). The process and appropriate governance arrangements are
currently being developed and will be shared once completed. Each provider has now
submitted relevant documentation relating to their C.Diff cases for the year-to-date and rereviewing cases where there is no evidence of ‘lapses in care’.
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5. INTEGRATED PERFORMANCE OUTCOMES INDICATORS
Integrated CCG Outcomes Indicators have been developed from NHS
Outcomes Framework and Public Health indicators and are intended to provide
clear and comparative information on progress against local priorities for quality
improvement and to demonstrate where the CCG is achieving gains in health
outcomes for the population of Liverpool. Where possible, Liverpool is
benchmarked against other ‘Core City’ CCGs and ranked against relevant NHS
Outcome ambitions. The ‘Joint Performance Report Dashboard’ is included as
Appendix 2 and summarises all relevant indicators in this area. It should be
noted that this section of the performance report is under development and will
be further refined over the remainder of the financial year.
5.1 Overarching Indicators
5.1.1 Good Performance
Indicator
Male Life Expectancy
Narrative
Healthy Life Expectancy
Healthy life expectancy has improved for both
males and females in the city, with a substantial
reduction in the gap with the core city average
between 2009-11 and 2010-12. Healthy life
expectancy among males (59.2 years) in
Liverpool is now greater than that for females
(59.1 years).
Male life expectancy increased by almost half a
year between 2009-11 and 2010-12, narrowing
the gap with female life expectancy. Although
ranked 7/8 among the core cities, the long term
trends show a narrowing of the gap in male life
expectancy with England.
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5.1.2 Areas for Improvement
Indicator
Potential Years of Life Lost
Narrative
(NHS Outcome ambition 1)
Liverpool currently has 7th highest rate in
core city CCG’s (/16) for Potential Years
of life Lost at 2,462 per 100,000 Direct
age Standardised Rate (DSR). The trend
is decreasing, however the target for
2014/15 is 2,384 per 100,000.
Indicator
Composite Avoidable
Emergency Admissions
The following schemes of work are aimed at
improving potential years of life lost:• Long Term Conditions management and
prescribing: Stroke/ CHD/ Diabetes / Atrial
Fibrillation (LTC)
• Exercise
• Smoking
Narrative
There are several work streams relating to the
management of long term conditions that are due
to impact on non-electives admissions between
14/15 and 18/19. Those that are due to impact in
14/15 are listed below with brief progress noted.
(NHS Outcome ambition 3)
Liverpool currently has the 6th highest
rate in core cities (/16) for Composite
Avoidable Emergency Admissions at
2,527 per 100,000 Direct age
Standardised Rate (DSR). The trend is
decreasing; however the target for the
end of 2014/15 is 2,332 per 100,000.
Local ‘year to date’ data (Apr-July 14)
shows Liverpool CCG is just slightly over
plan in delivering the composite
emergency admissions 14/15 target. The
year to date plan is 660.2 per 100,000
and the current performance is 662.3 per
100,000.
Four indicators make up the composite
avoidable admissions definition.
‘Conditions that are acute but avoidable’
is the indicator that is over performing.
•
•
Neighbourhood ‘Integrated Care’: The target
is to increase the number of people with a
coordinated health and social care plan to 800
by the end of 14/15. To date 467 people have
been referred into the model. This intervention
is anticipated to save 489 admissions over 5
years.
Other schemes include :o Cardiac rehabilitation,
o Pulmonary rehabilitation,
o Improved prevention and management
of strokes
o Improved management of Long Term
Conditions.
ACS admissions; children under 19 with epilepsy,
diabetes, asthma and LRTI are all performing to
plan.
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Indicator
Slope Index of Inequality
Narrative
The slope index of inequality measures
the gap in life expectancy between the
most deprived and least deprived areas
of the city.
Figures for 2010-12 show the gap in life
expectancy among males within Liverpool has
increased, with a 10 year difference between the
most deprived and least deprived areas. Although
high, this remains on a par with the core average.
Reducing inequalities across the city is a key
objective of the Healthy Liverpool Programme and
remains one of the CCG’s strategic objectives.
5.2 Prevention
5.2.1 Good Performance
Indicator
Smoking Quitters
Narrative
The percentage of smokers using the
smoking cessation service who are quit
at 4weeks has increased substantially,
from 43.8% to 51.3%. Liverpool is ranked
3rd among the core cities for successful
quitters.
Key deliverable for admissions
avoidance and potential years of life
lost indicators
Insight work is being commissioned to understand
local perceptions and use of e-cigarettes in the
city. The Tobacco Strategy aims to:
a) Promote systematic referral of all smokers to
the Stop Smoking Service, including people who
use e-cigarettes
b) Prohibit the use of e-cigarettes in all public
places where tobacco smoking is currently
prohibited
c) Support smoke free films activity through
referral to Liverpool City Council Licencing
Committee
d) Invest in the young people’s lobbying and
campaigning group to remove smoking in prewatershed programmes, particularly popular soap
operas
e) Invest in smoking prevention programmes for
children and young people
f) Enhance smoke free sports initiative for children
and young people
g) Continue to promote smoke free homes where
children are present, through Smoke Free
Families initiative
h) Offer smoke free homes within social housing
sector
i) Develop and implement local licencing scheme
for the sale of tobacco
j) Commission brief intervention training for all
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frontline, public sector staff in the city
5.2.2 Areas for Improvement
Indicator
Cancer Screening (Breast /
Bowel / Cervical)
There has been a fall in the coverage of
the 3 cancer screening programmes
compared to previous performance.
Coverage is below the core city average.
Reductions in 2013 have been seen both
locally and nationally.
Narrative
The Screening and Immunisation (NHS E) Area
Team launched a 2 year cancer screening plan in
September 2014 to improve cancer screening
performance across all programmes.
Cancer Screening has been identified as a priority
in each of the GP localities (Matchworks, Central,
North). These plans detail how primary care will
engage with patients to increase the uptake of
such screening programmes. Localities recognise
different parts of the city may be different and the
plans reflect this. Localities also plan to link with
different Voluntary Community and Social
Enterprise organisations in order to engage
patients in the uptake of screening.
5.3 Cancer
5.3.1 Good Performance
Indicator
Narrative
Liverpool Fights Lung Cancer is a campaign
Under 75 mortality from cancer
within the Healthy Liverpool programme. Currently
There has been a continued fall in the in its planning stage the campaign is looking to
rate, from 206.7 per 100,000 in 2009-11 target neighbourhoods with the worst lung cancer
to 203.4 per 100,000 in 2010-12, though outcomes. Giving out key prevention and survival
rates remain above the core city messages; using community health champions to
average. Since 2001-03 the mortality rate raises awareness and also offering early
detection of lung cancer to those most at risk via
has fallen by 10.8%.
CT scans. Funding decision expected Winter
2014.
Royal college of GP Cancer Audit: GP’s
undertaking a retrospective review of patients
diagnosed with cancer and undertake a lessons
learned to understand areas where they could
have identified symptoms sooner
Survivorship Initiative: To support those
diagnosed with cancer to access all the services
they need e.g. lifestyles; exercise for health etc.
and ensure equitable access across the city and
across tumour groups.
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5.4 Long Term Conditions
5.4.1 Good Performance
Indicator
Under 75 mortality for CVD
Narrative
Long Term Conditions
management/prescribing:
There has been a continued fall in the See LTC section below for indicators and
rate from 124.3 per 100,000 in 2009-11 schemes.
to 114.9 per 100,000 in 2010-12, though
rates remain above the core city
average. Since 2001-03 the mortality rate
has fallen by 42.9%.
% of CHD Patients prescribed a The rise in prescribing of statins for CHD patients
coincides with the high level of media interest in
statin
statin prescribing (following an article in the BMJ).
Whilst not the root cause, there is a possibility that
The % of CHD patients prescribed a
the media coverage has had a contributory effect
statin in August 2014 is 89.0% which
on prescribing levels.
above target of 88.8% and is an
improvement on 13/14 value of 85.5%
Key deliverable for admissions
avoidance and potential years of life
lost indicators
5.4.2 Areas for improvement
Indicator
Health Related Quality Of Life for
people with Long Term
Conditions
Narrative
A self-care strategy is being developed to
complement the new Integrated Diabetes (ID)
service. Key elements of the service includes joint
working between the Diabetes and Mental Health
groups to develop a mental health worker role
Liverpool currently benchmarks bottom of
that links in with both the IAPT and the ID service.
core cities for Health Related Quality Of
This self-care approach will be tested within the
Life for people with Long Term
new service and then rolled out across other LTC
Conditions at 65.3. The Target for 14/15
areas.
is 65.4.
NHS Outcome Ambition 2
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5.5. Healthy Ageing
5.5.1 Good Performance
Indicator
Permanent admissions to
residential and nursing care
homes, Aged 65+
Narrative
Better Care Fund Indicator
Performance improved from the previous
12 month period and Liverpool is
currently achieving the target. Overall
numbers reduced from 767 per 100,000
to 672.31 per 100,000 in the 12 months
to August 2014. This is mainly due to
reductions in Q1 2014/15 where only 114
new permanent admissions have been
recorded.
At a core city level the improvements seen have
been
significant,
this
has
somewhat
overshadowed the performance gains locally.
However, the impact of diversionary services such
as expanded reablement pathways and extra care
schemes rolled out in Q4 2013/14 should further
enhance the performance moving into 2014/15.
As part of the project plan for dementia the CCG
is currently testing a clean-up and review process
of coding in one practice. This follows a review of
evidence which showed an 8% rise in dementia
Better Care Fund Indicator
diagnosis rate following clean-up. If this testing
The diagnostic rate for dementia phase proves successful it will be rolled out
continued to rise to 60.0% in August across the city.
2014 following a substantial rise in
2013/14 (from a rate of 50% in 2012/13).
The August 2014 target is 60.6% the
March 2015 target is 64%.
Diagnosis rate for people with
dementia:
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5.5.2 Areas for Improvement
Indicator
Delay transfers of care from
hospital:
Narrative
Better Care Fund Indicator
The Bed-Days Delayed for transfers of
care from hospital increased in the first
quarter of 2014/15 to an average of 961
per month (2,884 in total for Q1) and an
increase from 2,550 in the previous
quarter. The target for the end of 2014/15
is 2,511. A total of 69% of the delayed
bed days in Q1 2014/15 are attributable
to NHS, 24% to Adult Social and 7%
jointly.
There has been a stark increase in the reported
number of delays in mental health transfers of
care; the main area of increase is associated with
mental health delays accounting for 38% of the
delayed bed days since April 2014. A joint review
of delayed transfers of care completed by Trust,
LA and CCG earlier in the resulted in a number of
recommendations to help improve the system.
Initially this has had positive results. Working
practices will be reviewed in line with these
recommendations to establish if the current
increase can be managed by different ways of
working. A working group has been set up to look
at bed occupancy rates which will incorporate
impacts on delayed transfers of care.
5.6 Children’s
5.6.1 Good Performance
Indicator
Emergency admissions for
Diabetes, epilepsy, asthma and
Lower Respiratory tract infection
Narrative
It is anticipated that the pilot for community
asthma provision will have an impact on children’s
emergency admissions for asthma by 2016/17
The CCG is rated as ‘Green for April-Jul
2014 against plan.
NHS Outcome ambition 3 (subindicator)
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5.7 Mental Health
5.7.1 Good Performance
Indicator
Proportion of adults in contact
with mental health services who
are living independently, with or
without support
Narrative
Recover following talking
therapies.
Performance in August was recorded as 38.5%
which is on trajectory to deliver the expected
target of 50% by March 2014/15
Performance improved from 60.8% to 67.4% in
August 2014. Significant gains have been made
over the last 2 years where performance at the
end of 2011/12 was 42.6%.
5.7.2 Areas for Improvement
Indicator
Proportion of people with severe
mental illness who have
received a list of physical
checks
Performance on this indicator has
reduced from 55.9% in April 2014 to
44.8% in August 2014.
6.
Narrative
Targets include the identification and treatment of
the physical health care needs of people with SMI
and LD (including the identification of serviceusers with an open episode of care to Mersey
Care who are not currently on primary care
registers but who need support with physical
health needs). Performance is reported through
Mersey Care CQPG. A community of practice
has been established as part of the CQUIN which
can discuss approaches to variations against
target reported via formal contract management
arrangements.
CCG QUALITY PREMIUMS
Appendix 3 provides a summary of performance against the Quality Premium,
although it should be noted that there is an overlap in a number of the items
shown in this dashboard and those in the CCG Corporate and Provider
Performance tables. Discussions are ongoing with between the CCG Business
Intelligence Team and the CSU to amend the Corporate Performance
Dashboard to reflect these changes.
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7.
