1. No category

CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
Wednesday 14th January 2015 at 1 pm
Meeting Rooms 1 and 2, Blackburn Central Library
Town Hall Street, Blackburn BB2 1AG
AGENDA
Item No:
Agenda Item
Member
Responsible
PUBLIC PARTICIPATION
1.
Chairman’s Welcome
Report
Mr Joe Slater
2.
Apologies for Absence and Confirmation of Quoracy
Mr Joe Slater
3.
Mr Joe Slater
4.
Declarations of Interest relating to items on the
agenda
Questions from Members of the Public
5.
Engage – Sexual Exploitation Assurance
6.
Patient Story
PART 1 BUSINESS (APPROXIMATELY 2 PM)
7.
Minutes of the Meeting Held on 5th November 2014
7.1
Extract from Part 2 of the Minutes of the Meeting held
on 5th November 2014
Mr Joe Slater
Mr Nick McPartlan –
Engage Team/
Ms Linda Clegg –
Director of Children’s
Services
Mr Stuart Sheridan/
Mrs Jeanette Pearson
Presentation
Mr Joe Slater
Attached
Attached
Presentation
8.
8.1
Matters Arising
Action Matrix
Mr Joe Slater
9.
Clinical Chief Officer’s Report
Dr Chris Clayton
Attached
10.
Chief Finance Officer’s Report
Mr Roger Parr
Attached
11.
Contract Performance Report
Mr Roger Parr
Attached
12.
Quality and Performance Exception Report
Mrs Kim Smith
Attached
13.
Stakeholder Support for Healthwatch Blackburn with
Darwen and Healthwatch Lancashire
Mr David Rogers
Deferred
14.
Co-Commissioning Primary Care Update
Mrs Julie Kenyon
15.
Intensive Support to People Living at Home Mrs Alison Shaw
Attached
16.
Healthier Lancashire Purpose Document
Dr Chris Clayton
Attached
Attached
Page 1 of 2
17.
Managing Conflicts of Interest – Revised Conflicts of
Interest Policy
18.
Lancashire Collaborative Commissioning Board
Terms of Reference and Membership
STRATEGY
19.
Planning Guidance – 2015/16 Year 2 Update
FOR INFORMATION
20.
Governing Body Sub-Committees and Groups’
Summary
21.
Any Other Business
22.
Date and Time of Next Meeting:
Wednesday 4th March 2015 in Meeting Rooms 1 and
2, Blackburn Central Library, Town Hall
Street, Blackburn BB2 1AG
Mr Iain Fletcher
Attached
Mr Roger Parr
Attached
Mr Roger Parr
Attached
Mr Iain Fletcher
Attached
All
Mr Joe Slater
EXCLUSION OF THE PRESS AND PUBLIC – ‘That representatives of the press and other members of the
public be excluded from the remainder of the meeting having regard to the confidential nature of the business to
be transacted, publicity on which would be prejudicial to the public interest’ (Section1(2)Public
Bodies(Admission to Meetings)Act 1960)
PART 2 (APPROXIMATELY 3.15 PM)
A/15
Minutes of Part 2 of the meeting held on 5th
November 2014
B/15
B/15.1
Mr Joe Slater
Attached
Matters Arising
Action Matrix
Mr Joe Slater
C/15
Independent Investigation Report
Mrs Kim Smith
Attached
D/15
Stakeholder Letter
Dr Chris Clayton
Attached
E/15
Out of Hours Service
Dr Chris Clayton
Attached
F/15
Any Other Business
Mr Joe Slater
Attached
Page 2 of 2
Subject to
approval at the
next meeting
CLINICAL COMMISSIONING GROUP (CCG)
Item 7
Minutes of the Governing Body Meeting held on
Wednesday 5th November 2014
in Rooms 1 and 2, Blackburn Central Library,
Town Hall Street, Blackburn BB2 1AG
PRESENT:
Mr Joe Slater
Mr Roger Parr
Dr Pervez Muzaffar
Mr Paul Hinnigan
Dr Penny Morris
Mrs Debbie Nixon
Dr Malcolm Ridgway
Dr Adam Black
Mrs Anne Asher
Chairman (Chair)
Chief Finance Officer
Executive Member
Lay Member - Governance
Executive Member
Chief Operating Officer
Clinical Director for Quality and Effectiveness
Executive Member (Part)
Lay Member - Nurse Representative
IN ATTENDANCE:
Mr Iain Fletcher
Dr Gifford Kerr
Mr Peter Sellars
Mrs Pauline Milligan
Min No:
14.076
Head of Corporate Business
Consultant in Public Health, Blackburn with Darwen Borough Council
Interim Commissioning Manager
Corporate Support Officer (minutes)
Chairman’s Welcome
The Chair opened the meeting by welcoming all attendees and members of the public.
He introduced himself and gave a short briefing with regard to the content of the agenda,
meeting protocol and housekeeping.
14.077
Apologies for Absence and Confirmation of Quoracy
Apologies for Absence had been received in respect of:
Dr Chris Clayton
Dr Nigel Horsfield
Dr Zaki Patel
Mr Dominic Harrison
Dr Tom Phillips
Clinical Chief Officer
Lay Member - Secondary Care Doctor (Retired)
Executive Member
Director of Public Health, Blackburn with Darwen Borough Council
Executive Member
The meeting was confirmed as quorate.
14.078
Declarations of Interest Relating to Items on the Agenda
The General Practitioners (GPs) at the meeting declared a generic interest with regard to
Item 13 – Primary Care Strategy and Item 14 – Co-commissioning Primary Care Update.
Page 1 of 10
The Chair reminded Governing Body (GB) members and members of the public that they
should, if appropriate, make a declaration should a conflict emerge during the meeting
and these would be recorded against the relevant agenda item.
14.079
Questions from Members of the Public
The Chair reminded those attending the meeting that the CCG had produced a protocol,
published on its website, in respect of members of the public who wished to ask
questions or make statements at GB meetings. The protocol requested that the CCG
received advanced notification of the question by 5 pm on the Monday prior to the
meeting so that an appropriate response could be prepared.
The Chairman stated that he was aware that a member of the public wished to ask a
question despite there being no advance notification. He added that depending on the
nature of the question, the CCG may need time to gather any information required and
provide a written response following the meeting.
Q
I understand that Blackburn with Darwen (BwD) will be used as a pilot area for the
Government’s care.data experience yet not a single patient in BwD had been informed
that this was happening. I would have thought as a CCG you would at least require your
General Practitioners (GPs) to let their patients know.
Q
This is a meeting in public but you do allow the public to actually participate. East
Lancashire Hospitals NHS Trust (ELHT) does not. It is a waste of time sitting there like a
rag doll listening to them. Could this CCG please take up the issue of making ELHT hold
a meeting in public that actually allows the public to participate?
A
The Chair: Thank you very much for those questions. With regards to the latter
question, I will discuss the matter with the Chair of ELHT when I next meet with her.
A
Mr Roger Parr, Chief Finance Officer: In reference to the first question raised regarding
care.data, the CCG will be a pathfinder. We are in the very early stages at the moment.
What we will be doing within the next few weeks is contacting GP Practices to find out
which GP Practices want to participate. When that happens we will then be contacting
their patients to involve them in things such as the content and design of materials; how
we are going to communicate to individuals with regards to the data and the processing
that needs to happen. So, it is in hand. There is a Communications and Engagement
Plan that will come along with this, it’s just that we are in the early stages at the moment.
The Chair invited any further comments from the GPs present at the meeting. There
were no further comments.
14.080
Due North Report
The Chair introduced Dr Gifford Kerr, Consultant in Public Health, BwD Borough Council
who provided a presentation on the Due North report which was published as a result of
an enquiry into health equity for the North; commissioned by Public Health England in
February 2014 and launched in September.
The report had been presented to the BwD Health and Well-being Board (H&WBB) and it
had since been agreed that the information was of sufficient interest to be shared with a
wider section of the public, hence the CCG’s decision to bring the presentation to its GB
meeting.
Page 2 of 10
Dr Kerr outlined the aim of the enquiry, which was to address the social inequalities in
the North of England. Dr Kerr drew members’ attention to the differences in life
expectancy throughout the United Kingdom and it was noted that for the poorest 20% life
expectancy has improved more slowly in the North than the rest of England over the last
10 years.
Dr Kerr referred to some of the policy drivers which resulted in inequalities, potential
solutions and recommendations for the North as a whole and central Government:
•
Economic development and living conditions
Recommendation 1: Tackle poverty and economic inequality within the North
and between the North and the rest of England
•
Development in early childhood
Recommendation 2: Promote healthy development in early childhood
•
Devolution and democratic renewal
Recommendation 3: Share power over resources and increase the influence
that the public has on how resources are used to improve the determinants of
health
•
The role of the health sector
Recommendation 4: Strengthen the role of the health sector in promoting health
equity
Questions and answers followed.
RESOLVED: That the Governing Body noted the content of the report.
14.081
Minutes of the Meeting held on 3rd September 2014
The minutes of the meeting were accepted as an accurate record.
RESOLVED: That the Minutes of the Meeting held on 3rd September 2014 were
approved as a correct record.
14.081.1
Extract of Part 2 of the Minutes of the Meeting held on 3rd September 2014
The extract of Part 2 of the minutes of the meeting was accepted as an accurate record.
RESOLVED: That the Extract of Part 2 of the Minutes of the Meeting held on 3rd
September 2014 was approved as a correct record.
Page 3 of 10
14.082
Matters Arising/Action Matrix
Minute 14.065 Contract Performance Report
Mrs Debbie Nixon reported that the issue related to the overall performance of the North
West Ambulance Service (NWAS) and its failure to hit the target and was not specifically
related to the BwD CCG area. Mrs Nixon had fed back the comments from the GB
relating to NWAS performance to Blackpool CCG, as the Lead Commissioner for
ambulance services. Mrs Nixon reported that there was an Action Plan in place, which is
monitored via the NWAS Commissioning Group and this information is fed back through
the Collaborative Commissioning Group. Mrs Nixon added that NWAS had written to
CCGs and Primary Care recently indicating that the service was under pressure due to a
significant increase in activity. She identified several initiatives which were in place
within BwD to reduce the pressure on ambulance services, e.g. the Acute Visiting
Scheme and the Intensive Support at Home Service.
14.083
Clinical Chief Officer’s Report
Dr Malcolm Ridgway presented the Clinical Chief Officer’s Report in the absence of Dr
Chris Clayton and highlighted key items of national and local interest.
Items of note related to:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Achieving Better Access to Mental Health Services by 2020
Government Response to Ebola
H&WBBs
NHS England appointments
The NHS Five Year Forward Review
Improving Eye Health and Reducing Sight Loss – a ‘call to action’
Healthwatch
Care Quality Commission Inspections of GP Practices
Making Every Adult Matter (MEAM)
Lancashire Health Expo
BwD CCG Annual General Meeting
Pennine Lancashire Mental Health Unit
ELHT
Health Service Journal Awards
Care.data Pathfinders
Mrs Nixon provided an update on the CCG’s submission of plans regarding the Better
Care Fund. The CCG had received national feedback earlier in the week and was very
pleased to have received a category grading of ‘approved with some support’.
Questions and answers followed.
ACTION: It was agreed that developments related to the NHS Five Year Forward
Review would be presented to the next meeting of the GB by Mrs Debbie Nixon.
ACTION: The Chair agreed to feedback comments related to the communication
and engagement of plans for the Pennine Lancashire Mental Health Unit to
Lancashire Care NHS Foundation Trust (LCFT).
RESOLVED: That the Governing Body noted the content of the report.
Page 4 of 10
14.084
Chief Finance Officer’s Report
Mr Roger Parr presented the Finance Report which provided details of the CCG’s overall
position at the end of September 2014.
Mr Parr drew members’ attention to actions from the last meeting indicated in the Action
Matrix and highlighted Appendix C of the report which now indicated the type of
contracts. He informed the meeting that he had discussed the scenarios and risks with
Mr Paul Hinnigan, Chair, Audit Committee, as this detailed scenario planning was not
contained within the Executive Financial Summary.
The current revenue position remains on plan to deliver the planned year end surplus of
£2,307k. Year to date the CCG is reporting a cumulative breakeven position.
Mr Parr highlighted the position within healthcare commissioning from providers and
reported a year-end forecast overspend of £3,378k.
Primary Care Services were reporting a forecast underspend of £104k and it was noted
that year to date there had been a deterioration in the position related to primary care
prescribing, which was being monitored.
Corporate Services were reporting a probable year-end underspend of £63k.
Mr Parr drew members’ attention to the highlighted risks.
Questions and answers followed.
RESOLVED: That the Governing Body noted:
i.
the content of the report
ii.
the overall position of the CCG at the end of September 2014
iii.
the risks highlighted within the report
iv.
the detailed appendices supporting the narrative
14.085
Contract Performance Report
Mr Roger Parr presented the Contract Performance Report, which gave the GB an
update on the activity performance of the major commissioned services of the CCG as at
Month 5, August 2014.
Mr Roger Parr drew members’ attention to key information:
•
•
•
LCFT – Mental Health – which continued to show a reduction in admissions
across Lancashire and a reduction in bed days (page 2)
Referrals – the position overall is down when compared to the same period last
year (page 3)
o Specialty levels – there was an increase in Ear, Nose and Throat (ENT)
referrals and investigation revealed that this was related to urgent ENT
referrals.
o Ophthalmology continued to be considerably under plan. It was noted
that this was across the whole of East Lancashire and not specifically
BwD and was being investigated with ELHT.
Contract Performance (page 3) – indicated a similar position to previous months
with pressures in Accident and Emergency (A&E) and elective activity but there
were reductions in activity in non-electives and out-patients.
Page 5 of 10
•
•
•
•
ELHT Waiting Lists (page 5) – the total size of the waiting list had decreased by
14 patients in August.
o Referral to Treatment (RTT) – a contract variation had been agreed with
ELHT with regards to the funding associated to delivering the 18 weeks
RTT target.
36 Week Waiters (page 5) – 11 patients are on an incomplete pathway waiting
over 36 weeks. There were no waiters over 52 weeks.
Ambulance Contract (page 5) – the ambulance contract for BwD was delivering
its target but acknowledged that NWAS overall was not hitting the target (as
referred to by Mrs Nixon under 14.082).
LCFT – Community Services (page 6) – Mr Parr referred to the Action Matrix and
reported that the CCG was in detailed discussions with LCFT regarding the
quality of community data.
Questions and answers followed.
ACTION: Following a comment from a member of the public Mr Parr agreed to
consider a request to include data related to Patient Transport Services in future
reports.
RESOLVED: That the Governing Body noted the content of the report and the
supporting appendices.
14.086
Quality and Performance Exception Report
Dr Malcolm Ridgway, Clinical Director for Quality and Effectiveness, presented the GB
with an update on the quality and performance exception report for month 5; the full
report being regularly presented to the Quality, Performance and Effectiveness
Committee (QPEC).
Dr Ridgway drew members’ attention to key information:
•
•
LCFT – Mental Health Service
o Improving Access to Psychological Therapies (page 1) – Dr Ridgway
referred to the prevalence target, i.e. how many people ought to be
referred to the service and how many people were actually referred to the
service and the expectation target for this, which was 15% annually. Dr
Ridgway reported a drop in the figure for the month of August but it was
predicted that the target would be reached by the end of the year.
o Memory Assessment Service (page 1) – the target had not been reached
and work was ongoing to improve the service.
o Care Programme Approach (CPA) 7 day follow-up (page 1) – the
operating standard referred to patients with more serious mental health
problems being followed up following discharge. Blackpool was the only
area for which the CPA was failing on a year to date position.
ELHT
o 18 Week RTT (page 2) – there were 3 areas which were failing to achieve
the standard but these were being monitored closely by the Lead
Commissioner, East Lancashire CCG.
o A&E 4 Hour Target (page 2) – the target is being reached cumulatively for
the year but would be closely monitored.
o Clostridium Difficile (page 2) – there have been an increase in cases but it
is hoped to still hit the target for the year.
o Stroke 4 Hour (page 2) – the figures have continued to show gradual
Page 6 of 10
improvement
Mortality (page 3) – the figure showed a slight deterioration but would not
trigger the CCG as an outlier. There was a lot of work taking place to
review mortality rates.
o Friends and Family Test (page 3) – the criteria had changed but, when
compared to other local A&E Trusts, ELHT still performs poorly.
Calderstones Partnership Foundation Trust (page 3) – a draft report following the
Care Quality Commission (CQC) inspection had been received which is being
reviewed by the Trust.
NWAS (page 3) – there had been no feedback to date following the CQC
inspection.
NHS Constitution
o Cancer waits 62 days (page 6) – the reported issues have been
discussed at previous GB meetings. The standard for 85% of patients to
receive first definitive treatment for cancer within 62 days was not met for
BwD patients in August. Further work is taking place to improve the
figures.
o
•
•
•
Questions and answers followed.
RESOLVED: That the Governing Body noted the contents of the report.
14.087
Governing Body Assurance Framework Update
Mr Roger Parr presented the Governing Body Assurance Framework (GBAF); reviewed
by the GB on a quarterly basis.
The CCG has 5 Corporate Objectives and, to assist with the delivery of the objectives,
the CCG manages 10 strategic risks associated with the objectives. This is part of the
CCG’s system of internal control and also provides good governance by the GB.
The report highlighted the CCG’s Corporate Objectives and indicated those risks being
managed.
Mr Parr drew members’ attention to one of the risks which had been
considered by the QPEC, with a recommendation for the GB to consider. The risk
referred to the target for GP workforce capacity, highlighted in section 4, in relation to
future plans for Primary Care delivery. It is noted that it was unlikely that the CCG would
deliver the target during this period. Mr Parr added that delivery was not currently within
the control of the CCG, as the CCG did not commission this area of work. The CCG had
been discussing this with NHS England and Health Education England, both locally and
across Lancashire but it was unlikely that the CCG would be able to mitigate this risk
during this financial year.
Questions and answers followed.
RESOLVED: That the Governing Body:
i.
noted the content of the report
ii.
noted the implications of risk CO4.3 as outlined
14.088
Primary Care Strategy
Dr Malcolm Ridgway introduced the Primary Care Strategy. Dr Ridgway stressed the
importance of the CCG having a vision and strategy for Primary Care. The document set
out an overarching strategic direction to realise the changes required to provide an
integrated high quality services model.
Page 7 of 10
Mr Peter Sellars outlined the aims of the CCG with regards to Primary Care (General
Practice), which as the foundation of care needs to fundamentally change from its
current operating arrangements of fragmented services to an integrated high quality
services model, having collective responsibility for the health of the population. The
report outlined how the CCG would deliver this from the provider aspect, as well as from
a commissioning perspective.
It was noted that General Practice was under pressure both locally and nationally in
terms of the current investment into Primary Care, which has seen a reduction over the
last few years. Along with this, General Practices have been requested to do more, e.g.
increased GP access and moving some services from a secondary care into a primary
care setting. There have also been difficulties relating to the recruitment and retention of
GPs. The strategy addressed some of these key issues and set out an operating
standard for General Practice. It also outlined what success would look like and how
patient benefits could be measured.
Questions and answers followed.
ACTION: Dr Ridgway noted comments and suggestions from members and
agreed to consider their inclusion within the strategy.
RESOLVED: That the Governing Body:
i.
ii.
14.089
received and considered the contents of the paper
approved and ratified the strategic direction set out in the paper
Co-commissioning Primary Care Update
Dr Malcolm Ridgway introduced the co-commissioning update, which provided
background to and an update on Co-commissioning Primary Care, in particular the
activities and timeframes involved.
Mr Peter Sellers outlined the background to the CCG submitting an expression of
interest in taking on an increased role in the commissioning of Primary Care Services
(General Practice). The CCG submitted an interest in the Category C commissioning of
Primary Care (General Practice), which was full delegated authority. Mr Sellars
explained the meaning of delegated arrangements, the approvals process and
timescales involved. Mr Sellars added that the CCG would need to resubmit its proposal
to NHS England by the 5th January 2015, in order to prepare for a commencement date
of 1st April 2015.
Questions and answers followed.
RESOLVED: That the Governing Body received and considered the content of the
paper and looked forward to receiving regular reports on progress.
14.090
System Resilience 2014/15
Mrs Debbie Nixon presented the report on System Resilience for 2014/15 which
provided an update on Pennine Lancashire plans for operational resilience and capacity
planning and to support delivery of the 4 Hour A&E and 18 Weeks RTT targets.
It had been agreed by the Governing Bodies across the Pennine Lancashire Health and
Social Care Economy that the newly established Chief Executive Officers Steering
Page 8 of 10
Group would undertake the role of the System Resilience Group (SRG) and would
provide oversight and assurance on shared plans.
Mrs Nixon reported that the SRG signed off the initial plans for system resilience in
August 2014 to support urgent care and elective activity and agreed jointly how to utilise
the non-recurrent resource for the health economy.
Mrs Nixon drew members’ attention to the resilience winter funded schemes outlined in
the report, some of which were linked to the CCG’s plans for the Better Care Fund.
Mrs Nixon added that the plans would be presented to the SRG next week for sign off
and then the resource would be allocated to the organisations.
Questions and answers followed.
RESOLVED: That the Governing Body noted the content of the update.
14.091
External Audit Annual Audit Letter 2013/14
The External Audit Annual Audit Letter 2013/14, which summarised the key findings
arising from the work that Grant Thornton had carried out with BwD CCG for the year
ended 31st March 2014 was circulated for information.
RESOLVED: That the Governing Body noted the content of the letter.
14.092
Governing Body Sub-Committees and Groups’ Summary
Mr Iain Fletcher presented the Governing Body Sub-Committees and Groups’ Summary
which summarised each Committee Meeting for the Governing Body and identified key
decisions or actions and items of particular interest was presented for information.
RESOLVED: That the Governing Body noted the content of the report.
14.093
Governing Body and Sub Committees and Groups’ Terms of Reference
14.093.1
Governing Body
Mr Iain Fletcher presented the Terms of Reference (ToR) for the GB which had been
revised to take into account the number of GPs on the GB
14.093.2
Executive Joint Commissioning Group
Mr Iain Fletcher presented the ToR for the Executive Joint Commissioning Group
(EJCG) which had been revised following the establishment of the localities within BwD
and was linked to the changes in the CCG’s Constitution.
RESOLVED: That the Governing Body approved the ToRs for the GB and the
EJCG.
Mr Fletcher reported that the submission of the revised CCG Constitution would now
take place prior to 1st December 2014 and requested approval from the GB for the
submission to be signed off by the Chair, following receipt of guidance awaited from NHS
England on arrangements to co-commission Primary Care.
RESOLVED: That the Governing Body agreed to approve Chair’s Action for the
sign off the CCG Constitution prior to its submission to NHS England.
Page 9 of 10
14.094
Mental Health Crisis Concordat Update
Mrs Debbie Nixon presented the report which provided an overview of the Mental Health
Crisis Care Concordat, which BwD CCG was coordinating on behalf of the CCGs across
Lancashire.
The CCG was working in partnership with Lancashire Constabulary and took part in a
successful stakeholder event on 10th October at Lancashire Police Headquarters.
Mrs Nixon reported that a comprehensive Action Plan would be in place by 31st March
2015 and work was progressing well. She added that Dr Chris Clayton would sign off
the necessary declaration by 31st December 2014, which would commit to CCG to
support the developing Action Plan. The Action Plan would be a Lancashire plan but on
the footprint of the three Lancashire H&WBBs. The BwD plan would be presented to a
future meeting of the BwD H&WBB.
RESOLVED: That the Governing Body noted the content of the update.
14.095
Any Other Business
No further business was discussed.
14.096
Date and Time of Next Meeting
The next meeting will be held on 14th January 2015 at 1 pm, Meeting Rooms 1 & 2
Blackburn Central Library, Town Hall St, Blackburn, BB2 1AG.
The Chair thanked everyone for their attendance and input and the meeting closed.
EXCLUSION OF THE PRESS AND PUBLIC – ‘That representatives of the press and
other members of the public be excluded from the remainder of the meeting having
regard to the confidential nature of the business to be transacted, publicity on which
would be prejudicial to the public interest’ (Section1(2)Public Bodies(Admission to
Meetings)Act 1960)
Signed ………………………………………………. Chairman …………………………………… Date
Page 10 of 10
CLINICAL COMMISSIONING GROUP (CCG)
Item 7.1
Extract from the Minutes of Part 2 of the Governing Body Meeting held on
Wednesday 5th November 2014 at 3 pm
in the Rooms 1 and 2, Blackburn Central Library,
Town Hall Street, Blackburn BB2 1AG
PRESENT:
Mr Joe Slater
Mr Roger Parr
Dr Pervez Muzaffar
Mr Paul Hinnigan
Dr Penny Morris
Mrs Debbie Nixon
Dr Malcolm Ridgway
Dr Adam Black
Mrs Anne Asher
Chairman (Chair)
Chief Finance Officer
Executive Member
Lay Member - Governance
Executive Member
Chief Operating Officer
Clinical Director for Quality and Effectiveness
Executive Member (Part)
Lay Member - Nurse Representative
IN ATTENDANCE:
Mr Iain Fletcher
Head of Corporate Business
Mrs Pauline Milligan Corporate Support Officer (minutes)
A/14
Minutes of Part 2 of the Meeting held on 3rd September 2014
The Minutes of Part 2 of the Meeting held on 3rd September 2014 were considered and
accepted as an accurate record.
RESOLVED: That the Minutes of Part 2 of the Meeting held on 3rd September
2014 were approved as an accurate record.
B/14
B/14.1
Matters Arising/
Action Matrix
The following items were noted:
Minute C/14 – September – Safeguarding Update
Dr Malcolm Ridgway reported that the safeguarding concern raised at the last meeting
had been resolved.
Dr Ridgway provided a verbal update to the Governing Body (GB) regarding
safeguarding issues.
Mr Iain Fletcher provided a verbal update on the current position related to Continuing
Healthcare (CHC) cases.
The GB discussed the difficulties involved in dealing with Deprivation of Liberty
Safeguarding (DoLS) assessments, which seemed to be a growing issue nationally.
Page 1 of 1
GOVERNING BODY (GB) MEETING - ACTION MATRIX
Item 8.1
Action Origin
Board Ref
14.083
14.083
14.085
14.088
Action
Clinical Chief Officer’s Report
It was agreed that developments related to the NHS Five Year Forward
Review would be presented to the next meeting of the Governing Body
by Mrs Debbie Nixon.
Clinical Chief Officer’s Report
The Chair agreed to feedback comments related to the communication
and engagement of plans for the Pennine Lancashire Mental Health Unit
to Lancashire Care NHS Foundation Trust.
Contract Performance Report
Following a comment from a member of the public Mr Roger Parr agreed
to consider a request to include data related to Patient Transport
Services in future reports.
Primary Care Strategy
Dr Malcolm Ridgway noted comments and suggestions from members
and agreed to consider their inclusion within the strategy.
Owner
Due Date
Status
DN
JANUARY 15
JANUARY AGENDA
JS
JANUARY 15
COMPLETED
RP
JANUARY 15
COMPLETED
MR
JANUARY 15
COMPLETED
GOVERNING BODY MEETING
Date of Meeting
Title of Report
Governing Body
Responsible Officer
Summary/Purpose of
Report
Governing Body
Action
14TH JANUARY 2015
Agenda
Item No.
CLINICAL CHIEF OFFICER’S REPORT
9
Lead
DR CHRIS CLAYTON,
Clinician
CLINICAL CHIEF OFFICER
Lead
MR IAIN FLETCHER, HEAD OF
Manager
CORPORATE BUSINESS
This report provides an update on national and local issues of interest to
Governing Body members not covered elsewhere on the agenda, and
provides an indication of where the Clinical Chief Officer’s efforts have
been directed since the last meeting.
The Governing Body is requested to receive this report and to note the
items as detailed.
DR CHRIS CLAYTON,
CLINICAL CHIEF
OFFICER
Please indicate the Committee(s)/Group(s) where the paper has been discussed/developed
None.
Please note the following section must be completed in full
N/A
Patient and Public
(if yes, complete outcome)
Engagement Completed
N/A
(if yes, complete outcome)
Equality Analysis
Completed
N/A
Financial Implication(s)
Risk(s) Identified
N/A
CCG Strategic Objectives supported by this paper
1.
2.
3.
4.
5.
We will continuously improve the health and well-being of the population of Blackburn with
Darwen.
We will build successful partnerships which promote collaborative working and integrated
service delivery.
We will effectively engage patients and the public in decision making.
Y
We will co-commission and deliver continuous improvement in Primary Care Services and
tackle inequalities.
We will commission safe and effective services for the population of Blackburn with
Darwen with integration at the heart of commissioning.
Y
CCG High Impact Changes supported by this paper
1.
2.
3.
4.
5.
6.
7.
8.
9.
Delivering high quality Primary Care at scale and improving access.
Self-Care and Early Intervention.
Enhanced and Integrated Primary Care and Better Care Fund.
Access to Re-ablement and Intermediate Care.
Improved hospital discharge and reduced length of stay.
Community based ambulatory care for specific conditions.
Access to high quality Urgent and Emergency Care.
Scheduled Care.
Quality.
Report of the Clinical Chief Officer – 14th January 2015
Page 1 of 9
Y
Y
Y
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
14TH JANUARY 2015
CLINICAL CHIEF OFFICER’S REPORT
1) Introduction
This report provides an update on national and local issues of interest to Governing Body (GB)
members not covered elsewhere on the agenda, and also provides an indication of where the Clinical
Chief Officer’s (CCO) efforts have been directed since the last meeting.
2) Department of Health
2.1 Female Genital Mutilation
NHS England and the Department of Health have issued a joint statement on Female Genital
Mutilation.
Female Genital Mutilation (FGM) is child abuse and the Department of Health and NHS England
are committed to caring for FGM survivors, protecting girls from FGM, and preventing future
generations from having to undergo FGM. On 22 July 2014, the UK hosted the first Girl Summit,
aimed at mobilising domestic and international efforts to end FGM and child, early and forced
marriage (CEFM) within a generation.
The Department of Health’s Female Genital Mutilation Prevention Programme, in partnership with
NHS England, was launched at the Girl Summit and work on a number of FGM projects is now
underway across NHS settings to improve the health response to FGM.
Further information via: http://www.england.nhs.uk/2014/12/08/fgm-prevention/
2.2 Genomes Project
Eleven new centres across England have been chosen to deliver the 100,000 Genomes Project.
The three year project, launched by the Prime Minister earlier this year, aims to improve diagnosis
and treatment for patients with cancer and rare diseases.
The initiative involves collecting and decoding 100,000 human genomes – complete sets of
people’s genes – that will enable scientists and doctors to understand more about specific
conditions.
The project has the potential to improve our ability to predict and prevent disease. It may also
lead to new and more precise diagnostic tests and the ability to more accurately personalise
drugs and other treatments to specific genetic variants.
It is anticipated that over 75,000 people will be involved, which will include some patients with life
threatening and debilitating disease. After samples are collected, they will be sent securely to
Illumina who have been procured by Genomics England to sequence the whole genome and to
analyse it. Results will be sent back to the NHS for validation and clinical action.
Report of the Clinical Chief Officer – 14th January 2015
Page 2 of 9
The 11 designated Genomic Medicine Centres (GMCs) in this first selection process are based
across the country covering areas including Greater Manchester, the North West coast, Oxford,
Birmingham and the West Midlands, Southampton, London, Cambridge and the East of England,
Exeter and the South West Peninsula, and the North East.
Over the lifetime of the project NHS England’s ambition is to secure more than 100 participating
NHS trusts.
Further information
genomics-project
via:
https://www.gov.uk/government/news/eleven-new-centres-to-lead-
3) NHS England
3.1 Changes to Regional and Area Responsibilities and Senior Appointments
On 1st October 2014 NHS England announced plans designed, in part, to streamline and align the
functions and structures which support the organisation to work more effectively – both nationally
and regionally – to minimise duplication and make more effective use of its resources.
A single integrated team for each of the current regions has been developed. Four geographical
locations have been identified in each region, taking into account factors such as: numbers of
relationships with Clinical Commissioning Groups (CCGs), Trusts, Local Authorities, population
size and patients flows.
NHS England announced on 28th November the following appointments to the Directors of
Commissioning Operations roles:
•
•
•
•
•
•
•
•
•
Moira Dumma – Yorkshire and the Humber
Graham Urwin – Lancashire and Greater Manchester
Clare Duggan – Cheshire and Merseyside
Wendy Saviour – North Midlands
David Sharp – Central Midlands
Andrew Reed – West Midlands
Andrew Pike – East
Anthony Farnsworth – South West
Felicity Cox – South East
I am pleased to confirm that Graham Urwin will be coming to Blackburn with Darwen Clinical
Commissioning Group (BwDCCG) on 4th February to meet with members of its GB.
The following appointments have also been announced for the Lancashire and Greater
Manchester region:
•
•
•
Raj Patel – Medical Director
Trish Bennett – Director of Nursing
Ian Currell – Director of Finance
3.2 Friends and Family Test
On 1st December the Friends and Family Test (FFT) went live in 8,000 GP practices across
England, giving up to a million patients a day the opportunity to have a say about their care and
treatment. The FFT aims to drive service improvement in local healthcare by providing people
with the opportunity to feedback on their experience.
Report of the Clinical Chief Officer – 14th January 2015
Page 3 of 9
Further information via: http://www.england.nhs.uk/ourwork/pe/fft/
3.3 Winter Resilience
NHS England produces a summary which offers an overview of the system and pulls together
information on waiting times in Accident and Emergency (A&E) Departments, ambulance
response times, daily situation reports from the NHS, and information on flu rates.
The Weekly A&E Attendances and Emergency Admissions collection collects the total number of
attendances in the week for all A&E types, including Minor Injury Units and Walk-in Centres, and of
these, the number discharged, admitted or transferred within four hours of arrival.
Also included are the number of Emergency Admissions, and any waits of over four hours for
admission following decision to admit.
Data are shown at provider organisation level, from NHS Trusts, NHS Foundation Trusts and
Independent Sector Organisations. Data for this collection is available back to November 2010.
The weekly A&E figures for the weeks ending 21st December and 28th December 2014, which is a
particularly busy time for services have been published.
The figures show that in the three months to the end of December more than nine out of ten A&E
patients in England continued to be seen and treated in under four hours – the best measured
performance of any major western country.
In the immediate run up to Christmas the NHS treated 446,500 A&E attendees, up 38,000 on the
same week last year. There were 112,600 emergency admissions – the highest number in a
single week since figures began to be published in 2010.
A similar demand was faced over Christmas itself. In the week ending 28th December, A&E
attendances were up more than 31,000 on the same period last year, meaning that the NHS
successfully treated more patients in under four hours than ever before.
3.3.1
Pennine Lancashire
There is a great deal of pressure on the system “nationally” and locally and across
services - GPs and other services are all busy; Social Services referrals are very high. All
Health and Social care services are working together actively and are under increasing
pressure – all staff are working extremely hard to make sure that patients receive safe,
high quality care.
The vast majority of patients attending A&E are being seen within target time period.
Despite talk of lengthy waiting times, 84% (92% nationally) of people are being seen within
the target.
Further information via:
http://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/
3.4 Coalition for Collaborative Care
A major new alliance committed to improving care and support for people with long-term
conditions was launched on 21st November.
The Coalition for Collaborative Care (C4CC) has people with long-term health conditions at the
heart of its powerful alliance and brings together some of the sector’s most influential national
groups and organisations.
Report of the Clinical Chief Officer – 14th January 2015
Page 4 of 9
With more than 15 million people in the UK living with a long-term condition, the Coalition will
champion a system-wide transformation in how they receive and use care and support.
This innovative new partnership will focus on re-framing the relationship between a person with
long-term health conditions and the professionals supporting them. This allows the expertise of
both to be used most effectively to help the person plan to manage their condition and maximise
their well-being.
It will draw strongly on the House of Care developed by the Year of Care Partnerships which
highlights what is required to achieve person-centred coordinated care.
There is good evidence to suggest that engaging with people with long-term conditions to codesign their care, leads to better outcomes and more successful independent living. C4CC aims
to ensure that professionals and people have the right support, knowledge, skills, power and
confidence to achieve this.
The Coalition will also put a strong emphasis on a much more holistic approach in which there is
less focus on a person’s condition in isolation and more on the full spectrum of support that is
required to enable people to be included in and play active, valued roles within their own
communities – an approach developed by Nesta in its People Powered Health programme and
often called ‘More than Medicine’.
Further information via: http://www.england.nhs.uk/2014/11/21/c4cc/
4) Blackburn with Darwen Clinical Commissioning Group
4.1 Lancashire Care NHS Foundation Trust (LCFT)
The Trust has been informed that planning permission for the proposed new Pennine Lancashire
Mental Health Unit inpatient facility on the land immediately adjacent to the Royal Blackburn
Hospital site, which will provide 72 beds for adults over the age of 18, has been granted by
Blackburn with Darwen (BwD) Borough Council.
4.2 East Lancashire Hospitals NHS Trust (ELHT)
See under Item 3.3 – Winter Resilience.
4.3 Midlands and Lancashire Commissioning Support Unit
Following a restructure, the Commissioning Support Unit (CSU) has announced the following
appointments in its leadership team to support Derek Kitchen, Managing Director.
•
•
•
•
•
•
•
•
Peter Spilsbury - Director of Strategy Unit
Carl Usher - Director of Finance and Commerce
Deb Thwaites – Director of Business Improvement
Tony Matthews – Director of Operations
Sarah Sheppard – Director of People
Linda Riley – Director of Clinical Services
Stephanie Belgeonne and Lynda Scott – Communications and Engagement Service
Chris Knight – Business Executive Lead
4.4 Care.data
The CCG is a pathfinder for the care.data initiative and is working with NHS England.
Report of the Clinical Chief Officer – 14th January 2015
Page 5 of 9
The CCG will engage with all relevant stakeholders, including patient groups, in launching the
initiative. BwD Healthwatch is also involved and will inform the learning from the pilot stages.
4.5 Better Care Fund
Following the submission of further evidence to move its plans for the Better Care Fund (BCF) to
a fully approved status, the CCG is pleased to have been informed by NHS England that,
following the subsequent Nationally Consistent Assurance Review (NCAR) process, its plans
have been classified as ‘Approved’. NHS England stated that it was clear that the CCG’s team
and partners have worked very hard over the last year to develop its plan to improve people’s
care and that the plan was clear and ambitious. NHS England supported BwD’s ambitions and
stated it was in a strong position to deliver the changes outlined in the plan; that it was confident
that there were no areas of high risk and that BwD should progress with implementation.
5) Blackburn with Darwen Health and Well-being Board
5.1 Joint Health and Well-being Strategy
The Blackburn with Darwen Joint Health and Well-being Strategy has been refreshed and it is
now structured around three life stages:
•
•
•
Start Well
Live Well
Age Well
It is intended that this will allow for the work to be overseen by the Children’s Partnership Board,
the local Prosperous Group of the Local Strategic Partnership and the 50+ Partnership
respectively. These bodies are aware of the need to allow for overlap as people make the
transition from child to adult and from working age to retirement.
The next steps will be:
•
•
•
•
•
•
Continue 1:1 and group discussions with key stakeholders to refine the priorities further
and clarify relationship with other partnership priorities and programmes of work
Stakeholder workshops to agree a small number of evidence based actions for the
achievement of each priority. These will be led by the thematic delivery groups (Children’s
Partnership Board, Prosperous Group and 50+ Partnership)
Agree outcomes and associated proxy measures that will demonstrate progress toward
achieving outcomes
Agree a performance reporting process that provides the Board with sufficient assurance
of progress and alerts the Board to areas requiring corrective action. This will be
integrated with other performance reporting processes so far as is possible
Finalise delivery structures and reporting arrangements and update as necessary
including role of Prosperous Group
‘Sense check’ with thematic and other groups/partners affiliated to the Health and Wellbeing Board (HWBB).
5.2 Regional Voices
This annual ‘Supporting Influence on HWBBs’ survey asks the voluntary, community and social
enterprise (VCSE) sector about engagement with HWBBs – what is working well, what could
work better and what support would help. The aim of the survey is to capture how VCSE
engagement with HWBBs is changing over time.
Report of the Clinical Chief Officer – 14th January 2015
Page 6 of 9
The survey is aimed at:
•
•
•
Voluntary sector representatives on HWBBs
Healthwatch representatives on HWBBs
The wider voluntary, community and social enterprise sector
It asks about routes into the H&WBB, how the VCSE sector is able to influence the Joint Strategic
Needs Assessment, the Joint Health and Well-being Strategy and local commissioning. It is
hoped to capture how engagement with the Boards is changing over time. It also includes a new
question, looking at HWB use of local Compacts.
The closing date for this survey is 23 January 2015.
Further information via:
https://www.surveymonkey.com/s/HWBengagementsurvey3?utm_medium=email&utm_source=T
he+King%27s+Fund+newsletters&utm_campaign=5071556_HMP+2014-1202&dm_i=21A8,30P8K,HPWAEQ,AV2DS,1
6) Good News
6.1 North West Towards Excellence
The Finance Skills Development Network has announced that Level 1 Accreditation has been
awarded to the Lancashire CCGs.
This is an excellent achievement which not only demonstrates continuous improvement and
development of the finance function within the Lancashire organisations but also a culture of
collaborative working.
6.2 Health Business Awards
The Health Business Awards has established a reputation for showcasing the success stories in
the health sector. The Awards recognise and celebrate the significant contributions made each
year by organisations and individuals that work inside and alongside the NHS.
The NHS Collaboration Award is presented to the NHS Trust which has worked with other
public/private sector organisations, such as local government, police, fire, charities, schools etc.
to engage the local community in preventative campaigns.
I am pleased to announce that an innovative project to reduce the demands on hospital and
police staff in A&E at the Royal Blackburn Hospital (RBH) has scooped the award for
collaboration in 2014.
The scheme involves two highly trained and extensively skilled Police Officers placed within the
A&E department at the RBH and is funded by the CCG commissioners across East Lancashire (in
Pennine Lancashire).
The A&E scheme went up against stiff opposition and won due to the partnership and team work
between Lancashire Constabulary and the NHS in Pennine Lancashire – involving BwDCCG,
East Lancashire CCG, ELHT and LCFT.
The scheme consists of a Pennine Lancashire Hospital Early Action Team which is based at the
hospital to provide a more co-ordinated and integrated police support role within A&E. The
scheme seeks to support individuals who visit A&E in a distressed state as the result of alcohol
Report of the Clinical Chief Officer – 14th January 2015
Page 7 of 9
and substance misuse or mental health problems. The aim is to manage these vulnerable
individuals where they live using community based resources.
The officers have worked with hospital staff to identify and support individuals who attend A&E as
a result of challenging behaviour, alcohol, substance misuse, a mental health problem, housing
issues and loneliness. The organisations involved in the scheme established it to help reduce
pressure on A&E as well as actively support those patients affected within the community.
The scheme began in April this year, and is now fully operational.
I am delighted that this award recognises the integrated work and collaboration between all of our
organisations. Patients and the public tell us that health and other services could be better joined
up and this is a perfect example where organisations have worked collectively to achieve this in
A&E. Patients should be reassured that we are working hard together to achieve the best
outcomes and services for them.
6.3 Excellence in Diversity Awards
I am pleased to announce that the CCG has been nominated for the Diverse Company Award:
Public in the Excellence in Diversity Awards 2015.
The Excellence in Diversity Awards is the only awards ceremony that rewards UK organisations
for harnessing a truly diverse workforce, thus recognising the significant efforts of companies
nationwide that excel in their commitment to diversity and inclusion.
The Excellence in Diversity Awards also focus on leading diversity champions, significant role
models and extraordinary employees that have displayed motivation, innovation and commitment
to the equality agenda.
Shortlisted nominees will be chosen following the close of nominations and will be invited to
attend the ceremony in May 2015.
6.4 Crisis Care Concordat
BwDCCG, as the Lead Commissioner for the mental health contract, submitted a bid on behalf of
all CCGs. This bid was for additional monies linked to the Crisis Care Concordat.
The bid was successful and an additional £868k has been allocated to a number of schemes to
allow an increase in existing unscheduled care services or new pilot schemes to be tested across
Lancashire whilst ongoing redesign of the services is undertaken.
The intended outcome is that the schemes are embedded as part of the overall unscheduled
care/
service and is within current resources following the redesign which is a Lancashire wide
commissioning intention.
7) Meetings
Members may be interested to note the following meetings and events which have taken place during
the course of the last two months.
4 November
5 November
6 November
6 November
North Tripartite Autumn Event
CCG Leaders meeting with Jeremy Hunt, Secretary of State for Health
CCG Executive Team Development Session
Practice Visit to Cornerstone Practice
Report of the Clinical Chief Officer – 14th January 2015
Page 8 of 9
7 November
10 November
11 November
12 November
13 November
14 November
19 November
20 November
24 November
26 November
26 November
27 November
27 November
2 December
3 December
3 December
3 December
4 December
4 December
8 December
9 December
10 December
17 December
18 December
Residents Meeting with Jack Straw, MP (Shadsworth with
Whitebirk/Audley)
Practice Visit to Little Harwood Health Centre
Practice Visit to The Montague Practice
Pennine Lancashire Chief Executives Steering Group
Local Medical Committee
Residents Meeting with Jack Straw, MP (Higher Croft)
Health Service Journal Awards
Protected Learning Time Event, Urgent Care in Children and the Elderly
Executive Joint Commissioning Group
CCG Staff Meeting
Practice Visit to The Family Practice
Lancashire CCG Network
Lancashire Leadership Forum
Blackburn with Darwen GP Development Session
Governing Body Development Session
Governing Body Development and Discussion Meeting
Pennine Lancashire Clinical Transformation Board
Practice Visit to Waterside Surgery
Practice Visit to Umar Medical Centre
Practice Visit to Brownhill Surgery
Practice Visit to Roe Lee Surgery
Pennine Lancashire Chief Executives Steering Group
Clinical and Management Executive Team
Practice Visit to Dr Hirst, Darwen Health Centre
8) Recommendation
The Governing Body is requested to receive this report and to note the items as detailed.
Dr. Chris Clayton
Clinical Chief Officer
5th January 2015
Report of the Clinical Chief Officer – 14th January 2015
Page 9 of 9
GOVERNING BODY MEETING
Date of Meeting
Title of Report
Governing Body
Responsible Officer
14TH JANUARY 2015
Agenda
Item No.
CHIEF FINANCE OFFICER’S REPORT
10
Lead
Clinician
Lead
MRS LINDA RING, SENIOR
Manager FINANCE MANAGER
The current revenue position is on plan to deliver the planned
Summary/Purpose of
year end surplus of £2,307k. Year to date (YTD) the Clinical
Report
Commissioning Group (CCG) is reporting a cumulative breakeven
position. A breakeven position is forecast at year end.
The
current forecast is based on best estimates of future expenditure.
Increasing acute activity and Continuing Healthcare pressures
within the health system remain a factor.
It is recommended that the CCG Governing Body note the
Governing Body
contents of this financial summary and the overall position of the
Action
CCG at the end of November 2014, noting the risks and detailed
appendices supporting this narrative.
Please indicate the Committee(s)/Group(s) where the paper has been
discussed/developed
N/A
MR ROGER PARR,
CHIEF FINANCE
OFFICER
Please note the following section must be completed in full
N/A
Result
Patient and Public
Engagement Completed
N/A
Result
Equality Analysis
Completed
N/A
Financial Implication(s)
Yes
Risk(s) Identified
CCG Strategic Objectives supported by this paper
1.
2.
3.
4.
5.
We will continuously improve the health and well-being of the population of
Blackburn with Darwen.
We will build successful partnerships which promote collaborative working and
integrated service delivery.
We will effectively engage patients and the public in decision making.
We will co-commission and deliver continuous improvement in Primary Care
Services and tackle inequalities.
We will commission safe and effective services for the population of Blackburn
with Darwen with integration at the heart of commissioning.
Y
Y
Y
Y
Y
CCG High Impact Changes supported by this paper
1.
2.
3.
4.
5.
6.
7.
8.
9.
Delivering high quality Primary Care at scale and improving access.
Self-Care and Early Intervention.
Enhanced and Integrated Primary Care and Better Care Fund.
Access to Re-ablement and Intermediate Care.
Improved hospital discharge and reduced length of stay.
Community based ambulatory care for specific conditions.
Access to high quality Urgent and Emergency Care.
Scheduled Care.
Quality.
Y
Y
Y
Y
Y
Y
Y
Y
Y
Executive Financial Summary Month 8 – Period Ending 30th November 2014 Funds Available Budget £000 139,324
Year to Date Actual £000 139,324
109,865
20,920
4,775
2,228
1,536
112,303
20,800
4,685
0
1,536
Variance £000 0
Budget £000 208,225
Full year forecast Actual £000 208,225
(2,438)
120
90
2,228
0
164,926
31,384
7,380
2,228
2,307
167,523
31,224
7,171
0
2,307
Variance £000 0
Commissioning Primary Care Corporate Reserves Balance (2,597)
160
209
2,228
0
Summary Financial Position ‐ The current revenue position is on plan to deliver the planned year end surplus of £2,307k. Year to date (YTD) the CCG is reporting a cumulative breakeven position. A breakeven position is forecast at year end. The current forecast is based on best estimates of future expenditure. Increasing acute activity and CHC pressures within the health system remain a factor. Commissioned Services RISKS • Healthcare Commissioning from providers is reporting a YTD overspend • Acute activity levels continue to be a key factor in 2014‐15. of £2,438k with a year‐end forecast overspend of £2,597k. The Schemes are in place to reduce non elective admissions with our overspending is mainly due to pressures in A&E, elective inpatients, main provider. critical care and radiology. The forecast is based on month 7 activity. • Continuing health care and complex packages continues to be a • Primary Care Services are reporting a YTD underspend of £120k and key risk. Data has been received for month 7 and this is being forecast underspend of £160k. Prescribing is reporting a small verified. This area of spend will be closely monitored in 2014‐15. overspend at November offset by savings reported on enhanced • Prescribing expenditure is volatile and is monitored closely by services and other primary care commissioning. Prescribing is based the Medicines Management Team. on actual spend to September with forecast spend for October and November. QIPP • Corporate Services are reporting a YTD underspend of £90k and • 67% of the QIPP target has been achieved at month 8 which is in forecasting a year end underspend of £209k mainly due to the CCG plan to meet a full year target of £4m. operating within its running cost allowance. Capital • The overspend in commissioning is covered by underspends in primary care, corporate services and reserves. • The CCG is planning Primary Care IT capital expenditure of £181k on infrastructure upgrade. YTD expenditure of £118k has been incurred. Recommendation ‐ It is recommended that the CCG Governing Body note the contents of this financial summary and the overall position of the CCG at the end of November 2014, noting the risks and detailed appendices supporting this narrative.
NHS Blackburn with Darwen CCG
APPENDIX A
Summary Governing Body Report ‐ November 2014
Budget to Date
£000
Expenditure to Date £000
Variance to Date
£000
Annual Budget £000
Annual Forecast Variance
£000
Annual Forecast
£000
Revenue Resource Limit
Confirmed
(139,324)
(139,324)
0
(208,225)
(208,225)
0
0
0
0
0
0
0
(139,324)
(139,324)
0
(208,225)
(208,225)
0
(2,437)
Anticipated
Total Revenue Resource Limit
Expenditure
Commissioning (Page 2)
130,785
133,103
(2,318)
196,310
198,747
Corporate (Page 4)
2,326
2,298
28
3,409
3,400
9
Reserves (Page 4)
2,228
0
2,228
2,228
0
2,228
135,339
135,401
(62)
201,947
202,147
(200)
Healthcare Sub Total
Running Costs (Page 4)
Total Expenditure
Surplus/(Deficit)
Better Payment Practice Code
NHS
Non NHS
2,449
2,387
62
3,971
3,771
200
137,788
137,788
0
205,918
205,918
0
1,536
1,536
0
2,307
2,307
0
YTD Value (%)
YTD Volume (%)
FOT Value (%)
FOT Volume (%)
Target (%)
100.0
98.5
100.0
98.5
95.0
98.1
99.2
98.1
99.2
95.0
Page 1
NHS Blackburn with Darwen CCG
Healthcare Commissioning Report ‐ November 2014
Budget to Date Expenditure to Date Variance to Date
£000
£000
£000
Annual Budget £000
Annual Forecast
£000
Acute Services
NHS contracts (includes Ambulance Services)
74,482
75,725
(1,243)
111,723
113,488
3,241
3,885
(644)
4,862
5,175
NHS Contract Exclusions / Cost per Case
412
319
93
618
434
Non Contract Activity
491
733
(242)
736
749
Non NHS Providers
Other
0
0
0
0
0
78,626
80,662
(2,036)
117,939
119,846
10,541
10,541
0
15,762
15,762
466
440
26
651
611
NHS Contract Exclusions / Cost per Case
92
83
9
107
103
Non Contract Activity
22
3
19
33
33
Sub Total Acute Contracts
Mental Health Services NHS contracts Non NHS Providers
Other
(221)
(217)
(4)
(221)
(217)
10,900
10,850
50
16,332
16,292
NHS contracts 9,537
9,537
0
14,305
14,305
Non NHS Providers
1,358
1,403
(45)
1,947
1,718
116
105
11
174
150
0
0
0
0
0
701
701
0
1,049
1,049
Sub Total Mental Health Services
Community Health Services
NHS Contract Exclusions / Cost per Case
Non Contract Activity
Hospices
Other
Sub Total Community Services
Total Healthcare Contracts
407
16
391
1,229
1,230
12,119
11,762
357
18,704
18,452
101,645
103,274
(1,629)
152,975
154,590
4,570
5,326
(756)
6,466
7,450
320
389
(69)
480
502
4,890
5,715
(825)
6,946
7,952
26,463
Continuing Care Services
Continuing Care
Free Nursing Care
Sub Total Continuing Care Services
Primary Care services
Prescribing
17,635
17,641
(6)
26,453
Enhanced Services
432
353
79
648
528
Out of Hours
757
757
0
1,135
1,135
1,712
1,684
28
2,564
2,558
384
365
19
584
540
20,920
20,800
120
31,384
31,224
77
61
16
125
101
Commissioning
Other Sub‐total Primary Care services
Other Programme Services
Other Non Acute
Complex Cases & Individual Funding Requests
Sub Total Other Programme Services
Surplus/(Deficit)
3,253
3,253
0
4,880
4,880
3,330
3,314
16
5,005
4,981
130,785
133,103
(2,318)
196,310
198,747
Page 2
APPENDIX B
Annual Forecast Variance
£000
(1,765)
(313)
184
(13)
0
(1,907)
0
40
4
0
(4)
40
0
229
24
0
0
(1)
252
(1,615)
(984)
(22)
(1,006)
(10)
120
0
6
44
160
24
0
24
(2,437)
Page 3
NHS Blackburn with Darwen CCG
APPENDIX C
Main Healthcare Contracts ‐ November 2014
Expenditure to Date £000
Budget to Date
£000
Variance to Date
£000
Annual Budget £000
Annual Forecast
£000
Annual Forecast Variance
£000
Acute Contracts
Main Provider
East Lancashire Hospitals NHS Trust
64,390
64,963
(573)
96,586
97,445
(859)
3,092
3,415
(323)
4,638
5,022
(384)
321
349
(28)
481
524
(43)
54
103
(49)
81
155
(74)
Other Lancashire Providers
Lancashire Teaching Hospitals NHS FT
Blackpool Fylde & Wyre Hospitals NHS FT
University Hospitals Morecambe Bay NHS FT
North West Ambulance Service NHS Trust (Block)
4,465
4,465
0
6,697
6,697
0
Sub Total Other Lancashire Providers
7,932
8,332
(400)
11,897
12,398
(501)
University Hospital South Manchester NHS FT
269
328
(59)
404
492
(88)
Salford Royal NHS FT
242
170
72
362
255
107
Royal Bolton Hospitals NHS FT
173
226
(53)
259
339
(80)
Wrightington, Wigan & Leigh NHS FT
351
444
(93)
526
666
(140)
Central Manchester University Hospital NHS FT
870
969
(99)
1,306
1,454
(148)
Greater Manchester Providers
Pennine Acute NHS Trust
Sub Total Greater Manchester Providers
120
107
13
180
160
20
2,025
2,244
(219)
3,037
3,366
(329)
Merseyside providers
Royal Liverpool & Broadgreen NHS Trust
136
186
(50)
203
280
(77)
Sub Total Merseyside Providers
136
186
(50)
203
280
(77)
2,564
3,254
(690)
3,846
4,230
(384)
211
164
47
316
245
71
2,775
3,418
(643)
4,162
4,475
(313)
77,258
79,143
(1,885)
115,885
117,964
(2,079)
10,036
10,036
0
15,053
15,053
0
482
482
0
674
674
0
21
21
0
32
32
0
10,539
10,539
0
15,759
15,759
0
Lancashire Care NHS FT (Block)
9,537
9,537
0
14,305
14,305
0
Total Community Health Contracts
9,537
9,537
0
14,305
14,305
0
97,334
99,219
(1,885)
145,949
148,028
(2,079)
Independent Sector Contracts
BMI Healthcare (Beardwood, Beaumont, Gisburne)
Ramsay
Sub Total
Total Acute Contracts
Mental Health Contracts
Lancashire Care NHS FT (Block)
Calderstones Partnership NHS FT (Block)
Greater Manchester West NHS FT
Total Mental Health Contracts
Community Health Contracts
Surplus/(Deficit)
Page 4
NHS Blackburn with Darwen CCG
APPENDIX D
Non Healthcare Commissioning Report ‐ November 2014
Budget to Date
£000
Expenditure to Date Variance to Date
£000
£000
Annual Budget £000
Annual Forecast Variance
£000
Annual Forecast
£000
Other Corporate Costs (Non‐Running Costs)
CSU re‐charge
397
382
15
566
566
1,439
1,439
0
2,158
2,158
0
490
477
13
685
676
9
2,326
2,298
28
3,409
3,400
9
Reserves
2,228
0
2,228
2,228
0
2,228
Sub Total Reserves 2,228
0
2,228
2,228
0
2,228
25
NHS Property Services re‐charge
Other
Sub Total Corporate Costs
0
Plan requirements & reserves
Running Costs
CCG Pay
1,052
1,046
6
1,585
1,560
CSU re‐charge
909
909
0
1,364
1,364
0
NHS Property Services re‐charge
108
109
(1)
162
162
0
Other
380
323
57
547
479
68
0
0
0
313
206
107
Sub Total Running Costs
2,449
2,387
62
3,971
3,771
200
Surplus/(Deficit)
7,003
4,685
2,318
9,608
7,171
2,437
Running Costs Reserve
Page 5
NHS Blackburn with Darwen CCG
APPENDIX E
Statement of Financial Position ‐ November 2014
Statement of Financial Position
November £000
Non Current Assets
Property, Plant, Equipment
0
Total Non Current Assets
0
Current Assets
Trade and Other Receivables
Financial Assets
Current Assets
Cash and Bank
467
0
0
468
Total Current Assets
935
Total Assets
935
Current Liabilities
Trade and Other Payables
Other Liabilities
Provisions
Borrowings
(11,137)
(42)
0
0
Total Current Liabilities
(11,179)
Total Assets less Current Liabilities
(10,244)
Non Current Liabilities
Trade and Other Payables
Provisions
Borrowings
Other Liabilities
0
0
0
0
Total Non Current Liabilities
0
Total Assets Employed
(10,244)
Financed By
General Fund
Revaluation Reserve
Donated Asset Reserve
Government Grant Reserve
Other Reserves
(10,244)
0
0
0
0
Total Equity
(10,244)
Page 6
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
Date of Meeting
Title of Report
Governing Body
Responsible Officer
Summary/Purpose of
Report
14th JANUARY 2015
Agenda
Item No.
CONTRACT PERFORMANCE REPORT
MR ROGER PARR,
CHIEF FINANCE
OFFFICER
11
Lead
Clinician
Lead
Manager
MRS ELAINE BUCKLEY,
CONTRACT MANAGEMENT
LOCALITY LEAD
This report provides the Clinical Commissioning Group (CCG)
Governing Body with an update on the activity performance of the
major commissioned services of the organisation.
The report relies upon aggregated anonymised data supplied by the
Midlands and Lancashire Commissioning Support Unit.
Governing Body
Action
The Governing Body is requested to note the content of the report
and the supporting appendices.
Please indicate the Committee(s)/Group(s) where the paper has been discussed/developed
Please note the following section must be completed in full
Patient and Public
Result
Engagement Completed
Equality Analysis
Result
Completed
Financial Implication(s)
Nil
Risk(s) Identified
N/A
CCG Strategic Objectives supported by this paper
1.
2.
3.
4.
5.
We will continuously improve the health and well-being of the population of Blackburn with
Darwen.
We will build successful partnerships which promote collaborative working and integrated
service delivery.
We will effectively engage patients and the public in decision making.
We will co-commission and deliver continuous improvement in Primary Care Services and
tackle inequalities.
We will commission safe and effective services for the population of Blackburn with
Darwen with integration at the heart of commissioning.
Y
Y
N/A
Y
Y
CCG High Impact Changes supported by this paper
1.
2.
3.
4.
5.
6.
7.
8.
9.
Delivering high quality Primary Care at scale and improving access.
Self-Care and Early Intervention.
Enhanced and Integrated Primary Care and Better Care Fund.
Access to Re-ablement and Intermediate Care.
Improved hospital discharge and reduced length of stay.
Community based ambulatory care for specific conditions.
Access to high quality Urgent and Emergency Care.
Scheduled Care.
Quality.
1 | P a g e N/A
Y
Y
N/A
Y
Y
Y
Y
Y
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
14 JANUARY 2015
CONTRACT PERFORMANCE REPORT
MONTH 7
1. Introduction
1.1
This report provides the Clinical Commissioning Group (CCG) Governing Body with an
update on the activity performance of the major commissioned services of the
organisation. The report relies upon aggregated anonymised data supplied by the
Midlands and Lancashire Commissioning Support Unit (MLCSU).
2. Lancashire Care Foundation Trust - Mental Health
2.1
The CCG as lead commissioner for mental health services from Lancashire Care NHS
Foundation Trust (LCFT) agreed a reporting pause for Quarter 3 in contract year 201415, in order to support the assurance of the top 50 indicators provided by LCFT. Due to
this agreement there will be no data received from LCFT other than agreed exceptions
to the pause including Out of Area Treatments (OATS), Improving Access to
Psychological Therapies (IAPT) and the Memory Assessment Service (MAS). Full
reporting will resume at month 10.
2.2
The quarter 3 data will be supplied in January 2015 in line with agreed timescales and
will be broken down monthly. Monthly updates on progress for the Top 50 indicators will
be shared with Blackburn with Darwen CCG (BwD CCG).
2.3
The tables below contain data for BwD CCG for Admissions and Occupied Bed Days
incurred out of the area per month.
OATS Admissions Bed Type Functional PICU CCG NHS Blackburn with Darwen CCG NHS Blackburn with Darwen CCG Grand Total OATS Occupied Bed Days Bed Type Functional PICU Grand Total 2 | P a g e CCG NHS Blackburn with Darwen CCG NHS Blackburn with Darwen CCG Apr‐
14 May‐
14 Jun‐
14 Jul‐
14 Aug‐
14 Sep‐
14 Oct‐
14 YTD 2 4 6 2 0 0 0 14 0 0 1 0 0 0 3 4 2 4 7 2 0 0 3 18 Apr‐
14 May‐
14 Jun‐
14 Jul‐
14 Aug‐
14 Sep‐
14 Oct‐
14 YTD 38 67 104 38 0 0 0 247 60 37 28 1 0 0 23 149 98 104 132 39 0 0 23 396 2.4
BwD CCG has a monthly target of 246 patients entering psychological treatment to meet
the 15% prevalence target. The table below shows the number of patients entered into
psychological therapies with LCFT and the Lancashire Women’s Centre for the CCG. In
month 7, 295 patients entered into treatment against a target of 246 (+49, +19.9%).
Should this performance continue during the final quarter of the year, the Q4 target
would be exceeded by 20%. This target continues to be closely monitored and a further
update will be given in the month 8 report.
Monthly Variance Compared to Q4 Target
IAPT Performance 2014‐
15 Target by Q4 14‐15 Patients Entered Treatment Variance % Variance 2.5
Apr May Jun Jul Aug Sep Oct Total 246 246 246 246 246 246 246 1722 177 230 309 317 183 250 295 1761 ‐69 ‐28.0% ‐16 ‐6.5% +63 +25.6% +71 +28.9% ‐63 ‐25.6% +4 ‐1.6% +49 +19.9% +39 +2.3% The referral number in October exceeded the target for the second month running. BwD
CCG received 415 referrals against a target of 295. Self-referrals continue to be
promoted in all areas via GPs, primary care professionals, third sector and in the
community. Historically, the post-Christmas period yields considerable increases in
referral rates, and as such, the Trust are confident in meeting the year-end target, which
will be measured via quarter 4, uploads of activity to the National IAPT System.
3. Referrals to Secondary care
3.1
The referrals for treatment to the CCG’s main provider, East Lancashire Hospitals NHS
Trust (ELHT) are monitored monthly. From the table below it can be seen that month 7
is showing a slight increase in activity compared to the same period last year. The
referral activity measured on an average working day shows an increase from the
previous year (3.3%).
Referral Type GP Other Excluded Total Average / working day 2014‐15 16,737 5445 4951 27,133 182.1 2013‐14 16,388 4930 5117 26,435 176.2 Variance 2.1% 10.4% ‐3.2% 2.6% 3.3% Month 7 Year‐on‐Year Comparison: October 2014 3.2
At specialty level, ENT referrals (GP) continue to show an increase at month 7, +177
(12.9%). ELHT have reported that a higher number of 2 week rule referrals for
suspected cancer are coming into the service, (monthly average 2013/14 = 24, monthly
average 2014/15 = 33). This accounts for at least a third of the variance. Routine
referrals from GP’s have also increased from last year.
3.3
Ophthalmology (GP) referrals continue to be under plan, -485 (-21.5%) when compared
YTD, with the previous year. The general trend across Lancashire for Ophthalmology
shows referrals across the eight CCG’s has decreased compared to last year. ELHT
have advised that, due to staffing issues, they have reduced the number of Choose and
3 | P a g e Book slots for this service. The Trust is currently looking at service redesign of this
specialty.
3.4
Appendix 1 contains the details of GP referrals to ELHT by specialty. The Specialist
Advice Service has now been renamed Advice and Guidance to ensure consistency of
approach from a system and familiarity purpose for GP’s. The scheme has been
implemented from 1st December 2014 across all 3 specialities (Gynaecology,
Haematology and Urology). Weekly teleconferences are taking place between
commissioners and ELHT to monitor the progress of the scheme and ensure that it
meets agreed timescales and deadlines. The CCG are awaiting activity figures from
ELHT in relation to advice requests.
4. Acute Contract Performance – East Lancashire Hospitals Trust
4.1
There has been an increase in the Elective care over trade at month 7. ELHT have
adjusted the activity profile for some specialties without prior agreement from the CCG.
As a result, the contract monitoring performance summary for Elective will not be
available until the month 8 report.
Point of delivery A and E (inc Minor Injuries Unit) Non Elective inc. ‘Non Elective Non Emergency’ Outpatients (inc procedures) Financial Variance £k % +193
+7% +304
+2% +36
+0.5% Activity Variance % +1326
+4%
+59
+0.5%
+1307
+2%
4.2
The non-elective (including non-elective non-emergency) activity, shows performance is
above plan +59 (+0.5%), +£304k (+2%). Non-elective performance is also above plan
+92 (+0.9%), +£278K (+1.9%). However, non-elective non-emergency activity is below
plan for the CCG -33 (-2.0%), although finance is above plan at +£26K (+1.0%). The
under performance in non-elective non-emergency care is mostly due to Midwifery, as
more patients are being coded intermediate or intensive than standard, indicating more
complex pregnancies.
4.3
For ordinary non-elective care, medical specialties are over performing against planned
cost levels by +£131K (+2%), although below plan in terms of activity [-72 spells, -1.0%].
Paediatrics is over performing against plan, +£183K (+14%), [+187 spells, +10%]. The
Trust has previously advised that overall ELHT are experiencing an increase in NonElective Admissions for paediatrics. The number of admissions to the Children’s
Outpatient Assessment Unit (COAU) is increasing year on year including those admitted
through Primary Care.
4.4
The graph on page 6 illustrates the pattern of activity beginning in April 2012 for nonelective admissions (NEL). This is the activity at ELHT (which is 96% of BwD CCGs nonelective activity).
4 | P a g e 4.5
This gra
aph shows that
t
perform
mance was
s close to plan in Octoober (1,532 spells verssus
plan 1,530). Year to date overr performan
nce now sho
ows +92 speells (+0.9%).
4.6
Overall, NEL Adm
missions are
e currently
y slightly higher than last year (2013-14).. A
y levels see
en in Surgic
cal Specialtties (-38, -33.2%) has been
b
offset by
reduction in activity
es in Medical Specia
alties, ENT
T, Gynaeco
ology, Rheuumatology, Trauma and
a
increase
Orthopaedics and in
n particularr Paediatrics
s (+85, +4.4
4%).
nce – Othe
er Acute Prroviders
5. ELHT Contractt Performan
5.1
At BMI Beardwood
d, the contrract is overr performing
g by £555kk (+27.2%). The electtive
over pe
erformance is mainly attributable
e to Traum
ma and Orrthopaedics
s (+96 spe
ells,
+39.1%)) and General Surgeryy (+78 spells, +28.8%). In both sppecialties, th
here has be
een
an incre
ease in the
e number o
of GP practtices referring into BM
MI (5 practices last ye
ear
compare
ed to 11 YT
TD). Outpatiient appointments are over plan i n addition to
t admissio
ons,
which in
ndicates tha
at the activitty is across
s the full pa
athway and driven by an
a increase
e in
referralss.
5.2
At Lanca
ashire Teac
ching Hospiitals, there is over perfformance inn elective ac
ctivity +£15
55k,
(+18.0%
%). The overr performan
nce is mainly attributab
ble to Traum
ma and Orth
hopaedics and
a
Gynaeco
ological Oncology.
6. ELHT Waiting Lists
L
6.1
5 | P
5
age The inpatient and daycase w
waiting list by specialty for the CCG’s ma
ain providerr is
detailed in appendix 4. The tottal size of the waiting list has incrreased by 166
1 patientss in
ory 0 to 6 weeks (this iss showing an
a increase
e of
October with the main increasse in catego
mparison to
o Septembe
er). Howeve
er, the waitiing list for 6 to 13 wee
eks
200 patients in com
eptember. This
T
indicates that addditional activ
vity has takken
has deccreased by 21 from Se
place in
n Septemb
ber followin
ng reduced
d activity during
d
the August ho
oliday period.
Ophthalmology remains a concern, accounting for 63% of the overall waiting list growth,
and is experiencing growth across all waiting time categories.
6.2
The CCG will receive Referral to Treatment (RTT) funding that has been allocated to
support achievement of the 18 week RTT target. A contract variation has been agreed
for the additional activity and weekly monitoring reports are being provided by the Trust.
7. 36+ week waiters
8.
7.1
The CCG has 8 patients on an incomplete patient pathway waiting over 36 weeks.