NHS TRUST CLINICAL QUALITY AND NHS CONSTITUTIONAL
RIGHTS
In line with the recommendations of the National Quality Board (NQB) the
Quality, Safety and Outcomes Committee have established a Quality Early
Warning Dashboard. The purpose of this dashboard is to provide the CCG with
a system to identify any issues and risks relating to patient quality and safety;
particularly for those areas identified by the NQB as potential indicators of
quality and safety issues. The dashboard covers all NHS Trusts within the
Merseyside area and includes Risk Profiles for each organisation issued by the
Care Quality Commission (CQC) and Monitor Risk and Financial Ratings.
Where risks have been identified they will be actively managed through CCG
governance arrangements overseen by the Quality, Safety and Outcomes
Committee, Trust Clinical Quality and Performance Meetings and collaborative
commissioning arrangements with Merseyside CCGs.
7.1 Care Quality Commission and Monitor Warning/Issue Notices &
Inspections
7.1.1 Liverpool Women’s Hospital Trust CQC Update
The Care Quality Commission carried out an unannounced visit to the Trust on
30th September 2014 to assess whether the agreed actions had been taken to
meet essential standards which were considered to have been non-compliant
following the original inspection of 9th April 2014. The standards identified as
requiring improvement were:
• Staffing;
• Assessing and Monitoring the Quality of Service Provision, and;
• Complaints
The CQC reported that there had been significant improvements in the above
areas of non-compliance since the previous visit, particularly regarding
midwifery staffing levels. Although considerable improvements had been made
to risk management and quality systems within the Trust, there were further
improvements needed in terms of the management of serious incidents and
assurance of systemic learning from complaints and incidents. The Trust board
had dedicated time and resource to improve its risk management arrangements
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and the meaningful use of its Board Assurance Framework, although this work
had not yet been fully completed. The CQC found that the Trust’s overall
management of complaints had improved considerably since the previous
inspection, with evidence of publicised materials throughout the Trust premises
and signage identifying the location of the Patient Advice & Liaison Service. The
CQC has asked the Trust to forward a report by 19th November 2014 setting out
the action taken/planned to meet the standards.
7.2
Quality Risk Profiles
The Care Quality Commission is still in the process of transferring Mental Health
and Community Providers onto Intelligence Monitoring Reports in line with acute
providers. These reports are due to be published imminently but were not
available at the time of writing. An update will be provided to the Governing
Body regarding this item as and when the Intelligent Monitoring Reports have
been released.
7.3
Patient Safety
The CCG rigorously monitors all reported patient safety incidents across the
local health and has recently asked all commissioned healthcare providers to
complete an aggregated review of all Serious Incidents for presentation at each
Clinical Quality & Performance Group. Providers continue to report Serious
Incidents within appropriate timescales and evidence wider dissemination of
report findings and the impact of lessons learned.
The Providers for which Liverpool CCG has co-ordinating commissioner
responsibility for have reported 55 Serious Incidents in the month of September.
Out of the 55 incidents reported a total of 33 relate to Liverpool patients; the
dominant theme for this month being Grade 3 and Grade 4 Pressure Ulcers
(reported by Liverpool Community Health). The pressure ulcer work stream
continues to explore previously identified issues and the impact on patient care,
e.g. assessment skills; training; competence and staffing.
8.
CCG FINANCIAL POSITION
As at 30th September 2014 the CCG financial position showed a year to date
underspend of £306k. The total CCG allocation for the financial year 2014/15
has increased from the previous month by £5.4m to £757m.
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Appendix 2 – CORPORATE PERFORMANCE DASHBOARD – PROVIDER CATCHMENT
This comprises of £5.6m additional monies in relation to NPfIT as agreed with
NHS England and a reduction of £167k in relation to adjustments for Charge
Exempt Overseas Visitors. Total allocations for the year are £745.3m
programme allocation and £11.7m running cost allowance.
The operational financial plan for 2014/15 incorporates a planned surplus of
£14.9m. No significant issues affecting the achievement of the financial plan
have been identified in the year to date.
Rating Year to
Date
Area
Commentary
Balanced
Position
On track
Surplus
No significant issues
2% Non
recurrent
Investment
Running Cost
Allowance
8.
Rating –
31 March
2015
On track
Running Costs expected to be fully utilised
in 2014-15
SUMMARY
Where performance is at variance to plan action is underway with Trusts to
deliver corrective action to improve performance in 2014/15 with contractual
levers utilised to support improvements. These improvements are actively led
by CCG Clinicians.
Stephen Hendry
Senior Corporate Services Manager
(Performance & Operations)
Ian Davies
Head of Operations & Corporate Performance
4th November 2014
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APPENDIX 1
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Appendix 2
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Appendix 3 – Quality Premium
Indicator
Potential Years of Life Lost
Data
Period
Aug 14
Friends and Family Response RateInpatients
Sept 14
Friends and Family Response Rate A&E
Sept 14
Number of Cases of MRSA
YTD Sept
Number of Cases of C Difficile
YTD Sept
YTD Aug
A&E Waits > 4 Hours
YTD Sept
Ambulance Cat A 8 Minutes
YTD Sept
Achieving Target
Not Available
Below Target
Not Applicable
Liverpool Heart
& Chest NHS
Trust
Liverpool
Womens
Hospital
Royal Liverpool
& Broadgreen
* RTT Incomplete Pathways Provider data at Aug
Friends & Family : To earn this portion of the quality premium, there will need to be:
1) assurance that all relevant local providers of services commissioned by a CCG have delivered the nationally agreed rollout plan to the national timetable
2) an improvement in average FFT scores for acute inpatient care and A&E services between Q1 2013/14 and Q1 2014/15
for acute hospitals that serve a CCG’s population.
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Alder Hey NHS
Trust
Sept 14
Cancer - 2 Week Wait GP Referred
Significantly below Target
Aintree
University
Hospital Trust
N/A
Emergency Admissions Composite
RTT Incomplete Pathways < 18 Wks*
Liverpool CCG
Appendix 4
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160
HEALTHY LIVERPOOL PROGRAMME - LEADS BOARD
09 September 2014
Arthouse Square 3:30pm - 4:45pm
MINUTES
Members
Nadim Fazlani(NF)
Katherine Sheerin(KS)
Tom Jackson (TJ)
Maureen Williams(MW
Dave Antrobus (DA)
Maurice Smith(MS)
Simon Bowers(SB)
Janet Bliss(JB)
Rosie Kaur (RK)
Fiona Lemmens(FL)
Donal O’Donaghue(DOD)
Shamim Rose(SR)
Jim Cuthbert (JC)
Paula Finnerty(PF)
Jude Mahadanaarachchi(JM)
Moira Cain(MC)
Ray Guy (RG)
Cheryl Mould(CM)
Jane Lunt (JL)
Ian Davies(ID)
Derek Rothwell(DR)
Kim McNaught (KM)
Chair
Chief Officer
Chief Finance Officer
Deputy Chair/Lay Member GB Member
Lay Member – Engagement GB Member
GP Governing Body Member
GP Governing Body Member
GP Governing Body Member
GP Governing Body Member
GP Governing Body Member
Secondary Care Doctor
GP Governing Body Member
GP Governing Body Member
GP Governing Body Member
GP Governing Body Member
Practice Nurse – GB Member
Practice Manager (left the meeting at 16.20pm)
Head of Primary Care Quality & Improvement
Chief Nurse/Head of Quality
Head of Operations and Corporate Performance
Head of Contracts and Procurement
Deputy Chief Finance Officer
In Attendance
Carole Hill(CH)
Sue Lavell (SL)
Helen Murphy (HM)
Jenny Levy(JL)
Sara Dewar (SD)
Kate Holian (KH)
James Kirk (JKirk)
Lynne Hill (LH)
Head of Communications and Engagement
Programme Office Manager
Senior Projects Manager - RHBC
Locality Development Manager
Social Value & Engagement Manager
NHS Graduate Trainee
Corporate Culture
PA/Minute Taker
Apologies
Tony Woods (TW)
Maurice Smith (MS)
Head of Strategy and Outcomes
GP – Governing Body Member
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1
Welcome and Introductions
All were welcomed to the HLP Leads Board and Kate Holian, NHS Graduate Trainee
was introduced to the meeting.
2
Minutes from the meeting held on 12 August 2014
The minutes and the actions were agreed as a correct record from the 12th August
2014 Healthy Liverpool Programme Leads Board.
2a
Actions from the meeting held on 12 August 2014
All actions have been completed.
3
Branding Update
CH introduced James Kirk from Corporate Culture who delivered the presentation on
the visual identify for Healthy Liverpool. James Kirk presented and copies were
circulated of the 2 options:
Following the presentation comments from the HLP – Leads Board members were
as noted follows:
• MW was unsure of the use of the word “future”.
CH stated that this was
indicative text and will not be part of the final presentation and it is more on
the overall look and feel of the branding document. The language will be
looked at next phase of the branding.
• MW stated that we need to move away from the advice on healthy eating.
• MC commented that she preferred the people approach, i.e. real people, local
GPs
• SR was not keen on the “peg” people.
• JB stated she prefers route one.
• ID stated his concern on the reprographics of the document as the colours will
not be as clear when producing copies.
• James Kirk commented that he will be able to review the colours and make
necessary changes without compromise.
• SB liked the “peg” people, but the document needs to signify what the “peg”
people represent.
• James Kirk commented that he took a deliberate approach on not using the
“Liverpool logo”
• JC likes the simplicity in the first option and the idea of linking in with real
people from the city.
• James Kirk stated that linking in with real people will be a bit further down the
branding design.
• CH confirmed there will be another brief aligned for this element of the launch
2
162
•
•
•
•
•
•
•
•
•
FL asked if we are putting photographs in the boxes. James Kirk confirmed
that this will be utilised for photos of people.
FL commented that she would like it to be real people from Liverpool and
subtle images from the city.
DOD supported the comments and that real people from around the city is a
good idea and would be a powerful image. Although, getting people to sign
up to this may prove very difficult. We have to be able to take on board what
people say to us.
JM found the presentation to be bright and catching and asked if there is an
audio and soundtrack to add to it. CH confirmed that this will be part of the
next stage.
SD stated that she thought both have strong elements in them and likes
elements from both. SD commented from past experience with regard to the
photography there is a lot of effort to go in to get local people involved.
However there is plenty of potential.
MW stated that she though it was positive and much better than the Q&A
sessions.
CH confirmed that the presentations will be shown to staff on Friday at the
CCG Floor meeting. Focus groups will have feedback by then and this will
also be presented. Should be ready to design the blueprint by in 2 weeks.
CM asked if it would be appropriate for locality leaders to see the
presentations.
PF thought this was a good idea and requested if they could show the
brochures to GP staff and GP partners.
 Action: CH to circulate the presentation to GP staff and partners and all
feedback to be sent back to CH by next Friday
4
Governance/Committee(s) in Common
KS reminded the HLP leads Board on governance structures and decision making
and has designed a proposal to have a joint decision making group involving the
Liverpool, South Sefton and Knowsley CCGs and NHS(England). A paper will be
presented to the other CCG Governing Body meetings and includes the Terms of
Reference (TOR) and how Committee(s) in Common would operate in practice. The
following comments were noted;
DA highlighted his concerns on the timescale for making the decisions if they have to
go back to each CCG and any delays this may cause.
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163
KS stated that we have looked at the Manchester Healthy Together version and
agreed that the Committee would only be receiving the strategic decisions that would
go back to the respective GB meetings.
MW stated that she was not unduly
concerned on the timescales as cannot see anything decisions being made on a
strategic level that would require an issue with a decision.
It was suggested that we need to have 3 names from each CCG with one alternative
named person for each and the quorate should be 6 voting members and 1 each
from CCGs and 1 from NHSE.
FL highlighted her concern on the quoracy with the number of members from each
CCG. MW suggested that if the quoracy is not met and CCGs did not engage, then
agreement should be that the decision is carried forward to the HLP Leads Board
who could decide that the issue is returned for further discussion and deliberation.
KS is preparing the paper for submission to the CCGs Governing Body meeting and
stressed that invitations to the subgroups (i.e. RBHC) are included in the paper. MW
stressed her concern with regard to the majority decision making and voting and if it
should include 1 member from each CCG. ID stated that it should be made clear
that co-opted member are non-voting members and that the Chair of the
Committee(s) in Common should be a LCCG rep and one must be a clinician.
ID suggested that the TOR include that the minutes from the Committee(s) in
Common are presented to the following Liverpool Clinical Commissioning Board.
Paper to include the review of 3-6 months in view of assurance process and
working/operational aspects.
 Action: KS to make appropriate changes to the Committee(s) in
Common paper and this will be presented to the Formal Governing Body
in October 2014.