These are as follows; 2 at Central Manchester University Hospitals; 1 at Lancashire
Teaching Hospitals; 3 at East Lancashire Hospitals and 2 at the University of South
Manchester.
7.2
The CCG continues to monitor and query the over 36 week waiters with the relevant
providers.
7.3
There are no waiters over 52 weeks at month 7.
Ambulance Contract
8.1
The Blackburn with Darwen CCG All Incidents activity of the ambulance service at
Month 7 is above plan by 3.3%.
8.2
It is of note that although the activity in terms of response times for Blackburn with
Darwen is performing strongly, it is the performance of NWAS overall that impacts on
the CCG quality premium payment. For the quality premium performance NWAS as a
provider is achieving 72.1% YTD against the target of 75% for Red 1 (%<8 mins).
8.3
The table below shows performance to date for Blackburn with Darwen.
Blackburn with Darwen CCG – October 2014 Month ‐ Activity
Year to Date ‐ Activity
Activity % Status Activity % Status
R1 (% <8 mins)
75%
46
78.3%
G
390
80.5%
G
R2 (% <8 mins)
75%
798
80.8%
G
5466
80.2%
G
All Reds (%<19 mins)
95%
844
94.5%
R
5856
96.7%
G
Green
1201
‐
‐
8904
‐
‐
AS3
7
‐
‐
63
‐
‐
All Incidents
2052
‐
‐
14823
‐
‐
Data Source: NWAS PES & HAS Reports
Performance Line
Target
Plan
404
5,025
5,429
8,664
254
14,347
Comparison to Plan
14/15
Var
390
‐14
5466
441
5856
427
8904
240
63
‐191
14823
476
% Var
‐3.5%
8.8%
7.9%
2.8%
‐75.2%
3.3%
CCG 14‐15 YTD Trend
9. Community Services – Lancashire Care NHS Foundation Trust
9.1
6 | P a g e Due to an agreed reporting pause for Quarter 3 in the contract year 2014-15, to support
the assurance of the top 50 indicators provided by LCFT, there will be no data received
and reported on until month 10. The quarter 3 data will be supplied in January 2015 in
line with agreed timescales and will be broken down monthly. Monthly updates on
progress will be shared by LCFT with Chorley and South Ribble CCG as the lead
commissioner.
10. Other Community Services
10.1
The General Practitioners with Special Interests (GPwSI) work on a block contract basis.
The activity performance against plan is in appendix 6 and shows activity variances
against plan by provider. Commissioners continue to work closely with the GPwSI
providers to monitor performance.
10.2
The Anticoagulation service is over plan for Community and Domiciliary by 18.4% and
33.3% respectively.
10.3
The Cardiology service is under plan for first appointments by 11.2% but over plan for
follow ups by 64.3%.
10.4
The Diabetes service is under plan for first appointments by 57.1% but over plan for
follow ups by 106.4%.
10.5
The Dermatology service is over plan in first and follow up appointments by 25.8% and
14.1% respectively.
10.6
The Ophthalmology service is over plan for first and follow up appointments by 38.9%
and 7.4% respectively.
10.7
The Scheduled Care Team have undertaken a full review of the current GPwSI services
across Blackburn with Darwen, in order to assure that they are delivering the desired
outcomes and to inform on the future commissioning of these services. The review
demonstrated that the GPwSI’s are providing services in line with quality and activity
plans, noting some under and over performance. The services themselves are well
received by patients, and patient engagement undertaken by the MLCSU has identified
that patients value the services and the delivery of them, which aligns to the ‘Care
Closer to Home’ strategy.
11. General Practice Out of Hours Service
11.1
The Out of Hours service is on a block contract with activity profiles based on a 2 year
average of activity. The table below shows activity for Blackburn with Darwen.
GP Out of Hours Service (ELMS) – October 2014
Year to date ‐ Activity
2014/15 2013/14
Variance
Full Year Forecast ‐ Activity
Status
2014/15
2013/14
Status
PCC Attendances (Primary 6,752
Care Centre)
6,372
380
6.0%
R
12,268
11,580
688
5.9%
R
Dr Advice
2,451
1,731
720
41.6%
R
4,453
3,205
1,248
38.9%
R
Home Visits
1,608
1,464
144
9.8%
R
2,922
2,597
325
12.5%
R
Total
10,811
9,567
1,244
13.0%
R
19,642
17,382
2,260
13.0%
R
Data Source: Monitoring report provided by East Lancashire Medical Services (ELMS)
7 | P a g e Variance
11.2
The total activity is performing above plan when compared to the same period last year
with the main increases in the Dr Advice and Home visits services. The detailed monthly
performance is contained in graphical form in appendix 7.
12. Recommendation
12.1
The Governing Body is requested to note the contents of the report and the supporting
appendices.
Mr Roger Parr
Chief Finance Officer
5 January 2015
8 | P a g e Appendix 1
BwD CCG GP Referrals to ELHT by Specialty – October 2014 (Year to Date) Specialty Number of Referrals Referrals per Working Day GP Referrals 2014‐15 GP Referrals 2013‐14 Variance Quantity Variance % 2014‐15 (149 days) 2013‐14 (150 days) Variance % General Surgery group 4 2841 2628 213 8.1% 19.1 17.5 8.8% E.N.T. 1637 1460 177 12.1% 11.0 9.7 12.9% T & O 1416 1278 138 10.8% 9.5 8.5 11.5% Other Specialty group 5 764 692 72 10.4% 5.1 4.6 11.1% Gynaecology 1804 1735 69 4.0% 12.1 11.6 4.7% Cardiology 839 776 63 8.1% 5.6 5.2 8.8% Rheumatology 408 366 42 11.5% 2.7 2.4 12.2% Dermatology 1172 1131 41 3.6% 7.9 7.5 4.3% Urology 852 819 33 4.0% 5.7 5.5 4.7% Obstetrics 1106 1094 12 1.1% 7.4 7.3 1.8% Paediatrics 571 560 11 2.0% 3.8 3.7 2.6% Pain Management group 123 6 General Medicine group 7 1483 147 ‐24 ‐16.3% 0.8 1.0 ‐15.8% 1496 ‐13 ‐0.9% 10.0 10.0 ‐0.2% Ophthalmology 1721 2206 ‐485 ‐22.0% 11.6 14.7 ‐21.5% Grand Total 16737 16388 349 2.1% 112.3 109.3 2.8% Data Source Ref: Referrals to Consultant‐Led clinics in ELHT Referrals dataset Definitions:
GP Other Excluded Referrals into Consultant‐led clinic from a GP Referrals into Consultant‐led clinic from non‐GP medical professional (e.g. Consultant, Nurse Specialist) Referrals into Consultant‐led clinic from other sources (e.g. Self‐Referral, A&E department, Midwifery) Specialty Groupings General Surgery Group General Medicine Group General Surgery, Breast Assessment, Vascular Surgery General Medicine, Gastroenterology, Diabetic and Thoracic Medicine 9 | P a g e Appendix 2
There has been an increase in the Elective care over trade at month 7. ELHT have adjusted the activity
profile for some specialties without prior agreement from the CCG. As a result, the contract monitoring
performance summary for Elective will not be available until the month 8 report.
10 | P a g e Appen
ndix 3
n Elective Activ
vity (NEL + NEL
LST) – BwD CCG
G Patients at ELHT - Trend of Plan versus Ac
ctivity 2010-11 to 2014-14
Non
The cumulative Activity Volumes (6 mo
onths) to Octoberr 2014‐15 are sligh
htly above the acttivity levels seen in 2010‐11 (+0.6%
%), 2011‐12 (+1.1%
%) and last year 2013‐
14 (++0.9%). However, year to date volumes are below (‐3.5%) the relativvely high levels experienced during the same period in 2012‐13. See below: 20
010‐11 : 10,477 sp
pells
20
011‐12 : 10,431 sp
pells
2012‐13 : 10,926 sp
pells
20
013‐14 : 10,450 sp
pells 20
014‐15 : 10,543 sp
pells 11 | P a g e Appendix 4
Source : ELHT Performance Report
Inpatient and Daycase Waiting List
East Lancashire Hospitals Specialty General Surgery Urology Breast Care Orthopaedics ENT Ophthalmology Oral Surgery / Maxillo Facial Pain Management General Medicine Rehabilitation Cardiology Thoracic Medicine Nephrology Rheumatology Gynaecology Haematology Total Page 12 of 15 Current Month ‐ October 2014 0‐<6 Weeks 6‐<13 Weeks 13‐<20 Weeks 20 + Weeks 706 253 49 517 209 456 278 147 540 21 166 23 0 51 302 0 3718 194
71
17
195
83
252
103
103
2
14
14
0
0
17
43
0
1108
47
5
4
51
51
61
54
40
2
3
1
0
0
3
3
0
23
0
0
8
21
35
15
1
1
5
0
0
0
0
0
0
325
109
Grand Total Previous Month ‐ September 2014 0‐<6 Weeks 6‐<13 Weeks 13‐<20 Weeks 20 + Weeks 970
329
70
771
364
804
450
291
545
43
181
23
0
71
348
0
5260
659 230 43 460 218 453 307 184 487 8 143 24 1 31 270 0 3518 200
77
25
183
125
173
126
101
3
13
37
0
1
15
50
0
1129
56
5
2
58
68
47
46
31
1
6
1
0
0
3
4
0
13
2
0
17
25
27
27
1
1
4
0
0
0
0
2
0
328
119
Grand Total Variance 928
314
70
718
436
700
506
317
492
31
181
24
2
49
326
0
5094
%age +/‐ 42 4.5% 15 4.8% 0 0.0% 53 7.4% ‐72 ‐16.5% 104 14.9% ‐56 ‐11.1% ‐26 ‐8.2% 53 10.8% 12 38.7% 0 0.0% ‐1 ‐4.2% ‐2 ‐100.0% 22 44.9% 22 6.7% 0 N/A 166
3.3% Appendix 5
LCFT: Service Line Activity against Plan – October 2014
Due to an agreed reporting pause for Quarter 3 in the contract year 2014-15, in order to support the
assurance of the top 50 indicators provided by LCFT, there will be no data received and reported on
until month 10. The quarter 3 data will be supplied in January 2015 in line with agreed timescales and
will be broken down monthly. Monthly updates on progress will be shared by LCFT with Chorley and
South Ribble CCG as lead commissioner.
Page 13 of 15 Appendix 6
General Practitioners with Special Interest (GPwSI) – October 2014
GPwSI Service Anti‐coagulation Cardiology Dermatology Diabetes Ophthalmology Activity Type Community Domiciliary First Follow‐Up First Follow‐Up First Follow‐Up First Follow‐Up Year to date ‐ Activity Plan Actual Variance 3,337 3,952 615 18.4%
758 1,011 253 33.3%
224 199 ‐25 ‐11.2%
56 92 36 64.3%
868 1,092 224 25.8%
609 695 86 14.1%
140 60 ‐80 ‐57.1%
140 289 149 106.4%
233 324 91 38.9%
175 188 13 7.4%
Data Source: Spreadsheet data returns from individual GPwSI services.
Page 14 of 15 Year‐on‐Year Comparison 14/15 13/14 Variance 3,952 3,412 540 15.8%
1,011 789 222 28.2%
199 162 37 22.7%
92 100 ‐8 ‐8.3%
1,092 939 153 16.3%
695 588 107 18.2%
60 100 ‐40 ‐39.8%
289 292 ‐3 ‐1.1%
324 268 56 20.7%
188 181 7 4.0%
Appendix 7
O of Hourrs (OOH) Se
ervice – Oc
ctober 2014
4
GP Out
BwD ‐ PCC A
Attendance ((OOH)
2000
Bw
wD ‐ Dr Advicce (OOH)
500
400
1500
300
1000
200
500
100
0
0
Apr M
May Jun Jul Aug Sep Oct Novv Dec Jan Feb M
Mar
2013‐14
Page 1
15 of 15 2014‐15
2012‐13
Apr May Jun Jul Aug Sep O
Oct Nov Dec Ja
an Feb Mar
2013‐14
20144‐15
20
012‐13
GOVERNING BODY MEETING
Date of Meeting
Title of Report
Governing Body
Responsible Officer
Summary/Purpose
Report
Governing Body
Action
14th January 2015
Agenda
12
Item No.
Quality, Performance and Effectiveness Report Month 7
Dr Malcom Ridgway,
Clinical Director for
Quality and
Effectiveness
Lead
Clinician
Dr Malcom Ridgway, Clinical
Director for Quality and
Effectiveness
Lead
Mr David Rintoul, Quality and
Manager
Performance Specialist
of This report provides the Clinical Commissioning Group (CCG)
Governing Body with an update on the Quality, Performance and
Effectiveness information of the main commissioned services as at
October 2014, Month 7.
The Governing Body is requested to note the contents of the report.
Please indicate the Committee(s)/Group(s) where the paper has been discussed/developed
Quality, Performance and Effectiveness Committee (QPEC)
Please note the following section must be completed in full
Patient and Public
N/A
Result
Engagement Completed
Equality Analysis
N/A
Completed
Financial Implication(s)
Nil
Risk(s) Identified
N/A
CCG Strategic Objectives supported by this paper
1.
We will continuously improve the health and well-being of the population of
Blackburn with Darwen.
2.
We will build successful partnerships which promote collaborative working and
integrated service delivery.
3.
We will effectively engage patients and the public in decision making.
4.
We will co-commission and deliver continuous improvement in Primary Care
Services and tackle inequalities.
5.
We will commission safe and effective services for the population of Blackburn
with Darwen with integration at the heart of commissioning.
CCG High Impact Changes supported by this paper
1.
Delivering high quality Primary Care at scale and improving access.
2.
Self-Care and Early Intervention.
3.
Enhanced and Integrated Primary Care and Better Care Fund.
4.
Access to Re-ablement and Intermediate Care.
5.
Improved hospital discharge and reduced length of stay.
6.
Community based ambulatory care for specific conditions.
7.
Access to high quality Urgent and Emergency Care.
8.
Scheduled Care.
9.
Quality.
1 | P a g e Y
Y
N/A
Y
Y
N/A
Y
Y
N/A
Y
Y
Y
Y
Y
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
14th JANUARY 2015
QUALITY, PERFORMANCE AND EFFECTIVENESS REPORT MONTH 7
1.0
Introduction
The following report contains information on CCG performance as well as provider quality
performance against contractual obligations throughout the month of October 2014. The report
focuses on exceptions and the progress of associated recovery plans and is collated from a range of
sources; including but not limited to: provider board reports; Midlands and Lancashire Commissioning
Support Unit (MLCSU) Business Intelligence; provider quality submissions; Clinical Commissioning
Group (CCG) staff exception reports; as well as information from external bodies such as Health &
Social Care Information Centre (HSCIC), NHS England; and Advancing Quality (AQ). Where
appropriate, additional information focusing on other CCG patients is included; this is intended to
provide a broader perspective for services where Blackburn with Darwen (BwD) CCG is the lead
Commissioner.
2.0
Lancashire Care Foundation Trust – Mental Health Services
2.1
Improving Access to Psychological Therapies
The notional 1.25% target for IAPT Prevalence was met in October 2014 for all CCGs except Fylde &
Wyre (1.05%), with Trust performance at 1.46%. Prevalence for BwD CCG was 1.35% in October
2014, meeting the notional target; however, YTD performance remains below trajectory by 0.45%.
The rebranding of the service, in an effort to reduce the stigma associated with accessing mental
health services, is now underway and the new logo (below) will be used for all printed materials, such
as new self-referral leaflets and promotional posters.
The Trust continues to promote the self-referral pathway across all services in an effort to improve
access for groups that might not traditionally engage with mental health services; for example,
veterans, perinatal women, older adults, young men and Asian women. Recovery rates remain below
the 50% target for all CCGs, at 36.1% in October 2014. The Trust has focussed resources on
Prevalence and waiting times, which has impacted on Recovery rates. Sustaining a good Recovery
rate is challenging due to areas of high deprivation within the region (e.g. parts of East Lancashire,
Morecambe and Blackpool) meaning that more service users begin therapy with high symptom
scores, and although patients may gain benefit from psychological interventions, the change in
symptom scores may not be sufficient to take them below the level of “caseness” which is required for
Recovery. Intensive Support Team work shows that if Clusters 1-3 can be the model client group (i.e.
people with mid-range rather than severe conditions.), better recovery outcomes are predicted. IAPT
services often fail to attract sufficient numbers of clients in the lowest clusters, which impacts on
recovery rates. This is informing the Trust’s promotional work with the Trust seeking to appeal to
people within lower clusters (e.g, the service’s rebranding to “Minds Matter”).
2 | P a g e 2.2
Memory Assessment Service
The target for 70% of patients to be seen by the MAS within 4 weeks has not been met for any CCG
area during October 2014. For BwD CCG, 32.26% of patients were seen within 4 weeks in October
2014, which is a decrease from a September 2014 performance of 57.50%. The average wait for BwD
patients is currently 9.4 weeks, which is below the average wait across the whole service of 10.7
weeks. The Trust continues to work on reducing the backlog of patients waiting in an effort to reduce
waiting times. For new patients, 69% are now seen within 4 weeks and LCFT are therefore confident
that once the backlog is cleared, the Trust will be able to meet the 4 week requirement. LCFT have
planned intensified work to clear the backlog in December 2014, and it is hoped that waiting time
targets will begin to be met from January 2015. There also remains a significant number of referrals
that do not have complete referral information (e.g. bloods). For example, for referrals received in
October 2014, 25% still had missing information as of the 11th November 2014. This negatively
impacts on waiting times in all areas that are affected by this issue. The Trust have made efforts to
communicate with GPs where information at referral is outstanding and have discharged referrals
back to GPs where information has been chased twice and still not completed.
2.3
Care Programme Approach 7 day follow-up
Care Programme Approach (CPA) 7 day follow-up data has not been submitted for Month 7. Errors
were highlighted by the MLCSU Quality and Performance team following the Month 6 data
submission and, as a result, the Trust is currently in the process of validating CPA data. An update
will follow in the Month 8 report.
3.0
Lancashire Care Foundation Trust – Community Services
No issues have been reported with regards to the provider’s Month 7 Quality submission, however
discussions are ongoing around the reporting criteria for Medicines Management following the Month
6/Q2 Quality submission. A meeting is also due to take place in December 2014 to discuss additional
information required to reconcile the service’s 7 day working CQUIN scheme.
4.0
East Lancashire Hospitals Trust
4.1
18 Week Referral to Treatment Times
Overall, the Trust is meeting the 18 weeks Referral to Treatment (RTT) standard; however, there
were 4 specialties failing to achieve the 90% 18 weeks target in October 2014: ENT (83.8%), Urology
(88.3%), Ophthalmology (88.7%) and Oral Surgery (83.0%). The host commissioner, East Lancashire
CCG (EL CCG), continues to closely monitor performance.
4.2
A&E 4 Hour
The 95% 4 hour target for A&E was not met in October 2014, with performance at 94.41%.
Underperformance has been attributed to bed capacity and patient flow pressures within the Trust as
well as short term staff sickness and surges in attendance at the Emergency Department (ED).
Current improvement measures include: the purchase of 15 care home beds; the opening of Ward D1
for 48 hours each Monday to assist patient flow; the development of a live data feed of performance
to support escalation; and the introduction of earlier discharges in the day (i.e. each ward to identify at
least 2 patients suitable for discharge the following day; with these patients expected to be discharged
between 10.00 and 13.00).
4.3
Clostridium Difficile
ELHT is over trajectory for C. Difficile with the YTD position at 17 cases, against an annual YTD
trajectory of 13 cases, there were no cases reported in October 2014. Post Infection Reviews (PIRs)
are being undertaken for all cases, and are discussed across the health economy to highlight
potential themes and trends.
4.4
Ambulance Handover – Hospital Arrival Screen Data Entry Compliance
In October 2014 there were 338 breaches over 30 minutes and 10 breaches over 60 minutes, which
is a decrease from the previous month. ELHT continues to meet weekly with North West Ambulance
Trust (NWAS) management to raise and review performance on both sides and agree action.
3 | P a g e 4.5
Stroke 4 hour
Despite consistent improvement earlier in the year against the 90% Local Quality Requirement target
for Stroke Unit Admission within 4 hours, performance has deteriorated in correlation with wider A&E
performance. 2013/14 year end performance was 50.46% and this had improved to 67.42% in August
2014; however, performance in October 2014 fell to 47.92%. The ring fencing of stroke beds on the
Acute Stroke Unit (ASU) continues; however, bed pressures endure when medical bed capacity within
the Trust is under pressure. Internal stroke improvement meetings continue to be held to review
learning and breach analysis and a new Specialist Stroke Nurse has been recruited (start date to be
confirmed) to support pulling patients through to the ASU. The Advancing Quality Appropriate Care
Score, 60% target continues to be met, with performance in August 2014 at 65.00%, which is the
latest validated position.
5.0
Calderstones Partnership Foundation Trust
The CQC report following the inspection of CPFT in July 2014 has now been published and the Trust
is due to develop an improvement plan. As the inspection was part of the new CQC Mental Health
pilot, ratings have not been released. A further unannounced inspection is planned for 2015, for
which, a formal rating will be published. A more detailed update will be available for the Month 8
report.
6.0
North West Ambulance Service
The Red 1 and Red 2 emergency call response targets were met in October 2014 for BwD patients, at
78.51% and 80.80%. However, it should be noted that the CCG’s Quality Premium is linked to
performance across the entire NWAS operational footprint for Red 1 calls on a YTD position, which is
currently failing at 72.04%. The target for 95% of both Red 1 and Red 2 calls to be responded to
within 19 minutes was also not met at both CCG and Trust level in October 2014, at 94.50% and
93.60%. Red call activity was 8% above plan for October 2014 (7.1% cumulative). NWAS has
implemented a number of improvement measures including: additional funding to support
performance and the utilisation of over time; weekly recovery meetings chaired by the Chief Operating
Officer; an accelerated recruitment programme; and an Urgent Care Service demand review is to be
undertaken against vehicle and staff availability, to increase capacity.
7.0
NHS Constitution
A full breakdown of October 2014 NHS Constitution performance has been provided on the following
pages 6 to 8, including exception information.
4 | P a g e 5 | P
5
age Period
Target
Oct 2014
Position
Year to
Date
Position
CCG
Oct 2014-2015
0
0
0.00%
CCG
Q2 2014-2015
95.00%
QTR
96.51%
CCG
Oct 2014-2015
0
0
1
CCG
Jan 2013-2014
0
0
ELHT
Oct 2014-2015
0
0
0
77: Number of G&A elective ordinary admission FFCEs in the period (77)
CCG
YTD 2014-2015
2,481
2,556
2,556
71: Number of G&A elective FFCEs in the period - Day Cases (71)
CCG
YTD 2014-2015
10,574
9,958
9,958
CCG
YTD 2014-2015
11,947
11,784
11,784
CCG
YTD 2014-2015
26,345
26,548
26,548
1926: A&E Attendances: Type 1 (1926)
ELHT
Nov 2014-2015
8,704
73,253
1927: A&E Attendances: All Types (1927)
ELHT
Nov 2014-2015
15,164
132,243
Metric
Level
NHS Constitution support m easures
Mixed Sex Accom m odation Breaches
1067: Mixed sex accommodation breaches - All Providers (1067)
Mental health
138: Proportion of patients on (CPA) discharged from inpatient care w ho are
follow ed up w ithin 7 days (138)
Referral To Treatm ent w aiting tim es for non-urgent consultant-led treatm ent
1839: Referral to Treatment - No of Incomplete Pathw ays Waiting >52 w eeks
(1839)
1851: Referral to Treatment - Non-Admitted Pathw ays - No of Specialties
Breached >52 Weeks (1851)
A&E w aits
1928: 12 Hour Trolley w aits in A&E (1928)
Activity Measures
Elective
Non Elective
72: Number of G&A non-elective FFCEs in the period - Total (72)
Outpatients
73: All first outpatient attendances (consultant-led) in general and acute
specialties (73)
A&E
6 | P a g e 7.1
A&E waits
Having met the 95% 4 hour A&E waiting time target at Trust level for the first four months of 2014/15,
ELHT have failed the target in each of the following three months. October 2014 A&E 4 hour
performance was 94.41% (please see section 4.2 on page 4).
7.2
Cancer waits - 31 days
For the standard, 94% of patients to receive ‘subsequent treatment for cancer within 31 days
(Surgery), although the BwD CCG YTD position is achieving the target at 97.52%, the target was not
met for BwD patients in October 2014, at 93.55%. This related to two patients.
7.3
Cancer waits - 62 days
The standard for 85% of patients to receive 1st definitive treatment for cancer within 62 days was not
met for BwD patients in October 2014, at 80.49%, having achieved the target in September 2014 at
90.32%. The YTD position remains Red, at 82.30%. A recovery plan has been broadly agreed
between ELHT, EL and BwD CCGs; however, certain elements require further agreement and
negotiation. The maximum monthly number of breaches allowable for the remaining 5 months of
2014/15 is 4.4, with the average over 2014/15 to date being 5.6 breaches per month. The Strategic
Clinical Network (SCN) position for the 62 day target is also failing at 84.2%. 7 of the 9 SCN
Lancashire and Cumbria CCGs failed the 62 day target in Q2 (excluding East Lancashire and Greater
Preston). This reflects overall declining performance. In Q1 2013/14, 4 CCGs failed and 5 achieved
the 62 day target; yet over 6 subsequent quarters this has declined to 7 failing and 2 achieving. Over
the same period, average performance across the 9 CCGs fell from 85% to 82.2% per quarter.
Performance against the 62 day Cancer target continues to be actively scrutinised by the CCG’s
Quality, Performance and Effectiveness Committee (QPEC).
7.4
Red 1 and Red 2 Category Ambulance
The NWAS position remains red for the sixth consecutive month for both Red 1 (immediately life
threatening) and Red 2 (life threatening but less time critical) emergency calls, at 71.20% and 72.04%
against a target of 75%. The measure for 95% of Category A calls to be responded to within 19
minutes was also not met at Trust or CCG level, with performance at 93.60% and 94.50% (please see
section 6.0 on page 5).
7.5
Activity Measures
Activity measures have been provided as a high level overview only. Activity performance is covered
in detail by the Contracting and Business Intelligence Report, which is available from Elaine Buckley,
Contract Management Locality Lead.
7 | P a g e 8.0
Quality Premium
8.1
National Measures
Domain(s)
Measure
Threshold
Percentage
of quality
premium
15%
Current
month
position
4,141.0 years
(2013 position)
Year to date
position
Potential years of life lost Achieve an agreed percentage reduction
Available
(PYLL) from causes
in the PYLL between the 2013 and 2014
summer 2015
amenable to healthcare: calendar years
adults, children and
Demonstrate account taken of local
young people
factors
An update is due to follow in the Month 8 report.
Improving access to
Achieve IAPT access levels of at least
15%
1.35%
8.30%
Enhancing quality of
psychological therapies
15% by 31 March 2015
life for people with
(IAPT)
(Notional target of 1.25% per month)
long term conditions
An update on progress for this indicator can be found on pages 21 to 22.
Avoidable emergency
A reduction or zero % change in
25%
DSR 1744.2
Available
Enhancing quality of
admissions
emergency admissions for identified
summer 2015
life for people with
conditions.
long term conditions.
The Indirectly Standardised Rate of
Helping people to
admission at less than 1,000 per 100,000
recover from
population
episodes of ill health
or following injury.
The table below shows progress on this indicator over time for Blackburn with Darwen. No Lancashire CCG is currently meeting the Directly
Standardised Rate (DSR) target of less than 1,000 per 100,000 population. Looking at historic data only Blackpool met this target in 2010-11
and 2011-12
Preventing people
from dying
prematurely
Period
April 2013 – March 2014
2012-13
2011-12
2010-11
Ensuring that people
have a positive
experience of care
8 | P a g e Friends and Family Test
and patient experience
Female
1719.6
1876.1
1676.4
1432.8
Male
1769.0
1837.2
1595.8
1504.5
Agree a plan with local providers with
specified actions and milestones
Obtain appropriate assurance and
evidence of action taken
Support local providers to co-ordinate the
Total
1744.2
1856.9
1636.7
1468.1
15%
LCFT
LCFT
implementation implementation
from January
from January
2015
2015
Domain(s)
Measure
Threshold
Percentage
of quality
premium
Current
month
position
Year to date
position
rollout of FFT
Improved average score for one of the
patient experience improvement
indicators
Clarification is being sought as to which provider the CCG will be measured against. An update will be provided in a future edition of this report.
Improved reporting of
Achievement of agreed increase in
15%
Available
Available
Treating and caring
medication safety
reporting of medication errors from
September
September
for people in a safe
incidents
specified local providers for the period
2014
2015
environment and
Q4, 2013/14 and Q4, 2014/14
protecting them from
avoidable harm
Clarification is being sought as to which provider the CCG will be measured against. An update will be provided in a future edition of this report.
8.2
Local Measure
Domain(s)
Measure
Threshold
Percentage
of quality
premium
15%
Current
month
position
Gap of
135
Year to
date
position
58.6%
Potential
adjustment
to funding
-25%
Current
month
position
96.11%
Year to
date
position
95.54%
-25%
94.41%
95.69%
-25%
98.03%
95.61%
Dementia Diagnosis Rate
67.04% diagnosis rate
Enhancing quality of
life for people with
long term conditions
Progress towards achieving this indicator is monitored through the Memory Assesment Service Performance Inprovement sub group. Further
information can be found on pages 24 and 25.
8.3
NHS Constitution Measure
NHS Constitution rights and pledges
Referral to treatment times (18 weeks)
A&E waits
Cancer waits – 14 days
9 | P a g e Threshold
Achieved for at least 92% of patients on
incomplete non-emergency pathways over
the course of the 2014/15 year
Achieved for at least 95% of patients over the
course of the 2014/15 year
Measure based on a mapped proportion of
ELHT patients
Achieved for at least 93% of patients seen
within 2 weeks from urgent GP referral to first
Category A Red 1 ambulance calls
8.4
outpatient appointment over the course of the
2014/15 year
Achieved for at least 75% of patients over the
course of the 2014/15 year
Measure based on NWAS performance
across its operational footprint
-25%
71.20%
72.04%
Quality and Financial Gateways
The CCG is required to demonstrate effective use of public resources while undertaking its business. Failure to do so will result in no Quality Premium
payment being made. NHS England also reserve the right to not make any Quality Premium payment where they assess that the CCG is not
considered to be making an appropriate and proportionate response to a local provider subject to enforcement action from the Care Quality
Commission (CQC), Monitor or the NHS Trust Development Authority (TDA).
Dr Malcolm Ridgway
Clinical Director for Quality and Effectiveness
5th January 2015
10 | P a g e Date of Meeting
Title of Report
Governing Body
Responsible Officer
GOVERNING BODY MEETING
Agenda
14th January 2015
15
Item No.
Approval of further development of a scheme to provide intensive
support to people living at home
Lead
Clinician
Summary/Purpose of
Report
Dr Malcolm Ridgway, Clinical
Director of Quality and
Effectiveness
Lead
Mrs Lisa Kiernan, Head of
Manager
Primary Care and Integrated
Community Services
To inform Governing Body about the Pennine Lancashire development
programme.
Governing Body Action
To seek approval for funding to extend the scheme that provides
intensive support to people living at home.
Approval of the Business Case
Mrs Alison Shaw,
Interim Programme
Director
Please indicate the Committee(s)/Group(s) where the paper has been discussed/developed
Pennine Lancashire Chief Executive Officers
BwD CCG Commissioning Business Group
Please note the following section must be completed in full
Patient and Public
Yes
Programme is part of communication underpinning winter
Engagement
and system resilience campaigns
Completed
Equality Analysis
Yes
PEAR completed
Completed
Financial Implication(s) In attached business case
Risk(s) Identified
In attached business case
CCG Strategic Objectives supported by this paper
1.
2.
3.
4.
5.
We will continuously improve the health and well-being of the population of Blackburn with
Darwen.
We will build successful partnerships which promote collaborative working and integrated
service delivery.
We will effectively engage patients and the public in decision making.
We will co-commission and deliver continuous improvement in Primary Care Services and
tackle inequalities.
We will commission safe and effective services for the population of Blackburn with Darwen
with integration at the heart of commissioning.
X
X
X
X
CCG High Impact Changes supported by this paper
1.
2.
3.
4.
5.
6.
7.
8.
9.
Delivering high quality Primary Care at scale and improving access.
Self-Care and Early Intervention.
Enhanced and Integrated Primary Care and Better Care Fund.
Access to Re-ablement and Intermediate Care.
Improved hospital discharge and reduced length of stay.
Community based ambulatory care for specific conditions.
Access to high quality Urgent and Emergency Care.
Scheduled Care.
Quality.
X
X
X
X
X
Page 1 of 21 GOVERNING BODY MEETING
14TH JANUARY 2015
PENNINE LANCASHIRE PROGRAMME
1.
Introduction
This paper provides a briefing on the 18 month pilot to test the impact of 3 of the schemes
associated with delivering System Resilience and the Better Care Fund in 2014/15 and
2015/16 across Pennine Lancashire.
2.
Background
2.1
Emergency admissions are rising across Pennine Lancashire, particularly in over 65’s.
Older people stay in hospital longer than average and costs of admissions increase with
age. More over 65’s are conveyed by ambulance, and of those conveyed 73% are
admitted to hospital.
2.2
Both Blackburn with Darwen and East Lancashire CCGs have submitted Better Care
Fund Plans which target approximately 2% reduction in emergency admissions from
trend. The plans focus on support of the frail elderly in the first instance.
2.3
In July 2014, Chief Executives from Blackburn with Darwen Council, Lancashire County
Council, Blackburn with Darwen and East Lancashire CCGs, Lancashire Care Foundation
Trust and East Lancashire Hospitals Trust agreed to a set of principles to facilitate the
development of a number of test changes to support system resilience and
implementation of the Better Care Fund Plan objectives. The key strategic intentions for
the development of the schemes across Pennine Lancashire can be summarised as
follows:
•
•
Initial focus for service redesign will be on complex frail elderly people
Simplification of the system is vital leading to a minimal number of options with
simple, single access points
•
Step up as well as step down as a feature of all Out of Hospital services
•
Discharge to assess long term care needs, allowing time outside of the acute
setting to develop appropriate care plan for patients, relatives and carers
Management of flow and capacity of the system needs to be co-ordinated and
managed as a whole system
•
3.
Project Aims
•
•
•
•
•
•
•
Fewer people will be admitted to hospital as an emergency
Quicker discharges and people will spend less time in hospital
Fewer people will be admitted to permanent residential care
Our system will be more easily navigated
Fewer conveyances to Emergency Department
System resilience will be maintained
Improved patient and carer experience
Page 2 of 21 3.1
The programme relates to services for complex frail adults and will initially focus on a test
for change in 3 specific areas:
•
•
•
Care Navigation Hub and Directory of Services
Intensive Home Support
Discharge to Assess / intermediate care
4.
Progress to date
4.1
Update on scheme development
A specific work stream on communications has commenced that will focus initially on
professionals use of the Directory of Services/ Hub and widen to ensure a greater
understanding of out of hospitals services as they develop.
4.2
Navigation Hub and Directory of Services (DOS)
The Care Navigation hub will provide a key interface with current services, Intensive
Home Support and Discharge to Assess / intermediate care services.
Alongside the hub a comprehensive DOS will provide advice, signposting and brokerage
for health and care professionals to enable them to access the appropriate services for
frail elderly patients.
Progress includes:
•
•
•
•
•
•
•
A group of primary and secondary care clinicians together with colleagues from
NWAS have tested the system using scenarios that reflect the range of need and
clinical issues present in the frail elderly population.
Testing has enabled enhancements to be made to the Directory and facilitated
discussions with clinical staff in all providers
The Directory of Services (DoS) has operational capability from 15th December
onwards
Focus is on step up from GP and Nursing Home sector with phasing in of A&E and
MAU referral.