5
Engagement Activities Update
Carole Hill (CH) updated the Board on the Engagement activities and stated that 4
focus groups/engagement events for patients are occurring over the next 4 weeks
and Sara Dewar was leading on these. Additional meeting dates for engagement
activities include:
 MP meetings during September and early October 2014
 Select Committee on 30 September 2014
 NHSE Assurance meeting on 1 October 2014
 Mayoral Summit on 3 November 2014
4
164
CH confirmed that the prospectus (Blueprint) will be sent out for comments and
currently working on what the engagement will look like over the winter across the
City, which links in to the investment we have approved today. We would need to
stop at least 6 weeks before the election process, it could be slightly more. So need
to plan to finish in March 2015. The Formal Consultation will then follow.
6
HLP Document Update
TJ stated that Phase 2 of the programme will finish in October and then next phase
will be the “discussion phase 2” will commence after that.
A “blueprint” or
discussion document “Building a Healthy Future” is being produced. The document
will go beyond aspirations and envisage sign-off a first draft at the Governing Body
development session on 24 September and will be circulated next week for
comments within a week. The final version will be signed off on 14th October 2014 at
the Governing Body meeting.
7
GB Development Session 24th September 2014
KS stated that this will include the “Blueprint/prospectus” and spend time on what
this all means and a more practical event rather than
 Organisation Models i.e. primary care,
 Role as a CCG to facilitate changes
 Risks
 What are the next 6 – 12 months look like
 Learning from Manchester.
 How to do things better.
 Communication/engagement
 Co-location of services, clinical arguments
 Reflections on the blueprint
8
HLP Risk Register
DR reported on the Risk Register as follows:
HLP 03
Most recruitment has taken place therefore risk is reducing for HLP.
HLP05
Other organisations involved in the HLP meetings and all activities being planned
and in diaries with MPs, LCC, engagement events.
HLP08
TDA along with NHSE are involved with the 4 steps on assurance processes. Will
be processing the steps and incorporating action plans and will be evidence based.
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165
HLP09
Workforce requirements being identified and currently working with colleagues in
provider organisation.
PF asked what has happened with the NHSE Workforce information. NF stated that
they are still working on this but was presented at a WGE meeting earlier today.
All above are summarised in the main Corporate Risk Register and will be updated
on a regular basis.
 Action: ID/DR Risk Registers to be presented quarterly (Dec, March,
June, Sept)
9
Any Other Business
Nothing further discussed.
Date of Next Meeting
Tuesday 14th October 2014 4:30pm – 6:30pm (immediately after the Governing
Body).
6
166
NHS LIVERPOOL CLINICAL COMMISSIONING GROUP QUALITY
SAFETY & OUTCOMES COMMITTEE
Minutes of meeting held on Tuesday 19th August 2014 at 3pm
Room 2 4th Floor Arthouse Square
Present
Dave Antrobus (DA)
Shamim Rose (SR)
Rosie Kaur (RK)
In attendance
Mavis Morgan (MM)
Kellie Connor (KC)
Denise Roberts (DR)
Tracy Forshaw (TF)
Esther Golby (EG)
Paula Parvulescu (PP)
Paula Jones
Chair/Lay Member
GP Governing Body Member
GP Governing Body Member
Healthwatch Volunteer
Clinical Quality & Performance Manager
Clinical Quality & Safety Manager
Deputy Head of Adult Safeguarding Safeguarding Team
Deputy Designated Nurse Safeguarding
Children – Safeguarding Team
Consultant in Public Health Medicine,
Liverpool City Council
PA/Minute taker
Apologies
Katherine Sheerin (KS)
Fiona Lemmens (FL)
Jane Lunt (JL)
Helen Smith (HS)
Chief Officer
GP Governing Body Member
Head of Quality/Chief Nurse
Head of Safeguarding Adults – Safeguarding
Team
Kath Moore (KM)
Deputy Medical Director NHS England Area
Team
Simon Bowers (SB)
GP - Vice Chair/Governing Body Member
Donal O’Donoghue (D’OD) Secondary Care Consultant
Tony Woods (TW)
Head of Strategy & Outcomes
Cheryl Mould (CM)
Head of Primary Care Quality & Improvement
1.
WELCOME & INTRODUCTIONS
The Chair welcomed everyone to the meeting and introductions were
made. It was noted that the meeting was not quorate.
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2.
DECLARATIONS OF INTEREST
None were made.
3.
MINUTES AND ACTIONS FROM 4th June 2014
The minutes from the meeting held on 4th June 2014 were approved
as an accurate record of the discussions which had taken place,
subject to the following amendments:
• Page 1 – Margi Daw was in attendance not Margi Dawes.
• Page 2 - the reference should be to Rosie Kaur not Rose Kaur.
It was noted by the Chair that the committee were to continue to
receive the action points on a separate sheet.
Matters Arising and Action Points not already on the agenda.
There were no actions or matter arising which were not already on the
agenda.
4.
NHS TRUST CONTRACT QUALITY REPORT - EARLY WARNING
DASHBOARD – REPORT NO: QSOC 22-14
KC presented the paper to the Quality Safety & Outcomes Committee
which reported on the key aspects of the CCG’s performance in the
delivery of quality, safety and clinical effectiveness performance
targets for the year 2013/14. She highlighted:
• Healthcare Acquired Infections: DR noted that the cases of C
Difficile were increasing, the process has now changed as
previously reported and a Post Infection Review is required to
be undertaken within 14 days. The PIR documentation should
then be submitted to the CCG for review to identify if any lapses
in care have taken place An MRSA case assigned to RLBUHT
in June was considered to have no lapses in care and was
forwarded to NHSE North for potential 3rd Party assignment.
Each Post Infection Review requires the completion of an action
plan should there be lapses in care. KC noted that the process
was the same for MRSA detected via pre-operative
assessments (but the commissioning clinician would be
included in the Post Infection Review, as MRSA identified from
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a community not acute trust source was still attributable to the
CCG. DA noted that the figures in the table on page 3 did not
add up as other trusts were included in the target for Liverpool
CCG as they included other CCG’s.
• Mixed Sex Accommodation: there had been no issues over the
previous two years but now there was an issue over bed
capacity at the Coronary Care Unit and High Dependency Unit
which the Care Quality Commission had highlighted at the
Royal Liverpool Hospital for improvement. JL/KC were
attending a “walk round” at the Royal Liverpool Hospital at the
end of August to understand what was happening.
• Care Quality Commission: KC gave an update on:
o the Liverpool Women’s Hospital inspection. An
unannounced visit had taken place outside of working
hours, improvement had been found in some areas but
there were still issues around Risk Management,
Governance and Complaints. Staffing levels had
improved. A follow up Quality Review meeting with the
Trust is planned for the 11th September 2014 to pick up
the issues of risk and governance. Enforcement Actions
had been given to the trust on Staffing Issues and
Assessing Quality of Care to patients. Previously the
issue identified was concerning Serious Incident
reporting/follow up but now the issue concerned lower
level incidents and lack of follow up and process.
o Liverpool Community Health – the Care Quality
Commission report had not been available at the time the
paper was prepared but had now been received. An
improvement/action plan had been prepared addressing
the issues which would go to their board and then
ultimately the Liverpool CCG Governing Body.
• Patient Safety/Serious Incidents: DR referred to the table on
page 10 of the report. There had been 4 incidents at the Royal
Liverpool Hospital in June (2 were unexpected deaths). An
issue has been identified concerning the delays in the transfer
of patients to the Royal who had received cold surgery at the
Broadgreen site. Of the 4 incidents reported from Alder Hey, 2
were for the deaths of children for whom Alder Hey was not
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169
responsible for the care- it was due to their provision of
morturary services..
•
Friends & Family Test: KC noted that this was a national
CQUIN and had now been extended to Primary Care and
Children’s and Young People. The Royal and Aintree had not
met their targets in the areas of A&E and In patient but was now
improving in A&E. DA noted that patients did not understand
what the survey meant, MM suggested calling it a patient
satisfaction survey.
The Quality Safety & Outcomes Committee also discussed screening
for dementia and VTE Assessment rates given the fact that the
population for VTE was larger than for dementia but the VTE target
was achieved that the dementia target was not. KC noted that it was
better to screen patients prior to discharge rather than with the first
72 hours re dementia in order not to confuse distress over
circumstances with lack of cognitive function.
The Quality Safety & Outcomes Committee:

5.
Noted the performance of the CCG in delivery of key
national performance indicators and the recovery actions
taken to improve performance.
BRIEFING REPORT – SAFER STAFFING - REPORT NO: QSOC
23-14
KC presented a paper to the Quality Safety & Outcomes Committee
to inform it of the new requirement for reporting and publishing
nurse/midwife and care staffing levels to the public. This year
organisations were required to publish the following indicators on the
NHS Choices website:
•
•
•
•
•
•
•
Infection control and cleanliness
Compliance against CQC Standards
Staff recommendation
Safe Staffing
VTE Assessment
Compliance against Patient Safety Alert Notices
Open and Honest Reporting.
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It was also recommended that a six monthly report should be sent to
the Board on staffing levels. Commissioners needed to be assured
that the information was published and fitted into the organisational
plans. There were issues around the publication of out of date
information which did not reflect the progresses made.
The Quality Safety & Outcomes Committee commented:
• Would the use of the bank staff be published? KC noted that it
was not a national CQUIN but Trusts were reporting this.
• Was “staff sickness” subdivided into “normal” and “stressrelated”? KC noted that again this was not a national CQUIN
and was not required.
The Quality Safety & Outcomes Committee:


6.
Noted the requirements contained within the report for
Providers reporting and publishing nursing and midwifery
staffing levels to the public.
Noted the National Quality Expectations for Providers and
Commissioners
SAFEGUARDING SERVICE UPDATE REPORT– REPORT NO:
QSOC 24-14
TF provided an update on key activity over the last quarter for both
adults and children and outlined activity and key issues currently
being addressed in order to raise awareness of current and emerging
themes for both safeguarding children and adults.
Appendix 1 contained Red Amber Green rating of provider evidence:
Alder Hey were rated amber for safeguarding assurance for children.
KC raised the issue of transition from child to adult which affected
around 20 patients and some might have mental health issues so
were more vulnerable
Both Liverpool Community Health and Liverpool Women’s Hospital
were rag-rated Red due to the non-receipt of information for quarter
4. Liverpool Community Health were in discussion re: their
feedback. Within the organisation itself safeguarding concerns would
be reported internally to their own Safeguarding Team.
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DA raised the issue of Serious Incident Reporting in residential care.
DR confirmed that if an incident was reported on StEIS then it also
needed to be reported to the Safeguarding function for the provider
organisation.
Mersey Care was rag-rated amber, the Royal Liverpool Hospital had
provided reasonable assurance with regards to adults but there were
issues around children’s safeguarding.
Feedback had been given to the providers and new KPIs would be
set via a provider event in July. The end of year analysis for each
provider would be presented to the NHS England September 2014
Quality Surveillance Group meeting.
The Safeguarding Team also mentioned in the report:
• Mental Capacity Act/Deprivation of Liberty Safeguards
(MCA/DOLS)
• Care Quality Commission Inspections Update: contained in
section 8 of the report, including an update on the work being
undertaken to prepare for the inspection.
• Safeguarding children training
• Local Safeguarding Children Board Health Sub-Group – this
was chaired by the Liverpool CCG Head of Quality/Chief Nurse
(JL).
• Child Sexual Exploitation (Appendix 3).
• Learning from Serious Case Reviews: there were two Serious
Case Reviews and two Critical Case Reviews. There had been
a meeting in June to go through the recommendations both for
learning and to identify themes. These had not yet been
formally accepted but were outlined in the paper. It was
highlighted that some of the reviews had been spread out over
a long period of time and therefore many of the issues identified
had already been dealt with and actions implemented, for
example the use of the Common Assessment Framework tool.
The Safeguarding Team agreed to pull together a paper for the next
Quality Safety & Outcomes Committee which detailed the
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commissioning actions once the formal presentation had been made
to Dr Simon Bowers.
The Quality Safety & Outcomes Committee:
 Noted the contents of the paper.
 Noted that a paper would be brought to the next Quality
Safety & Outcomes Committee which detailed the
commissioning actions once the formal presentation had
been made to Dr Simon Bowers.
7.
LIVERPOOL COMMUNITY HEALTH QUALITY REVIEW/CARE
QUALITY COMMISSION INSPECTION UPDATE - VERBAL
On behalf of JL, DR gave a verbal update on Liverpool Community
Health Quality Review/Care Quality Commission (‘CQC’) inspection.
A follow up visit had taken place in May and the results had just been
published:
• The areas which required improvement were concerning
services being safe, effective, responsive and well-led. The
Trust had been marked as good for caring services.
• Liverpool Community Health was providing assurance to the
CQC that it was slowly but steadily improving. It was in the
process of recruiting100 additional staff.