The Pathway to services is being developed beginning with DoS to existing
services and Intensive Home Support from February
Specific communications for professional in relation to DoS are being developed
The Phase 1 business case received approval by CBG on 10th December 2014.
4.3
Intensive Home Support
The Intensive Home Support Service will be a community based, medically supported
multidisciplinary team that focuses on the highest need patients at risk of a hospital
admission or requiring intensive support following hospital discharge. It will provide
rapid access to sub-acute and crisis care based on the needs of patients, and their carers
supporting them to remain in their own home. The health and social care economy will
work in partnership and in collaborative teams to deliver services.
Page 3 of 21 Referrals will be able to be made direct by hospital and community through the Integrated
Locality/Neighbourhood Teams or the Navigation Hub. The service is the very intensive
element of integrated community provision in Blackburn with Darwen. Individuals will be
supported for a maximum of 5 days and stepped into the most appropriate community
service to ensure maximum flow and utilisation is achieved.
Progress includes:
•
•
•
•
•
•
Staff recruited to posts that will enable commencement of pilot on 2nd February
2015
Pathway developed that enables a maximum length of stay on Intensive Home
Support of 5 days to ensure throughput and maximum utilisation
On-going development of medical support to the pathway
Work with local nursing homes in Blackburn with Darwen to ensure they are
integrated into the scheme
Review of virtual ward in East Lancashire to ensure additionality delivers the
outcome of reduced conveyance to hospital.
The business case with financial and activity modelling is attached for approval by
Governing Body- Appendix 1
4.4
A ‘Discharge to Assess’ / intermediate care model is being developed and piloted. The
pilot is initially testing a single model of step down care in Blackburn with Darwen that
removes the current separation of health and social care beds.
Progress includes:
•
•
•
•
Stocktake of existing beds and usage
Development of pathway to ensure that additional therapy capacity increases
throughput and outcomes that ensure patients return to their own residence/ do
not default to nursing home placement
Development of test of change for an integrated discharge team- this includes
rationalisation of team functions in and outside t h e h o s p i t a l b a s e a n d a n
assessment pathway that enables a reduction in delayed discharges.
Business case is to be developed once the delivery model is fully understood.
5.
Risks and Deliverable Benefits
The schemes will aim to deliver the following benefits which are consistent with our Better
Care Fund submissions and our plans for system resilience:
•
•
•
•
•
Reducing unnecessary acute admissions and readmissions
Reducing the length of stay in an acute bed
Increasing patient choice and enhancing personalisation of care
Reducing the number of patients discharged into residential care
Increasing the number of patients who feel supported to manage their condition in
their place of residence.
Page 4 of 21 The risks are outlined in the table below
Risk
Extreme winter pressures impact on ability to
achieve emergency admissions target
Transformation change is not achieved within
planned timescales
Cultural shift in organisational thinking,
delivery and decision making
We do not have the right workforce with the
right skills and capacity to deliver our plans
including for 7 day services
Financial risk – cost of community care is
greater than acute episode
We will not gain agreement from all partners
for scale of pace required
Mitigating actions
Annual Resilience Plan monitored by the
multi-agency Systems Resilience Group
Existing governance structure includes
providers and risks escalated accordingly
through shared risk register, clear
performance framework with KPIs in
development
Workforce development identified as a
key enabler and plans will be progressed
through Pennine Lancashire programme
office
As above
Schemes will be piloted and phased
delivery to enable evaluation of impact
Plans have been jointly agreed by
Pennine Lancashire Chief Executives
6.
Impact of the Pilot
2014/15 – this period will focus on set up and mobilisation therefore we intend to maintain
system resilience over the winter period
2015/16 - to delivery 2/3 of Better Care Fund Plan target for unplanned admissions from
baseline (1000 across Pennine Lancashire. Approx. 600 for East Lancashire CCG and
400 for BwD CCG)
7.
Governance Arrangements
7.1
Following the initial development and mobilisation of schemes the Executive Officers
Group has reverted to its original development function working with the Pennine
Lancashire Transformation Board to operationalise strategic clinical redesign.
7.2
A clinically led implementation group meets weekly to ensure introduction, review and
monitoring of the Pennine Lancashire schemes. Representatives from provider
organisations are supported by commissioners who will work to bring the scheme into a
‘business as usual’ position.
7.3
The implementation group reports to the Executive Officers Group and onwards to the
Pennine Lancashire Chief Executives Group. The Chief Executives provide leadership
and direction for the Pennine Lancashire programme and commissioning intentions and
are currently considering the implications of the 5 Year Forward View for the health
economy.
8.
Recommendations
Members are requested to approve the attached business case.
Alison Shaw: Interim Programme Director: January 2015
Page 5 of 21 Non Recurrrent Funding
Project Bus
siness Cas
se
Appendixx A
Nam
me of proposed pro
oject:
In
ntensive Home
H
Supp
port
Business C
Case develloped by: Paula Fielld (LCFT)
Date:Decem
mber 2014
4
Business C
Case supported by: Jamie Wa
augh (LCFT
T)
PR
ROJECT L
LEADERSHIP:
Prroject Sen
nior Lead:
Proje
ect Manager:
Claire Jacksson
(Strattegic respo
onsibility foor delivery)) Lisa
Kiernan
Prroject GP Lead:
Proje
ect Lead Accountan
A
nt:
Dr
D Malcolm Ridgway
Gill Marr
M
Background to the proposal:
Th
he Pennin
ne Lancasshire Healtth Econom
my is a natural
n
foo
otprint covvering the Boroughss of
Blackburn w
with Darwe
en, Burnley
y, Hyndburrn, Pendle
e, the Ribb
ble Valley aand Rosse
endale. W hilst
sttrong relationships exist
e
across health a
and social care orga
anisations in the area it has been
b
re
ecognised that a morre formal arrangemen
a
nt would enable deve
elopment oof a Pennin
ne Lancasshire
he
ealth and care stra
ategy and establish
h a system
m design blue prinnt that is resilient and
su
ustainable..
Th
he system development is led by
b the Pen
nnine Lancashire Chief Executivve Officers
s Group witth
clinical advicce from the
e Clinical Transforma
T
ation Board
d. At the initial meetinng in June 2014 the
Chief Execu
utive Office
ers agreed there wou ld be:
•
Colle
ective owne
ership of a transforma
ation progrramme and
d single plaan
•
An im
mmediate requiremen
r
nt to identiffy the ‘quic
ck wins’ wh
hich would form part of
o the
progrramme and
d a plan to design an
nd impleme
ent them.
Th
he aim of tthe project is to develop ideas i n the short, medium and long tterm to ens
sure that
pe
eople are d
diagnosed,, treated an
nd cared fo
or in the most
m
effectiv
ve way; at least cost to the
sy
ystem.
Ac
cross Pennine Lanca
ashire it ha
as been a
agreed thatt any chan
nges to sysstem chan
nge must build
b
on
n, and nott duplicate or introdu
uce comple
exity into the existing
g system. All system
m changes will
be
e responssive to our ongoin
ng develo pment of integrate
ed locality//neighbourrhood tea
ams;
integrated d
discharge and the re
emodel of the entire
e intermediate care ssystem aligned to CCG
C
sttrategic and
d operation
nal plans and
a agreed
d Better Ca
are Fund sc
chemes.
Im
mproved qu
uality of ca
are and in
n particularr patient experience
e
is the keyy driver fo
or this servvice
re
edesign.
1
Page 6
6 of 21 The strategic objective of the Pennine Lancashire initiatives are detailed in the Cases for
Change for both BwD and East Lancashire CCGs and the principles can be summarised as
follows:
• Simplification of the system is vital leading to a minimal number of options with simple,
single access points.
• Clear separation of Acute Hospital and Out of Hospital services
• Step up as well as step down for all Out of Hospital services.
• Discharge to assess long term care needs from acute care, allowing time to think for
patients, relatives and carers.
• Management of flow and capacity of the system needs to be co-ordinated and managed
as a whole system.
• Trust in the robustness of the Out of Hospital system has to be established.
• Capacity has to be available and greater flexibility of the system is required, specific to
the needs of the person
• Response has to be quick when needed and must be 7 day.
• Assessment needs to be trusted rather than repeated with exclusion criteria removed.
• Robust medical oversight is required.
• Full spectrum of need will be addressed from light touch through to intensive support.
• Predominantly frailty related initially.
BWD IHS Outline Business CaseDec14dec14
Blackburn with Darwen Intensive Home Support Service
Executive Summary
The purpose of this business case is to obtain agreement to the commissioning of a ‘step up’
admission avoidance service for the Blackburn with Darwen health economy to be provided by
Lancashire Care Foundation Trust.
The service will facilitate proactive prevention & early intervention, out of hospital care, to meet
the physical, mental health & social care needs of frail elderly patients to empower and support
them to live independently in their own homes.
The Intensive Home Support service is a medically led, multi-disciplinary team with dedicated
pharmaceutical & social work provision. It will work in collaboration with existing physical &
mental health teams to facilitate a seamless patient pathway on a step-up basis
The pilot phase will commence in February 2015 with a phased implementation which will
deliver 14 virtual beds when fully operational in May 2015.
The following is a high level summary of finance and activity and reflects 3 years data to
evidence the increased savings potential from year 2. More detail is shown in financial and
activity analysis and appendix C.
Admissions Saved
Year 1
783
Year 2
1,040
Year 3
1,040
Savings
£532k
£948k
£917k
1) Project Aim(s)
The service will facilitate proactive prevention & early intervention, out of hospital care, to meet
the physical, mental health & social care needs of frail elderly patients to empower and support
them to live independently in their own homes by:
Collaborating with Integrated Neighbourhood Teams to identify patients who require an
intensive service, on a step-up basis, to prevent a hospital admission
Using a community based multi-disciplinary team, wrapping services around the needs of
the patient
Providing a holistic assessment of need and necessary support, equipment and
interventions to promote stability in the patient’s condition
Preventing an avoidable admission to hospital by providing support and therapeutic
interventions during acute illness or sudden deterioration in condition
Providing a rapid access, high quality ‘step-up’ service that meets the needs of those at
risk of a hospital admission
Preventing unwarranted admissions into short-term residential care beds
BWD IHS Outline Business CaseDec14dec14
Actively develop close working relationships with partner organisations, e.g. health,
social, VCFS & NWAS, housing providers to maximise patients to remain at home, where
appropriate
Reduces duplication of assessment
2) Deliverable Benefits
The services main objectives include:
reducing unnecessary acute admissions and readmissions
increasing patient choice and enhancing personalisation of care
increasing the number of patients who feel supported to manage their condition in
their place of residence
In order to meet the objectives the service will need to:
Retain medical responsibility for the patients whilst in the service
Be medically led by a fully accountable generalist doctor
Be provided by a multi-disciplinary, community based team
Integrate with existing physical and mental health provision & social care; including the
direct commissioning of re-ablement and crisis offer
Be accessible & responsive to meet the needs of referrers
Validate a ‘Trusted Assessment’ to ensure appropriateness of case mix and undertake
assessment when needed
Provide full medicines management reconciliation to prevent negative polypharmacy & pill
burden
Ensure sharing of information regarding management plans and interventions
Ensure regular caseload reviews take place in primary health care settings within the
MDT of the Neighbourhood teams
BWD IHS Outline Business CaseDec14dec14
3) Service Delivery
The Intensive Home Support service is a medically supported, multi-disciplinary team with
dedicated pharmaceutical & social work provision. It will work in collaboration with existing
physical & mental health teams to facilitate a seamless patient pathway on a step-up basis as
detailed below:
BWD IHS Outline Business CaseDec14dec14
This service provides an admission avoidance scheme. As required by the CCG, the first phase
of implementation will focus on preventing the admission of patients in nursing homes. This will
commence in February 2015. Patients will be ‘stepped-up’ from nursing homes in Blackburn
with Darwen onto the Intensive Home Service. A roll-out of step-up from the patient’s own home
will follow.
In collaboration with East Lancashire Hospitals NHS Trust, patients will be stepped-up from the
‘front door’ of the acute hospital, working in conjunction with teams in the Urgent Care Centre &
Emergency Departments to support the identification of clinically appropriate patients to admit to
the Intensive Home Support Service. It will enhance & identify any required redesign of current
processes to facilitate effective & co-ordinated care across the health economy.
Cognisant that the Integrated Locality Teams (ILTs) are essential to the effective delivery of this
service, robust collaborative clinical pathways will be developed to ensure patients are stepped
up into the IHS & stepped down to the ILT as clinically appropriate.
To facilitate this, a Trusted Assessment will be carried out by ‘Trusted Assessors’ identified from
existing acute & community teams to support the seamless coordination of the patient’s
pathway. It is planned that the ILTs will be trained as Trusted Assessors in the initial stages of
roll out.
Acute Bed Intensive Home Support Integrated Locality Teams 4) Performance Monitoring
Integral to the successful implementation & delivery of Intensive Home Support, is the
supporting technology & infrastructure to support it. This operational infrastructure supports the
following:
•
•
•
24/7 nurse triage & helpline
Live patient activity & case notes
Scheduling of appointment
BWD IHS Outline Business CaseDec14dec14
•
Robust activity & performance management data
Our system will capture both the inputs, outputs & outcomes for patients referred onto the
service. Reporting is expected to capture the following, however, is not an exhaustive list.
•
•
•
•
•
•
•
•
•
Referring clinician
Referral route
Number of patients referred into IHS
Number of patients accepted
Diagnosis/presenting complaint
Number of days remaining on service
Discharge destination
Number of patients ‘rejected’ and reason why
Detail of alternative service patient navigated to
It is expected that a number of performance reports will be generated to include the following
information:
•
•
•
•
number of admissions avoided & length of stay
number of patients accepted on service and number of patients discharged each day
response times
patient satisfaction
It should be noted that this is not an exhaustive list. It is expected that pre & post
implementation, LCFT will work closely with commissioners to identify the detailed information
required to support the evaluation of the pilot to inform the future planning and procurement
requirements.
5) Rationale for IHS
This additional service is required to deliver the culture, capacity & competency shift required to
deliver significant change. Lancashire Care NHS Foundation Trust is unable to provide this
within its existing services owing to the pressures in the health economy to achieve radical
change in a short length of time. LCFT intends to sub-contract this service, whilst integrating
with current services to demonstrate & share the benefits of working in a different way to
achieve significant change. This gives LCFT the opportunity to learn from a provider who has
achieved success with this model & shape its services accordingly.
It should be noted, that the IHS will work in a seamless way with existing services to provide the
shared learning & development required for a sustainable out of hospital service offer. The
service will be truly integrated including medical responsibility, social worker, mental health
services together with a multidisciplinary nursing & therapy team wrapped around the holistic
needs of the patient.
BWD IHS Outline Business CaseDec14dec14
6) Key Partners
•
•
•
•
•
•
•
•
•
Blackburn with Darwen General Practices
Lancashire Care Foundation Trust
Care Homes and Nursing Homes
Blackburn with Darwen Borough Council
Lancashire County Council
NWAS
Voluntary Community Faith Sector
East Lancashire Medical Services
East Lancashire Hospitals Trust
7) Scope
In Scope:
Blackburn with Darwen registered patients who are identified as appropriate for out of hospital
care and whose care package is identified as requiring Intensive Home Support
Out of Scope:
Initially, non-Blackburn with Darwen registered patients
Patients whose care package can/should be provided by existing community service
8) Timescales – Key dates
Project Start Date: Mid October 2014
Checkpoint 1: Mid-November 2014
Checkpoint 3: Mid-May 2015 – Service review
Please see appendix A for more detailed timeline
BWD IHS Outline Business CaseDec14dec14
Project End Date: 31st December 2015
Checkpoint 2: End January 2015
Checkpoint 4: Mid October 2015
Non Re
ecurrent Funding
Projectt Business Cas
se
App
pendix A
9) FINA
ANCIAL AND A
ACTIVITY APP
PRAISAL
PLEASE
E NOTE THES
SE COSTS ARE
E EXCLUSIVE
E OF ADDITION
NAL COSTS RELATING
R
TO MEDICAL
M
PRO
OVISION, BASED ON THE
ASSUM
MPTION THAT COMMISSION
NERS HAVE ADVISED LCFT
T TO WORK WITH CURRENT
T SERVICE PR
ROVIDERS.
Financiial Implication
ns
Year 1 ((Feb 2015 to Ja
an 2016)
Disaggrregated to Feb--Mar 2014-15
Year 2 ((Feb 2016 to JJan 2017)
Year 3 ((Feb 2017 to Ja
an 2018)
Gross (totall) cost to deliv
ver
the scheme
e
£962k inc £8
85k set up costts
£200k inc £8
85k set up costts
£1,036k
£1,067k
Gross
s (total) saving
gs to deliver
the sc
cheme
£1,494
4k
Net Savings (Total Savings
s less
total costs)
£532k
£1,984
4k
£1,984
4k
£948k
£917k
Notes
The cossts above do no
ot include any additional
a
costss of prescribed
d drugs outside
e what the patie
ents will have already
a
been prrovided by theirr GP
The savvings are based
d on avoiding emergency
e
adm
missions as sta
ated in the activ
vity table in app
pendix B provid
ded by the CCG
G
The unitt cost stated byy the CCG for an
a emergency admission is £
£1,908
Year 1 ccosts, savings and activity are
e lower than ye
ears 2 and 3 du
ue to the phase
ed implementattion of the serv
vice
Not included in the abo
ove savings arre the costs of a
any associated
d A&E attendan
nces/re-attenda
ances and follo
ow up appointm
ments
Activity
y Implications
Year 1 ((Feb 2015 to Ja
an 2016)
Year 2 ((Feb 2016 to Ja
an 2017)
Year 3 ((Feb 2017 to Ja
an 2018)
Number of
Virtual Beds
s
14
14
14
Average
e Length of
Stay (da
ays)
5
5
5
Admissions
eek
Saved Per We
20
20
20
Admissions
P Year
Saved Per
7
783
1,0
040
1,0
040
Please see appendix C for detailed roll-out
r
plan & a
activity – which
h demonstrates
s the total numb
ber of admissio
ons is in line witth commissioner
ptions. Robust monthly perforrmance monito
oring will suppo
ort the reconcilia
ation of these assumptions
a
ag
gainst activity planned.
p
assump
9
Non Recurrrent Funding
Project Bus
siness Cas
se
Appendixx A
10
0) Workforce
To
o deliver th
he service as outlined
d above th
here will be
e a requirem
ment of addditional ca
apacity to
prrovide support to the existing health and social serv
vices. This will be acchieved through the
prroactive exxternal recrruitment off additionall staff.
Th
he service will require
e a change
e in some methods of
o current practice
p
as well as the
e way in
which teamss across th
he health and
a social ccare econo
omy work together too co-ordinate care
pa
athways. In
n order to achieve
a
this there is a phased introductio
i
n to servicce delivery which allows
th
he balance of providin
ng time forr changes tto be introd
duced and embeddedd whilst als
so beginnin
ng
to
o deliver the
e benefits to the patie
ent.
It is assume
ed that exissting knowlledge, skillls and expe
erience witthin the heealth and so
ocial care
ec
conomy will enable fa
ast and efffective servvice mobilis
sation and delivery.
11
1) Estates
s/Infrastruc
cture
Th
here is a re
ecognition that to ena
able all rele
evant prov
viders across Blackbuurn with Da
arwen to work
w
to
ogether the
ere is a more detailed
d piece of w
work requirred to unde
erstand thee IT solutio
ons needed
d
which will en
nable partn
nership wo
orking acro ss organis
sations. This is flaggeed as a risk
k to the
prroject.
Th
here are no
o estates implications for the C
CCG in prov
viding an Intensive H
Home Supp
port service
e
12
2) Quality
Staff will:
Monittor the effe
ectiveness of clinical practice th
hrough the quality asssurance sttrategies su
uch
as the
e use of au
udit and pe
eer review
Mainttain professsional registration
Particcipate in co
ontinuing professiona
p
al development oppo
ortunities too ensure th
hat up-to-d
date
evide
ence-based
d knowledg
ge and com
mpetence in
i all aspec
cts of roless is maintained
Workk within the
e latest NM
MC Code off Professio
onal Condu
uct
Reco
ord accuratte consulta
ation data in patients
s records in
n accordannce with th
he latest NMC
guida
ance and other
o
pertin
nent standa
ards
Keep
p up to datte with pertinent hea
alth-related
d policy an
nd work w ith the Loc
cality team
m to
consiider the im
mpact and strategies
s
ffor implementation
Workk collaborattively with colleaguess within an
nd external to the Loccality.
Enco
ourage and develop te
eamwork w
within the Locality.
L
Particcipate in multi-discipl
m
inary proto
ocol and Patient Grou
up Directioons development
10
13) Key Performance Indicators
First line metrics and Key performance indicators have been agreed as follows:
Provider Activity
Frequency of reporting
Performance Target
Number of admissions avoided
Monthly
Total number of referrals
Source of referral
Total number of assessments
Total number accepted on programme
Total accepted on programme were admission would
have been action of referrer
Utilisation of IHS beds
% of capacity utilised
Monthly
Length of stay on IHS
Average length of stay on IHS programme
Monthly
Quality Target
Discharge
Monthly
Number and % discharged to primary care
Number and % admitted to secondary care
Number and % deaths expected (palliative) a
14) Alternative options
Elements of an Intensive Home Support service already exist and are successful e.g. East
Virtual Ward pilot, however to provide the holistic model required, a significant step-change is
required.
BWD IHS Outline Business CaseDec14dec14
15) Impact Assessment
Area
Primary Care
X
Community Care
X
Secondary Care
X
Social Care
X
Voluntary Sector
X
Other (please
state)
X
Details regarding impact and engagement/consultation which
has taken place
Engagement with practices has been through face to face meetings
at the Senate and at each of the 4 locality group meetings.
Primary care will be able to refer patients to IHS to prevent a
hospital admission.
Collaborative working with the Acute Visiting Scheme will free up
primary care capacity to deliver core business
Represented at the Executive Officers Group.
LCFT will deliver the physical nursing & therapy elements of the
service in collaboration with current mental health services. This
will require additional workforce capacity to provide a quick
responsive 7 day service that is capable of addressing the full
spectrum of patient need.
Represented at the Executive Officers Group.
The main objectives of the IHS service include preventing a
hospital admission/readmission via step up provision.
Represented at the Executive Officers Group.
Social Care will form an integral part of HIS, providing social care
assessments and reablement as part of the multi-disciplinary team
approach.
Represented at the Executive Officers Group.
The voluntary sector will provide support to those patients on IHS
via self-care support etc.
NWAS & ELMS – both organisations are represented at the
Executive Officers Group.
NWAS will be able to refer patients to IHS to prevent hospital
admissions.
Early discussions have commenced with ELMS & the CCG to
facilitate AVS providing the medical cover for the IHS service.
16) Interfaces
•
Internal
Integrated locality teams – the ILTs are a key component of overall service delivery. The
IHS will work seamlessly with ILTs to provide a step-up/step-down service for patients as
clinically appropriate
IST & Care Home Liaison – pathway development to facilitate collaborative working
between the IHS & our mental health services will provide a holistic model of care for
patients. It delivers a positive outcome for both our patients and LCFT. Joint working will
facilitate the development of additional competencies across our physical and mental
health teams.
Medicines management – will form part of the IHS MDT team to provide full medicines
management reconciliation to prevent negative polypharmacy and pill burden.
Current LCFT services – gives LCFT the opportunity to review & redesign existing
services whilst developing its capacity, competency & capability to deliver the IHS.
BWD IHS Outline Business CaseDec14dec14
External
Acute Visiting Scheme – the CCG has advised that we work with the existing service in
the pilot phase to provide our medical oversight. The impact on AVS capacity is currently
unknown but will be measured throughout the lifetime of the service mobilisation and
ramp up.
Primary care – the IHS offers GPs an alternative, where clinically appropriate, to a
hospital admission. GPs will feel supported in the knowledge that their patients are being
kept safe, under separate medical leadership, whilst in the care of the Intensive Home
Support service.
17) Interdependencies
For this service to operate successfully, all partners identified above will need to commit to
working together to maximise patients to remain at their place of residence.
This is likely to mean sharing best practice, creating a trusted assessment that can be used
across health and social care, access to shared IT systems and collaborating to design service
and referral pathways across Blackburn with Darwen. The development and agreement of a
robust governance structure to support a dedicated medical model is key to the success of the
project.
18) Risks
Insufficient lead-in time to mobilise service delivery to reduce pressures for winter
Partners are unwilling to support IHS
Medical model has still to be agreed
Unable to recruit additional capacity needed leading to delay in service delivery
IT issues unable to be addressed or too costly
Not enough time to be able to understand the complex care and referral pathways
resulting in inefficiencies
Lack of clearly defined scope and specification
Assumptions relating to demand & capacity modelling have not been able to be validated
due to the lack of supporting evidence and data
19) Agreement to Proceed
Name
Project Senior Lead:
Project Manager:
Project GP Lead:
Project Lead Accountant:
Date business case reviewed
BWD IHS Outline Business CaseDec14dec14
Signature
Outcome
Date
Non Re
ecurrent Funding
Projectt Business Cas
se
App
pendix A
14
ELEMENT SIX Activity, Bed Day and Cost Impacts of Step Up into Intensive Home Support (HIS) [Indicative] Activity LOS Cost Average LOS Average Cost Activity LOS Cost Average LOS Average Cost Activity LOS Cost Average LOS Average Cost Activity LOS Cost Average LOS Average Cost Activity LOS Cost Average LOS Average Cost TOTAL [4] 20+ days [3] 10‐19 days [2] 3‐9 days [1] 0‐2 days LOS £
£ £
£ £
£ £
£ £
£ 2013‐14 Emergency Admissions
BwD CCG EL CCG PENNINE LANCS
1950 4923 6873
1436 3694 5130
1,765,777 £ 4,521,187 £
6,286,964
0.74 0.75 0.75
906 £ 918 £ 915
1400 3483 4883
7554 18570 26124
3,371,709 £ 8,639,013 £ 12,010,722
5.40 5.33 5.35
2,408 £ 2,480 £ 2,460
557
1147 1704
7424 15289 22713
1,621,468 £ 3,266,479 £
4,887,947
13.33 13.33 13.33
2,911 £ 2,848 £ 2,869
303
955 1258
10798 36152 46950
1,274,081 £ 3,599,926 £
4,874,007
35.64 37.86 37.32
4,205 £ 3,770 £ 3,874
4210 10508 14718
27212 73705 100917
8,033,035 £ 20,026,605 £ 28,059,640
6.46 7.01 6.86
1,908 £ 1,906 £ 1,906
Source Secondary Uses Service Spell Data ‐ MLCSU Data Warehouse BWD IHS Outline Business CaseDec14dec14
STEP UP IMPACT 50% Activity, Bed Day and Cost Impact [Indicative]
BwD CCG EL CCG PENNINE LANCS
975
2462
3437
718
1847
2565
£
882,888 £
2,261,053 £ 3,143,941
STEP DOWN LOS Impact
0% 0 15% £
210
1133
505,756
£
522
2783
1,294,736 £ 732
3916
1,800,492
Activity, Bed Day and Cost Impact [Indicative] BwD CCG EL CCG PENNINE LANCS 0
0
0 0
0
0 £
‐
£
‐
£ ‐ 0.74
0.75
0.75 140
280
10% 2 £
5% £
28
373
81,510 £
57
760
162,327 £ 85
1133
243,837
25% 3 5% £
15
535
63,073 £
48
1817
180,939 £ 63
2352
244,012
40% 8 £
1228
2759
1,533,228
£
3089
7207
3,899,054 £ 4317
9966
5,432,283
£
£
‐
£ ‐ 3.33
3.35 139
458.7
287
947.1
426 1405.8 ‐
£
‐
£ ‐ 10.03
10.03
10.03 121
968
382
3056
503 4024 £
‐
488 976 3.40
£
348
696
‐
£
‐
£ ‐ 27.64
29.86
29.32 400
1706.7
1017
4699.1
1417 6405.8 ‐
£
‐
£ Bed Impact [100% / 365 days per annum]
7.56
19.75
27.30
Bed Impact [100% / 365 days per annum] 4.68
12.87
17.55 ‐ Blackburn with Darwen – Intensive Home Support Implementation Schedule
Month 2015
Virtual
Beds
Admissions
Saved
Bed Nights
Saved
BWD IHS Outline Business CaseDec14dec14
Feb
Mar
Apr
May
Jun
July
Aug
Sep
Oct
Nov
Dec
Jan 16
3
6
8
14
14
14
14
14
14
14
14
14
18
36
49
85
85
85
85
85
85
85
85
85
92
184
246
430
430
430
430
430
430
430
430
430
GOVERNING BODY MEETING
Date of Meeting
14th January 2015
Agenda
Item No.
16
Title of Report
Healthier Lancashire Purpose Document
Governing Body
Responsible Officer
Summary/Purpose of
Report
Lead
Dr Chris Clayton, Clinical Chief
Clinician
Officer
Lead
Manager
This document is structured in three sections; section one sets out the
Healthier Lancashire journey from the first paper to the three Health and
Wellbeing Boards, to the Lancashire Leadership Forum’s agreement to
establish a programme of work to bring about change across the
Lancashire health and social care system, right up to the present day with
the desire to move forward to develop and deliver a strategic plan.
Dr Chris Clayton, Clinical
Chief Officer
Section two aims to set out some of the evidence that supports the need for
change and has been derived from the Sustainability Assessment
Framework (SAF) that the Leadership Forum commissioned from Oliver
Wyman. The third and final section is intended to describe the proposal for
creating a system wide programme of work. The first phase of which would
be a strong process to develop a strategic plan for Lancashire by the end of
May 2015.
The Healthier Lancashire Team has co-ordinated the compilation of this
document to summarise the essence of discussions and decisions taken by
the Healthier Lancashire Executive and Lancashire Leadership Forum since
the beginning of September 2014.
In establishing the Healthier Lancashire Programme, the Leadership Forum
recognised the challenges associated with improving outcomes and that
these cannot be met by one organisation alone.
This document is all about ensuring that the Healthier Lancashire
Programme is co-designed and engages people through strong
relationships and commitment. It is hoped therefore, that it can be used to
support discussions to ensure that all the organisations which are members
of Healthier Lancashire feel engaged in and informed about the work to date
and the planned activities for early 2015. The Leadership Forum in February
will continue the journey with detailed discussions about the process for
developing a Strategic Plan.
Governing Body Action
The Governing Body is requested to consider and submit views on the
content of the purpose document to be fed back to the Lancashire
Leadership Forum in February.
Please indicate the Committee(s)/Group(s) where the paper has been discussed/developed
Lancashire Leadership Forum
Page 1 of 2
Please note the following section must be completed in full
Patient and Public
N/A
(if yes, complete outcome)
Engagement Completed
Equality Analysis
N/A
(if yes, complete outcome)
Completed
Financial Implication(s) N/A
Risk(s) Identified
N/A
CCG Strategic Objectives supported by this paper
1.
2.
3.
4.
5.
We will continuously improve the health and well-being of the population of Blackburn with
Darwen.
We will build successful partnerships which promote collaborative working and integrated service
delivery.
We will effectively engage patients and the public in decision making.
We will co-commission and deliver continuous improvement in Primary Care Services and tackle
inequalities.
We will commission safe and effective services for the population of Blackburn with Darwen with
integration at the heart of commissioning.
Y
Y
Y
Y
CCG High Impact Changes supported by this paper
1.
2.
3.
4.
5.
6.
7.
8.
9.
Delivering high quality Primary Care at scale and improving access.
Self-Care and Early Intervention.
Enhanced and Integrated Primary Care and Better Care Fund.
Access to Re-ablement and Intermediate Care.
Improved hospital discharge and reduced length of stay.
Community based ambulatory care for specific conditions.
Access to high quality Urgent and Emergency Care.
Scheduled Care.
Quality.
Page 2 of 2
N/A
Y
Y
Y
Y
N/A
Y
Y
Y
Healthier
Lancashire
Programme
Purpose Document
A Lancashire System Response
to the Five Year Forward View
December 2014
Healthier
Lancashire
Programme
“All Lancashire people are united
around a common cause; one that
stops people from being patients”
The Healthier Lancashire mission…
“To lead the way in an unprecedented
collaboration between people and
organisations to define a new and
better future for health and care in
Lancashire”
2
‘
The programme has a clear vision…
Purpose Document
A Lancashire System Response
to the Five Year Forward View
Contents
INTRODUCTION
The origins of Healthier Lancashire
The Purpose of this document
Strategic context
There are mounting demands on care budgets
The NHS “Five Year Forward View”
An emerging consensus within Lancashire
Lancashire - demographics and geography
The strategic challenge
The moment of opportunity
WHERE WE ARE STARTING FROM
Lancashire has an ageing population
Residents in Lancashire are less healthy than the national average
Many Lancashire people have three or more long-term health conditions (LTCs)
Lancashire residents are also more likely to die early
There are significant health inequalities within Lancashire
Health services struggle to meet current performance targets
Patient experience is variable
Staff satisfaction is deteriorating
There are also big workforce challenges
While demand for health and social care services is growing
Social care has challenges too
The third sector is not adequately financed to fill the gaps
CREATING A SYSTEM WIDE PROGRAMME
Why a Strategic Plan?
What is a Strategic Plan?
A Strategic Plan for All Lancashire
Leadership
Organising
Timetable
Mobilising the Strategic Plan
Underpinning Communication and Engagement Strategy for the Strategic Plan
CONCLUSION
GLOSSARY OF KEY TERMS
REFERENCES
This document has been prepared on behalf of the Lancashire Leadership Forum in partnership with Oliver
Wyman, a global leader in management consulting, and Freshwater UK, an integrated communications
consultancy. The content has been complemented by the stakeholder activities designed and facilitated by
True North Communications Limited.
3
Healthier
Lancashire
Programme
Introduction
The origins of Healthier Lancashire
In Lancashire, there has been some history of close collaboration between health and care
organisations and Councils, but there has been a collective frustration that it has not
delivered the anticipated outcomes. Following the implementation of the Health and Social
Care Act 20121 the Lancashire Leadership Forum was created with representation from the
three top tier Local Authorities, Clinical Commissioning Groups, Provider NHS Trusts, Health
Education England, HealthWatch, the third sector, Public Health England and NHS England.
The Leadership Forum agreed to create a Lancashire level health and care strategy, called
“Healthier Lancashire” following two workshops in autumn 2013. This was followed by a
paper presented by the Area Team Medical Director, on behalf of the Leadership Forum, to
the three Health and Wellbeing Boards. Subsequently, a Programme Director was appointed,
supported by a Programme Team. NHS England has provided the initial non-recurrent
funding which has covered the establishment of the Programme, and the development of
this Purpose Document and the future development of the Strategic Plan.
The purpose of this document
The Purpose Document is intended to set out the journey to date and the proposed next
phase of development. It is designed to confirm the scope, align plans and set out priorities
for action. This work will be undertaken within a legally robust governance framework,
follow best practice processes and will ensure a consistency of approach.
In establishing the Programme, the Leadership Forum recognised the challenges associated
with improving outcomes. These cannot be met by one organisation alone and strategic
planning needs to be worked through at a Lancashire level to build a sustainable health and
care system. However, it is understood that need varies across the county and this will not be
a one-size-fits-all strategy. Healthier Lancashire will align with and add value to the
strategies of the Health and Wellbeing Boards and the two and five year plans of our CCGs
and Provider Trusts, including the Better Care Fund. While there must be clear and
transparent standards of care across the whole of Lancashire, the response and delivery of
these standards will be tailored to meet local need and will build on existing successes.
This document has been produced to stimulate a wider discussion across the health and care
system, reflecting the extensive engagement that has taken place over the past few months.
The discussions are expected to lead to a reaffirmed commitment to the next stage of the
work. The Strategic Plan will detail opportunities for collaboration within Lancashire and
within local health and care systems. It mirrors the ambition and desire for change that has
been apparent in discussions over the past few months, never more so than at the summit
held at Turf Moor in November.
4
Purpose Document
A Lancashire System Response
to the Five Year Forward View
This document is all about ensuring that the activities within the Programme are co-designed
and engage people through strong relationships and commitment. By people, this means the
leaders of Lancashire organisations, all the staff that work within health and care - in the
statutory, third and private sectors - that contribute to health and wellbeing. The document
is written for the Boards and Governing bodies of Lancashire’s health and care organisations,
although it will also be discussed on a wider level.
Strategic Context
The health and care system, nationally and locally, continues to be exposed to number of
significant challenges including; evolving needs and demographic trends, emerging
technologies, and the political landscape. With these challenges comes great opportunity.
The NHS has been variously described as one of “the most trusted organisations in British
society”, our “proudest achievement” and “the envy of the world”. It is not just a great
institution but a unique expression of a noble ideal - that healthcare should not be a
privilege to be purchased but rather a moral right available to all.
As we acknowledge and celebrate the achievements of the NHS we must also address the
health and care challenges of the future to build a fully integrated, collaborative system.
The problems that the NHS faces cannot be solved by the NHS alone. Nationally these issues
have recently been addressed in the NHS Five Year Forward View2 which notes that while the
values of the NHS are unchanging, the service itself must change if it is to meet the needs of
the people in a rapidly evolving world.
5
Healthier
Lancashire
Programme
The proposal made to the Health and Wellbeing Boards for a Healthier Lancashire
Programme was largely borne out of a shared recognition of the need to transform the poor
outcomes that are outlined in Section Two, titled ‘Where we are starting from’. The health
and care system continues to grapple with the challenges of finite resources, growing
demand, changing health needs and the public requirement for greater information and
more involvement.
There is a growing sense that “We can’t go on like this” but there are differing views as to
what exactly “this” is. For some people it is principally about tackling poor health outcomes,
for others it is a question of unsustainable service models and for others still it is a matter of
changing health needs.
In truth, all of these factors mean we cannot carry on as we are. If we do not address these
challenges we will not be able to maintain the comprehensive, high quality NHS the people
of Lancashire clearly want.
There are mounting demands on care budgets…
There is evidence that investing in spending on the right kinds of social care can reduce the
strain on the wider health and care system – by avoiding unnecessary admissions and
reducing the length of hospital stay where appropriate. However, preventative services and
social care often become a low priority when resources are squeezed.
Councils have been working closely with the health and care system to support the
increasing numbers of people who leave hospital every week. They have also had to cut back
on free adult social care and many local councils feel that the scope for further savings is
now reduced. By 2020, it is predicted that councils will have to find £4.3 billion just to
manage care services at the current levels. Furthermore, estimates that were produced for
the Dilnot Commission suggest that even without reform, spending on social care will have
to rise from £14.6 billion in 2010/11 to £23 billion by 2025/26.
Local government has faced tough spending settlements over the last four years that have
impacted dramatically on adult social care and its capacity to deliver. The prospects for third
sector funding are fragile too. Combine this with the pace of demographic change, adult
social care services will soon reach a critical point.
This will have clear knock-on effects on and across the health care system unless we do
things differently. Without investment in preventative and out of hospital services, even
without the economic pressures, increases in the numbers of older people would mean more
emergency admissions to hospital, delayed discharges and longer waits for treatment, as
well as increased pressure on hospital accident and emergency departments. Care funding
faces a deepening crisis which must be addressed.
A better understanding of the reciprocal relationship between spending in health and social
care is essential to ensure a holistic and integrated approach.
6
Purpose Document
A Lancashire System Response
to the Five Year Forward View
The NHS “Five Year Forward View”
NHS England recently published a “Five Year Forward View” that offered a route map for
the proposed direction of travel for the health and care system over the next five years. The
message that emerged from this Forward View was that we are at a crossroads. To secure the
future that we all know is possible, we need to change radically, empower the public and
work more closely with our partners.
The purpose of the Five Year Forward View is to articulate why change is needed, what that
change might look like and how we can achieve it. It envisages action on four fronts:
• Action to tackle the root causes of ill health. The future of the NHS now depends on a
radical upgrade in prevention and public health. The Forward View calls for hard-hitting
action on obesity, alcohol abuse and other major health risks.
• Action to meet the needs of a population that lives longer. This means breaking down the
boundaries between family doctors and hospitals, between physical and mental health
and between health and social care and it means getting better at dealing with the
complexities associated with multiple long-term conditions.
• Action to develop new models of care, greater flexibility and more investment in our
workforce, technology and innovation.
• A commitment to giving patients more control of their own care, including the option of
combining health and social care, and new support for carers and third sector workers.
The Forward View argues that if the NHS received flat real terms funding over the next five
years, and made no further efficiency savings, then growing demand for healthcare would
lead to a national NHS shortfall of £30bn a year by 2020/21. (The Lancashire share of this
shortfall would be in the order of £830m.3) The Forward View says that to sustain a
comprehensive, high-quality health and care system, action will be needed on all three
fronts - demand, efficiency and funding.
Much of the Forward View focuses on secondary care in hospitals, but it also recognises the
importance of reforming primary care too. The challenges facing primary care include:
•
•
•
•
•
An increasing workload and falling income
Poor career structures and problems with workforce recruitment and retention
Under-utilised skills and a lack of investment in education and training
Lack of investment in infrastructure including premises
The challenge of seven-day working
The Forward View leads the move towards a different health and care system. It does not
propose a one-size-fits-all plan but nor does it suggest the solution is to let a ‘thousand
flowers bloom’. Rather it sets the framework for further detailed planning about how health
and care needs to evolve over the next five years and it invites health communities across
England to respond by developing their own thinking.
It represents a clear consensus that has developed between NHS England, Monitor, Health
Education England, the NHS Trust Development Authority, Public Health England and the
Care Quality Commission. It is the first time the NHS has set out a clear sense of direction for
the way services need to change and improve.
7
Healthier
Lancashire
Programme
An emerging consensus within Lancashire
This national consensus is now being echoed across Lancashire. The Lancashire health
community comprises eight Clinical Commissioning Groups (CCGs), more than 200 GP
practices, five acute NHS hospital Trusts, a health and wellbeing Trust and a single specialty
learning disability Trust. Social care is provided by Lancashire County Council and the two
unitary authorities of Blackburn with Darwen and Blackpool. Additionally there is an active
third sector supporting health and social care. Within this community there is a growing
sense of common purpose and a growing sense of urgency around the need for change.
Many of the themes in the Forward View have resonance in Lancashire too.
For example, just over a decade ago the Derek Wanless health review warned that unless we
took prevention seriously we would be faced with a sharply rising burden of avoidable
illness. That warning was not heeded, the rising burden is upon us and the need for a radical
upgrade in prevention and public health is now urgent. A priority for England AND for
Lancashire.
The Healthier Lancashire programme aims to significantly improve health and social care
outcomes for the people of Lancashire and to radically shift the way in which health and
social care services are delivered. The Leadership Forum started to develop a vision and a
series of principles, which were refined at the summit in November. This means that we are
able to put forward a clear vision…
“All Lancashire
people are united
around a common
cause; one that
stops people from
being patients”
8
‘
The age of the passive patient is passing. The NHS of the future will be one of personal
power and personal engagement. The time has come for us to encourage active citizen
partnership in which people take greater control over - and assume greater responsibility for
- their own health and care. Our aim should be nothing less than to stop people being
patients before they absolutely need to be and to support them appropriately when they
are.
Purpose Document
A Lancashire System Response
to the Five Year Forward View
When people need health or social care they will be treated as individuals, as equal partners
in their care and will receive the best care possible.
The programme is guided by some key objectives:
• To set out a clear direction of travel for the health and care system in Lancashire as the
Five Year Forward View has across England
• To achieve fundamental and measurable improvements in health outcomes
• To reduce health inequalities in Lancashire
• To achieve parity of esteem for mental health and physical health
• To ensure greater focus on health prevention, early intervention and self-care
• To ensure change is supported by a clear evidence base or an evaluation structure where
evidence is not available
• To remove organisational or professional boundaries that get in the way of progress
• To make maximum use of new technology.
If we fail to address these objectives, if we do not embrace radical change, health outcomes
in Lancashire will simply get worse, the quality of care will decline, individual services will
fail, costs will rise and patient satisfaction will plummet.
Lancashire - demographics and geography
Lancashire is a fusion of urban and rural environments, stretching from the sea to the
Pennines and includes two cities and several large towns. It is a diverse area with some of the
most deprived communities in England and a few of the more affluent. This social and
economic diversity is reflected in local health outcomes. The people of Lancashire are not as
healthy as they should be. Life expectancy is eighteen months shorter than in the rest of the
country, the prevalence of heart failure, asthma and depression are all higher than average
and there are wide health inequalities both within Lancashire itself and between Lancashire
and the rest of the country.
Yet Lancashire is also a place of invention and innovation. It was here in the late 18th
century that the industrial revolution took shape. The transition from hand production to
mechanised manufacturing foreshadowed dramatic improvements in efficiency and
productivity. It marked a major turning point in world history that eventually led to
sustained improvements in the living standards of ordinary people.
Today we need a new revolution - a revolution in health and social care that delivers similar
efficiencies and improvements in standards. If we embrace this idea as our common cause we
can inspire radical, unrecognisable change with Lancashire once again leading the way.
9
Healthier
Lancashire
Programme
The strategic challenge
Lancashire faces many of the same health and care challenges that other parts of England
face, but it also has some unique challenges of its own.
• People are living longer - typically with multiple long-term conditions (LTCs) that are
expensive to manage. Lancashire has 24,000 more people with three or more LTCs than
the national average.
• The present health and care system is not designed to meet current needs. It is a complex
system where despite the best intentions of professionals, patients can experience delays
and frustration as they are handed between services, often without their records being
available.
• Lancashire faces significant variations in health outcomes, many of which are worse than
those in other parts of England.
• We face growing public demand for health and care services and growing public
expectation that we will provide them effectively but the evidence suggests that the
public – and indeed the staff delivering these core services – have little faith in our ability
to deliver well.
Ignoring these challenges is not an option.
The moment of opportunity
We will only address these challenges successfully if we seize this moment of opportunity to
make strategic changes. We need to:
• Encourage people to take their health seriously and assume greater responsibility for
their own good health
• Develop robust integrated care services across Lancashire that reduce the reliance on
acute hospital-based services
• Create a multi-skilled, flexible and responsive workforce
• Enhance the role of the third sector to support mainstream services
• Establish joint system leadership across Lancashire’s entire health and social care
environment.
The organisations that comprise the health and social care system in Lancashire can only
address the challenges effectively if they address them together. Success requires a whole
system approach. Nobody can fix this alone. The time has come for us to look beyond the
interests of our individual organisations and towards the future development of the whole
health and care economy in Lancashire, building on what is already working well.
At the summit in November 2014 at Turf Moor, the views of many health and social care
stakeholders were canvassed. The tone of this document is largely drawn from this event,
and the proposals contained build on the original discussions of the Leadership Forum and
conversations with key stakeholders. It has been co-created, co-designed and co-produced.
This is a principle which will remain central throughout the Healthier Lancashire Programme.
10
Purpose Document
A Lancashire System Response
to the Five Year Forward View
Some clear themes emerged:
We must work together
• Health and social care organisations need to offer leadership through an unprecedented
collaboration - a whole system approach - involving people and organisations to define a
new way of working.
• We must create a confederation to break open silos and ensure Lancashire gets what it
needs, through sharing best practice.
• We must put aside our territorial ambitions and look beyond the ‘organisational’ towards
the individual.
We need not just a campaign but a social movement
• It was clear that stakeholders believed that only a “common cause” campaign with clear
and measurable objectives would deliver the right results for Lancashire.
• However, even that wasn’t enough on its own. There was a feeling that this campaign
needed to go further and become an all-embracing social movement that is value-based
and commitment-led and to which everybody could contribute and from which everybody
could benefit.
Change should be revolutionary rather than evolutionary
• The time has come for bold, brave, radical action. We need to challenge how things stand
and shout loudly where necessary.
• It is time to embrace the idea of becoming a rebel with a cause.
It is time for the active and responsible person
• To benefit from a fair and sustainable society - in which everyone has an improved chance
of a longer, independent life - we all have responsibilities to participate more in our own
health and wellbeing. It is all about keeping people fit and healthy for longer.
• Our common cause should be to create a fair and sustainable society that stops people
from being patients sooner than they really need to.
The strategic challenges outlined can only be successfully addressed by having a firm-rooted
understanding of the current health and care system in Lancashire. The following section,
‘Where we are starting from’, sets out to inform strategic change and seize this moment of
opportunity.
11
Healthier
Lancashire
Programme
HS Lancashire - brochure.qxp_Layout 1 19/12/2014 14:57 Page 10
Where we are
starting
The
Evidencefrom
Base
Healthier Lancashire Programme
One of the key principles of the Healthier Lancashire programme is that change should be
supported by a clear evidence base. With this in mind, the Healthier Lancashire team
commissioned a major piece of work to establish a “single truth” fact base about health and
care in Lancashire. In summary, this work indicates the following:
One of the key principles of the Healthier Lancashire programme is that change
should be supported by a clear evidence base. With this in mind, the Healthier
Lancashire team commissioned a major piece of work to establish a “single
truth” fact base about health and care in Lancashire.
Lancashire has an ageing population…
In summary, this work indicates the following:
People are living longer4. While this is good news, it also presents a number of challenges.
Compared to
the
Lancashire has a higher proportion of people in all age
Lancashire
has
anEngland
ageingaverage,
population…
bands above 50 years old.5 And by 2021, there will be 42,000 more over-70s in Lancashire.6
Between 2014 and 2021,
all eight of Lancashire’s CCGs will see growth of at least 13% in
People
are living longer1. While
this is good news, it also presents a number of challenges. Compared
their populations aged 70 or over.7
to the England average, Lancashire has a higher proportion of people in all age bands above 50 years
old.2 And by 2021, there will be 42,000 more over-70s in Lancashire.3 Between 2014 and 2021, all
8
eight
of Lancashire’s
CCGs by
willage
seeband
growth
of at least 13% in their populations aged 70 or over.4
Proportion
of population
Proportion of population by age band5
Proportion of Population (%)
13
12
14%
13%
14
12%
13%
12%
11%
12%
12%
13%
12%
12%
12%
12%
11%
11
10%
10
9%
9
8
7
6
5%
6%
5
Lancashire
4
England
3
0-9
10 - 19
20-29
30-39
40-49
50-59
60-69
70-79
80+
L
hire
Age Bands
With two thirds of hospital patients over retirement age, NHS England’s chief executive Simon Stevens
has highlighted the ageing population as the greatest challenge facing the NHS.
In line with this, residents of Lancashire aged between 81 and 90 use double the resources of a 51 to
60 year old. Furthermore, just 3% of the Lancashire’s population accounts for a disproportionately
high percentage of hospital care spending (43%).6
12
Purpose Document
A Lancashire System Response
to the Five Year Forward View
With two thirds of hospital patients over retirement age, NHS England’s chief executive
Simon Stevens has Ithighlighted
the
ageing
is guided by
some
keypopulation
objectives: as the greatest challenge facing the
health and care system.
• To set out a clear direction of travel for the NHS in Lancashire as the
of Lancashire
aged has
between
81NHS
andacross
90 useEngland
double the resources
In line with this, residents
Five Year
Forward View
for the
of a 51 to 60 year old.
Furthermore,
just
3%
of
Lancashire’s
population
accounts
for a
• To achieve fundamental and measurable improvements
in health
9
disproportionately high
percentage
of
hospital
care
spending
(43%).
outcomes.
• To reduce health inequalities in Lancashire
• To ensure greater focus on health prevention, early intervention and
self-care
• To ensure change is supported by a clear evidence base or an
evaluation structure where evidence is not available
• To remove organisational or professional boundaries that get in the
way of progress
• To make maximum use of new technology
Residents in Lancashire are less healthy than the
national average…
If we fail to address these objectives, if we do not embrace radical
A priority must be to get better at preventing disease. Lancashire’s heart failure, asthma and
change, health outcomes in Lancashire 10
will simply get worse, the quality
depression rates are all in the highest quintile in England.
of care will decline, individual services will fail, costs will rise and patient
satisfaction will plummet.
While the overall burden of disease is only expected to increase in the future, the scale of
this challenge is uncertain. If recent trends continue, however, the number of people with
diabetes will almost double to 175,000 by 2021/22.11
Similarly, the prevalence of cancer in Lancashire will more than double between now and
2021/22, up from 39,000 cases to 89,00012 cases and obesity will affect 275,000 people in
Lancashire by 2021/22 (up by more than 70% compared with today).13 In addition, every CCG
in Lancashire is already at or above the England average for prevalence of stroke14 and heart
failure.15
Many Lancashire people have three or more longterm health conditions (LTCs)…
While people in Lancashire are living longer, they are often living with a number of LTCs
such as diabetes, heart disease and kidney disease, which impacts their quality of life and the
number of ‘healthy’ life years they can expect to enjoy.16
Nationally, treatment and care for people with LTCs is estimated to absorb around £7 in
every £10 of total health and social care spending.17 Lancashire has 20% more people (24,000
patients in total) with three or more LTCs compared with the England average. Currently,
over 80% of hospital spending in Lancashire is expended on less than 15% of Lancashire’s
population and this group includes the vast majority of people with LTCs.
Efforts must be focused on providing better health and social care for those with multiple
health conditions, as these patients also have a higher than average incidence of mental
health problems (over 6% compared with just over 5% nationally)18 and they consider
themselves to be poorly supported by the health and care system.19
People with multiple LTCs must be managed differently. Patients could and should be more
involved in their own care, and better self-management would mean fewer hospital visits
and lower costs to the health and care system in Lancashire.
13
Healthier
Lancashire
Programme
Lancashire residents are also more likely
to die early…
Andlife
Lancashire
are more
likely
to die early…
expectancyresidents
of the average
resident
of Lancashire
has increased by one year over the
The
last four years. However, this rate of increase has mirrored the national picture, meaning
that the average English resident can expect to live 18 months longer than the average
The average English resident can expect to live 18 months longer than the average resident of
resident of Lancashire.20
Lancashire.
21
Life
- years
Lifeexpectancy
expectancy
- years18
Chorley and South
Ribble CCG
86
Greater Preston CCG
84
Life Expectancy
82
80
West Lancs CCG
Fylde and Wyre
CCG
Blackburn with Darwen
Lancs North CCG
CCG
East Lancs CCG
England average: 81.0
Blackpool CCG
Lancashire average: 79.5
78
76
CCGs
74
The population
populationcovered
coveredbybyNHS
NHS
England’s
Lancashire
Area
Team
ranks
out
25 area teams for
The
England’s
Lancashire
Area
Team
ranks
23rd23rd
out of
25of
area
teams
for
under-75
mortality
with
most
of
Lancashire’s
CCGs
significantly
above
the
England
under-75 mortality with most of Lancashire’s CCGs significantly above the England average for under22
average
for under-75
This
is particularly
parts ofwith some CCGs falling
19
75 mortality.
This ismortality.
particularly
pronounced
in pronounced
certain partsinofcertain
Lancashire,
Lancashire, with some CCGs falling into the worst-performing 10% nationally
for under-75
into the worst-performing
10% nationally for under-75 mortality20.
23
mortality
.
Preventing
would
significantly
reduce
premature
death
rates.
The The majority of
Preventing disease
diseaseininthe
thefirst
firstplace
place
would
significantly
reduce
premature
death
rates.
majority of deaths from the major diseases, such as cancer, are related to lifestyle factors
deaths from the major diseases, such as cancer, are related to lifestyle factors such as smoking, alcohol,
such as smoking, alcohol, lack of21exercise and poor diet.24 This demands a radical upgrade in
lack ofhealth
exercise
and poor
This demands
radical upgrade in public health services with a
public
services
with adiet.
heightened
focus on a
prevention.
heightened focus on prevention.
14
Purpose Document
A Lancashire System Response
to the Five Year Forward View
There are significant health inequalities within
There are significant health inequalities within Lancashire…
Lancashire…
22
The Health
Health and
and Social
Social Care
CareAct
Act2012
2012recognised
recognisedthe
theimportance
importance
tackling
health inequalities.
The
ofof
tackling
health
25 as well as across England, we need to take action to reduce both inequality of access
In Lancashire,
inequalities.
In Lancashire, as well as across England, we need to take action to reduce both
inequality
of access
and inequality
outcome. Health
inequalities
most and
and inequality
of outcome.
Healthofinequalities
between
the most between
and leastthe
deprived
20% of peop
least
deprived
20%
of
people
in
Lancashire
have
widened
or
remained
static
for
a number
of inequ
Lancashire have widened or remained static for a number of diseases. As an example,
health
diseases. As an example, health inequality for diabetes sufferers increased
significantly
for diabetes sufferers increased significantly between 2009 and 2013.23
between 2009 and 2013.26
As well
well as
as faring
faring poorly
poorly on
on the
the national
national scale,
scale,there
thereare
arewide
widevariations
variationsinindisease
diseaseprevalence
prevalence within
As
within
Lancashire
too.
The
residents
of
one
Lancashire
CCG
have
among
the
highest
10%for
of the
Lancashire too. One Lancashire CCG is among the worst 10% of CCGs in the country
prevalence
rates
in
the
country
for
the
prevalence
of
15
out
of
22
major
diseases
while
the
prevalence of 15 out of 22 major diseases while another is not ranked among the worst2710% for a
residents of another are
not ranked among the worst 10% for any of the major diseases.
24
of the major diseases.
The Marmot Review recognised that there is a social gradient in health – the lower a
28
The Marmot
recognised
that
a social
gradient
in health –stem
the lower
a person’s socia
person’s
socialReview
position,
the worse
his there
or herishealth.
Health
inequalities
from more
25
than
just
differences
in
income
–
education,
geography,
and
gender
can
all
play
a
role.
position, the worse his or her health. Health inequalities stem from more than just differences in
income – education, geography, and gender can all play a role.
Comparisons between the most and least deprived 20% of people in Lancashire reveal
massive health inequalities. For example, people in the most deprived quintile are over seven
Comparisons
between
most andfrom
leastdiabetes
deprivedthan
20%those
of people
Lancashire
reveal
massive he
times
more likely
to die the
prematurely
in theinleast
deprived
quintile.
For
all nine diseases
highlighted
in in
the
graph
people
in Lancashire
at thetimes
lowermore
end likely to
inequalities.
For example,
people
the
mostbelow,
deprived
quintile
are over seven
of
the deprivation
scale are than
at least
twice
as likely
die prematurely
the
prematurely
from diabetes
those
in the
least to
deprived
quintile. as
Forpeople
all nineatdiseases
highlighte
29
opposite
end
of
the
deprivation
scale.
the graph below, people in Lancashire at the lower end of the deprivation scale are at least twice a
likely to die prematurely as people at the opposite end of the deprivation scale.26
Size of health inequality gap within Lancashire – premature mortality30
Size of health inequality gap within Lancashire – premature mortality27
Inequality ratio between most and least
deprived quintiles
7.5
7.18
7.0
6.5
6.0
5.5
5.0
4.65
4.5
4.0
3.5
3.48
2.98
3.0
3.07
2.59
2.5
2.33
2.49
2.11
2.0
1.5
1.0
0.5
0.0
Diabetes
Respiratory
disease
COPD
Digestive
disease
Chronic liver Lung cancer Circulatory
disease
disease
CHD
Stroke
Page
15
Healthier
Lancashire
Programme
Health services struggle to meet current
performance targets…
Services in Lancashire do not compare well nationally when it comes to meeting
performance targets. Our hospitals are under increasing strain and are not able to focus on
more complicated cases where their expertise is really needed. In the recent past, some of
our hospitals have been identified by Keogh31 for review, and are working hard to improve
their standards in the face of mounting pressures.
Across England there is an increasing demand that the health and care system provides
services seven days a week like many other industries. The lower level of service provision at
the weekend means patients are more likely to die in hospital if they are admitted at the
weekend and this problem is particularly acute in Lancashire. For example, at one Lancashire
acute Trust the mortality rate is 23% higher than expected for weekend emergency
admissions.32
It is not just secondary care that’s failing to meet performance targets. Seven of Lancashire’s
eight CCGs have higher than average unplanned admissions for conditions that should
normally be managed in a primary care setting.33 In addition, some Lancashire residents with
LTCs are not adequately supported to remain independent because services are not available
in the community and as a result they are being admitted into hospital.
Patient experience is variable…
A combination of financial and demographic pressures means our health and social care
services are under greater pressure. Therefore, despite the shared commitment and
dedication of our health service staff, we know that our hospitals vary in the quality of care
they provide. Our residents’ experience of hospital services often lags behind expectations.
We know, for example, that more than half of acute and specialist Trusts in Lancashire fall
below the NHS average score for inpatient satisfaction.34
For outpatients, the picture is similarly bleak. One of our acute Trusts is in the bottom
quintile of Trusts in England for outpatients in terms of patient satisfaction, while the other
Lancashire Trusts fall in the middle of the pack nationally.35 Patient satisfaction with inpatient
services is at best average but mostly below average and in two cases well below average.31
We want the public to be at the heart of everything we do – but too often their experience
of health and social care services do not reflect that aim. We have a lot to do to make
improvements in the coordination of patient-centred care to provide a seamless service, as
well as assessing the compelling arguments for introducing seven day services. If we work
together, we can increase the number of people having a positive experience of health and
social care.
16
Purpose Document
A Lancashire System Response
to the Five Year Forward View
Staff satisfaction is deteriorating
Staff satisfaction is deteriorating
It is not only our patients who are dissatisfied. NHS staff in Lancashire are also generally less
It issatisfied
not onlythan
our they
patients
who
dissatisfied.
NHSstaff
staffare
in Lancashire
are also
generally less satis
should
be,are
reflecting
that while
highly motivated
to provide
compassionate
care,Three
they are
concerned
about
staffing
levels,
workloadpoorly
pressures
and recommend
than
they should be.
of our
hospital
Trusts
perform
particularly
on staff
compromises
to
the
quality
of
care
they
deliver.
Three
of
our
hospital
Trusts
perform
35
as a place to receive care.
37
particularly poorly on staff recommendation as a place to receive care.
Staff
at all
of of
ourour
Trusts
are
less
to aafriend
friendororrelative
relative than
Staff
at all
Trusts
are
lesslikely
likelytotorecommend
recommend their
their organisation
organisation to
36 member.38 In 2010, four out of our five Trusts were above average
than the
NHS staff
average
NHSaverage
staff member.
In 2010, four out of our five Trusts were above average but by 2013
39
by 2013 all five were
fivebut
were
below average.37 below average.
The graph below shows that while generally NHS staff across England are becoming more
Thelikely
graph
showstheir
thatown
while
generally
NHS
staff
across
England are
becoming
to below
recommend
trust
to friends
and
family,
in Lancashire
NHS
staff are more likely to
generally becoming
likely
to recommend
theirinown
Trust.40 NHS staff are generally becoming
recommend
their own less
trust
to friends
and family,
Lancashire
likely to recommend their own Trust.38
Staff satisfaction with Trust as a place to receive care41
Staff satisfaction with Trust as a place to receive care39
68
70
64
65
60
55
64
60
54
57
66
62
62
56
51
50
59
51
47
Score (%)
45
40
35
30
25
England
2013 Percentile
Lancashire
East Lancs
Lancs
Teaching
Morecambe
Bay
Blackpool
74%
89%
51%
82%
56%
Southport
& Ormskirk
92%
And we face big workforce challenges…
Recruiting and retaining medical, nursing and specialist staff poses a significant problem as does t
employment of significant numbers of agency staff. In Lancashire, medical and dental staff turno
exceeds the England average.40 As ever, there is a wide variation within Lancashire – with one of t
hospitals’ turnover rate for medical and dental staff being in the highest 10% nationally.41
As a result of workforce shortages across the North West, there is a need to increase the number o
in training and practice to ensure that the supply and demand gap is closed. A further challenge is
we simply do not have enough medical and dental staff for the number of patients requiring treatm
17
Pag
Healthier
Lancashire
Programme
There are also big workforce challenges…
Recruiting and retaining medical, nursing and specialist staff poses a significant problem,
particularly in Emergency Medicine and Accident and Emergency Departments, as well as
specialties of growing importance, such as Clinical and Interventional Radiology.42 The shortterm fix to these issues is to employ significant numbers of agency staff, which is an
unsustainable solution.
In Lancashire, medical and dental staff turnover exceeds the England average.43 As ever,
there is a wide variation within Lancashire – with one of the hospitals’ turnover rate for
medical and dental staff being in the highest 10% nationally.44
As a result of workforce shortages across the North West, there is a need to increase the
number of GPs in training and practice to ensure that the supply and demand gap is closed.
A further challenge is that we simply do not have enough medical and dental staff for the
number of patients requiring treatment.
While demand for health and social care services
is growing…
The demand for health and social care services in Lancashire is growing as the population
ages and as people with ill health require more care. It is difficult to meet this increased
demand because adult social care, community services and hospitals do not work together as
well as they could.
In the past three years, we have seen a 2.7% increase in overall hospital activity across
Lancashire.45 Almost two-thirds of under-five year olds in Lancashire visited A&E last year
alone, with 135 children visiting A&E more frequently than every other month. The very fact
that parents feel the need to take children to A&E rather than to use their local GP service
suggests that health services are not working in the way they should be, with people
confused about which service to use and understandably choosing to go to the service that
they know is available, even if they have to wait.
Admissions to A&E vary widely across Lancashire. While one of the Lancashire CCGs has one
of the highest emergency admission rates in the country for acute conditions that should not
usually require hospital admission, another is significantly below the national average.46
Breaking down the barriers between different services is crucial if we are to improve both
quality and efficiency of care, and to ensure a collaborative one-system approach. Our aim
should be to give individuals the care and support they require in the most appropriate and
efficient settings and to ensure a truly integrated service.
18
Purpose Document
A Lancashire System Response
to the Five Year Forward View
Social care has challenges too…
Social care services also face significant challenges, with the proportion of temporary staff
being almost double the English average.47 In two of Lancashire’s three local authority areas,
the vacancy rate is also higher than the England average. In fact, Lancashire’s social care
vacancy rates have grown by 155% in the past three years, whereas they have grown less
than three times as fast in England over the same time period.48
The third sector is not adequately financed to fill
the gaps…
There is a clear eagerness from the third sector in Lancashire to build on the work it already
does and to do more through direct support services to help people to lead healthier lives,
especially people with LTCs. It is also clear, however, that many third sector organisations are
experiencing severe financial pressures and even continuing to fulfill their present functions
is a challenge let alone expanding to do more, as detailed in the Five Year Forward View.
Healthier Lancashire recognises the added social value the third sector brings and will work
with the third sector, with local authorities and with commissioners to ensure that
relationships are as effective as possible and that contracts are as flexible as they can be.
19
Healthier
Lancashire
Programme
Creating a
system wide
programme
The previous sections have detailed the need for a social movement to create a revolution
that will lead to a radically different and better health and care system, but social
movements don’t happen by themselves. They need structure, strong direction and
leadership. To ensure success, an unprecedented collaboration, whole system approach is
needed, to define a new and better future for the delivery of health and care.
The emerging consensus is that the changes should include:
•
•
•
•
All of Lancashire
All providers
All services
All of the population
It was evident at the recent Healthier Lancashire stakeholder event that a clear campaign
with measurable objectives is needed to deliver the right results for Lancashire. Such a
campaign would need to be preceded by the development of a Strategic Plan.
20
Purpose Document
A Lancashire System Response
to the Five Year Forward View
Why a Strategic Plan?
Other large scale change programmes including North-West London, Healthier Together in
Greater Manchester, have found that the use of a Strategic Plan is essential to improve the
planning and execution of the activities to successfully deliver the agreed outcomes.
Strategic Plans are particularly useful in situations where:
• There are a large number of disparate stakeholders involved
• There is a need to show how a programme relates to the needs of each participating
public sector partner
• The system and its ambition is novel, risky and complex
• The parameters of the programme are ill-defined, particularly the objectives and scope
• There is a need to allow key stakeholders an early opportunity to influence the direction
of programmes, avoiding abortive effort, and securing better value for money from the
considerable sums of money which are sometimes spent on ill-specified programmes.
• If the Strategic Plan is properly implemented it will lead to better decision-making and
quicker decisions.
What is a Strategic Plan?
The Strategic Plan should be viewed as a scoping and planning document, designed to:
• Establish the strategic context and need for the programme
• Develop a financial model that can be used to make the economic case for change across
Lancashire
• Identify key dependencies between the programme and other developments
• Identify the view of main stakeholders and gatekeepers and the position of potential
public sector partners and other prospective partners
• Identify a wide range of viable options for meeting the care model objectives
• Appraise the relative efficacy of the options and their affordability and, where feasible,
identify a short-list for more rigorous assessment at the Design Phase
• Identify the critical success factors for developing and implementing the programme with
emphasis on risk management and benefit realisation
• Identify what further work needs to be undertaken to inform implementation.
They are based upon widely accepted best practice programme management approaches
that have been designed using learnings from a number of other large scale health and
social care change programmes. These plans and structures have recently been tested at
judicial review and were found to be robust.
21
Healthier
Lancashire
Programme
A Strategic Plan for All Lancashire
The Healthier Lancashire process plan and governance structure have been developed to
include all health and social care services in Lancashire including children's services and
mental health services.
The proposed governance and programme arrangements for the Strategic Planning Phase
are illustrated in the following diagram:
22
Purpose Document
A Lancashire System Response
to the Five Year Forward View
Leadership
Structures must be designed that create the space within which growth, innovation and
action can flourish. Leaders must be recruited, trained and developed on a scale required to
build the relationships, maintain the motivation, and carry out the strategising and action
to achieve success. Therefore, the delivery of the Strategic Plan will require:
The Programme Board to oversee the delivery of the Strategic Plan in line with the scope,
aims and timescales agreed by the partner organisations. It will also receive inputs from
Health and Wellbeing Boards, Health Overview and Scrutiny Committees and Healthwatch.
This is also where Monitor, the NHS Trust Development Authority and the
Care Quality Commission will input their views. The Programme Board will have an
independent chair.
The Care Quality Board to provide clinical and care professional leadership and assurance to
the programme, ensuring the programme develops effective proposals for the delivery of
quality standards and acting as ambassadors for the programme including representing the
programme at public events.
The Finance and Investment Group to ensure that the plans are within agreed budgets and
will develop an estates strategy to support the delivery of any proposed care models.
Organising
The Programme Management Group will manage programme activities required for the
delivery of the Strategic Plan in line with directions from the Programme Board, the Care
Quality Board and the Finance and Investment Group.
Actions and Activities
The delivery of the Strategic Plan will require actions and activities to be driven across three
complementary work streams:
• Cultural Transformation
• Care Components
• Digital Technologies
The cultural transformation work stream is an integral part of all aspects of the Healthier
Lancashire work programme. It will involve developing the empowered person and an
engaged population and workforce, utilising new technology to support self-care as well as
making it easier for people to access support when they need it. It will facilitate change
management, a greater role for the third sector and the development of effective
collaborative leadership at the Lancashire level. It will support the work of the groups
developing new care models.
23
Healthier
Lancashire
Programme
The care professionals work stream will undertake the required activities to develop the
possible options for the design phase. A range of care model components will be considered
to ensure the ambition of providing a step change in care can be realised and deliver the
improvements in quality, outcomes and accessibility that are required. The proposals will
align closely with the Better Care Fund, QIPP programmes and other local projects, including
the development of co-commissioning to support primary care development. It will also
ensure alignment of its work with CIP programmes, NHS England, Monitor, TDA, CQC and
other local projects.