• Future reports would be brought to the Quality Safety &
Outcomes Committee as this was a work in progress.
The Quality Safety & Outcomes Committee:

8.
Noted the verbal update and looked forward to receiving
updates in due course.
LIVERPOOL CLINICAL LABORATORES AINTREE BASED
PATHOLOGY SYSTEM ISSUES – REPORT NO: QSOC 25-14
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173
DR presented a paper to the Quality Safety & Outcomes Committee
to give an update on the issues concerning Liverpool Clinical
Laboratories and the potential impact on Liverpool patients to ensure
that the Committee was fully aware of the key risks identified and
mitigating actions in place to address current and potential future
issues.
There were four issues identified, three of which applied to Liverpool
Patients:
• Issue 1- some results had not been seen at the laboratory at
Aintree and were therefore not returned to practices. All 48
missing results had been found and returned.
• Issue 2 – non-receipt of results on GP practice IT systems.
This involved a larger investigation as detailed analysis showed
a total of 1,354 GP results unreported.
• Issue 3 – EMIS web related non availability of a small number
of results on GP IT systems. Results had been sent in bundle
form to practices and had remained bundled together. A
scoping exercise was being carried out to determine potential
impact of the issue. Clinisys were continuing to try to identify
the cause.
NHS England was working with the 3 CCGS involved to ort practices.
The difficulty was having assurance around “knowing what we did not
know” but every step was being taken to ensure that the issues were
fully investigated and avoid re-occurrence. In response to a query
from PP DR confirmed that there were no issues of breach of patient
confidentiality. The long term aim was to move all GP testing
permanently to the Royal but first the capacity at the Royal to process
the additional workload needed to be assessed which would probably
take 3 months.
In response to a query from DA it was noted that Liverpool Clinical
Laboratories had developed from the QIPP process/programmes. It
was agreed that this matter would be brought back to the next
meeting.
The Quality Safety & Outcomes Committee:

Noted the content of the report.
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174



9.
Gave endorsement to proceed as per plan.
Noted the broader risks identified as a result of this
incident and the steps being taken to mitigate them.
Noted that an update would be brought back to the next
meeting.
OVERVIEW OF CURRENT QUALITY ISSUES AT RLBUHT –
REPORT NO: QSOC 26-14
KC presented a paper to the Quality Safety & Outcomes Committee
to update on the current issues and proposed action to secure
improvements in quality at the Royal Liverpool and Broadgreen
University Hospitals. The Trust was a pilot for the new Care Quality
Commission Scheme and had received good responses overall but
improvement was required in:
• Bed capacity in Coronary Care and High Dependence Units
• Infection Control A&E
• Pharmacy services not 24/7 therefore delays in discharge due
to medications required.
• Delays caused by bed transfers.
• Risk Management.
These issues were:
• 4 hour A&E Wait – remedial action plan was in place,
performance was improving but still a challenge.
• Referral to Treatment- had been achieved overall but not by
each Speciality. Four Hour Operating Standard achieved in
days but failed for a number of quarters.
• 52 Week Wait/Diagnostic Testing – staffing levels increased
and new equipment purchased to be operational from
September 2014.
• Single Item Quality Surveillance Group held last week called by
NHS England and there would now be a follow up meeting
involving the provider. Improvement had been made in all the
areas over the last few weeks but theses needed to be
sustained going forward.
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DA noted the issue of additional winter pressures support and
highlighted that Aintree Hospital had received substantial winter
monies from central government due to previous underperformance
whereas the Royal had not as it had historically hit the A&E targets
and was now struggling. This was also the case with the setting of C
Diff targets for the two trusts, as the Royal had performed well its
target was set higher than for Aintree. It was noted that this should
be flagged up as a risk factor.
The Quality Safety & Outcomes Committee:


10.
Noted the quality issues at RLBUHT.
Noted the proposed action to secure improvements in
quality at the Trust.
LIVERPOOL CCG POLICY FOR THE PERFORMANCE
MANAGEMENT OF SERIOUS INCIDENTS/NEVER EVENTS –
REPORT NO: QSOC 27-14
DR presented a paper to the Quality Safety & Outcomes Committee
to present the draft CCG Policy for the Performance Management of
Serious Incidents/Never Events for approval. As the meeting was
not quorate the Quality Safety & Outcomes Committee was unable to
approve the Policy. The Policy was therefore approved in principle
subject to ratification by a quorate group of members either virtual or
real. It was also noted that the language used in the policy was an
excellent of use of plain, easily understandable English and was to be
commended.
The Quality Safety & Outcomes Committee:


11.
Noted the content of the Policy.
Gave approval to the policy in principle and agreed the
reporting process contained within subject to ratification
by a quorate group of members.
REVISION OF TERMS OF REFERENCE – REPORT NO: QSOC 2814
DR presented an updated version of the Terms of Reference for the
Quality Safety & Outcomes Committee for approval. She noted that
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176
the changes were minimal. In response to a query from PP it was
noted that approval of IVF/Procedures of Lower Clinical Priority
Policy revisions was not the role of this committee.
The Quality Safety & Outcomes Committee:


12.
Noted the reviewed Terms of Reference.
Adopted the reviewed Terms of Reference subject to
ratification by a quorate group of members.
RISK REGISTER - REPORT NO: QSOC 29-14
The Quality Safety & Outcomes Committee reviewed the risk register
and agreed the following additions to be made:
1. More explanation to be given on right hand side of the register
on red risks as 16 out of 25 scoring and above raised real
concerns and evidence of progress was required.
2. From Safeguarding – lack of progress on Common Assessment
Framework and the impact of Mental Capacity Act/Deprivation of
Liberty Safeguards on provider organisations.
3. Concerns over lack of monitor of quality of care in nursing
homes.
The Quality Safety & Outcomes Committee:

13.
Noted the content of the Risk Register and on-going
actions against medium and high risk areas.
ANY OTHER BUSINESS
There were no items of any other business.
14.
DATE AND TIME OF NEXT MEETING
Tuesday 21st October 2014 – 3pm to 5pm
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178
MINUTES OF THE APPROVALS PANEL
Tuesday, 7 October 2014
1.30 – 2.30 pm - Meeting Room 1, 4th Floor, Arthouse Square
Present:
Dave Antrobus (chair)
Katherine Sheerin
Jane Lunt
(DA)
(KS)
(JL)
Lay Member/Governing
Chief Officer
Head of Quality/Chief Nurse
In attendance:
Cheryl Mould
Colette Morris
Michelle Urwin
Kate Holian
Carol Hughes
(CMo)
(CM)
(MU)
(KH)
(CH)
Head of Primary Care Quality and Improvement
Locality Development Manager - Central
Transformational Change Manager – Dementia
NHS Management Trainee (observing)
PA/Minute Taker
1
Welcome and Apologies:
The Chair (MW) welcomed everyone to the meeting and apologies were noted from:
Professor’ Maureen Williams and Professor Donal O’Donoghue.
2
Minutes from the previous meetings:
Subject to the following amendment:
Page 3 – Para 4 from top:
to change ‘physical issue’ to ‘physical capacity’
The minutes of the meeting held on 30 September 2014 were agreed as a true and
accurate record
3
Healthy Ageing Scheme:
3a
Review of risks on bids approved to date:
Michelle Urwin (MU) confirmed that 63 bids out of 67 submissions had been
approved to date giving a total of 72% of the 93 practices.
This equated to 76% of population aged 75+ covered by the submissions and
including those under query, with a £1.351m budget currently approved.
MU confirmed that the 2 bids presented today were queried at the last Approvals
Panel and totalled £56,820
In addition, a number of social isolation bids had been put together which will be
reviewed with Sarah Dewar as agreed by the Approvals Panel in line with the Grant
Approvals Process.
MU advised that the Village Medical Centre were considering employing a
1
179
Pharmacist to undertake medication reviews on a neighbourhood basis and should
have applied for CGA reviews, however, due to misinterpretation of the paperwork
they will also now have to apply for medication reviews. MU asked the panel if they
would consider this and if agreed they will submit a request. This was agreed.
3b
Review of Bids:
Grey Road Surgery: Notional Budget £28,505 Cost of bid £17,390
148 GAs and follow ups
3 anticipatory care plans
23 comprehensive medical reviews
AGREED
Sefton Park Medical Centre: Notional Budget £38,665 Cost of Bid £29,700
200 Gas and 150 follow ups
5 anticipatory care plans
300 comprehensive medical reviews
AGREED
Risks for both practices have been considered and no issues anticipated.
MU advised that a further bid had been received following the 19 September
deadline and asked if bids after that date could still be accepted.
DA commented that they should be considered if they were seen to give quality to
patients aged 75 and over.
TJ queried whether other practices had not previously submitted. In response MU
advised that practices who had not previously submitted had asked if bids could be
submitted after the deadline.
Following discussion it was agreed that a letter would be sent to practices who had
not submitted bids inviting them to submit by the end of October, support will be
offered to practices.
4
Winter Resilience Scheme:
4a
Winter Schemes Application Summary:
CM confirmed that of the 76 submissions received to date, 6 were approved at the
previous meeting, 29 were submitted for approval today and the remaining 41 under
query will be submitted to panel for approval at the next meeting.
Seventeen practices who had not submitted have been contacted. It was noted that
these practices were an even spread across the localities.
4b
Review of Risks on bids approved to date:
CM advised that the 6 practices whose bids were approved at the previous meeting
had been assessed to look at vacancies, staff levels, resource issues and
performance around the GP specification and an issue highlighted was that
Grassendale Medical Centre though having the resources, does have newly
qualified GPs.
TJ queried the 21 week period and in response CM advised that his was from the
2
180
1 November 2014 to 31 March 2015.
KS queried whether there was a danger that after 31 March additional appointments
would decline. In response CM advised that this is not envisaged due to demand
being met.
TJ queried whether the additional sessions being offered could be delivered and if
so by whom?
CM advised that this information had not been requested up front
but information will be provided through the invoicing and assessment process.
Princes Park Practice CMo advised that they had now recruited 3 more regular
Locums and had increased their GP workforce to 5.
Belle Vale: It was highlighted that 2 GPs will leave the practice on 1 December.
The recruitment process has started and the practice is confident that posts will be
filled. If posts are not filled then Locums will be used to deliver additional sessions.
Yew Tree: A new Partner and administration staff have been employed.
4c
Review of Bids:
Details of 29 proposed bids were submitted by CM (see Appendix 1) which equated
to 128.78 additional sessions per week at a total cost of £789,714 and following
discussion by the panel this was APPROVED.
Risks identified were highlighted:
Ellergreen Medical Centre: CM advised that additional sessions are unable to start
until a new salaried GP is recruited commencing January 2015 and asked in terms
of consistency whether this was acceptable. CM also highlighted that the total cost
identified was reduced to reflect 13 weeks and not 21.
DA requested that this information should be included on the summary document.
CM to include on future summary sheet.
CMo highlighted that some practices had not submitted bids as they felt they could
not commit to 21 weeks.
5
Following discussion it was agreed that practices who had not submitted would be
contacted to check if they would like to submit a bid and if they were unable to
commit for 21 weeks to indicate a date when additional sessions could be provided.
Any other business:
The panel queried how practices would publicise the additional sessions provided.
CM confirmed that of the 6 bids approved at the previous panel 3 practices had
responded and confirmed that sessions would be publicised by:
•
•
•
•
Display in practices
On practice websites
Leaflets in practices
Included on reverse of scripts
3
181
•
•
Shared with PPG
On screen in practices
Once all bids had been approved information of additional sessions and extra
capacity would be provided to Carole Hill to consider for inclusion in the ‘Examine
your Options’ campaign.
CM queried the intention to include age profiles and it was agreed that due to the
complexity of collating this information this would not be included.
TJ asked CM to provide total figures for current commission sessions and additional
sessions provided.
SSP:
MU advised that a query had been received from SSP requesting that a Geriatric
Consultant could be employed to undertake geriatric assessments.
JL noted that this may give a different outcome if looking from a secondary care
perspective. This was agreed but SSP would manage outcomes and risks.