The digital technologies work stream will develop proposals for a digital health ecosystem
that will underpin the work of the other groups and will be a key component of the drive
for better health outcomes, improving the experience of care and service efficiency. As part
of our strategy, we will be seeking to increase digital literacy, share digital records and build
partnerships across industry, academia, and the third sector. The aim is to empower people
to take more control of their health and wellbeing.
Each of these groups will be developing plans and proposals within the agreed financial
envelope. They will agree the enablers required for implementation including governance,
cost implications, estates and capital requirements, workforce, contracting and IM&T. They
will also engage with the public, patients, carers and staff to ensure understanding of, and
sign-up to, the proposals.
Healthier Lancashire Programme
There are independencies between these three groups which will be managed through the
Programme Management Group.
Timetable
It is proposed that the programme activities will be organised into five phases which will run
Timetable
from
2015 to 2020. These will overlap at certain points as detailed below.
The Healthier
programmeLancashire
is currently organised
into is
five
phases which
runstages
from 2015 to 2020 but which
The
Programme
structured
intowill
five
will overlap at certain points.
Sep – May ‘15
Strategic Plan
• Baseline SAF
Model
• Set up
programme
structure
• Develop and signoff PID
• Agrre resources
• Recruit
programme team
• Write a Strategic
Outline Case for
Lancashire
• Communications
and Engagement
Strategy
Jun – Dec ‘15
Design
• Develop case for
change
• Develop the
Quality Standards
• Develop the care
model components
• Develop options
for service change
• Equality Impact
Assessment
• Write business
case document
• Agree consultation
plan and appoint
resources
• Stakeholder
engagement and
communication
• External
Assurance Process
Jan – Mar ‘16
Mar – Jul ‘16
Implementation
• Write business
plans for
prioritised care
model
components
• Deliver public
consultation if
needed
• Plan for post
consultation
• Stakeholder
engagement and
communications
by law
Delivery
• Consider and
respond to
consultation
feedback
• Finalise proposal
including
additional work
particularly on
finance,
workforce and
implementation
plans
• Equality impact
assessment
• Stakeholder
engagement and
communications
24
Aug ’16 – Mar ‘20
Procurement, Contracting
& Delivery
• Detailed
implementation
plans
• Service
specifications
• Commissioning
intentions
• Capital business
cases (if required)
• Service charge
• Stakeholder
engagement and
communications
Purpose Document
A Lancashire System Response
to the Five Year Forward View
Key Deliverables, January – May 2015
The expected outcomes of the Strategic Plan are:
• A clear definition of the problems across the whole system and the case for change. As
well as ownership of a single overall position
• Priorities for action – what we need to do as a whole system, a local system and
individual organisations
• Key tasks and the arrangements to make change happen
• Collaborative leadership and consensus decision-making
• Improved and mature relationships and value-based behaviours.
Mobilising the Strategic Plan
The Lancashire Leadership Forum has indicated its desire to act and behave differently in
order to achieve radical change.
Through the existing Director of Finance and Chief Financial Officer Group (Health and Local
Authorities) which is chaired by NHS England, it has been agreed that specialist external
expertise would ensure a robust Strategic Plan. The tender to deliver this piece of work will
be undertaken through January 2015 with a completed delivery date of the end of May
2015. The key success factor for delivery of the Strategic Plan is that all members of the
system work collaboratively at scale and pace.
The specification for the Strategic Plan will involve ensuring the consolidation of existing
information within the local health and social care economy into a Strategic Plan for the
delivery of a new care system. A well run tender process with a detailed specification
designed by all the health and social care stakeholder organisations of Healthier Lancashire
will support local economies to assess and agree new care models in line with their
ambitions to maximise the opportunities afforded by the Five Year Forward View.
The proposed framework for the specification to ensure that the right expertise to enhance
the development of the Strategic Plan between January and May 2015 will include:
• The establishment of a baseline case – i.e. current service provision models, associated
activity, costs and expenditure from all sectors. Including the interdependencies between
local plans and schemes.
• The use of current health and social care data to build a robust financial and economic
model to include activity, workforce, estates, costs and expenditure. The use of financial
metrics from both Commissioners and Providers. The outputs from current and recent
successful Lancashire projects and measures demonstrating current levels of efficiencies.
Other locally and nationally generated data to enable clinical and financial modelling.
• The use of external benchmarking data in public/private sectors - organisations and
examples to provide external perspectives and order of magnitude for cost savings.
• The impact of utilising evidence-based and best standards of care e.g. Healthier Together
Programme
• Defining the “do nothing” scenario forecast and scale of the funding gap
• The process testing of current proposed models within local systems and best practice
alternatives for their impact on the baseline. This will include public health and needs
assessment analysis, strategic modelling of activity and financial and human resource,
utilisation of co-production methodology and testing through facilitated workshops.
25
Healthier
Lancashire
Programme
• Undertaking scenario modelling and impact assessment on quality and affordability
• Identifying assumptions and financial analysis - testing assumptions in respect of the
opportunities they offer to improve the quality of care, the outcomes of care and the
affordability of care over the next five years.
• Identifying productivity opportunities and potential savings
• Co-producing the benefits realisation plan
• Developing further the strategic outcomes
• Consider alternative funding and contractual agreement frameworks that will support
sustainability of the health and care system (Prime Provider or Alliance Model for
instance)
• Establishing potential levels of transitional resource required, including the required dual
running costs and outline realistic timescale for the milestone plan
• Ensuring knowledge transfer for the development of the Programme Management
Office required to support the delivery of a whole system integrated care approach.
Underpinning Communication and Engagement
Strategy for the Strategic Plan
Best practice requires engagement of the public and workforce at all stages of the
Programme, adopting the principles of co-production and co-design. The Strategic Plan
requires a clear communications and engagement strategy against the same timeline.
This will include the following:
•
•
•
•
•
•
•
Engagement with Health and Wellbeing Boards
Summit 2
Engagement events in localities, involving the public, frontline staff and leaders
MPs briefings
Clinical engagement
Development of social media platforms and launch of the brand
Newsletters and other communications.
26
Purpose Document
A Lancashire System Response
to the Five Year Forward View
Conclusion
The Five Year Forward View acknowledges that while the values of the health and care
system are unchanging, the service itself must change. We must move from the age of the
passive patient to the age of the active, responsible and empowered person. Our aim must
be nothing less than to stop people being patients before they absolutely need to and to
support them appropriately when they do.
The future is one of growing public expectations, emerging technologies and changing
needs, all of which pose significant challenges and all of which demand change. There is a
growing consensus in Lancashire that we cannot carry on as we are because:
• We haven’t taken prevention as seriously as we should
• We have poorer outcomes than we should
• We are now faced with a sharply rising burden of avoidable illness and marked pressures
on the health and care system.
• We cannot ignore the context of the national financial challenges of meeting increasing
demand with limited or zero growth.
Lancashire Leadership Forum discussions with stakeholders reveal the same story that
emerges from internal discussions with staff, stakeholders and health and care leaders:
•
•
•
•
We must work together more effectively
We need not just a campaign but a social movement
Change should be revolutionary rather than evolutionary
It is time for the active and responsible person
This is what we must do if we are to tackle the unacceptable - indeed intolerable - liability of
poor health outcomes that is apparent across Lancashire.
Lancashire can no longer accept:
•
•
•
•
•
•
Shorter life expectancy
Higher rates of heart failure, asthma and depression
Many more people with multiple long term conditions
Shameful health inequalities
Health services that struggle to meet performance targets
Substandard patient satisfaction
We need to act and act quickly. We need a programme approach that is designed to mobilise
the necessary resources, recruit the right team of people to galvanise action, develop the
case for change and the appropriate options, engage with all of our key stakeholders,
develop final proposals and then ensure the delivery of radical system and service change.
27
Healthier
Lancashire
Programme
Glossary of key
terms
BCF - the £3.8bn Better Care Fund (formerly the Integration Transformation Fund) was
announced by the Government in the June 2013 spending round, to ensure a transformation
in integrated health and social care.
CCG - Clinical Commissioning Group, a local community group led by GPs and healthcare
professionals responsible for commissioning healthcare services.
CIP - a Cost Improvement Programme is the identification by an NHS Trust of schemes to
increase efficiency/or reduce expenditure. CIPs can include both recurrent (year on year) and
non-recurrent (one-off) savings.
CQC - the Care Quality Commission is an executive non-departmental public body of the
Department of Health. It was established in 2009 to regulate and inspect health and social
care services in England.
Dr Foster Hospital Guide - the Hospital Guide publishes data about acute hospital care across
England.
Health and Wellbeing Boards - established under the Health and Social Care Act 2012 as a
forum where key leaders from the health and care system work together to improve the
health and wellbeing of their local population and reduce health inequalities. Health and
wellbeing board members collaborate to understand their local community's needs, agree
priorities and encourage commissioners to work in a more joined-up way.
HEE - Health Education England is the national leadership organisation for education,
training and workforce development in the health sector.
HSMR - the Hospital Standardised Mortality Ratio compares the expected rate of death in a
hospital with the actual rate of death.
Keogh Review – assessed patient safety and was carried out by Professor Sir Bruce Keogh in
July 2013. This review was ordered by the Prime Minister in response to the Francis Inquiry
into poor care at Mid Staffordshire Hospitals NHS Foundation Trust.
LTCs - long-term health conditions cannot be cured but their symptoms and complications
can usually be controlled with treatment. Examples are arthritis, asthma, diabetes, epilepsy
and high blood pressure.
Marmot Review - a report into health inequalities in England published in 2010 which
proposed an evidence based strategy to address the social determinants of health, the
conditions in which people are born, grow, live, work and age and which can lead to health
inequalities.
28
Purpose Document
A Lancashire System Response
to the Five Year Forward View
Monitor - an executive non-departmental public body of the Department of Health. It is the
sector regulator for health services in England. The body was established in 2004 under the
Health and Social Care (Community Health and Standards) Act 2003, which made it
responsible for authorising, monitoring and regulating NHS foundation trusts.
NHS Adult Inpatient Survey - this survey looks at the experiences of a sample of people who
were admitted to an NHS hospital in a given year.
NHS England - an executive non-departmental public body of the Department of Health.
NHS England oversees the budget, planning, delivery and day-to-day operation of the
commissioning side of the NHS in England as set out in the Health and Social Care Act 2012.
NHS Five Year Forward View - was published on 23 October 2014 and sets out a vision for
the future of the NHS. It was developed by the partner organisations that deliver and
oversee health and care services including NHS England, Public Health England, Monitor,
Health Education England, the Care Quality Commission and the NHS Trust Development
Authority. Patient groups, clinicians and independent experts also provided their advice to
create a collective view of 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.
NHS Outpatient Survey - a national survey of the views of patients' experiences which asked
people about their most recent visit to an outpatient department. The survey included
questions on waiting times, hospital facilities, seeing a doctor or other members of staff,
tests and treatments and prescribed medications.
NHS Staff Satisfaction Survey - an annual national survey of NHS staff.
PHA - Public Health England is an executive agency of the Department of Health in the
United Kingdom that began operating on 1 April 2013. Established under the Health and
Social Care Act 201 it took on the role of the Health Protection Agency, the National
Treatment Agency for Substance Misuse and a number of other health bodies.
PROMS - Patient Reported Outcome Measures record health gain in patients undergoing hip
replacement, knee replacement, varicose vein and groin hernia surgery in England, based on
responses to questionnaires before and after surgery.
QIPP - the Quality, Innovation, Productivity and Prevention programme is a large-scale
programme developed by the Department of Health to drive forward quality improvements
in NHS care, at the same time as making up to £20 billion of efficiency savings by 2014/15.
Seven-day working - since 2010 there has been a growing movement towards more NHS
services being available seven days a week.
SHMI - the Summary Hospital-level Mortality Indicator is an indicator which reports on
mortality at trust level across the NHS in England. The SHMI is the ratio between the actual
number of patients who die following hospitalisation at the trust and the number that
would be expected to die on the basis of average England figures, given the characteristics
of the patients treated there.
TDA - the NHS Trust Development Authority is responsible for providing leadership and
support to the non-Foundation Trust sector of NHS providers. This includes 99 NHS Trusts,
providing around £30bn of NHS funded care each year.
Wanless Review - Securing our Future Health: Taking a Long-Term View was a report
published in 2002 which assessed the long-term resource requirements for the health service
in the UK.
29
Healthier
Lancashire
Programme
References
1
https://www.gov.uk/government/publications/health-and-social-care-act-2012-fact-sheets
2
http://www.england.nhs.uk/ourwork/futurenhs/
3
NHS England Lancashire Area Team Finance Team (not publically available). It is based on
local allocations and may be subject to revision. Pg 284 Indexed Factbase, table 11.2
4
Select Committee on Public Service and Demographic Change - Report of Session 2012–13
- Ready for Ageing, March 2013
5
ONS data - http://www.ons.gov.uk/ons/guide-method/method-quality/specific/populationand-migration/pop-ests/index.html [Indexed Factbase p.17; section 2.2]
6
ONS data - http://www.ons.gov.uk/ons/guide-method/method-quality/specific/populationand-migration/pop-ests/index.html [Indexed Factbase p.15; section 2.1]
7
ONS data - http://www.ons.gov.uk/ons/guide-method/method-quality/specific/populationand-migration/pop-ests/index.html [Indexed Factbase p.15; section 2.1]
8
ONS data - http://www.ons.gov.uk/ons/guide-method/method-quality/specific/populationand-migration/pop-ests/index.html [Indexed Factbase p.17; section 2.1]
9
Secondary Uses Services (SUS) data provided by the CSU, which has also derived cost
estimates [Indexed Factbase p.213; section 8.1]
10
Quality and Outcomes Framework (QOF); House of Care; CCG Outcomes Tool [Indexed
Factbase p.37; section 3.1]
11
Quality and Outcomes Framework (QOF); House of Care; CCG Outcomes Tool [Indexed
Factbase p.39; section 3.1]
12
Quality and Outcomes Framework (QOF); House of Care; CCG Outcomes Tool [Indexed
Factbase p.39; section 3.1]
13
Quality and Outcomes Framework (QOF); House of Care; CCG Outcomes Tool [Indexed
Factbase p.38; section 3.1]
14
QOF prevalence of disease by CCG, National General Practice Profiles & HSCIC [Indexed
Factbase p.41; section 3.3]
15
CCG Outcomes Tool, 2012/13 [based on same QOF disease prevalence dataset] [Indexed
Factbase p.42; section 3.5]
16
QOF prevalence of disease, National General Practice Profiles & HSCIC [Indexed Factbase
p.54; Section 3.17]. Also see table 5.1 Healthy Life Expectancy: Years [Indexed Factbase
p116] / ONS Data
17
Department of Health (2012). Report. Long-term conditions compendium of Information:
3rd edition
18
Quality and Outcomes Framework (QOF); House of Care; CCG Outcomes Tool [Indexed
Factbase p.37; section 3.1]
19
CCG Outcomes Tool; House of Care [Indexed Factbase p.107; section 5.1]
20
ONS data [Indexed Factbase p.81; section 4.1]
30
Purpose Document
A Lancashire System Response
to the Five Year Forward View
21
ONS data [Indexed Factbase p.81; section 4.1]
22
ONS data [Indexed Factbase p.81; section 4.1]
23
Public Health England, Health Profiles
24
http://www.england.nhs.uk/wp-content/uploads/2013/07/nhs_belongs.pdf
25
http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted
26
ONS data [Indexed Factbase p.81; section 4.1]
27
Quality and Outcomes Framework (QOF); House of Care; CCG Outcomes Tool [Indexed
Factbase p.37; section 3.1]
28
http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmotreview
29
Public Health England [Indexed Factbase p.86; section 4.7]
30
Joint Strategic Needs Assessment (JSNA) Health inequalities in Lancashire, March 2014
[Indexed Factbase p.86; section 4.8]
31
http://www.nhs.uk/NHSEngland/bruce-keogh-review/Pages/Overview.aspx
32
HSCIC – http://www.hscic.gov.uk/ (current at 1st August 2014) [Indexed Factbase p.108;
section 5.1]
33
CCG Outcomes Tool, 2012/13 data
34
NHS Adult Inpatient Survey 1st June 2013 – 31st August 2013; CCG Outcomes Tool, July
2014 [Indexed Factbase p.148; section 6.3]
35
NHS Outpatient Survey [Indexed Factbase p.145; section 6.1]
36
NHS Adult Inpatient Survey 1st June 2013 – 31st August 2013; CCG Outcomes Tool, July
2014 [Indexed Factbase p.148; section 6.3]
37
NHS Staff Satisfaction Survey [Indexed Factbase p.146; section 6.1]
38
NHS Staff Satisfaction Survey [Indexed Factbase p.146; section 6.1]
39
NHS Staff Satisfaction Survey [Indexed Factbase p.147; section 6.2]
40
NHS Staff Satisfaction Survey [Indexed Factbase p.147; section 6.2]
41
NHS Staff Satisfaction Survey [Indexed Factbase p.147; section 6.2]
42
Cumbria and Lancashire Local Workforce Education Group Workforce Plans 2014/15 –
2018/19, October 2014 [Indexed Factbase p.248]
43
CQC Intelligent Monitoring, 2014 [Indexed Factbase p.234; section 9.7]
44
CQC Intelligent Monitoring, 2013/14 [Indexed Factbase p.228; section 9.1]
45
SUS, Inpatient, Outpatient and A&E data [Indexed Factbase p.167; section 7.1]
46
SUS, Inpatient, Outpatient and A&E data, 2013/14
47
Skills for Care, August 2014 [Indexed Factbase p.254; section 10.1]
48
Skills for Care, August 2014 [Indexed Factbase p.254; section 10.1]
31
Healthier
Lancashire
Programme
Member organisations of the Lancashire
Leadership Forum
Age UK Lancashire (on behalf of the Third Sector)
Blackburn with Darwen CCG
Blackburn with Darwen Council
Blackpool CCG
Blackpool Council
Blackpool Teaching Hospitals NHS Foundation Trust
Calderstones Partnership NHS Foundation Trust
Chorley Council (on behalf of Lancashire District Councils)
Chorley & South Ribble CCG
East Lancashire CCG
East Lancashire Hospitals Trust
Fylde & Wyre CCG
Greater Preston CCG
Lancashire Care NHS Foundation Trust
Lancashire County Council
Lancashire North CCG
Lancashire Teaching Hospitals NHS Foundation Trust
NHS England
North West Ambulance Service NHS Trust
Progress Housing (on behalf of the Housing Federation)
Public Health England
Southport & Ormskirk Hospital NHS Trust
University Hospitals of Morecambe Bay NHS Foundation Trust
West Lancs CCG
32
GOVERNING BODY MEETING
14th January 2015
Date of Meeting
Title of Report
Governing Body
Responsible Officer
Summary/Purpose of
Report
Governing Body
Action
Agenda
17
Item No.
Managing Conflicts of Interest – Revised Conflicts of Interest
Policy
Lead
Dr Chris Clayton,
Dr Malcolm Ridgway,
Clinical Chief Officer Clinician Clinical Director for
Quality and Effectiveness
Lead
Mr Iain Fletcher, Head of
Manager Corporate Business
The purpose of this report is to present the Clinical
Commissioning Group’s (CCG) Governing Body with a
revised Conflicts of Interest (CoI) Policy for approval.
•
•
Note the contents of the report
Review and approve the revised Conflicts of Interest
Policy
Please indicate the Committee(s)/Group(s) where the paper has been
discussed/developed
Primary Care Delivery Assurance Group
Please note the following section must be completed in full
Patient and Public
Yes/Not
(if yes, complete outcome)
Engagement
applicable
Completed
Equality Analysis was undertaken on the existing
Equality Analysis
Yes
CCG policy and this will be reviewed to ensure no
Completed
additional impact due to the revisions made.
If
conflicts
of
interest
are not managed effectively then there is
Financial
potential for challenge, which may have a financial implication.
Implication(s)
Yes – held on Governing Body Assurance Framework (Risk ID
Risk(s) Identified
C04.4) – “Failure to effectively manage conflicts of interest”)
CCG Strategic Objectives supported by this paper
1.
2.
3.
4.
5.
We will continuously improve the health and well-being of the population of
Blackburn with Darwen.
We will build successful partnerships which promote collaborative working and
integrated service delivery.
We will effectively engage patients and the public in decision making.
We will co-commission and deliver continuous improvement in Primary Care
Services and tackle inequalities.
We will commission safe and effective services for the population of Blackburn
with Darwen with integration at the heart of commissioning.
Y
Y
Y
Y
Y
CCG High Impact Changes supported by this paper
1.
2.
3.
4.
5.
6.
7.
8.
9.
Delivering high quality Primary Care at scale and improving access.
Self-Care and Early Intervention.
Enhanced and Integrated Primary Care and Better Care Fund.
Access to Re-ablement and Intermediate Care.
Improved hospital discharge and reduced length of stay.
Community based ambulatory care for specific conditions.
Access to high quality Urgent and Emergency Care.
Scheduled Care.
Quality.
Page 1 of 3
Y
Managing Conflicts of Interest –
Revised Conflicts of Interest Policy
1.
Introduction
1.1
The purpose of this report is to present the Clinical Commissioning Group’s (CCG)
Governing Body with a revised Conflicts of Interest (CoI) Policy for approval.
2.
Background
2.1
As part of the CCG’s application to undertake delegated commissioning arrangements for
Primary Medical Care Services, there is a requirement to submit details of how the CCG
will manage conflicts of interest under the proposed delegated arrangements.
2.2
In December 2014, NHS England published statutory guidance setting out how CCGs
should manage conflicts of interest with specific provisions in relation to cocommissioning primary medical care services. The guidance does not mandate what
must be included in a CCG CoI policy, but states that non adherence must be explained.
2.3
The CCG’s existing policy has now been revised in accordance with the statutory
guidance and has been submitted (as a draft document) to NHS England as part of the
application process for delegated commissioning arrangements.
3.0
Overview of changes to existing arrangements for managing Conflicts of Interest
3.1
Attached at Appendix 1 is the revised CoI policy. The main amendments relate to the
adherence of the regulations which govern the management of procurement decisions.
The statutory guidance strengthens the wording within the revised policy to emphasise
the importance managing potential conflicts of interest where a commissioner may also
be a provider of services:
“CCGs must not award a contract for the provision of NHS health care services, where
conflicts, or potential conflicts, between the interests involved in commissioning such
services and the interests involved in providing them affect, or appear to affect, the
integrity of the award of that contract”.
In addition, other changes to the policy based on the guidance, include the frequency of
the review of the register of interests which is proposed to be undertaken quarterly, and
the requirement to maintain and publish a register of procurement decisions which
should be updated whenever a procurement decision is taken. The register must set out:
3.2
•
•
•
The details of the decision
Who was involved in making the decision (i.e. governing body or committee
members and others with decision-making responsibility)
A summary of any conflicts of interest in relation to the decision and how this
was managed by the CCG
To further support the management of conflicts of interest under the proposed delegated
arrangements, the CCG has reviewed its governance processes and agreed that a subcommittee will be formed with delegated authority for decision making in support of
primary care commissioning (medical services). The committee will have a lay and
executive majority and will extend a standing invitation to a representative from the local
Healthwatch organisation and the Health and Wellbeing Board.
3.3
Page 2 of 3
4.
Conclusion
4.1
This report has provided the governing body with an update on the requirement to revise
the CCG’s CoI policy based on the publication of statutory guidance and the proposed
intention to undertake delegated arrangements for primary care commissioning (medical
services) from 1st April 2015.
5.
Recommendations
5.1
The Governing Body is requested to:
•
•
Note the contents of the report
Review and approve the revised Conflicts of Interest Policy
Mrs Claire Moir
Governance, Performance and Risk Manager
January 2015
Page 3 of 3
Conflict of Interests Policy
Author/s:
Chief Finance Officer
Governance, Performance and Risk Manager
In Consultation with:
NHS Blackburn with Darwen Clinical Commissioning Group
Governing Body
Formally ratified/approved by:
CCG Governing Body
Sphere of Activity:
This policy spans all Clinical Commissioning Group activity
Version Number:
3.0
Date of previous revisions:
1.0
All staff
CCG website
Health and Wellbeing Board
Healthwatch
Blackburn with Darwen Borough Council
All Governing Body members, members of the CCG’s
committees or sub-committees and its employees
Distribution:
Target Audience:
POLICY STATEMENT / KEY OBJECTIVES
This policy sets out how Blackburn with Darwen Clinical Commissioning Group (CCG) will
manage conflicts of interest arising from the operation of the CCG’s business; it applies to the
Governing Body members, members of the CCG’s committees or sub-committees and its
employees, to ensure there can be confidence in the probity of commissioning decisions and the
integrity of those involved with the work of the CCG.
REFERENCES AND SUPPORTING DOCUMENTS
• Managing Conflicts of Interest: Statutory Guidance for CCGs, December 2014
• Next steps towards primary care co-commissioning, November 2014
• Managing Conflicts of Interest: Guidance for Clinical Commissioning Groups, March 2013
• Code of Conduct: Managing Conflicts of Interest where GP practices are potential
providers of CCG commissioned Services, October 2012
• Towards establishment: Creating responsive and accountable Clinical Commissioning
Groups (and technical Appendix 1): Code of Conduct, February 2012
• Standards for Members of NHS Boards and Clinical Commissioning Group Governing
Bodies in England, Professional Standards Authority, November 2012
Sponsoring Director:
Chief Finance Officer
Signature:
Issue Date: January 2015
Page 1 of 18
Date Stage 1 of Equality Impact Assessment
was carried out:
1st May 2013
Was a Stage 2 Equality Impact Assessment
Carried out?
n/a
Date Stage 2 of Equality Impact Assessment
was undertaken:
n/a
Date sent for ratification
Date published on the Website
Issue Date: January 2015
Page 2 of 18
CONTENTS
PAGE
4
1. Introduction
1.1 Statement of Intent
4
2. Definitions
4
3. Statutory Requirements
5
4. Scope of Policy
5
5. Duties and Responsibilities
6
4.1 All CCG members
6
4.2 CCG Secretariat
8
6. Declaration of Interests
8
6.1 On Appointment
8
6.2 Quarterly
8
6.3 At Meetings
8
6.4 On Change of Role or Responsibility
9
6.5 On any other Change of Circumstance
9
7. Declarations of Interest in relation to procurement
7.1 Managing conflicts to protect the integrity of the decision-making process
9
10
8. Compliance
11
9. Review
11
Appendices
1
Declaration of conflict of interests for bidders/contractors template
13
2
Declaration of interests for members/employees template
15
Issue Date: January 2015
Page 3 of 18
1.
Introduction
The Governing Body of NHS Blackburn with Darwen Clinical Commissioning Group (CCG)
has ultimate responsibility for all actions carried out by staff and committees throughout the
CCG’s activities. This responsibility includes the stewardship of significant public resources
and the commissioning of healthcare services to benefit the local community.
The CCG recognises that it is not possible to avoid conflicts of interest: they are inevitable in
many aspects of public life. By recognising where and how they arise and dealing with them
appropriately, commissioners will be able to ensure proper governance, robust decision
making and appropriate decisions about the use of public money
1.1
Statement of Intent
The CCG is determined to ensure the organisation inspires confidence and trust amongst its
patients, staff, partners, funders and suppliers by demonstrating integrity and avoiding any
potential or real situations of undue bias or influence in the decision-making of the CCG.
2.
Definitions
A conflict of interest occurs where an individual’s ability to exercise judgement or act in one
role is or could be impaired or otherwise influenced by his or her involvement in another role
or relationship.
The individual does not need to exploit his or her position or obtain an actual benefit,
financial or otherwise. A potential for competing interests and/or a perception of
wrongdoing, impaired judgement or undue influence can also be as detrimental as any of
them occurring.
As well as direct financial interests, conflicts can arise from an indirect financial interest (e.g.
payment to a spouse) or a non-financial interest (e.g. kudos or reputation). Conflicts of
loyalty may arise (e.g. in respect of an organisation of which the individual is a member or
has an affiliation). Conflicts can arise from personal or professional relationships with others
(e.g. where the role or interest of a family member, friend or acquaintance may influence an
individual’s judgement or actions or could be perceived to do so. Depending on individual
circumstances, these factors can all give rise to potential or actual conflicts of interest.
For any individual involved in commissioning, a conflict of interest may, therefore, arise when
their own judgement as an NHS commissioner could be, or be perceived to be, influenced
and impaired by their own concerns and obligations as a healthcare or related provider, as a
member of a particular peer, professional or special interest group, or as a friend or family
member. For GPs involved in commissioning, an obvious example is the award of a new
contract to a provider in which an individual GP has a financial stake.
The underpinning principles for managing conflicts of interest within the CCG are to ensure
that:
•
•
•
•
The CCG is able to do business appropriately
Conflicts of Interest are managed proactively not reactively
The CCG and clinicians in commissioning roles demonstrate that they are acting
fairly and transparently and in the best interests of their patients
The CCG operates within the legal framework, but without being bound by overprescriptive rules that risk stifling innovation
Issue Date: January 2015
Page 4 of 18
•
•
•
The public, providers, Parliament and regulators have confidence in the probity,
integrity and fairness of commissioners’ decisions
The confidence and trust between patients and GP, in the recognition that individual
commissioners want to behave ethically but may need support and training to
understand when conflicts (whether actual or potential) may arise and how to
manage them if they do
A balanced and proportionate approach is maintained to safeguard clinically led
commissioning, whilst ensuring objective investment decisions
To support staff, and ensure the principles with the policy are implemented, the following
definitions are offered: a “fundamental interest” would require the individual to withdraw
from the meeting room completely, and take no part in the debate or the decision-making
process.
A “significant interest” would allow the individual to remain in the meeting, and to
participate in the discussion, but to abstain from taking part in the decision-making process.
3.
Statutory Requirements
Section 14O of the National Health Service Act, 2006, inserted by section 25 of the 2012
Health and Social Care Act, sets out that each CCG must:
•
•
•
•
•
Maintain one or more registers of interest of: the members of the group, members of
its governing body, members of its committees or sub-committees of its governing
body, and its employees
Publish or make arrangements to ensure that members of the public have access to
these registers on request
Make arrangements to ensure individuals declare any conflict or potential conflict in
relation to a decision to be made by the group, and record them in registers as soon
as they become aware of it, and within 28 days; and
Make arrangements, set out in their constitution, for managing conflicts of interest,
and potential conflicts of interest in such a way as to ensure that they do not and do
not appear to affect the integrity of the CCG’s decision-making process
Have regard to guidance published by NHS England and Monitor in relation to
conflicts of interest
The NHS (Procurement, Patient Choice and Competition) Regulations 2013 set out that
commissioners:
•
Must not award a contract for the provision of NHS health care services where
conflicts, or potential conflicts, between the interests of those involved in
commissioning such services and the interests involved in those providing them
affect, or appear to affect, the integrity of the award of that contract
• Must keep a record of how it managed any such conflict in relation to NHS
commissioning contracts it enters into.
The CCG will ensure that details of all contracts awarded, including contract value, are
published on the CCG’s website as soon as the contract is agreed.
For the purpose of regulation 6 of the NHS procurement regulations (2013) an interest is
defined as including an interest of the following:
•
A member of the commissioner organisation
Issue Date: January 2015
Page 5 of 18
•
•
•
A member of the governing body of the commissioner
A member of its committees or sub-committees, or committees or sub-committees of
its governing body; or
An employee
This is set out in detail in the CCGs Constitution (Part 8, Para 8.4 Transparency in Procuring
Services).
4.
Scope of Policy
This policy applies to the Governing Body members, members of the CCG’s committees and
sub-committees and all employees of NHS Blackburn with Darwen CCG. It will be the
subject of review no later than 6 months after initial approval and annually thereafter. The
CCG Governing Body members will be supplied with a copy of the policy on appointment by
the Chair of the CCG, and will be available on the CCG’s website.
The Governing Body has a legal obligation to act in the best interests of NHS Blackburn with
Darwen CCG, and in accordance with the CCG’s constitution and terms of establishment
created by the NHS England.
5.
Duties and Responsibilities
5.1
All CCG Governing Body Members, Committee or Sub-Committee Members and
Employees
All CCG Governing Body members, committee or sub-committee members and employees
are required to declare any relevant and material personal or business interests and any
relevant and material personal or business interests of their spouse; civil partner; cohabitee;
family member or any other relationship which may influence or may be perceived to
influence their judgement.
Examples of interests that will be deemed to be relevant and material include:-
•
•
•
•
•
•
•
•
Roles and responsibilities held within member practices
Directorships including non-executive directorships, held in private companies or
PLCs
Ownership or part-ownership of private companies, businesses or consultancies
likely or possibly seeking to do business with the CCG
Shareholdings (more than 5%) of companies in the field of health and social care
A position of authority in an organisation (e.g. a charity or voluntary organisation) in
the field of health and social care
Any connection with a voluntary or other organisation contracting for NHS services
Research funding/grants that may be received by the individual or any organisation in
which they have an interest or role
Any other role or relationship which the public could perceive would impair or
otherwise influence the individual’s judgement or actions in their role within the CCG
Where an individual changes role or responsibility within the CCG any change to the
individual’s interest should be declared. Wherever an individual’s circumstances change in a
way that affects the individual’s interests (e.g. where an individual takes on a new role
outside of the CCG or sets up a new business or relationship), a further declaration should
Issue Date: January 2015
Page 6 of 18
be made to reflect the change in circumstances. This could involve a conflict of interest
ceasing to exist or a new one materialising.
In the case of the Registered Nurse and the Secondary Care Consultant, if they become an
employee or member (including shareholder) of, or a partner in/with:
a) A person who is a provider of primary medical services for the purposes of Chapter
A2 of the 2006 Act; or
b) A body which provides any relevant service to a person for whom the CCG has
responsibility
they have a statutory interest which, on declaration, debars them from continuing as
members of the CCG Governing Body.
There are similar scenarios in the governing legislation which debar individuals from
becoming, or continuing as, CCG Lay Members, or Governing Body members at all. If these
scenarios occur, such as election to Parliament or to a Member role in a Local Authority,
again the event and consequent declaration would debar the individual concerned from
continuing as a Governing Body member.
A waiver will apply in relation to the disability to participate in the proceedings of the CCG on
account of a pecuniary interest.
It will apply to:
(i) A member of the Blackburn with Darwen Clinical Commissioning Group
(“the CCG”) who is a healthcare professional, within the meaning of
regulation 5(5) of the Regulations, and who is providing or performing, or
assisting in the provision or performance, of–
(a)
services under the National Health Service Act 1977; or
(b)
services in connection with a pilot scheme under the National
Health Service (Primary Care) Act 1997;
(ii)
Where the pecuniary interest of the member in the matter which is the
subject of consideration at a meeting at which he is present:(a)
arises by reason only of the member’s role as such a
professional providing or performing, or assisting in the
provision or performance of, those services to those persons;
(b)
has been declared by the relevant chair as an interest which
cannot reasonably be regarded as an interest more substantial
than that of the majority of other persons who:–
(i)
are members of the same profession as the member in
question;
(ii)
are providing or performing, or assisting in the provision
or performance of, such of those services as he
provides or performs, or assists in the provision or
performance of, for the benefit of persons for whom the
CCG is responsible.
Issue Date: January 2015
Page 7 of 18
(iii)
Conditions which apply to the waiver and the removal of having a pecuniary
interest
The removal is subject to the following conditions:
(a)
the member must disclose his interest as soon as practicable after the
commencement of the meeting and this must be recorded in the
minutes;
(b)
the relevant chair must consult the Clinical Chief Officer before making
a declaration in relation to the member in question pursuant to
paragraph 7.3.3 (2) (b) above, except where that member is the
Clinical Chief Officer;
In the case of a meeting of the CCG:
5.2
(a)
the member may take part in the consideration or discussion of the
matter which must be subjected to a vote and the outcome recorded;
but
(b)
may not vote on any question with respect to it.