6
Date of next meeting:
Wednesday, 15 October 2014
11.15 – 12.15
Meeting Room 1
Arthouse Square
4
182
Enhancing access to primary care – winter scheme 2014/15
Approvals Panel – 7 October 2014
Ref
Practice
7
Aintree
Park Group
Practice
8
Breeze Hill
SSP
9
Dingle Park
Practice
Weighted
population
(June 14)
To deliver
GP spec
minimum
70 per
1000
weighted
pop
Current
number
of appts
delivered
Additional
capacity to
be
provided
(75 or
80/1000)
per week
Additional
number of
sessions
per week
@ £300 per
session
Cost
per
week
Total
cost for
21
weeks
Verified
by
team
10
£3,000
£63,000
Yes
1.5
£450
£9,450
Yes
3.66
£1,098
£23,058
Yes
7
£2,100
£44,100
Yes
80 = 1199
15275
1049
1232
(extra 150
appts)
80 = 183
2278
160
160
(extra 23
appts)
80 = 441
5513
386
686
(extra 55
appts)
80 = 848
10
Edge Hill
HC
10602
742
1000
(extra 106
appts)
5
183
Risks
Identified
Weighted
population
(June 14)
To deliver
GP spec
minimum
70 per
1000
weighted
pop
Additional
capacity to
be
provided
(75 or
80/1000)
per week
Additional
number of
sessions
per week
@ £300 per
session
Cost
per
week
Total
cost for
21
weeks
Verified
by
team
3.9
£1,170
£24,570
Yes
244
80 = 279
(extra 35
appts)
2.3
£690
£14,490
yes
2.3
£690
£14,490
yes
Current
number
of appts
delivered
Ref
Practice
11
Everton
Road SSP
12
Fiveways
Family HC
SSP
13
Garston
Urban SSP
3354
235
235
80 = 269
(extra 34
appts)
14
Great
Homer
Street
2510
226
250
80 = 258
(extra 32
appts)
2
£600
£12,600
yes
15
Kensington
Park SSP
368
80 = 421
(extra 53
appts)
3.5
£1,050
£22,050
yes
80 = 464
5797
3478
5251
406
244
368
406
(extra 58
appts)
6
184
Risks
Identified
To deliver
GP spec
minimum
70 per
1000
weighted
pop
600
Current
number
of appts
delivered
Additional
capacity to
be
provided
(75 or
80/1000)
per week
Additional
number of
sessions
per week
@ £300 per
session
Cost
per
week
Total
cost for
21
weeks
Verified
by
team
709
80 = 686
(extra 86
appts)
6
£1,800
£37,800
yes
370
80 = 423
(extra 53
appts)
3.5
£1,050
£22,050
yes
3.4
£1,020
£21,420
yes
2.5
£750
£15,750
yes
Ref
Practice
Weighted
population
(June 14)
16
Long Lane
MC
8575
17
Marybone
HC SSP
18
Netherley
HC SSP
5122
359
359
80 = 410
(extra 51
appts)
19
Park View
SSP
3797
266
266
80 = 304
(extra 38
appts)
20
Princes
Park SSP
5284
8440
370
591
591
80 = 676
(extra 85
appts)
7
185
5.7
£1,710
£35,910
yes
Risks
Identified
SSP Practice,
recent
changes in
GP staffing
and new PM.
To deliver
GP spec
minimum
70 per
1000
weighted
pop
168
Current
number
of appts
delivered
Additional
capacity to
be
provided
(75 or
80/1000)
per week
Additional
number of
sessions
per week
@ £300 per
session
Cost
per
week
Total
cost for
21
weeks
Verified
by
team
168
80 = 192
(extra 24
appts)
1.6
£480
£10,080
yes
603
80 = 678
(extra 75
appts)
5
£1,500
£31,500
yes
2.8
£840
£17,640
yes
Ref
Practice
Weighted
population
(June 14)
21
Robson
Street SSP
2389
22
Sefton
Park MC
23
Stanley
Road SSP
4222
296
296
80 = 338
(extra 42
appts)
24
Storrssale
MC
2756
193
200
80 = 221
(extra 28
appts)
2
£600
£12,600
yes
25
The Elms
MC
768
80 = 780
(extra 97
appts)
6.5
£1,950
£40,950
yes
576
80 = 647
(extra 82
appts)
5.5
£1,650
£34,650
yes
26
Valley MC
8479
9760
565
594
683
576
8
186
Risks
Identified
Ref
Practice
Weighted
population
(June 14)
27
West
Speke SSP
2056
28
29
Belle Vale
HC
Yew Tree
Centre
8285
4333
To deliver
GP spec
minimum
70 per
1000
weighted
pop
144
580
303
Current
number
of appts
delivered
Additional
capacity to
be
provided
(75 or
80/1000)
per week
Additional
number of
sessions
per week
@ £300 per
session
Cost
per
week
Total
cost for
21
weeks
Verified
by
team
144
80 = 165
(extra 21
appts)
1.4
£420
£8,820
yes
797
303
80 = 663
(extra 83
appts)
80 = 347
(extra 43
appts)
9
187
5.5
2.89
£1,650
£867
£34,650
£18,207
Risks
Identified
yes
2 x GP
Partner
leaving end
Nov. Practice
started
recruitment
and will
secure locums
to deliver
extra sessions
yes
Practice
stretched.
New partner
in post 1/9/14
however they
are dedicated
and will
Ref
Practice
Weighted
population
(June 14)
To deliver
GP spec
minimum
70 per
1000
weighted
pop
Current
number
of appts
delivered
Additional
capacity to
be
provided
(75 or
80/1000)
per week
Additional
number of
sessions
per week
@ £300 per
session
Cost
per
week
Total
cost for
21
weeks
Verified
by
team
Risks
Identified
deliver
30
Knotty Ash
MC
2592
181
31
Grey Road
Surgery
6194
434
32
Fir Tree
MC
33
Ellergreen
MC
3982
13510
278
946
182
80 = 207
(extra 26
appts)
1.73
£519
£10,899
yes
458
80 = 496
(extra 62
appts)
4.13
£1,239
£26,019
yes
278
80 = 318
(extra 40
appts)
2.62
£786
£16,506
yes
946
80=1081
(extra 135
appts)
10
188
9
£2,700
£35,100
yes
Practice
unable to start
extra capacity
until 5/1/15
when new GP
recruited to
Ref
Practice
Weighted
population
(June 14)
To deliver
GP spec
minimum
70 per
1000
weighted
pop
Current
number
of appts
delivered
Additional
capacity to
be
provided
(75 or
80/1000)
per week
Additional
number of
sessions
per week
@ £300 per
session
Cost
per
week
Total
cost for
21
weeks
Verified
by
team
Risks
Identified
start
34
Shah,
Bousfield
HC
3526
247
35
Brownlow
Group
Practice
27866
1950
Total
185791
251
80 = 282
(extra 35
appts)
2.35
£705
£14,805
yes
3110
80 = 2229
(extra 279
appts)
18.5
£5,550
£116,550
yes
128.78
£38,634
£789,714
11
189
190
MINUTES OF THE APPROVALS PANEL MEETING
Wednesday 15 October 2014 - 11.15 – 12.15 pm
Meeting Room 1, 4th Floor, Arthouse Square
Present:
Prof Maureen Williams
Katherine Sheerin
Jane Lunt
Tom Jackson
(MW)
(KS)
(JL)
(TJ)
Panel Chair
Chief Officer
Head of Quality/Chief Nurse
Chief Finance Officer
In attendance:
Cheryl Mould
Colette Morris
Michelle Urwin
Carol Hughes
(CMo)
(CM)
(MU)
(CH)
Head of Primary Care Quality and Improvement
Locality Development Manager - Central
Transformational Change Manager – Dementia
PA/Minute Taker
1
Welcome and Apologies:
The Chair (MW) welcomed everyone to the meeting and apologies were noted from:
Dave Antrobus and Professor Donal O’Donoghue.
2
Minutes from the previous meeting:
Subject to the following amendments:
Members present:
•
•
•
Maureen Williams – remove from attendees as she had given apologies
Tom Jackson – to include in list of those present
Dave Antrobus – to include in list of those present as meeting Chair
The minutes of the meeting held on 10 October were agreed as a true and accurate
record
3
Healthy Ageing Scheme:
3a
Budget Summary:
Michelle Urwin (MU) confirmed that 70 submissions had been received to date and
that following the last Panel an e mail had been sent to practices to remind them of
the closing date for bids.
This equated to 75% of practices and 82% of the population aged 75+ covered by
the submissions, including those under query with £1.4rm of budget currently
approved, £29,040 submitted for approval today and £81.,601 under query, giving a
total of £959,555 unallocated.
1
191
3b
Review of Bids:
The following bids were submitted for approval:
Anfield Group Practice: Notional Budget £21,545 Cost of Bid: £24,810
209 Geriatric Assessment and follow ups
13 Anticipatory Care Plans
APPROVED
The Village Medical Centre: Notional Budget £17,665 Cost of Bid: £4,230
141 comprehensive medication reviews
APPROVED
It was noted that this did not include Geriatric Assessments. This was agreed with
the Neighbourhood who will employ a Pharmacist to undertake medical reviews
across neighbourhood practices.
MW congratulated the team for having 82% of the 75+ population covered, which is
a positive step forward and a good news story in terms of compliance by the CCG
with national instruction in targeting our population in a very measured way. MW
suggested that this should also be highlighted as a good news story.
In response
to this, KS suggested that the outcomes should be included in the Annual Report
next year. Action: Outcomes to be included in the Annual Report
3c
Social Isolation Bids:
A paper was presented by MU to review the four isolation proposals submitted by
Practices/Neighbourhoods which included recommended next steps for
consideration by the Panel.
MW noted that the paper was useful in terms of raising issues and to inform an
understanding of the submitted bid.
The Following proposals were discussed:
Anfield OWLS: Funding requested £30,000
To address unwanted isolation, promote preventative health services and identify
patients need and barriers to access.
This would be done by the provision of: Centre based and off site social activities,
Nutrition and cooking, exercise to encourage mobility and skill share though
intergenerational engagement projects.
In addition awareness of NHS services
such as GP services, chiropody, pharmacy, physiotherapy, dentistry, hearing
services etc. would be promoted.
A partner had been identified who was doing straight forward activities with more
objective and possible community focus on social isolation.
Gateacre/Woolton: Funding requested £24,000 (6 months)
To employ additional health trainers specifically to pro-actively visit socially isolated
patients and elderly patients on discharged from hospital. This will source socially
isolated patients with the intention to make use of community resources available
and with target patients 75+ on discharge from hospital and those who are high on
2
192
the practice ‘at risk’ register.
It is expected that 100 home visits per month will be undertaken to independently
living elderly patients by 2 health trainers across 4 practices.
Everton: funding requested: £43,404
To provide 2 full days of engaging and bespoke activities to individuals aged 75+
residing in the Everton Ward.
Sessions will operate on a weekly basis for 12
months at Goodison Park with a shuttle service providing home pick up and drops
offs offered to individuals with mobility issues.
The services provided will include befriending, activities focused on historical
sessions, sport related reminiscence and match day experience’s
The above bids were approved in principle, subject to further work being done to
liaise with practices to look at who will take on local responsibility and for practices
to take the lead and deliver.
Brownlow/Vauxhall: funding requested £118,000
To implement a pro-active service offering enhanced social/community health care
services by engaging with the third sector to provide support to tackle isolation and
activities of daily living such as shopping, transport, home care etc.
Following discussion the panel agreed that this bid was not specific and lacked
substance. CMo noted that this practice already had access to a team of 7 social
workers.
The panel agreed that this bid should be rejected due to lack of detail and
information and insufficient value for money in terms of outcomes.
4
Winter Resilience Scheme:
4a
Winter Schemes Application Summary:
CM confirmed that of the 80 submissions had been received to date, 35 had been
approved, 33 were submitted for approval today and a further 13 were under query.
The budget approved to date was £978,714.
4b
Review of Risks on bids approved to date:
Review of Bids:
Details of 33 proposed bids were submitted by CM (see Appendix 1) which equated
to 128.49 additional sessions per week at a total cost of £809,487and following
discussion by the panel this was APPROVED.
Risks identified were highlighted:
Lance Lane Medical Centre:
CM highlighted that the practice had recently recruited a replacement GP for a
senior partner who had left due to illness. This has had an impact on the practice.
Recruitment process has been undertaken which has caused some instability in the
practice. This was highlighted as a risk in case the additional sessions cannot be
3
193
delivered.
Poulter Road Medical Centre:
CM highlighted that a risk identified was the ability to deliver due to the GP (singled
handed) being off due to sickness.
Picton Green:
CM highlighted that this practice had been subject to a validation appeal process
and a recommendation had been received to withdraw monies for last year in
relation to GP sessions and the level of availability of appointments. This has now
been rectified by the practice and additional sessions have been provided
throughout to week to increase to 70 sessions.
5
Any other business:
None raised.