CCG Secretariat
The CCG secretariat, on behalf of the CCG Chair, will maintain a register of interests
declared by the CCG Governing Body members, committee or sub-committee members and
employees, together with the date that the interest was declared. The register of interests
will be refreshed every three months and an annual check will be carried out to ensure the
register is accurate and up to date.
All interests declared will be published in the CCG’s Annual Report; the register will be made
available upon request either by post or email, and can also be accessed from the CCG’s
website.
6.
Declarations of Interests
6.1
Pre and On Appointment
Applicants for any appointment to the CCG or its Governing Body will be asked to declare
relevant interests to ensure there is no conflict so significant that it would debar them from
appointment. When an appointment is made, a formal declaration of interests should be
made again and recorded.
6.2
Quarterly
All interests should be confirmed on a quarterly basis to ensure that the information is
accurate and up to date.
6.3
At Meetings
At all meetings including external and public meetings, all individuals should declare any
interest that they have in any agenda item before it is discussed or as soon as it becomes
apparent. Even if the interest has already been declared in the Register of Interests, it
should be declared in meetings where matters relating to that interest are discussed.
Declarations of interest should then be recorded in the minutes.
Issue Date: January 2015
Page 8 of 18
In the event of the committee having to decide upon a question in which an individual has an
interest, all decisions will be made by vote, with a simple majority required. A quorum must
be present for the discussion and decision; interested parties will not be counted when
deciding whether the meeting meets quorum requirements. Interested governing body
members must not vote on matters affecting their own interests, even where the use of the
waiver has been approved by the Chair and used, they may however take part in the
discussions but will be excluded from the decision. One of the lay members will undertake
the role of Deputy Chair and they would take the Chair’s role for discussions and decisions
involving a conflict of interest for the Chair.
All decisions under a conflict of interest will be reported in the minutes of the meeting with
the following information:• the nature and extent of the conflict
• an outline of the discussion
• the actions taken to manage the conflict
• use of the waiver and reasons for its implementation.
Where an individual benefits from the decision, this will be reported in the annual report and
accounts, as a matter of best practice. All payments or benefits in kind to governing body
members will be reported in the CCG’s accounts and annual report, with amounts for each
governing body member listed for the year in question. Independent external mediation will
be used where conflicts cannot be resolved through the usual procedures.
The committee may consider that there are certain conflicts of interest that are so
fundamental that the individual concerned should be excluded from the meeting or the
relevant part of the meeting, during which related issues are discussed. The Chair will have
responsibility for deciding whether there is a conflict and the course of action to be taken and
all decisions recorded in the minutes. For certain conflicts, the decision will need to be made
on a case-by-case basis and the final decision made by the Chair.
Where the CCG Governing Body is required to make a decision where the majority of the
GP members have a declared conflict, the following process will be invoked:
a)
The decision will be voted on by the remaining members who are not conflicted in
respect of the single agenda item. To achieve quoracy in such a situation at least
five of the following members (and any non-conflicted GP members) should be
present at the beginning of the meeting:
• Chair
• Chief Operating Officer
• Chief Finance Officer
• Registered Nurse
• Secondary Care Doctor
• Lay members
6.4
On Changing Role or Responsibility
Wherever an individual changes role or responsibility within the CCG or its Governing Body
any change to the individual’s interests should be declared within 28 days of becoming
known.
6.5
On any other Change of Circumstances
Wherever an individual’s circumstances change in a way that affects the individual’s
interests (e.g. where an individual takes on a role outside of the CCG or sets up a new
business or relationship), a further declaration should be made to reflect the change in
Issue Date: January 2015
Page 9 of 18
circumstances. This could involve a conflict of interest ceasing to exist or a new one
materialising.
7.
Declaration of Interests in relation to procurement
Where a relevant and fundamental interest or position of influence exists in the context of the
specification for, or award of, a contract the individual will be expected to:
• Declare the interest;
• Ensure that the interest is recorded in the register;
• Withdraw from all discussion on the specification or award;
• Not have a vote in relation to the specification or award.
It is expected that all interests are declared at the outset of any procurement process if the
individual intends to be a potential bidder in that process. Failure to do so could result in the
procurement process being declared invalid and possible suspension of that individual from
the CCG.
Potential conflicts will vary to some degree depending on the way in which a service is being
commissioned e.g. where a CCG is commissioning a service through Competitive Tender
(i.e. seeking to identify the best provider or set of providers for a service) a conflict of interest
may arise where GP practices or other providers in which the individual has an interest are
amongst those bidding, or where the CCG is commissioning a service through Any
Qualified Provider a conflict could arise where one or more GP practices (or other
providers in which individuals have an interest) are amongst the qualified providers from
whom patients can choose.
Guidance within the GMC’s core guidance Good Medical Practice (2006) and reiterated in its
document Conflicts of Interest (2008) indicates, in such cases, that:
“You must act in your patients best interests when making referrals and when
providing or arranging treatment of care. You must not ask for or accept any
inducement, gift or hospitality which may affect or be seen to affect the way you
prescribe, treat or refer patients. You must not offer such inducements to colleagues
if you have financial or commercial interest in organisations providing healthcare or in
pharmaceutical or other biomedical companies, these interests must not affect the
way you prescribe for, treat or refer patients. If you have a financial or commercial
interest in an organisation to which you plan to refer a patient for treatment or
investigation, you must also tell the patient about your interest. When treating NHS
patients you must also tell the healthcare provider.”
The GMC also provides the following general guidance:
“You may wish to note on the patient’s record when an unavoidable conflict of interest
arises; and if you have a financial interest in an institution and are working under an
NHS employers’ policy you should satisfy yourself, or seek other assurance from your
employing or contracting body, that systems are in place to ensure transparency and
to avoid, or minimise the effects of, conflicts interest. You must follow the procedures
governing the schemes.”
7.1
Register of Procurement Decisions
A register of procurement decisions will be maintained by the CCG which will include:
Issue Date: January 2015
Page 10 of 18
•
•
•
The details of the decision
Who was involved in making the decision (i.e. governing body or committee
members and others with decision-making responsibility)
A summary of any conflicts of interest in relation to the decision and how this was
managed by the CCG
The register will be updated whenever a procurement decision is taken. In the interests
of transparency, the register of interests and register of decisions will be made available
via the CCG’s website or upon request to the CCG. Making evidence of deliberation on
conflicts publicly available will provide assurance:
•
•
•
•
7.2
That the CCG is seeking and encouraging scrutiny of its decision-making
process;
To the Health and Wellbeing Board, local Healthwatch and the local community
that the proposed service meets local needs and prioities; it will enable them to
raise questions if they have concerns about the approach being taken;
To the Audit Committee and where necessary, external auditors, that a robust
process has been followed in deciding to commission the service, in selecting
the appropriate procurement route and, in addressing potential conflicts;
To NHS England in their role as assurers of the delegated commissioning
arrangements
Managing conflicts to protect the integrity of the decision-making process
To support the CCG to deliver its statutory requirements the following features will need to
be integral to the commissioning of all services. They will be particularly important at the key
commissioning decision making points leading up to and after the actual procurement of
services and in deciding whether to go out to procurement:
•
•
•
•
•
•
•
•
Openness: ensuring early engagement with patients, the public and health and
wellbeing boards in relation to proposed commissioning plans. Governing Body
members will also be members of the Health and Wellbeing Board and ensure that
plans are supportive of the Health and Wellbeing Strategy. The Governing Body also
has an engagement plan which sets out how patients the public will be involved in
the work of the CCG
Transparency: a clearly documented approach to be taken at each stage of the
commissioning cycle
Responsive and best practice: commissioning intentions are based on local health
needs and reflect evidence of best practice – securing “buy-in” from patients and
clinicians to the clinical case for change
Securing expert advice: ensure that plans take account advice from appropriate
health and social care professionals e.g. through the clinical senate and networks;
and draw on commissioning support e.g. for more formal consultations and for
procurement processes
Engaging with providers: early engagement with both incumbent and potential new
providers over potential changes to the commissioned services for the local
population through involving them in the re-development of care pathways
Create clear and transparent commissioning specifications: that reflect the
depth of engagement and set out the basis on which any contract will be awarded
Follow proper procurement processes: and legal arrangements, including even
handed approach to providers
Ensure sound record-keeping, including an up to date register of interests:
applying best practice in sound record-keeping, making appropriate information
Issue Date: January 2015
Page 11 of 18
•
8.
available and accessible, and maintaining a register of interest with a clear system
for declaration of interests
Dispute resolution: having systems for resolving disputes, clearly set out in
advance
Compliance
Failure to comply with this policy will be addressed under the disciplinary processes of the
CCG, or otherwise as set out in the CCGs Standing Orders for Members of the Governing
Body.
9.
Review
The Governance, Performance and Risk Manager will ensure this document is reviewed in
accordance with the Review Date.
The policy will be reviewed earlier should the CCG become aware of changes in practice,
changes to statutory requirements, revised professional or clinical standards and local /
national directives that affect, or could potentially affect the policy.
Issue Date: January 2015
Page 12 of 18
Appendix 1
Declaration of conflict of interests for bidders/contractors template
NHS Blackburn with Darwen Clinical Commissioning Group Bidders/potential
contractors/service providers declaration form: financial and other interests
This form is required to be completed in accordance with the CCG’s Constitution,
and s140 of the NHS Act 2006 (as amended by the Health and Social Care Act
2012) and the NHS (Procurement, Patient Choice and Competition) (No2)
Regulations 2013 and related guidance
Notes:
•
All potential bidders/contractors/service providers, including sub-contractors,
members of a consortium, advisers or other associated parties (Relevant
Organisation) are required to identify any potential conflicts of interest that
could arise if the Relevant Organisation were to take part in any procurement
process and/or provide services under, or otherwise enter into any contract
with, the CCG, in circumstances where the CCG is jointly commissioning the
service with, or acting under a delegation from, NHS England. If any
assistance is required in order to complete this form, then the Relevant
Organisation should contact the CCG for clarification.
•
The completed form should be sent to the Head of Corporate Business.
•
Any changes to interests declared either during the procurement process or
during the term of any contract subsequently entered into by the Relevant
Organisation and the CCG must notified to the CCG by completing a new
declaration form and submitting it to the Head of Corporate Business
•
Relevant Organisations completing this declaration form must provide
sufficient detail of each interest so that the CCG, NHS England and also a
member of the public would be able to understand clearly the sort of financial
or other interest the person concerned has and the circumstances in which a
conflict of interest with the business or running of the CCG or NHS England
(including the award of a contract) might arise.
•
If in doubt as to whether a conflict of interests could arise, a declaration of the
interest should be made.
Interests that must be declared (whether such interests are those of the Relevant
Person themselves or of a family member, close friend or other acquaintance of
the Relevant Person), include the following:
•
•
the Relevant Organisation or any person employed or engaged by or otherwise
connected with a Relevant Organisation (Relevant Person) has provided or is
providing services or other work for the CCG or NHS England;
a Relevant Organisation or Relevant Person is providing services or other work
for any other potential bidder in respect of this project or procurement process;
Issue Date: January 2015
Page 13 of 18
•
the Relevant Organisation or any Relevant Person has any other connection
with the CCG or NHS England, whether personal or professional, which the
public could perceive may impair or otherwise influence the CCG’s or any of its
members’ or employees’ judgements, decisions or actions.
Declarations:
Name of Relevant
Organisation:
Interests
Type of Interest
Details
Provision of
services or other
work for the CCG or
NHS England
Provision of
services or other
work for any other
potential bidder in
respect of this
project or
procurement
process
Any other
connection with the
CCG or NHS
England, whether
personal or
professional, which
the public could
perceive may
impair or otherwise
influence the
CCG’s or any of its
members’ or
employees’
judgements,
decisions or
actions
Name of Relevant
Person
[complete for all Relevant Persons]
Interests
Issue Date: January 2015
Page 14 of 18
Type of Interest
Details
Personal interest or
that of a family
member, close friend
or other
acquaintance?
Provision of
services or other
work for the CCG or
NHS England
Provision of
services or other
work for any other
potential bidder in
respect of this
project or
procurement
process
Any other
connection with the
CCG or NHS
England, whether
personal or
professional, which
the public could
perceive may
impair or otherwise
influence the
CCG’s or any of its
members’ or
employees’
judgements,
decisions or
actions
To the best of my knowledge and belief, the above information is complete and
correct. I undertake to update as necessary the information.
Signed:
On behalf of:
Date:
Issue Date: January 2015
Page 15 of 18
Appendix 2
Declaration of interests for members/employees template
NHS Blackburn with Darwen Clinical Commissioning Group Member/
employee/ governing body member/committee or sub-committee member
(including committees and sub-committees of the governing body) [delete as
appropriate] declaration form: financial and other interests
This form is required to be completed in accordance with the CCG’s Constitution
and section 14O of The National Health Service Act 2006, the NHS (Procurement,
Patient
Choice and Competition) regulations 2013 and the Substantive guidance on the
Procurement, Patient Choice and Competition Regulations
Notes:
•
•
•
•
•
•
•
•
Each CCG must make arrangements to ensure that the persons mentioned
above declare any interest which may lead to a conflict with the interests of the
CCG and the public for whom they commission services in relation to a
decision to be made by the CCG or which may affect or appear to affect the
integrity of the award of any contract by the CCG.
A declaration must be made of any interest likely to lead to a conflict or
potential conflict as soon as the individual becomes aware of it, and within 28
days.
If any assistance is required in order to complete this form, then the individual
should contact the Head of Corporate Business, or the Governance,
Performance and Risk Manager.
The completed form should be sent by both email and signed hard copy to the
Head of Corporate Business.
Any changes to interests declared must also be registered within 28 days by
completing and submitting a new declaration form.
The register will be published on the CCG website at
blackburnwithdarwenccg.nhs.uk
Any individual – and in particular members and employees of the CCG must
provide sufficient detail of the interest, and the potential for conflict with the
interests of the CCG and the public for whom they commission services, to
enable a lay person to understand the implications and why the interest needs
to be registered.
If there is any doubt as to whether or not a conflict of interests could arise, a
declaration of the interest must be made.
Interests that must be declared (whether such interests are those of the individual
themselves or of a family member, close friend or other acquaintance of the
individual) include:
• roles and responsibilities held within member practices;
• directorships, including non-executive directorships, held in private companies
or PLCs;
• ownership or part-ownership of private companies, businesses or
consultancies likely or possibly seeking to do business with the CCG;
Issue Date: January 2015
Page 16 of 18
•
•
•
•
•
shareholdings (more than 5%) of companies in the field of health and social
care;
a position of authority in an organisation (e.g. charity or voluntary organisation)
in the field of health and social care;
any connection with a voluntary or other organisation (public or private)
contracting for NHS services;
research funding/grants that may be received by the individual or any
organisation in which they have an interest or role;
any other role or relationship which the public could perceive would impair or
otherwise influence the individual’s judgment or actions in their role within the
CCG.
If there is any doubt as to whether or not an interest is relevant, a declaration of
the interest must be made.
Declaration:
Name:
Position within or
relationship with,
the CCG:
Interests
Type of Interest
Details
Personal interest or
that of a family
member, close friend
or other
acquaintance?
Roles and
responsibilities
held within member
practices
Directorships,
including
nonexecutive
directorships, held
in private
companies or PLCs
Ownership or part
ownership of
private companies,
businesses or
consultancies likely
or possibly seeking
to do business with
the
CCG
Issue Date: January 2015
Page 17 of 18
Shareholdings
(more than 5%) of
companies in the
field of health and
social care
Positions of
authority in an
organisation (e.g.
charity or voluntary
organisation) in the
field of health and
social care
Any connection
with a voluntary or
other organisation
contracting for NHS
services
Research
funding/grants that
may be received by
the individual or any
organisation they
have an interest or
role in
[Other specific
interests?]
Any other role or
relationship which
the public could
perceive would
impair or otherwise
influence the
individual’s
judgment or actions
in their role within
the CCG.
To the best of my knowledge and belief, the above information is complete and
correct. I undertake to update as necessary the information provided and to review
the accuracy of the information provided regularly and no longer than annually. I
give my consent for the information to be used for the purposes described in the
CCG’s Constitution and published accordingly.
Signed:
Date:
Issue Date: January 2015
Page 18 of 18
Agenda Item 18
NHS BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
14TH JANUARY 2015
Report Title:
Lancashire Collaborative Commissioning Board Terms of Reference and
Membership
Written By:
Mr Peter Tinson, Chief Operating Officer, Fylde and Wyre CCG and Mr Carl
Ashworth, Strategic Locality Lead – Fylde & Wyre CCG, Midlands and
Lancashire Commissioning Support Unit
Presented By:
Mr Roger Parr, Chief Finance Officer, Blackburn with Darwen CCG
Purpose of the paper:
The purpose of this paper is to present for approval the Terms of Reference and Membership
(v6.0) of the Lancashire Collaborative Commissioning Board (CCB) for consideration and approval
by the members of the CCGs’ Governing Bodies.
Key Issues:
Members are asked to receive the CCB Terms of Reference and Membership (v6.1)
The Terms of Reference and Membership include the following:
• Definition
• Aim
• Range of benefits
• Principles
• Responsibilities
• Process for Programme Management
• Management of Programme Change Control
• Membership
• Authority Accountability and Governance
• Chair
• Role of the Senior Responsible Officer
• Frequency of Meetings
• Agenda and Meetings
• Quorum
• Reporting Review
• Overall CCB Process
• Strategic Model
• CCB Architecture
• Responsibilities for Management of papers
Actions Required by Collaborative Commissioning Board Members:
Members are asked to consider and approve the CCB Terms of Reference and Membership (v6.1)
CCB Terms of Reference and Membership
20 November 2014 Collaborative Commissioning Board Item 18 Terms of Reference and Membership (v6.1) 1
Definition Collaborative commissioning is the process whereby two or more commissioners work together in order to effectively commission some of the services for which they are responsible, but also to share risk safely, transfer skills and secure commissioning support. 2
Aim To collaboratively commission efficient and effective health care for Lancashire residents, where there is benefit from commissioning on a larger footprint. 3
Range of Benefits The expected benefits include:‐ Clinical Improvement • Consistent, evidence based pathway development • Effective and consistent performance management, clinical governance and risk management • Service integration Efficiency • Leverage with providers • Keeping transaction costs low • Sharing (potentially scarce) expertise and capacity Resilience and risk management • Managing financial risks • Managing regulatory and legal change • Managing extended absence of key staff • Improved risk management and intelligence systems • Business continuity arrangements 4
Principles The members will:‐ 4.1. At all times act in good faith towards each other. 4.2. Collaborate and co‐operate to deliver the agreed work programme. 4.3. Act in a timely manner. 4.4. Communicate openly about concerns, issues or opportunities relating to delivery of the agreed work programme. Page 1 of 12 20 November 2014 4.5.
4.6.
4.7.
4.8.
Be accountable for the delivery of the agreed work programme and deployment of associated resources. Share information and experience to learn from each other. Adhere to statutory duties, laws and standards. Adopt a positive outlook and proactive manner. 4.9. Manage internal and external stakeholders effectively. 4.10 Seek to identify and manage any potential unintended consequences of collaborative decisions on individual members. 5
Responsibilities Services 5.1. Co‐ordinate the development an overarching strategic approach to collaborative commissioning across Lancashire and delivery within that approach of agreed collaborative programmes. 5.2. Ensure the public, partners and stakeholders are engaged in the development and delivery of the strategic approach. 5.3. Engage Health and Well Being Boards in the development of the strategic approach.. 5.4. Contribute to the development of member and partner strategies, for example Healthier Lancashire. 5.5. Identify and prioritise those service areas that will benefit from collaborative commissioning. 5.6. Identify the breadth of the collaborative arrangements, specifically which commissioning functions are included. 5.7. For each priority/project clearly identify and document the scope of the collaboration, decision making process and reporting arrangements. Specifically this should identify the mechanism for any collaborative decision making (paragraph 7.2 refers) and any associated decision making ‘gateways’. 5.8. Promote integrated commissioning and provision. 5.9. Promote innovation, research and evidence based practice. Contracts 5.10. Determine which providers and services to collaboratively contract and the underpinning arrangements. Programme Management 5.11. Ensure that robust programme management arrangements are in place for the delivery of the agreed work programme. 5.12. Ensure that component projects remain aligned to the Strategy and fit together properly, Page 2 of 12 20 November 2014 maximising opportunities for working across projects. 5.13. Ensure clinical and managerial resources are allocated from member organisations and commissioning support providers to successfully achieve project outcomes. Commissioning Support 5.14. Identify and secure the commissioning support required to underpin the collaborative commissioning arrangements. 6. Process for programme management 6.1 The general procedure for new programme consideration and overview of current programmes by the CCB is shown in Appendix A. This includes the Gateway reviews that CCB will be conducting on programmes. Steps between the Gateways may vary according to the nature of the programme or project. 6.2 In between the gateway reviews, CCB should seek simple assurance via the SRO that the programme is on track to deliver against milestones or be aware of the implications of any potential deviation. Should a risk or issue arise that could have significant strategic importance to CCB and / or its constituent members then CCB may call for a more detailed review paper. 6.3 All programmes will be underpinned by resource plans, detailing clearly how collaborative resource across CCGs, CSU, SCN, NHSE and others is anticipated will be applied in the delivery of programmes. Where application of resource to delivery of programmes varies significantly from plans, this should be escalated to CCB for review. Where PIDs for new programmes highlight additional resource requirements, CCB may consider the relative priority of the programme against others already underway. 6.4 The CCB should conduct an annual review of programmes to ensure that work is aligned to 2 year and 5 year plans, delivering on the highest priorities and focused on the areas of greatest complexity and maximum value. 7. Management of Programme Change Control 7.1 Change Control should be applied such that approval is sought from the lowest appropriate level within the programme hierarchy. Any substantive changes to previously approved programmes and/or programme documents should require re‐submission and approval of changes. 7.2 Papers submitted to boards / groups for approval of changes to agreed programmes should usually set out the reason for making the change and any known risks or impacts from the change as well as details of the change itself. Where the requested change impacts upon the resource plan, this should be highlighted in the paper to the CCB. 7.3 All transformation or development projects should have a means by which they report into either one of the programme boards or to CCB. This hierarchal structure maintains clear lines of reporting for projects to avoid ambiguity, which ensures that all transformation activity can be developed in a coherent, structured, integrated approach with consideration to inter‐dependencies and potential impacts across the whole system. Page 3 of 12 20 November 2014 8. Membership a) Chair Role Name Dr Amanda Doyle Title Clinical Chief Officer b) Vice Chair Peter Tinson Chief Operating Officer c) CCG Representative and NWAS/111 Group Chair d) CCG Representative and Medicines Optimisation Group Chair e) Collaborative Operational Delivery Group Chair (1) f) CSU Customer Forum Chair g) CCG Representative and Vascular Senior Responsible Officer h) CCG Representative and Collaborative Commissioning Support i) CCG Representative and Mental Health and Dementia Senior Responsible Officer j) CCG Representative and LD/CAMHS Senior Responsible Officer David Bonson Chief Operating Officer Organisation Blackpool CCG Fylde and Wyre CCG Blackpool CCG Dr Tony Naughton Clinical Chief Officer Fylde and Wyre CCG Carl Ashworth Senior Executive ‐ Transformation Midlands and Lancashire CSU Roger Parr Chief Finance Officer Andrew Bennett Chief Officer Blackburn with Darwen CCG Lancashire North CCG Peter Tinson Chief Operating Officer Fylde and Wyre CCG Sarah Camplin Debbie Nixon Chief Operating Officer Blackburn with Darwen CCG Roger Parr Dr Mike Ions Clinical Chief Officer East Lancashire CCG Page 4 of 12 Deputy Hilary Fordham k) CCG Representative and Stroke/TIA Senior Responsible Officer l) CCG Representative m) Chief Finance Officer Representative n) Primary Care Co‐
commissioner o) Specialised Commissioner p) Local Authority Commissioner q) Local Authority Commissioner r) Local Authority Commissioner Jan Ledward Chief Officer Mike Maguire Mark Youlton Chief Officer Chief Finance Officer Martin Clayton Alison Rylands Commissioning Director Mike Banks Val Raynor Paula Spence Deputy Medical Director (Clinical Strategy) Interim Director of Commissioning, Adult Services Public Health Head of Strategic & Procurement, Adult Social Care Greater Preston CCG and Chorley and South Ribble CCG West Lancashire CCG East Lancashire CCG 20 November 2014 Karen Sharrocks NHS England Lancashire Area Team NHS England Specialised Commissioning Team Lancashire County Council Terry Mears/Dawn Butterfield Blackpool Council Blackburn with Darwen Council Head of Contracting and Commissioning (1) ‘Close down’ collaborative work streams will report to Collaborative Operational Delivery Group. 8.1 Attendees A Strategic Clinical Network representative will be invited to attend all meetings and other partner or member representatives will be invited to attend as necessary. This includes CCG and CSU staff who are supporting the delivery of priorities/projects. Page 5 of 12 20 November 2014 9 Authority Accountability and Governance 9.1 The Collaborative Commissioning Board reports to the member organisations through their representatives. 9.2 The Board will consider the commissioning issue and identify the most appropriate mechanism to seek a collaborative decision, either:‐ o Individual members may participate in collective decisions in accordance with their delegated authority. o Delegated authority may be requested and received from members in relation to individual projects. o The Board may recommend to members a decision for ratification. 9.3 Each member retains accountability for the commissioning of care for which they are responsible and in accordance with their statutory duties and schemes of delegation. 9.4 A simple structure of accountability is set out in Appendix B. This establishes a simple hierarchy that links all projects back to delivery of the CCGs’ Strategic Plans. 9.5 Appendix C shows the governance architecture for the CCB and the groups reporting to it. 10 Chair The Collaborative Commissioning Board will be chaired by a Clinical Commissioning Group Clinical Accountable Officer or Clinical Chair. 11 Role of the Senior Responsible Officer (SRO) 11.1 The SRO for each agreed programme should be a regular board member of CCB and therefore by default a senior executive of one of the member organisations. 11.2 The SRO is not just a named lead of the particular programme, but should take an active leadership role to ensure the programme plans are appropriate and progressing to design. The SRO will be the programme representative at CCB. 11.3 The SRO should support and promote the programme to colleagues, key stakeholders, members of the public, politicians and the media. The SRO may be required to provide updates to sister organisations and public boards. 12 Frequency of Meetings Meetings will be held monthly. 13 Agenda and meetings 13.1
The agenda will be set by the Chair. 13.2
The agenda and all relevant papers will be circulated at least five working days prior to the meeting. Items that are late but urgent and important for circulation outside of the above can be done so with approval from the Chair. Page 6 of 12 20 November 2014 13.3
The CCB will operate a ‘Management by Exception’ approach seeking assurance from lower programme / project groups that satisfactory progress is being made and risks / issues identified and managed. Review of details, actions and progress of projects should be addressed through other more appropriate meetings. 13.4
The Senior Responsible Officer (SRO) will be responsible for reviewing and signing off highlight reports and other papers with the Service Redesign Team (SRT) lead(s) and agree with the Chair the time required to present each item. The agreed time slot will be strictly adhered to during the CCB meeting 13.5
Standard format highlight reports will be produced to ensure consistency of information passing to each board. 13.6
All papers should be clear around the recommendations being made and the decisions required from CCB and reflect the purpose and responsibilities for the SRO, CSU and CCB members as detailed in table in Appendix D. 13.7
The SRO will normally be responsible for presenting the paper to the meeting following discussion with SRT lead(s). 13.8
Individuals presenting papers should assume everyone has read the paper and give a short overview of the papers and describe the recommendations and decisions required from CCB. Individuals who are not core members of CCB should arrange to attend the meeting at the allotted 13.9
time on the agenda to present their paper and leave the meeting at the end of their item. 13.10 Any updates to member’s own organisation’s meetings should use the same papers as last issued to the CCB to ensure consistency between public board meetings. 13.11 Each CCB member is responsible for ensuring appropriate briefings are provided to their own organisations in regard to programmes and projects 14 Quorum The Collaborative Commissioning Board meeting is quorate when 5 of the 8 CCGs in Lancashire are represented by their named representative or deputy. 15 Reporting The minutes of meetings will be issued to all members within 10 working days of the meeting. 16 Review The Terms of Reference and Membership of the Collaborative Commissioning Board will be reviewed annually by the members. Page 7 of 12 20 November 2014 – Overall CCB Process
Programme
Proposed
No further action
Draft PS
developed by
CSU
PS revised by
CSU
Draft PS Agreed
by SRO
Draft PS
Presented to CCB
PS Not Approved
by CCB – Further
work required
Gateway 1 –
PS Approval
Programme Scope (PS) Should be 1 – 4 pages briefly covering: •
•
•
•
•
•
Vision / Outline of programme Key Outcomes Aim and Objectives Benefits to be realised Interface / Governance Timeline and key milestones •
•
•
•
•
PS Not Approved
by CCB
Programme
Scope Approved
by CCB
PID Developed by
CSU
Assumptions In‐scope / Out‐of‐scope Risks Roles and Responsibilities SRO / Exec Sponsor Gateway 2 – PID
Approved
Programme Initiation Document (PID) • Detailed programme plans by project • Key metrics and reporting • Stakeholders • Communications Plan • Methodologies • Diversity & Inclusion Checklist Specification /
procurement
development
Gateway 4 –
Service Procured
•
•
•
•
•
•
•
Detailed timelines Detailed resource plans Financial Plan Interdependencies Risk and Mitigation Plans Options Appraisal Potential Procurement
Service to be reprocured
Service
Mobilisation
Monthly
Programme
Assurance
Gateway 3 –
Approach to securing
service change agreed
by CCB
Review
Implementation of
Service
Page 8 of 12 Option appraisal
and case for
change developed
Gateway 5
Closure of
Programme
20 November 2014 – Strategic Model
Accountability and Quality Assurance
Framework
CCG / LA Public Boards
Collaborative
Commissioning Board
Programme Boards &
Operational Delivery Group
CSU Internal
Review
Process
Project
Groups
(as appropriate)
Strategic Plans and
Controls Overview
Public
Accountability
Overall
strategic plans
& Clinical
Accountability
Programme
Plans,
Progress and
Corrective
Actions
Individual
project plans,
actions, details
and tactical
changes
Page 9 of 12 Change
Control
Strategic
Direction
Change
Control
Strategic
Direction
Change
Control
Strategic
Direction
20 November 2014 Page 10 of 12 20 November 2014 Appendix D – responsibilities re management of papers
Type of
Paper/Report
Purpose
SRO
Responsibility
CSU
Responsibility
Decision
For discussion
and a decision
by all CCGs
Debate
To discuss and
• To introduce • To identify
debate a subject
subject and
topics for
e.g. to see if
SME if in
discussion of
there is local
attendance.
local or national
appetite for a
relevance
work stream or
• To facilitate
to raise
• To provide
discussion
awareness of
and gain
sufficient
particular or
consensus
information for
local or national
issues etc.
on next
background of
steps
subject matter
to aid
• To align
discussions.
workstream
with agreed • To invite SME
next steps
to attend CAG
where required
CCG
Responsibility
• Present paper • To ensure there • CCG
representative
and facilitate
is sufficient
discussion to
information in
had sufficient
discussion
allow required
the paper and
decisions to
suitable
with local lead
for subject
be made.
questions
around
matter to be
able to make
questions.
a decision on
• To ensure that
behalf of CCG
papers are out
• To raise any
in time to
issues with
enable local
SRO or CSU
discussions to
lead for the
take place
programme
• To ensure
prior to the
sufficient time
meeting
on agenda for
brief discussion
and decision
Page 11 of 12 • To ensure
• To read
subject matter
provided
• To identify if
there are local
colleagues
who need to
also attend
debate
20 November 2014 sufficient time
on the agenda
for debate
• Provide
Teleconference
arrangements
to encourage
more
participation
from CCGs in
debate
Information Only Operational
To provide brief
(Highlight
update of
progress report
Report)
progress since
last HL report to
CAG
Parking Lot
To put work
• To lead the
• To manage
(list which we
streams on hold, discussion as
this within
add to and
due to no
to the next
agreed criteria
remove from)
appetite,
steps with for
(don’t want it
awaiting
the
to be a
national/local
programme
dumping
decision’s
ground for the
• The ensure
“too hards”).
regular review
of ‘Parked’
• To review
programmes/
each month
projects
with a brief
comment on
list and update
at CAG
Page 12 of 12 To note
progress and
share with local
CCG
• To support
discussion at
CAG and
recommendati
ons to “close”
programmes/
projects.
GOVERNING BODY MEETING
Date of Meeting
14th January 2015
Title of Report
Agenda
Item No.
Planning Guidance 2015/16 – Year 2 Update
Governing Body
Responsible Officer
Mr Roger Parr, Chief
Finance Officer
Summary/Purpose of
Report
Governing Body
Action
19
Lead
Clinician
Lead
Manager
Mrs Claire Moir,
Governance, Performance
and Risk Manager
The purpose of this report is to provide the Clinical
Commissioning Group’s (CCG) Governing Body with an
overview of the requirements outlined within the planning
guidance (2015/16) which was published by NHS England on
23rd December 2014.
The Governing Body is requested to:
• Note the contents of the report
Please indicate the Committee(s)/Group(s) where the paper has been
discussed/developed
Operations and Delivery Group
Please note the following section must be completed in full
Patient and Public
Yes
Undertaken as part of the development of the CCG
Engagement
5 Year Strategic Plan
Completed
Equality Analysis
Yes
Equality Analysis Assessment undertaken on the
Completed
CCG 5 Year Strategic Plan
Financial
Finance and Activity templates will be populated as part of
Implication(s)
the planning process
Risk(s) Identified
Any risks identified will be managed through the planning
and delivery process
CCG Strategic Objectives supported by this paper
1.
We will continuously improve the health and well-being of the population of
Y
2.
3.
4.
5.
Blackburn with Darwen.
We will build successful partnerships which promote collaborative working and
integrated service delivery.
We will effectively engage patients and the public in decision making.
We will co-commission and deliver continuous improvement in Primary Care
Services and tackle inequalities.
We will commission safe and effective services for the population of Blackburn
with Darwen with integration at the heart of commissioning.
Y
Y
Y
Y
CCG High Impact Changes supported by this paper
1.
2.
3.
4.
5.
6.
7.
8.
9.
Delivering high quality Primary Care at scale and improving access.
Self-Care and Early Intervention.
Enhanced and Integrated Primary Care and Better Care Fund.
Access to Re-ablement and Intermediate Care.
Improved hospital discharge and reduced length of stay.
Community based ambulatory care for specific conditions.
Access to high quality Urgent and Emergency Care.
Scheduled Care.
Quality.
Page 1 of 4
Y
Y
Y
Y
Y
Y
Y
Y
Y
Planning Guidance – 2015/16
Year 2 Update
1.
Introduction
1.1
The purpose of this report is to provide the Clinical Commissioning Group’s (CCG)
Governing Body with an overview of the requirements outlined within the planning
guidance (2015/16) which was published on 23rd December 2014.
2.
Planning Guidance – Key Headlines
2.1
All existing objectives from the 2014/15 mandate have been carried over with 2 important
updates:
•
•
To join up health and social services through the Better Care Fund
To introduce access and waiting time standards in mental health by March 2016
2.2
The 2015/16 mandate remains structured around the 5 domains of the NHS Outcomes
Framework. Whilst there is no requirement to upload a narrative operational plan as part
of the national submission process, there is an expectation that CCGs will produce
narrative annual plan to demonstrate progress with the outcome framework indicators
and trajectories to be achieved during the 2015/16 financial year.