6
Date of next meeting:
Wednesday, 22 October 2014
1.00 – 2.00 pm
Meeting Room 1
Arthouse Square
4
194
Enhancing access to primary care – winter scheme 2014/15
Approvals Panel – 22nd October 2014
Ref
Practice
69
Sandringham
MC
70
Stoneycroft
MC
Weighted
population
(June 14)
7549
5133
To deliver
GP spec
minimum
70 per
1000
weighted
pop
528
359
Current
number
of appts
delivered
Additional
capacity to
be provided
(75 or
80/1000)
per week
Additional
number of
sessions
per week @
£300 per
session
Cost per
week
Total cost
for 21
weeks
Verified
by team
559
75 = 566
(extra 38
appts)
2.5
£750.00
£15,750.00
yes
360
80 = 411
(extra 51
appts)
4
£1,200.00
£25,200.00
yes
£600.00
£12,600.00
71
Dr
Choudhary &
Dr Singh
2698
189
190
72
Langbank
MC
5449
381
534
195
80 = 220
(extra 30
appts)
80 = 426
(extra 54
2
3.63
yes
£1,089.00
£22,869.00
yes
Risks
Identified
Enhancing access to primary care – winter scheme 2014/15
Approvals Panel – 22nd October 2014
Ref
Practice
Weighted
population
(June 14)
To deliver
GP spec
minimum
70 per
1000
weighted
pop
Current
number
of appts
delivered
Additional
capacity to
be provided
(75 or
80/1000)
per week
Additional
number of
sessions
per week @
£300 per
session
Cost per
week
Total cost
for 21
weeks
£450.00
£9,450.00
Verified
by team
appts)
73
Kirkdale MC
4291
118
300
126
75 = 126
(extra 8
appts)
0.5
80 = 503
(63 appts)
4.2
74
Dr SN Singh
75
Westminster
MC
6285
440
445
76
Dr Thakur
3732
261
261
196
1684
300
80 = 322
(extra 22
appts)
80 = 299
(extra 38
1.5
yes
£150.00
2.5
£3,150.00
yes
£1,260.00
£26,460.00
£750.00
£15,750.00
yes
yes
Risks
Identified
Enhancing access to primary care – winter scheme 2014/15
Approvals Panel – 22nd October 2014
Ref
Practice
Weighted
population
(June 14)
To deliver
GP spec
minimum
70 per
1000
weighted
pop
Current
number
of appts
delivered
Additional
capacity to
be provided
(75 or
80/1000)
per week
Additional
number of
sessions
per week @
£300 per
session
Cost per
week
Total cost
for 21
weeks
£2,700.00
£21,600.00
Verified
by team
appts)
77
78
197
Ellergreen
MC
13510
946
946
80 = 1081
(extra 135
appts)
1.79
31.62
Gateacre MC
2685
188
190
80 = 215
(extra 13
appts)
Total
50331
3522
3721
4169
9
yes
£537.00
£11,277.00
yes
£8,949.00
£164,106.00
Risks
Identified
198
NHS LIVERPOOL CLINICAL COMMISSIONING GROUP
PRIMARY CARE COMMITTEE
Minutes of meeting held on Tuesday 30th September 2014 at 1pm
Boardroom Arthouse Square
Present:
Dr Rosie Kaur (RK)
Dave Antrobus (DA)
James Cuthbert (JC)
Paula Finnerty (PF)
Ray Guy (RG)
In attendance:
Cheryl Mould (CM)
Helen McManus (HMc)
Jenny Levy (JL)
Colette Morris (CMo)
Steve Appleton (SAp)
Paula Parvulescu (PP)
Kate Hoolian (KH)
Paula Jones (PJ)
Apologies:
Nadim Fazlani (NF)
Moira Cain (MC)
Jude Mahadanaarachchi
(JM)
Shamim Rose (SR)
Rob Barnett (RB)
Jacqui Waterhouse (JW)
Simon Bowers (SB)
Peter Johnstone (PJ)
Scott Aldridge (SA)
GP Governing Body Member/Vice Chair
Governing Body Lay Member – Patient
Engagement
GP Governing Body Member/Matchworks
Locality Chair
GP – North Locality Chair
Governing Body Practice Manager co-opted
member
Head of Primary Care Quality and
Improvement
Principal Analyst
Neighbourhood Transformational Manager –
North
Locality Development Manager – Liverpool
Central
Head of Clinical Informatics, Informatics
Merseyside
Consultant in Public Health Medicine,
Liverpool City Council
NHS Graduate Trainee
PA/Note Taker
Chair
Practice Nurse Governing Body Member
GP Governing Body member /Liverpool
Central Locality Chair
GP/Governing Body Prescribing Lead
LMC Secretary
Locality Development Manager – Matchworks
GP Governing Body Member
Transformation
Change
Manager
–
Prescribing
Neighbourhood Manager – North &
Local Quality Improvement Schemes and
Veteran Health Lead
Page 1 of 13
199
Rose Gorman (RG)
PART 1:
Contract
Manager,
Directorate - NHS England
Commissioning
INTRODUCTIONS & APOLOGIES
The Vice Chair welcomed everyone to the meeting. A discussion took
place about whether or not the meeting was quorate as there were only
two Governing Body full clinical members present in addition to the Vice
Chair and a quorum required three. However there were two Governing
Body Co-opted members present although only one was a clinician.
Concern was raised by RG that there were only three GPs present. It
was decided that given that most requests were for
noting/recommendation to proceed to next steps this did not pose a
problem. It was concluded that the meeting was quorate.
1.1
DECLARATIONS OF INTEREST
There were no declarations of interest made specific to the
Agenda
1.2
MINUTES OF PREVIOUS MEETING, ACTIONS AND MATTERS
ARISING NOT ALREADY ON THE AGENDA
The minutes of the previous meeting held on 29 July 2014 were
accepted as an accurate record of the discussions which had
taken place.
1.2.1 Re Verbal Update from NHS England re Choice of GP, RK
requested an update. CMo responded that this had been
put back until January 2015. CM added that it had been
discussed at Senior Management Team and the process
needed to be clarified with NHS England (RG) at the next
meeting.
1.2.2 Action Point 1: CM noted that the Policy for the adoption of
sponsored projects to support the medicines management
strategy was to be discussed by the Governing Body but
would come first to the October Primary Care Committee
then go to the Governing Body.
1.2.3 Action Point 2: Equality & Diversity Planning – DA noted
that the Equality Delivery Plan would be shared with the
public when there was more detail available. An update
would be brought back to the October meeting.
Page 2 of 13
200
1.2.4 Action point 3: it was confirmed that the Primary Cared
Quality Framework Review of Year 1 Year 2 update had
been shared at the Locality meetings. CM noted that the
Organisational Development Plans for the Localities and
member practices had been deferred to the October 2014
meeting as it was better to bring the entire Plan when
ready.
1.2.5 Action Point 4: it was noted that Implementation of
FARSITE System had been included on the Locality
agendas.
1.2.6 Action Point 5: it was noted that the Governing Body GP
Prescribing Lead had been added to the membership of
the Primary Care Committee and the Terms of Reference
had been updated.
1.2.7 Action Point 6: it was noted that the full end of year GP
Specification Report including Validation would be sent to
the October 2014 meeting.
The Primary Care Committee:
 Noted the points made under matter arising.
PART 2:
2.1
UPDATES
WORKSTREAMs UPDATE – REPORT NO: PCC 32-14
a) Localities – Report No PCC 32a-14
North – PF
• Clarification given on Diabetes and Impaired Glucose
Regulation.
• Lay Member queried the recruitment of District Nurses.
• Sharon Elliott had presented on changes to Procedures of
Lower Clinical Priority and MCAS Pilot (which North had
already been using for a long time).
• Scott Aldridge was to re-schedule his meeting with Roz
Gladden.
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• Congress to be held on 22nd October 2014. Topics to
include session of Phil Bliss on Bowel Scoping, issues
arising from the All Practice Event on 8th October 2014, GP
Specification, Winter Plans. With regard to the description
of “sessions” for winter planning CM clarified for PR that the
proposals were for number of additional sessions, how
those were achieved via visits and administration were not
taken into account.
• Transforming Neighbourhoods, PF had attended the Walton
meeting, the compromise position was to have 2 Clinical
Leads.
• Commercial Sponsorship for practices – concerns raised
over costs and the involvement of drugs companies.
• Research and Development - it was fine for practices to take
part:
o Envisage screens in practices – nothing had
happened yet re updating the screens, SAp to report
back.
o CMIP issues – 4 months of data to be looked at and
there were concerns about how accurate the data
was. RK felt that the parties concerned should
discuss this outside of the meeting and report back to
the next Primary Care Committee.
Central – CMo
• Meetings held in August and September for Liverpool
Central.
• Planned Care Update: tuning of the referral process,
Catheter Passport Services (CM to arrange a meeting to go
through the issues) and Dermatology.
• Healthwatch response being drafted to Access Report.
Final report to be sent to the next Locality meetings.
• There had been a positive response to the Transforming
Neighbourhoods meetings including Riverside.
• Proposal had been made for City Bikes to be available at
each practice with special rates for use by clinicians.
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Matchworks – JC
• Neighbourhoods presentation and progress given by JL
(representation also from Liverpool Community Healthy).
Three remaining Neighbourhoods to go live in the next
round. Role of the Locality to be made clear going forward.
CM meeting with JL and the Locality Development
Managers to look at the first draft and get citywide
consistency.
• Issue of increase in workload coming from hospitals to
Community Primary Care (to be discussed later on the
agenda).
• Matchworks Locality Plan – how to increase cervical
screening uptake.
• Sponsored Projects – looking at multiple pharmaceutical
companies coming together, there was broad support but
careful thought needed to be given so as not to sponsor just
one.
• Email to go out practices on the achievements of the
Primary Care Quality Framework.
• Statins update – recommendation for risk reduction had
been reduced to 10%. PP noted that the CVD Group would
be taking this up.
CM noted that each Locality was drawing up its plans with
different priorities and an update would be brought quarterly
with the Primary Care Quality Framework update.
b) Medicines Management Sub Committee Report: PCC 32b-14
CM Updated:
• Sponsored Projects (diabetes in particular) – diabetes
project withdrawn due to disputes with the new diabetes
model.
• Medicines Management GP Lead to do some work looking
at the variation in prescribing across practices.
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• It was noted that the indicators to be posted on the Intranet
referred to CMIP not the CCG but this was accessed via the
Intranet.
• PP noted that she was to pick up the issue of Lipid
Lowering guidance with PJ. CM added that she would
speak to PJ and the newly appointed Long Term Conditions
Manager as it was important for Long Term Conditions and
Prescribing to work together.
c)
Stakeholder Engagement - Report PCC 32c-14
DA updated:
•
•
•
Mental Health BME Policy – a great deal of work had been
done and to do what should be done will take a great deal
of time and work with 2 patient representatives involved
Stakeholder Database – from My NHS, paid for by NHS
England this year, was used very successfully for the
recent patient events to send out the invitations. From next
June the CCG would have to pay but the cost was on a
Merseyside footprint.
Patient Experience Webinar took place last Friday with
positive responses.
CM requested the Stakeholder Engagement Database should
be brought back to the Primary Care Committee in three
months’ time with an update.
The Primary Care Committee:
 Noted the reporting templates.
2.2
UPDATE FROM NHS ENGLAND – VERBAL
In the absence of representation from NHS England CMo updated
the Primary Care Committee as follows:
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• GP Choice had been put back until January 2015.
• Friends and Family Testing – work was ongoing and a
communication would go out to practices in the next few
months.
• Merseyside Area Team was to merge with Cheshire Area
Team.
• Winter Plans agreed with urgent Care Boards across the
patch.
JC raised the issue of continued non-attendance of NHS
England at the Primary Care Committee. The committee
discussed the benefit of getting an email update in advance of
the meeting directed as per the issues relevant at the time.
PART 3:
3.1
SERVICE DEVELOPMENT/IMPLEMENTATION
HEALTHY LIVERPOOL PROGRAMME – TRANSFORMING
ROUTINE NEIGHBOURHOOD SERVICES REPORT NO: PCC
33-14
PF presented the paper on Transforming Routine Neighbourhood
Services to the Primary Care Committee. The Vision had already
been agreed “To deliver excellent health outcomes, health
prevention and improved physical and emotional wellbeing for the
local community. Patients will experience a co-ordinated and
integrated health and social care experience using evidence
based pathways, case management and personalised care
planning”.
She highlighted:
• There were currently 18 Neighbourhoods and engagement
was taking place with member practices citywide on 8th
October 2014 at LACE.
• First meeting of the External Stakeholder Group held on 26th
September 2014 with full representation. There was a
question of whether an Internal Steering Group was required
as well.
• The Locality Chairs met each Thursday with a variety of
visitors attending to inform on what was happening in the
programmes.
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• Terms of Reference for the Steering Group to be shared with
the Governing Body, Local Medical Committee, Select
Committee and Health & Wellbeing Board.
• Neighbourhood
Development
Fund:
9
Wave
1
Neighbourhoods were mobilised but at different stages.
Each Neighbourhood was to have a GP Clinical Lead, Non
Clinical Lead, support from a Liverpool CCG Neighbourhood
Support Manager and weekly meetings.
• Next Steps: refining service delivery as some services would
lend themselves more to a specialist community footprint in
say less than 5 settings.
• Devolved Budgets to neighbourhoods.
• Neighbourhood Intelligence Pack being developed and
Neighbourhood Quality Framework.
The Primary Care Committee noted the challenges:
•
•
•
•
•
•
•
•
Neighbourhoods needed to have a bottom up approach but
be aligned with the wider picture. CM noted that the GP
Clinical Leads meetings held monthly would be key to
achieving this.
Feedback needed to strengthen the commissioning element
of the draft Blueprint.
IT Challenge: SAp noted that Neighbourhood modelling
was built on existing work but then the wider clinical
strategies would require collaboration not just sharing of
information, i.e. when it was safe to use email and when not
and that informatics champions needed to be identified.
There was still a lot of work to be done on devolved
budgets.
CM noted that the monthly external group needed to report
in to the Primary Care Committee via the reporting template
mechanism.
JL noted there was an information gap for the Steering
Group around Children’s Services although CM confirmed
that that the Governing Body Children’s Clinical Lead was a
member of the Group and had been unable to attend the
first meeting.
CM noted that the Neighbourhood Development Fund would
be discussed at the Heads of Service meeting and would
also go to the Healthy Liverpool Programme Leads Board
on 14th October 2014 then to the Governing Body in
November 2014.
PF noted that a prioritisation process was required.
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It was agreed that the reporting to the Primary Care Committee
should be monthly using the governance template format from the
External Steering Group with a more detailed paper on a bimonthly basis.
The Primary Care Committee:
 Noted the content of the paper
 Supported agreed next steps.
 Noted that reporting would be monthly to the Primary Care
Committee via reporting template with a more detailed
paper bi-monthly.
3.2 CO-COMMISSIONING OF PRIMARY CARE REPORT NO: PCC
34-14
CM presented a paper to the Primary Care Committee on CoCommissioning of Primary Care. Back in June of 2014 Liverpool
CCG had submitted an expression of interest as follows:
Delegated Commissioning arrangements
 Working with patients and the public and with Health &
Wellbeing Boards to assess needs and decide strategic
priorities
 Managing financial resources and ensuring that expenditure
does not exceed the resources available
 Monitoring contractual performance
Greater Involvement in influencing decisions / Joint
Commissioning
 Designing and negotiating local contracts ( e.g PMS, APMS,
any enhanced services commissioned by NHS England )
 Approving "discretionary payments, e.g. Premises
reimbursement
 Deciding in what circumstances to bring in new providers and
managing associated procurements
 Decision making on practice mergers
It was proposed to set up a Joint Commissioning Group to
oversee the implementation of the arrangements and to provide
alignment to the Healthy Liverpool Programme, however further
guidance was awaited.
The membership of the Joint Commissioning Group would be:
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From Liverpool CCG:
• Three Governing Body members one of whom will be the Chair
of the Group
• Head of Primary Care Quality & Improvement
• Deputy Chief Finance Officer
• Head of Procurement & Contracts
From NHS England:
•
•
•
•
Deputy Medical Director
Head of Primary Care
Contracts Manager
Finance Lead
From Liverpool City Council:
• Deputy Director of Adult Social Care
• Deputy Director of Children's Social Care
From Public Health:
• Director of Public Health
Patient Representative
The role of the Group would be to:
• Oversee Practice performance and clinical governance issues
to ensure the delivery of high quality Primary Care, reduction in
variation and health inequalities.
• Support CQC and General Practice with the new inspection
regime, receive individual practice reports and agree any
actions
• Undertake joint PMS reviews
• Discuss & approve any potential mergers
• Undertake procurements of any new contracts
• Support implementation of any new Directed Enhanced
Services to ensure neighbourhood coverage of services
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• Discuss & approve premises applications in line with estates
strategy group
• Develop workforce strategy required for future in response to
Healthy Liverpool Program
• Approve Local Quality Improvement Scheme's following CCG
approval process
• Develop & review annual monitoring framework for all Local
Quality Improvement Scheme's
• Ensure financial resources are utilised effectively and within
budget.
The Governance structure would be for the Group to be a subcommittee of the Primary Care Committee also reporting in to the
Validation Committee and the Approvals Panel. The first meeting
would be in October 2014 and would then follow on a monthly
basis.
Guidance had been issued for future opportunities/models for cocommissioning.
This included the standardised model of
delegation was for GMS/PMS Contracts, Enhanced Services,
property costs and QOF.
The Primary Care Committee members commented as follows:
• RG noted that there were potential conflicts of interest with
GMS and QOF and that the group needed to be smaller with
more GPs in order to be more robust.
• JC noted that there were huge potential issues for the
Group to deal with and something different was required.
• CM noted that the Primary Care Committee needed to
decide upon the model and the Governing Body would
approve the detail. The Local Medical Committee Secretary
would be a co-opted member
The Primary Care Committee:
 Noted the content of the proposal
 Approved the proposal to establish a joint cocommissioning group
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 Approved the proposed membership of the group noting
that the Local Medical Committee Secretary would be a coopted member.
PART 4:
4.1
QUALITY & PERFORMANCE
CARE QUALITY COMMISSION INSPECTION - VERBAL
CM gave a verbal update on Care Quality Commission (‘CQC’)
Inspections to the Primary Care Committee. Along with NF she
had met with the CQC General Practice Merseyside Manager a
few weeks ago to discuss the inspections planned to start in
October over a two year period. A National Tool would be used by
the CQC which meant that the data would be 12 months out of
date. Practices were being asked to give a presentation at each
visit of where they were doing well, where they could improve etc.
The CCG would support practices through this process.
PF noted that it would be good to get feedback on lessons learned
from the first wave of inspections back to the Primary Care
Committee. She added that practices were feeling very much
under pressure at the moment and was good to see the support
they were receiving from the CCG.
RG suggested that this
should be discussed at the all practice members meeting to take
place on 8th October 2014. CM noted that best demonstrated
practice could be shared via the Locality Development Managers.
The Primary Care Committee:
 Noted the verbal update.
4.2
GROWING DEMAND FROM SECONDARY CARE TO PRIMARY
CARE – VERBAL
The issue was raised by JC of the growing demand on the
resources of General Practice and Secondary Care throwing back
requests for follow up post discharge back to the GP practice. It
was agreed that a number of clinicians would be involved in a
small group to draw up a policy to manage this (suggested JC,
RG, RB PF and RK and include Alison Picton). This would be
brought back to the November 2014 Primary Care Committee.
The Primary Care Committee:
 Noted the verbal update.
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4.3
RISK REGISTER REPORT NO: PCC 35-14
CM presented the Risk Register for review.
The Primary Care Committee:
 Noted the content of the risk register and on-going actions
against medium and high risk areas.
5.
ANY OTHER BUSINESS
None
6.
DATE AND TIME OF NEXT MEETING
Tuesday 28th October 2014 – 1pm to 3pm.
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NHS LIVERPOOL CLINICAL COMMISSIONING GROUP
FINANCE, PROCUREMENT AND CONTRACTING COMMITTEE (FPCC)
TUESDAY 23 SEPTEMBER 2014 10AM – 12NOON
ROOM 2 - ARTHOUSE SQUARE
MINUTES
Members
Nadim Fazlani (NF)
Maureen Williams (MW)
Dave Antrobus (DA)
Tom Jackson (TJ)
In Attendance
Kim McNaught (KM)
Derek Rothwell (DR)
Kate Holian (KH)
Siobhan Elliot (SB)
Chair
Lay Member
Lay Member
Chief Finance Officer
Lynne Hill (LH)
Deputy Chief Finance Officer
Head of Contracts and Procurement
NHS Management Trainee
Accounts Assistant (Observer and shadowing Kim
McNaught)
PA/Minute Taker
Apologies
Katherine Sheerin (KS)
Maurice Smith (MS)
Ray Guy (RG)
Tony Woods (TW)
Cheryl Mould (CM)
Ian Davies (ID)
Jane Lunt (JL)
Alison Ormrod (AO)
Phil Saha(PS)
Alison Picton (AP)
Tim Cain (TC)
Andy Kerr (AK)
Scott Aldridge (SA)
Chief Officer
GP – Governing Body Member
Practice Manager
Head of Strategy and Outcomes
Head of Primary Care Quality and Improvement
Head of Operations and Corporate Performance
Chief Nurse/Head of Quality
Chief Accountant
Head of Programme Finance
Senior Contracts Manager
Principle Analyst
Programme Delivery Manager (Mental Health)
Neighbourhood Support Manager – North Locality
1
Welcome and Introductions
Introductions were made and Kate Holian and Siobhan Elliott were
welcomed to the meeting.
It was agreed that due to the large agenda, agenda items would be
taken out of order so that the appropriate approvals and agreements
could be made.
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213
2
Declaration of Interest
No declarations were made.
2
Minutes of the previous meetings held on 29th July 2014
Agreed as a correct record with the following minor amendment:Page 3 - should read NF stated that a sum of money has been
requested by Liverpool Community Health.
Actions from the previous meeting held on 29th July 2014
Anticoagulation and Widening Access to Psychological
Therapies Step 2 (FPCC31-14)
 Action: DR to present an update at the November 2014 FPC
Committee
3
3.1
3.2 Fragility Fractures Investment Proposals
Michelle Urwin was to have a discussion with Dr Maurice Smith with
regard to the fragility fractures regarding the business case and the need
to be clear on what is required.
 Action: Michelle Urwin to present Fragility Fractures to the
November 2014 Finance Procurement and Contracting
Committee
3.3 Community Services
Community Services are on the agenda for the Governing Body
development day on 24 September 2014.
3.4 Draft Contracts Performance Month 2 (FPCC36-14)
Action 1 - completed
Action 2 - to be actioned following the FPC Committee.
3.5 Review of Aintree Contract Process
Paper on the agenda for fuller discussion.
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3.6 Procurement of BME of Mental Health Projects (FPCC38-14)
MW stated that there is an issue with the BME paper and that it has not
taken account of the comments made at the previous meeting. It
appears that there is some confusion in the paper and needs to be clear
on what is being commissioned. There is a need for it to go back to the
authors and to have a separate meeting as it appears the 2 strands are
being confused and some of the information in the paper may be
factually incorrect i.e. equality duties. Overall there is not enough rigour
in the paper.
NF stated that this is the 2nd time that the BME had been presented and
discussed at the FPC Committee and the BME paper needs to be
clarified with the appropriate personnel and an agreement on what is
presented to the FPC Committee.
 Action: DR to follow up with Andy Kerr / Tony Woods
4 Proposed Funding of Clatterbridge Cancer Centre (FPCC40-14)
The FPC Committee watched the 4 minute video of the proposed
Clatterbridge Cancer Centre development.
TJ gave further background information and stated that this has been
approved by the wider scheme, highlighting page 9 where the funding
details were listed. TJ talked through the bullet payment and the
transfer of £6.5m transferring into specialised commissioning; however
some of this has been transferred to Clatterbridge Cancer Centre as a
block payment within their Specialised Commissioning contract. LCCG
has received £3.3m allocation transfer from Specialised Commissioning
recurrently.
MW stated she was satisfied with the programme and would prefer a
one off payment and queried the difference in payments if it is a 50%
match. TJ confirmed that it is not a 50% match and coincidental that
the figures are similar.
MW asked what the risks on the loans are and will our contribution be
lost. TJ stated that the mitigation strategy for CCC will be included and
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that the auditors have agreed that it will be shown correctly in the
accounts.
DA discussed his involvement in the engagement process and that the
main concern is the long process of the programme which started in
2008 and is not finishing until 2016.
NF summarised that the programme has been to various previous
organisations’ Board meetings, i.e. (Liverpool PCT) and this had been a
payment that was agreed by the Liverpool PCT Board, prior to the
Merseyside Cluster arrangement. LCCG will receive £3.3m recurrent
and the reason we are not asking for a business case is due to the very
robust strategic link between strategy and spend, the legacy issues, outwith our normal investment discussions and this is a restricted income
which enables the spend to occur. Therefore, the above reasons mean
that it does not require a business case and the CCG could approve the
spend and make this one payment.
The FPC Committee made the recommendation to take the approval to
the Governing Body to make the final decision on the spend
arrangement.
 Action: Agreed that Clatterbridge proposal will be presented
to the Governing Body for final decision on spend.
5
Specialised Commissioning Update
TJ updated the FPC Committee on the Specialised Commissioning
situation and confirmed that he is a member of the Specialised
Commissioning task and finish group. Overall there is £4bn spent on
specialised commissioning and there are 11 specialities that will come
back to CCGs, this includes chemotherapy, level 1 and level 2 mental
health, renal and obesity and this is approximately 45% of the
Specialised Commissioning budget. Co-commissioning may be required
for some of the services.
There are some financial risk attached to this and may require a due
diligence process to be undertaken. TJ has discussed with the Trust
Director of Finances and other CCGs’ Chief Finance Officers.
A
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feasibility study will be led by Phil Heywood, reviewing this on a Mersey
footprint. Discussions with Core Cities network colleagues have also
taken place.
TJ stated that when we get to decision making on the Healthy Liverpool
approach then we will need clinical sign off and approval at the
appropriate committee level and then at the Committee(s) in Common
group.
NF commented that level 3 commissioning is going to be largely
enforced. Approval in November 2014 will likely be from NHSE on cocommissioning.
DA asked if there is a threat to any of the services in Liverpool. TJ
explained the specialised commissioning logarithms and the fact that it is
not straight forward on unplanned care.
More likely the high level
specialities may be the ones that are more risky.
MW thanked TJ for the comprehensive update. However, would like to
have Specialised Commissioning included on the Risk.
 Action: TJ/DR to discuss with ID for the risk register for the
November 2014 FPCC Committee
 Action: Once reviewed this may be escalated to the Corporate
Risk Register.
6
Investment Prioritisation Process (FPCC41-14)
DR reported on the Investment Prioritisation Process. DR reported that
there is a typographical error in the report on page 6 and should
state Enhanced.
DR presented the read through of the 6 programmes stating that the full
reports are available for review.
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6.1-6.3
NWAS GP Pathfinder, Royal A&E GP Scheme, Primary
Care in ED (Children’s)
DR highlighted the relevant aspects from all three proposals and stated
that the provider in all cases would be UC24 and that a Single Tender
Action was proposed.
MW stated that she agreed the procurement route for all. However,
highlighted section 2 and asked who, when and where the signature
boxes are completed. DR stated that signatures are not required at this
stage as the FPC Committee are to approve them and they would be
completed in cases that did not require FPC approval .
DA highlighted that the contract start dates and some say July 2014 and
the yearly costs are the same as the contract amount. DA asked what
would happen if the contract finished in April 2015 will it come back to
the FPC Committee for an extension.
MW stated that she was unhappy to roll the proposals over without the
appropriate data and if we require the service then we need to
commission the service appropriately and that we would need to go to
market now.
TJ stated that there are some developments in Urgent Care and that
Monitor is going to be using us as a pilot and is potentially looking to an
outcomes based approach for urgent care. TJ stated that the message
needs to go back to the clinical leads that the process needs to be
aligned and not be pushed through on a “panic” mode. MW queried if
this can be robust in the use of single tender and are comfortable with
that and roll over, however we will look scathingly at another request for
a roll over for any of the schemes.
 Action: DR to discuss with the clinicians and the leads in
relation to each of the programmes
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NF asked how realistic would it be to go to market in March 2015. DR
stated that a specification could be undertaken and discussions held by
November/December 2014 with additional data requirement.
TJ stated that the schemes were presented to the HLP Leads and those
presented today are based on the future procurement process. TJ
stated that the movements in relation to Urgent Care may allow a
different way of delivery allowing alignment with the Healthy Liverpool
Programme.
MW stated that she was comfortable with the proposal coming back in
January 2015 however needs to be more robust in the reasons why it
should be rolled over and will it be the 3rd year without any competition.
 Action: Proposal for Urgent Care to be presented at the
January 2015 FPCC (DR/ID)
NF summarised the discussions and stated that the delivery of Urgent
Care is being revised and this is the second time we are extending this,
it therefore seems unlikely that we will have a new provider by 1 April
2015 or a new specification by December 2014 and suggested that a
further extension to December 2015 for all 3 programmes be agreed.
TJ stated that we may not have a specification, but a different
requirement based on outcomes. i.e. redesign of the urgent care
provision.
 Following further discussion the FPC Committee agreed that
provision of services be extended for all 3 programmes up to
December 2015 namely;
• NWAS GP Pathfinder,
• Royal A&E GP Scheme
• Primary Care in ED (Children’s)
 Action: Due to the extended time and increase in costs the 3
Business Cases will be presented to the October 2014
Governing Body meeting.
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6.4 Enhanced Capacity in Primary Care – Winter Pressures
It was agreed that Enhanced Capacity in Primary Care –
Pressures proposal will be presented to the Approval Panel
September 2014.
 Action: DR Enhanced Capacity in Primary Care –
Pressures to be presented to the Approvals Panel
September 2014.
Winter
on 30
Winter
on 30
6.5 Urgent Care – Examine your Options
 Proposal for multiple tender £447,836 - agreed.
6.6 Engagement - Engagement
 Proposal for multiple tender of £312,500 - agreed.
It was agreed the following items could be discussed in this order Item 7,
13, 14, 15 and 16.
7.
Finance Update – Month 05
(FPCC42-14)
KM updated the FPC committee on the finance reports and highlighted
the following:
• Continuing Care: overspend report and some issues in relation to
late invoicing for joint funding on funded nursing care, plus an
additional new complex patient. Have had discussions with the
Liverpool City Council to receive invoices in a timelier manner.
• Prescribing - £900k overspend, however year end showing as
underspend. We have used PME figures, however KM stated that
Peter Johnstone (PJ) is not comfortable with the figures and has
added local intelligence to update the forecast.
• Running costs - overspend to date. This is currently being
reviewed to ensure that the correct split between running costs
and programme costs is reflected in the ledger.
• Reserves – RAG rated to identify whether committed to areas of
investment. Showing c£30m unallocated but does not take into
account any contract overspends
• BPPC – the 95% target has been met by total value of invoice but
the number of invoices target has not been met cumulatively. This
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continues to be reviewed by the Finance Team and on-going
discussion with budget holders. A Procurement Assistant has
been recruited and the roll out of the use of purchase orders for all
areas of expenditure is on-going. This should improve the
performance against target.
DA queried the delays in payment resulting from the SBS processes..
KM explained that the smaller non-NHS organisations are contacted by
the Finance Team to ensure they understand the invoice processes to
facilitate prompt payment.
 The Finance Procurement and Contracting Committee noted
the report.
13 Contracts Performance Month 5 (FPCC47-14)
DR updated the FPC Committee on the Contracts Performance report
and highlighted the following:
RLBUHT
• Contract process and methodology being strictly adhered to
• Meetings are taking place on a fortnightly basis with the Trust due
to the significant over performance figures being reported.
• Significantly overperforming in the urgent care arena.
• Contract managers are working with the providers to understand
the position.
• Executive level meetings between LCCG and RLBUHT had taken
place
• Audit being initiated to ensure that the coding process is being
applied correctly.
• External organisations will be asked to undertake audits at all our
providers
Aintree
• £2m overperformance being reported
• Contract not fully signed by all commissioners although LCCG
have signed.
• Urgent care work is an issue (see report)
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• DR has had discussions with Sefton CCGs contract manager to
review the approach on urgent care in order to maintain
consistency with the Liverpool CCG model
• Contract queries are being raised as per contract process
Liverpool Women’s Hospital
 Contract process and methodology being strictly adhered to
 Activity query notices have been issued and the contract process
is being followed. Potential for this to go to dispute resolution if
necessary. TJ is signing all the documents before they are being
submitted.
 HRG – drift towards “intensive” rather than standard.
 Audit being initiated to ensure that the coding process is being
applied correctly.
 External organisations will be asked to undertake audits at all our
providers.
 Action: DR will bring back to the FPC committee if the
contract for external audit work is in excess of £100k.
Alder Hey Hospital
• Staffing issues are being reported by Alder Hey Hospital and this is
being monitored.
St Helens
• Forecasting a considerable catchment overperformance, LCCG
currently £700k .
Spire
• Currently reporting as an underperformance.
Liverpool Heart and Chest
• Slight underspend being reported.
Mersey Care
• Still awaiting information requested in July 2014.
• Discussions are ongoing with Merseycare on their activity.
Information they have shared is not robust.
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15
•
•
•
•
Discussions with Royal Liverpool and Broadgreen University
Hospital
DR and TJ updated the FPC Committee on the Trust’s position
and a letter detailing the issues has been sent to the Trust
Planned Care – there is potential for us to have to pay for this.
However, any other payments for RTT, resilience money, frailty
clinic, etc. will not be paid until all of the issues are rectified.
TJ is meeting with John Graham, Director of Finance, to explore
further and to negotiate a solution.
DR requested any comments back to him if required.
NF queried the Spire underperformance. DR will review the information
from a legal aspect.
 Action: DR to review legal aspect of underperformance
and report back in December 2014
 The Finance Procurement and Contracting Committee noted
the report.
16 Aintree Contract 2015/16
DR updated the FPC Committee on the discussions regarding Aintree
with the LCCG clinical leads and the 2015/16 contracts process. It was
outlined that LCCG want to stay with Sefton CCGs on the 2015/16
process but may look to the 2016/17 contract round for a change of the
contract lead. Clinical leads not 100% assured that best interests were
being addressed. Additional contract management communication with
Aintree is being put in place as requested by the Clinical leads.
 The Finance Procurement and Contracting Committee noted
the verbal updated.
14 HLP Economical Modelling
(FPCC48-14)
DR reported on the HLP Economic Modelling report and the process
undertaken for the bidding process. Bidders were bidding for Phase 1
work initially. However for Phase 2 and 3, highly likely that we will ask
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FTI Atkins to progress this work based on the understanding of the
process and the positive feedback about their approach from the Trusts
The committee discussed the spend on consultation and the strategic
envelope has been approved and the chosen procurement route is being
agreed. TJ stated that benchmarking will be undertaken similar to
London and the Manchester Healthier Together programmes.
The FPC Committee agreed the following recommendation:
 Approve the award for Phase 1 for circa £298K and if Phase 2
and 3 awarded approve the increase of the additional costs of
circa £750k.
10
Zero Based budgeting
(FPCC45-14)
 The FPC Committee noted the report.
Any issues brought back to the next meeting.
11
Finance KPIs Month 5
(FPCC47-14)
 The FPC Committee noted the report.
Any issues brought back to the next meeting.
12 HMRC Visit update
KM reported that there are no further updates since the last Informal
Governing Body meeting.
8
Care Technology Procurement (FPCC43-14)
DR presented the report and highlighted the following:
In July 2014, the Joint Procurement Group approved the
commencement of plans to jointly procure a Care Technology (extended
telecare) Service for Liverpool City Council and NHS Liverpool Clinical
Commissioning Group to replace separate services with expiring
contracts.
 The FPC Committee agreed to progress the recommendations
and procurement route 3 as the most suitable and flexible to
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ensure an appropriate provider and reflect social value
requirements. The other routes could be utilised and may
shorten the procurement timescale but at the risk of
narrowing the market and reducing flexibility.
9
Military Veteran IAPT
(FPCC14-14)
The FPC Committee discussed and approved the recommendations:
 Support the decision to continue with patients being referred to
mainstream services and/or to the Military Veterans IAPT service
whilst a full review of the needs of military veterans in undertaken.
17 LCH Improvement plan and Contractual Claim
TJ updated the FPC Committee on CQC report and the improvement
plan has been developed and shared with NF, KS and TJ. The
Improvement Plan changes LCH’s financial plan and creates a £9m
deficit. The visual presentation stated that there were some quality
issues, which led to the request for £7m additional funding, however, the
TDA were not in agreement.
KS received a letter on 22 September 2014 requesting £3.4m for various
issues. TJ stated that they have no basis for contractual claim, but they
do have a financial problem. TJ stated that he has brought this to the
committee for information and not for agreement on the request for
additional payments.
NF stated that we are clear on the quality issue, however there is a
financial issue for LCH. We have signed a contract in April and
therefore stay with the contract.
 Action: Agreed this would be discussed
Development day on 24th September 2014
at
the
GB
9
WAPT
DR reported that the evaluation process is taking place on 24th
September 2014 and will be circulated next week.
18 Any Other Business
Grants Panel
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DR reported that 64 organisations have been awarded grants. Sarah
Dewar (SD) will be summarising the details on where the grants are
going to and will put together a geographical map of where they are
based in the region
 Action: SD to provide a geographical allocation map of where
grants have been allocated.
Dates of Next Meeting(s)
It was agreed, due to the increasing agenda items requiring agreement
the Finance Procurement and Contracting Committee would be held
monthly as from October 2014 to March 2015.
The dates have been agreed as follows:
•
•
•
•
•
•
rd
Thursday 23 October 2014
Tuesday 25 November 2014
Tuesday 16 December 2014
Tuesday 27 January 2015
Thursday 12 February 2015
Tuesday 24 March 2015
10am – 12:30pm
10am – 12:30pm
9:30am – 12:00pm
10am – 12:30pm
10am – 12:30pm
10am – 12:30pm
Room 2 – Arthouse Square
Room 2 – Arthouse Square
Room 2 – Arthouse Square
Room 2 – Arthouse Square
Boardroom–Arthouse Square
Room 2 - Arthouse Square
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