2.3
Additional supplementary information has also been provided which outlines further
information for planning and business rules for 2015/16. The guidance also sets out the
fundamental requirements for all commissioning plans under the following headings:
•
•
•
•
•
Outcomes
o Delivery across 5 domains and seven outcome measures
o Improving health
o Reducing health inequalities
o Parity of esteem
Access
o Convenient access for everyone
o Meeting NHS Constitution standards
Quality
o Responses to Francis, Berwick and Winterbourne View
o Patient safety
o Patient experience
o Compassion in practice
o Staff satisfaction
o Seven Day Services
o Safeguarding
Innovation
o Research and Innovation
Delivering Value
o Financial resilience; delivering value for money for taxpayers and patients
and procurement
Page 2 of 4
3.
Operational and Planning Measures 2015/16
3.1
Detailed operational plan measures which formed part of the 2 year operational plans
submitted in 2014/16 will need to be reviewed and refreshed. Key changes for 2015/16
are highlighted in the guidance and include a requirement for inpatient activity plans to be
based on spells as used in the Secondary Uses Service (SUS) data.
Additionally, as
the CCG intends to apply to NHS England for delegated commissioning responsibilities,
additional primary care metrics will also need to be included as part of the year 2 refresh
process.
3.2
Activity and financial planning data templates have been provided for completion by
commissioners in line with national timescales (see below). This year more emphasis
has been placed on finance associated with activity which will be considered and aligned
to the contracting process for 2015/16.
4.
Planning Requirement Timescales
4.1
Attached at Appendix 1 is an outline of the actions required against the national
timescales.
5.
Next Steps
5.1
The CCG’s Operational Delivery Group will undertake and coordinate the work required
to ensure the operational and planning measures are reviewed and refreshed, and that
the 2015/16 narrative annual plan is developed in accordance with the guidance.
5.2
The Governing Body will receive progress reports at both the February and March
meetings prior to final submission of the planning templates to NHS England.
6.
Recommendations
6.1
The Governing Body is asked to:
•
Note the contents of the report
Mr Roger Parr
Chief Finance Officer
7 January 2015
Page 3 of 4
Appendix 1
Planning Requirements Timescales
Date
Action
13 Jan 15 1st cut of activity trajectories submitted via UNIFY
From 29 Jan 15 onwards Weekly contract tracker to be submitted (Thursdays)
13 Feb 14 Checkpoint 1 – feedback on progress with planning measures and trajectories 20 Feb 2015 National contract stocktake
27 Feb 2015 Submission of full draft plans 27 Feb ‐ 30 Mar 15 Assurance of draft plan
6 Mar 15 Checkpoint 2 – further feedback on plans
11 Mar 15 12‐23 Mar 15 25 Mar 15 Contracts signed post mediation
Contract arbitration
Arbitration outcomes notified to commissioners
31 Mar 15 Plans approved by CCG Governing Body
10 Apr 15
Submission of full final plans
10 Apr 15 onwards
Assurance and reconciliation of operational plans
Page 4 of 4
GOVERNING BODY MEETING
Date of Meeting
Title of Report
Governing Body
Responsible Officer
Summary/Purpose of
Report
14TH JANUARY 2015
Agenda
20
Item No.
GOVERNING BODY SUB COMMITTEES AND GROUPS’ SUMMARY
Lead
Clinician
Lead
Manager
This document summarises each Committee Meeting for the Governing
Body (GB), identifying key decisions, recommendations and items of
particular interest. Full copies of the minutes are available from the
Corporate Support Officer, if required.
The Governing Body is requested to note the content of the report.
MR IAIN FLETCHER,
HEAD OF CORPORATE
BUSINESS
Governing Body
Action
Please indicate the Committee(s)/Group(s) where the paper has been discussed/developed
Commissioning Business Group
Audit Committee
Quality, Performance and Effectiveness Committee
Lancashire Clinical Commissioning Group Chairs’ Network
Blackburn with Darwen Health and Well-being Board
N/A
Result
Patient and Public
Engagement Completed
Equality Analysis
N/A
Result
Completed
None
Financial Implication(s)
None
Risk(s) Identified
CCG Strategic Objectives supported by this paper
1.
2.
3.
4.
5.
We will continuously improve the health and well-being of the population of Blackburn with
Darwen.
We will build successful partnerships which promote collaborative working and integrated
service delivery.
We will effectively engage patients and the public in decision making.
We will co-commission and deliver continuous improvement in Primary Care Services and
tackle inequalities.
We will commission safe and effective services for the population of Blackburn with
Darwen with integration at the heart of commissioning.
Y
Y
Y
Y
Y
CCG High Impact Changes supported by this paper
1.
2.
3.
4.
5.
6.
7.
8.
9.
Delivering high quality Primary Care at scale and improving access.
Self-Care and Early Intervention.
Enhanced and Integrated Primary Care and Better Care Fund.
Access to Re-ablement and Intermediate Care.
Improved hospital discharge and reduced length of stay.
Community based ambulatory care for specific conditions.
Access to high quality Urgent and Emergency Care.
Scheduled Care.
Quality.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 1 of 29
CLINICAL COMMISSIONING GROUP (CCG)
GOVERNING BODY MEETING
14TH JANUARY 2015
GOVERNING BODY SUB-COMMITTEES AND GROUPS’ SUMMARY
1) Introduction
This document summarises each Committee Meeting for the Governing Body (GB), identifying key
decisions, recommendations and items of particular interest. Full copies of the minutes are
available from the Corporate Support Officer, if required.
2) Commissioning Business Group (CBG)
Chair – Dr Muzaffar Pervez, General Practitioner (GP) Executive
The members present declared their conflicts of interest to the appropriate agenda items.
2.1 Minutes of the Meeting held on 12th November 2014
a) Proposed Pennine Lancashire Cancer Local Improvement Scheme 2015/16
A power point presentation was given by Dr Neil Smith, GP Lead for Cancer and CBG were
asked to consider the future funding of the Local Improvement Scheme (LIS).
Proposed LIS is to maintain a practice core team and continue training.
Recommend that Blackburn with Darwen (BwD) CCG support the scheme and confirm to
NHS England.
b) Drug and Alcohol Misuse Prevention and Recovery Services Tender Prime Provider
Model.
The paper set out what has already been achieved and what is being proposed for the
future of commissioning these services. A number of stakeholder workshops have been
held, with the main outcomes being improving recovery with a prime provider model.
CBG asked to note the process being undertaken by Public Health.
c) Primary Care Resilience
GP access over the holiday period, was discussed within the context of Annual Resilience
funding. The various different initiatives were discussed:
• In house additional appointment
• Longer weekly opening hours
• Weekend working
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 2 of 29
There was recognition that a decision needed to be made swiftly in order for practices to
mobilise.
2.2 Minutes of the Meeting held on 10th December 2014
a) Calculating the Quality Premium 2013-14
The purpose of the paper was to provide a final position relating to the 2013/14 Quality
Premium.
b) Scheduled Care Demand Management – Community Care Development
The purpose of the paper was to outline the proposed developments across community
services within a primary/community setting as part of the wider scheduled care demand
management initiative.
c) Faecal Calprotectin Testing
CBG were asked:
•
•
•
To support the development of a Faecal Calprotectin pathway in partnership with
East Lancashire Hospitals NHS Trust (ELHT).
To support the implementation of Faecal Calprotectin testing within secondary care
To consider, and approve or otherwise, the proposal to develop a Faecal
Calprotectin primary care screening service for patients with suspected
inflammatory bowel disease.
The clear benefits associated to the use of Faecal Calprotectin testing, including improved
patient experience, and considerable cost benefits were discussed. The implementation of
the test within secondary care can be established within short timeframes.
d) Primary Care Co-Commissioning – Primary Care Development and Assurance
Group Terms of Reference (ToR)
A general update was given in terms of the group and ToRs already established. At the
last GB and Senate it was agreed that BwD would go with full delegation rights, and letters
have been issued to all Practices and the Health/Social Community.
It was agreed that this had to be a separate Committee to GB and CBG, although it may
follow on from one of these meetings to allow for quoracy.
Noted and accepted the paper.
Action:
Needs to come to CBG in February for GB in March – with agreed positions in place.
e) Scheduled Care Highlight Report
No action is required, the paper was noted
f) Prescribing Update – Quarter 2
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 3 of 29
The increased drug costs are putting pressure on BwD CCG, with no direct control of the
expenditure of the prescribing. The Medicines Management are working to manage these
cost pressures.
The paper was noted and comments passed to Medicines Management, no action
required.
g) Any Other Business
Primary Care Access over Holiday Period
26 practices offering additional in hour appointments. Working at promoting these centrally
through Communications. Mrs Lisa Kiernan, Head of Primary Care and Integrated
Community Services, to link with East Lancashire Medical Services and 111 re the practice
data and to include BwD North practices for appointments they don’t use.
3) Quality, Performance and Effectiveness Committee (QPEC)
Chair – Dr Nigel Horsfield, Lay Member – Secondary Care Doctor (Retired)
3.1 Minutes of the meeting held on 8th October 2014
a) Performance Report & Appendix 1 & 2
Mr David Rintoul, Performance and Quality Specialist and Mr Michael Connell, Quality and
Performance Support Officer, jointly presented the Month 4 Quality and Exception Report
produced by the Midlands and Lancashire Commissioning Support Unit (CSU).
b) Lancashire Care NHS Foundation Trust
Improving Access to Psychological Therapies: Continued improvement demonstrated
across Lancashire with the notional 1.25% monthly target being exceeded @ 1.29% The
trust is projecting that all CCG areas will be compliant with the national target by February
2015. The trust is actively engaging with disparate and hard to reach groups to meet the
prevalence target including employers premises (BAE Systems) veterans, perinatal
women, older adults, young men and Asian heritage women.
Memory Assessment Service (MAS): Errors have been identified in the trusts recent
data submissions which have meant that their levels of compliance with the 3 day triage
target have been overstated. These have now been resolved. Consultation is underway
with other commissioners regarding the removal of this target as it is felt to be ineffective
and poor utilisation of resources now that waiting times have reduced significantly. 60.5%
of BwD patients met the 4 week treatment target in July, below the 70% target, but a
significant increase on the June figure of 33.3%. The trust has highlighted incomplete
referrals as being a major contributory problem to delays in treatment, particularly in
Chorley South Ribble/GP areas.
Care Programme Approach (CPA): CPA 7 day follow up continues to be an issue with
Blackpool in particular. All other areas are meeting the 95% target on a year to date basis.
The trust continues to provide detailed breach reports on each individual breach but the %
effect of each breach is significant because of the low numbers involved.
Falls Assessment: It was reported that in a previous edition of the report concerns were
raised around falls at Lancashire Foundation NHS Trust (LCFT). It has been agreed in
future to include a specific update on adult mental health wards and are working with the
trust to improve reporting in this area.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 4 of 29
d) ELHT
Cancer 62 day wait: The target for 85% of patients to receive first definitive treatment for
cancer within 62 days is not being met on a year to date basis. BwD patients stands at
81.3%. To meet the trajectory BwD CCG need to have less than 4.5 breaches per month
from now until the end of 2014/15. As this target may be difficult to reach initiatives were
given to the committee to consider.
Stroke: Currently not meeting 90% for last quarter of patients admitted to the stoke unit
within 4 hours. Improvement measures have been maintained at 50.46% for 2013/2014,
61.4% in July and figure to date for September show a huge improvement of 77.76%.
Friends & Family Test: The response rate to date for ELHT is 8.3% failing both the
Commissioning for Quality and Innovation Payment Framework Target (CQUIN) of 15%
and the Trust Development Authority target of 20%. The trust is due to report back some
analysis around the friends and family test as part of its Q2 Commissioning for Quality and
Innovation (CQUIN) reconciliation process next month.
Accident and Emergency (A&E) 4 Hour: To note the Trust did meet the 95% target in
July but has failed in both August and September at 93.49% and 94.55%. The trust is
looking at implementing a new
e) Other Providers
North West Ambulance Service: Significant deterioration in RED 1 performance in BwD
over the last few months. North West Ambulance Service has been missing the 75% target
overall for several months but meeting the target in BwD.
f) BwD CCG Balanced Scorecard July 2014
Clostridium Difficile: Current position nine over trajectory. Post Infections reviews have
been completed on all nine cases of which were deemed to be unavoidable. Seven were
attributed to ELHT and the remaining two are community acquired. ELHT to carry out a
route cause analysis.
Francis/Keogh/Berwick Update: Mrs Kim Smith, Head of Quality, confirmed that actions
from main providers are to be taken to the Lancashire Quality and Performance meeting
and to be brought back to the committee monthly.
g) Business Items
BwD Public Health Research and Development Update: Ms Ruth Young, Public Health
Consultant, outlined the report which is to highlight progress on identified shared priorities
and to consider opportunities to work with the National Institute for Health Research
Collaboration (CLAHRC)
Safeguarding – BwD Engage – Child Sexual Exploitation Update: Ms Rebecca
McGeowan, Lead Clinician, provided the committee with a summary of the national
updates and recommendations regarding child sexual exploitation and an overview of the
existing developments locally.
Risk Management Report Quarter 2 Update: Mrs Claire Moir, Governance, Performance
and Risk Manager, updated the committee on the current risks held on the full corporate
risk register and asked the committee to note the contents of the report and approve the
closure of Risk 2014/03 - Risk of service disruption due to notice served by East
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 5 of 29
Lancashire CCG to ELHT for Dermatology, Ophthalmology and Musculoskeletal service.
Risk 2014/05: Failure to achieve all levels of Quality, Innovation, Productivity and
Prevention (QIPP) savings 2014/15. Risk ID 2014/06: There is a risk that the CCG will be
unable to accurately forecast the year-end financial outturn due to individual patient activity
services being inaccurately reported within the Broadcare Database system. Assurance
has been given that the information in the database is now correct, spot checks will
continue to be carried out and the risk managed operationally.
Conclusion: Risks approved for closure
In addition, Mrs Moir asked for the following new risks to be included on to the Corporate
Risk Register.
2014/08 - There is a risk that regional requirements to attain RED 1 and RED 2 targets for
emergency services will not be met. 2014/09: There is a risk that scheduled care service
re-design across Pennine Lancashire may not be aligned between East Lancashire and
BwD CCG leading to differences in configuration and inequity of provision.
Conclusion: Risks approved for inclusion.
Cancer Update: Dr Smith provided committee members with a presentation on the
important cancer care targets from April 2014 – March 2014 and also the proposed
governance arrangements for the Pennine Lancashire Cancer Programme Board. Dr
Smith further outlined the financial penalty that each CCG will lose if they do not reach
target. Lengthy discussion with regards to the various breach reasons across the trust
which related to 66% of all breaches plus a further breakdown of all reasons given on Open
Exeter by patient choice. Lengthy discussion on the reasons why BwD consistently fail to
reach target compared to East Lancashire raised concern amongst committee members.
Mrs Lynn Scott, Service Redesign Manager, confirmed that East Lancashire CCG are to
advertise for a cancer tracker to pull out urgent GP referrals to help manage a patients
journey through the system.
3.2 Minutes of the meeting held on 29th October 2014
a) BwD 62 Day Cancer Recovery Plan: Mrs Scott and Ms Juliette Mottram, Cancer Services
Manager, were asked to attend the meeting and provide a further understanding of the various
issues across the cancer pathways and whether it would it be possible to get a list of all
patients who are at 40 days and then pull those patients to see how far they are along the
pathway and to see what could be done to prevent them from breaching.
Ms Mottram
informed the Committee that the service are already doing this, and outlined the various multidisciplinary team/tracker/hot clinics/ meetings that are held weekly to try and pull out the
various patients that may breach and pull them through the system. Ms Mottram said that an
analysis of the breaches for BwD has been carried out to which it was noted that patient choice
was a one of the factors for the breaches as there appears to be a reluctance from patients to
attend the unit at the Burnley site, and that some patients who need a bowel screening scope
are going to Preston.
Conclusion: The committee thanked Mrs Scott and Ms Mottram for attending but commented
that they felt less assured than previous and that there was now an acceptance amongst the
committee that BwD would fail to reach target and therefore the recovery plan needs to be
explicit regarding actions to be taken with clear timescales
Action: Escalation of BwD 62 day cancer breaches to be raised with Dr Chris Clayton, Clinical
Chief Officer, and Governing Body members that BwD will not reach target.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 6 of 29
b) Performance Report and Appendix 1 & 2
Mr Connell presented the Month 5 Quality and Exception Report produced by the Midlands
and Lancashire CSU.
c) LCFT
Improving Access to Psychological Therapies: Prevalence rates have fallen in August to
below the 1.25% notional target at both Trust level and for BwD patients. The Trust are
continuing to look to improve rates via promoting the self-referral pathway aimed at target
groups. Recovery rates remain below 50% target for al CCG’s at 36.72% Trust and 34.48%
for BwD patients.
Memory Assessment Service (MAS): The target of 70% of patients triaged within 3 days by
the MAS was met across the trust in August with the exception of Blackpool.
Monitor: LCFT Continuity of Service Ratings. The risk that the Trust will fail to carry on as a
going concern has been downgraded from 4 to 3. As a result of the Trusts financial position at
month 1, where the Trust have reported a deficit due mainly to out of area treatments and cost
improvement failures. Since month 1 the Trusts financial position has improved and they
expect to move back up to 4 at the end of Quarter 2.
National Reporting and Learning Systems: To note that both trusts show lower degrees of
harm, however it was noted that LCFT are showing a significantly higher number of incidents
than other mental health organisations.
d) ELHT
National Cancer Patient Experience Programme: Results from the survey show a
downward trend with only the question around patients bringing a friend with them to
appointments shows an improvement.
18 weeks referral to treatment: 3 specialties failing 18 weeks Refer to Treatment (RTT) at
Ear Nose and Throat, Urology and Oral Surgery. It was noted that more narrative is needed
from the Trust.
A&E 4 Hour: The Trust failed the 95% target in August at 93.49% under performance
attributed to bed capacity and patient flow.
Stroke 4 hour target: August performance of 68.67% against the stroke 4 hour target, which
is below the 90% local quality requirement but is still an improvement from previous years.
Friends & Family: A&E response rates remain low and are below CQUIN target of 15% for
the 3rd consecutive month at 12.6%.
e) North West Ambulance Service
Red 1 and Red 2 Emergency Calls – Performance has improved against both Red 1 & Red 2
response time targets with the CCG position of 82.35% and 77.72% against a target of 75%.
To note the CCG’s quality premium is linked across the whole of the Trust on a year to date
position. Mrs Smith confirmed that a meeting with all providers looking at the number of
increased failings is to be addressed shortly.
f)
NHS Constitution: The CCG is currently rated Red for 6 NHS Constitution measures in
August 2014: 4 Hour A&E waiting times; 31 day cancer subsequent treatment waits; 62 day
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 7 of 29
cancer 1st definitive treatment waits; 62 day NHS Cancer Screening Service waits; Ambulance
Red 1 response times; and Ambulance Red 2 response times.
g) Business Items
Safeguarding Review Action Plan: Mrs Sue Clarke, Head of Safeguarding, outlined the
purpose of the review which was to understand the governance arrangements and the capacity
within the CCG to deliver statutory functions and inform future commissioning arrangements.
Strategic Clinical Network Care Education Standards for Care and Support for the dying
person: The Committee noted the contents of the report and agreed the process and the
suggested monitoring arrangements.
Risk - Risk Management Report – Quarter 2: Mrs Moir asked the Committee to note the
contents of the report and said that at present there are currently no new risks for inclusion on
the corporate risk register and also that there are no risks recommended for closure.
ACTION: Following discussions with committee members around the 62 day cancer
recovery plan it was agreed to increase Risk 2013/08 to 15 – Increase Risk CO4.2 to 16
as committee members were in agreement that there is added risk around the financial
element of the CCG’s co-commissioning bid of delegated responsibility and to reduce
2014/02 to 9 following Mr Keith Dibble’s confirmation that LCFT’s protocol has now
been signed off and in place. To be reviewed in 3 months.
3.3 Minutes of the meeting held on 26th November 2014
a) Mr Stuart Sheridan, Learning Disabilities and Complex Needs Manager, provided the
Committee with an overview of the national response following the Winterbourne Hospital
2011 abuse allegations and outlined the actions and locally agreed joint plan aims that
are in place, plus the next steps to reduce admissions and out of borough placements of
children and young people across BwD.
To Note: Mr Sheridan asked the Committee to note that there are currently 20
people in different types of hospitals at a cost of approximately £1.5 million.
b) Performance Report and Appendix 1 and 2
Mr Rintoul and Mr Connell Performance Support Officer presented the Month 6 Quality
and Exception Report produced by the Midlands and Lancashire CSU.
c) LCFT
Improving Access to Psychological Therapies (IAPT): The notional 1.25% target for
prevalence was not met in September at CCG level or provider level, however there was
some slight improvement in August. Referral rates in all areas are below that required to
meet the 15% target to which the trust are implementing a wide range of strategies to
increase referrals in particular self-referrals. Mr Rintoul asked the Committee to note that
the planned relaunch of the IAPT service under the ‘Minds Matter’ is now underway.
Memory Assessment Service (MAS): The 70% target for patients to be seen within 4
weeks was not met in any CCG area in September with 57.5% being seen in BwD and
42.19% on a trust wide basis. The average wait in BwD was 7.4 weeks below the trust
average of 11 weeks. Poor quality referrals continue to be an issue. Mrs Smith
commented that the referral criteria for this is to be challenged next year.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 8 of 29
Care Programme Approach: Blackpool continues to be reported as not achieving whilst
other areas are. Reporting errors within LCFT have been identified and raised with the
Trust. An internal investigation is currently underway and it is likely that there will be
some revision of previously submitted information.
CQUIN: Mr Rintoul confirmed that of the 8 CQUIN Schemes 5 have met target, 1 has not
met and the remaining 2 are not due to report this quarter. The friends and family test
scheme is not meeting the target which is due to a combination of national delays and
poor implementation within the trust.
d) ELHT
Cancer: The trust met the 62 day cancer target in September at 90.33% but is failing the
year to date position at 82.78%.
Pennine Lancs 62 Day Cancer Waiting Times Business Plan: The Committee noted
the contents of the business assurance plan and commented that they are all still not
assured that the trust will meet target.
A&E 4 Hour: It was noted that East Lancashire Hospitals trust have failed the 95%
target in September at 94.55%. A&E targets are failing nationally with a national figure of
92.9%. Underperformance was attributed to bed capacity and patient flow pressures.
Improvement measures at the trust include the development of triggers and responses
for earlier escalation and the development of a live data feed of performance to support
escalation and the introduction of earlier discharges in the day.
Stroke 4 hour: Performance against the stroke 4 hour admission target has declined in
correlation with A&E performance. 60% of patients were admitted to the acute stroke unit
within 4 hours in September. Medical bed capacity was attributed to one of the causes.
North West Ambulance Service: The Red 1 and Red 2 response time targets have
been met at CCG level with performance at 81.63% and 82.02% against a target of 75%
in September. However as previously discussed the CCG’s quality premium is linked to
performance across the whole of the trust on a year to date position which is still failing
due to performance in other areas.
A&E Benchmarking: Analysis carried out around A&E attendances across Lancashire
shows that BwD has a significantly low level of A&E attendance which stands at 6%
below expected levels. It was noted that patients in the East locality have the higher rate
of attendance to the A&E department.
Outpatient Benchmarking: Mr Rintoul gave an overview of the two specialties currently
experiencing significant overtrades at the trust which are pain management and trauma
and orthopaedics.
e) Safety
Insulin Incident Update Response Diabetologists: Dr Malcolm Ridgway, Clinical
Director for Quality and Effectiveness, provided the Committee with a brief overview of
the insulin incident and the investigations that was carried out. CONCLUSION: It was
noted that as no harm was caused to the patient this is not classed as a never
event.
Safeguarding Quarterly Report:
Mrs Clarke provided the Committee with the first
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 9 of 29
quarterly update report which in the future is to be presented dashboard style.
Conclusion: The Committee noted the contents and the identified risks.
Pan Lancashire Child Death Overview Panel Annual Report 2013 -2014: Dr Gifford
Kerr, Public Health Consultant, provided a summary of the sixth annual report since the
Child Deaths Overview Panel became statutory in April 2008. Dr Kerr asked the
Committee to note that the number of notifications received in each reporting year since
becoming statutory in 2008 shows a decline in child deaths. It was noted that
chromosomal, genetic and congenital anomalies are the largest category of death for
BwD.
f) Risk
Risk Management Report: Mrs Moir asked the Committee to note the contents of the
report and approve the inclusion of one new risk 2014/10 Risk to inappropriate
arrangements made under the Mental Health Capacity Act Deprivation of Liberty
Standards to the register and to approve the closure of Risk ID 2014/09 Risk that the
service re-design models in scheduled care are not aligned resulting in inequity of service
across Pennine Lancashire.
CONCLUSION: Chairs Actions: Recommendations approved.
4) Audit Committee
Chair – Mr Paul Hinnigan, Lay Member – Governance
Minutes of the Meeting held on 22nd October 2014
a) Apologies for Absence and Confirmation of Quoracy
Apologies were received. The meeting was confirmed as quorate.
b) Minutes of the Meeting held on 4th June 2014
The minutes of the meeting of 4th June 2014 were reviewed and approved as an accurate
record.
RESOLVED: That the Minutes of the Meeting held on 4th June 2014 were approved as
an accurate record.
c) Matters Arising
Minute 14.006.4 – External Audit – Key Issues for CCGs – National Update
Mr Roger Parr, Chief Finance Officer, provided feedback on the issue relating to
pharmaceutical companies’ discounts, which was one of the ‘top ten issues’ identified in the
national update. Mr Parr confirmed that there were no issues locally.
d) Minute 14.039.1 Audit of Annual Accounts and Financial Statements and Review of
External Audit Opinion – Value for Money Conclusion
The Chair reported that the action related to a number of Information Technology (IT)
issues had been discussed during a Governing Body (GB) meeting.
e) Risk Management Report
Mrs Claire Moir, Governance, Performance and Risk Manager, presented the Risk
Management Report, which provided members with an update on the management of risks
held on the Corporate Risk Register (CRR) for the period April – September 2014.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 10 of 29
At the GB meeting in August, 10 risks were identified and assigned to a Senior Officer in
the CCG.
The CRR is presented to the QPEC every month to approve or remove risks; discussed at
the Executive Team and Operations Group and also reviewed by the Clinical Chief Officer
on a monthly basis.
The Governing Body Assurance Framework (GBAF) is reviewed by the GB on a quarterly
basis and the dates for review were provided in the report.
It was noted that some risks may continue to be monitored by the QPEC on a monthly
basis, even if the target was being achieved.
Members of the Audit Committee (AC) agreed that they were satisfied with the adequacy of
the systems of internal control within the CCG and that the processes in place appeared to
be robust.
RESOLVED: That the Audit Committee noted the content of the report.
f) External Audit
Progress Report
Mrs Karen Murray, Director, Assurance, Grant Thornton UK LLP, presented the first
progress report for this year, which provided the AC with a report on progress of the
delivery of External Audit’s responsibilities for 2014/15.
Mrs Murray added that audit work has not yet commenced but there would be an interim
visit to the CCG within the next few months. It was noted that, once the Department of
Health (DH) had notified CCGs of the 2014/15 pre-audit and post-audit final accounts
deadlines, AC meetings would need to be coordinated with the deadlines.
Mrs Murray drew members’ attention to the emerging issues and developments section of
the report which highlighted matters the CCG needed to be made aware of and the section
which reflected on the process of the preparation and audit of the CCG financial statements
for 2013/14. Mrs Murray invited comments from the CCG on how the process could be
improved for 2014/15.
Annual Audit Letter
Mr Chris Whittingham, Manager, Assurance, Grant Thornton UK LLP, presented the
Annual Audit Letter for 2013/14, which was the final element of the audit process and
brought it to a close. Mr Whittingham highlighted key elements of the letter:
•
•
•
Auditing the 2013/14 accounts
Final statements opinion
Value for Money conclusion
Mr Whittingham reminded members that the Audit Findings report had been presented to
the June meeting of the AC. He confirmed that there had been no issues for the group
auditor to consider and that all deadlines had been met.
Mr Whittingham stated that, once guidance was available from the DH, he would meet with
Mr Parr to discuss planning for 2014/15. He confirmed that the audit fee for 2014/15 would
be in line with expectations.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 11 of 29
RESOLVED: That the Audit Committee noted the content of the reports.
g) Internal Audit
Progress Report
Mrs Lisa Warner, Senior Internal Audit Manager, Mersey Internal Audit Agency (MIAA),
presented the Progress Report which provided an update to the AC in respect of the
assurances, key issues and progress against the Internal Audit Plan 2014/15.
Mrs Warner drew members’ attention to key messages; one of which related to a report
regarding the Quality of Commissioned Services and the subsequent actions required by
the CCG. The report concluded that there were good systems and processes in place with
just three recommendations.
Mrs Warner reported that all the recommendations for 2013/14 had been actioned.
Mrs Warner outlined work in progress, which would be reported to the AC following
completion. She assured the AC that the plan would be delivered by the end of the financial
year.
Mr Parr reported that he had met with Mrs Warner to discuss the plan and ensure that
delivery remained on track. He had also discussed the Quality of Commissioned Services
Report with Mrs Kim Smith, Head of Quality and the three recommendations within the
report would be addressed via the QPEC.
Charter
The Internal Audit Charter is mandated through the Public Sector Internal Audit Standards
(2013) and is a formal document that defines the internal audit activity’s purpose, authority
and responsibility.
Mrs Warner requested that the AC consider and approval the Internal Audit Charter.
Audit Committee Handbook Briefing
The briefing provided a summary of the key changes to the revised AC Handbook that was
issued in June 2014.
It was suggested that the AC may wish to review its Terms of Reference in light of the
changes.
MIAA Briefing – Sustainability and Human Factors
The two briefings produced by the MIAA were circulated for information and in order for the
CCG to consider its own arrangements.
Clinical Commissioning Group Assurance Framework Benchmarking Report
Mrs Warner provided an overview of the report which set out the results of a recent
benchmarking exercise undertaken by MIAA on CCGs GBAFs. It was noted that Blackburn
with Darwen CCG had been included in the exercise. The report provided an opportunity
for CCGs to compare key elements of their frameworks to other CCGs.
RESOLVED: That the Audit Committee:
• noted the content of the reports
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 12 of 29
•
approved the content of the Internal Audit Charter.
h) Anti-Fraud
Progress Report
Mrs Clare Ward, Local Counter Fraud Specialist, presented the progress report in the
absence of Mr Roger Causer. Mrs Ward informed the AC that Mr Chris Morris, Senior
Counter Fraud Service Manager, was leaving the MIAA and Mr Causer was the Interim
Senior Counter Fraud Service Manager whilst a replacement was being recruited.
The report set out the work undertaken during the period of April – September 2014 and
highlighted activities and outcomes to be brought to the attention of the AC. Section 2 of
the report indicated the type of work agreed in the plan for the financial year with Mr Parr
and progress made against each area of work. Sections 3 and 4 indicated any detailed
findings and investigations summaries respectively.
Following an enquiry from the Chair, Mrs Ward assured the AC that the full plan would be
delivered by the end of the financial year.
RESOLVED: That the Audit Committee noted the content of the report.
i)
Losses and Special Payments:
Mr Parr presented the Losses and Special Payments report.
There were no losses or special payments made during the period 1st April – 30th
September 2014.
RESOLVED: That the Audit Committee noted the losses and special payments made
during the period 1st April – 30th September 2014.
j)
Waivers and Standing Orders
Mr Parr presented the Waivers and Standing Orders report.
There were two single tender waivers for the period 1st April – 30th September 2014.
RESOLVED: That the Audit Committee noted the single tender waivers recorded for
the period 1st April – 30th September 2014.
k) Gifts and Hospitality/Register of Interests
Mr Parr presented the Registers Update.
Mr Parr reported that the CCG was in the process of completing its Staff Register of
Interests (not including members of the GB who were included in a separate register
published on the CCG’s website) but the quality of information was not of a standard to
meet the requirements of the national template distributed by NHS England.
There were plans to complete the register on a face to face basis and then it would be
brought back to a future meeting of the AC.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 13 of 29
There were several entries to the Gifts and Hospitality Register since the last meeting of
the AC. The entries related to vouchers received by the Chairman for work to complete
online surveys and would be used in staff incentive schemes.
RESOLVED: That the Audit Committee noted the current position related to Gifts
and Hospitality/Register of Interests.
l)
Out of Pocket Expenses Update
Mr Parr presented an update on the current position related to Out of Pocket expenses.
This was a legacy issue from the former Care Trust Plus.
RESOLVED: That the Audit Committee noted the content of the update.
m) Consultation of Consultation of Regulations for NHS Bodies’ Auditor Panels
The Chair presented the draft regulations developed by the DH to implement new
constitutional requirements for ACs (acting as auditor panels) of NHS Trusts and CCGs for
information and to bring to members’ attention that the consultation had taken place and
the outcome was awaited.
RESOLVED: That the Audit Committee noted the content of the proposed
regulations.
n) Audit Committee Work Plan 2014/15
The Chair presented the work plan and enquired if members were happy with the content.
The content of the work plan was agreed.
RESOLVED: That the Audit Committee Work Plan for 2014/15 was agreed.
o) Quality, Innovation, Productivity and Prevention
Mr Parr presented the report to inform the AC of the current position relating to
achievement of 2014-15 Quality, Innovation, Productivity and Prevention (QIPP) target and
provide assurance on the process.
It was noted that the schemes would be presented to the Operations Group in November
which monitors performance and progress.
RESOLVED: That the Audit Committee noted the achievement against the 2014/15
QIPP target for the period April 2014 to September 2014.
p) Quality, Performance and Effectiveness Committee
Dr Nigel Horsfield drew out key elements from the minutes from the QPEC.
Minutes of the meeting held on 30th April 2014
The Audit Committee noted the minutes.
Minutes of the Meeting held on 28th May 2014
The Audit Committee noted the minutes.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 14 of 29
Minutes of the Meeting held on 25th June 2014
The Audit Committee noted the minutes.
Minutes of the Meeting held on 30th July 2014
The Audit Committee noted the minutes.
RESOLVED: That the Audit Committee noted the content of the minutes of the
Quality, Performance and Effectiveness Committee.
5) Information Governance Steering Group
Chair – Mr Roger Parr, Chief Finance Officer/Senior Information Risk Owner (SIRO)
Minutes of the Meeting held on 25th November 2014
a) Information Governance (IG) Toolkit
The CCG is aiming for level three on some of the requirements this year. Internal audit are
visiting the CCG on 9th December 2014 for an initial view of the evidence available so far.
Internal audit will then submit a report with recommendations to complete actions by the
end of March 2015.
b) IG Training
The CCG is currently at 99% of staff having completed their annual IG training. 1 member
of staff is being followed up.
c) Information Security
SIRO reports show that there is a good level of information security awareness within the
CCG and this is reflected within spot check audit reports.
d) Freedom of Information (FOI)
The IG Group agreed the FOI process has improved, however, Mrs Claire Moir,
Governance, Performance and Risk Manager, will be meeting with the Commissioning
Support Unit to review outstanding issues.
e) Privacy Impact Assessments (PIAs) and Information Sharing Agreements (ISAs)
The PIA and ISA for the Accident and Emergency project is now complete and in the
process of being signed off.
6) Lancashire Clinical Commissioning Group Chairs’ Network
Chair – Dr Chris Clayton, Blackburn with Darwen CCG
Minutes of the Meetings held on 25th September 2014 and 30th October 2014
The ratified minutes of the above meetings are attached as Appendices A, B and C.
7) Blackburn with Darwen Health and Well-being Board
Chair – Councillor Mohammed Khan
Minutes of the Meeting held on 8th December 2014
The approved minutes of the above meeting are attached as Appendix D but subject to the
following amendment: Page 4, paragraph 5, line 3 to “and the delivery of early help for children
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 15 of 29
and families “ to be deleted and replaced with “and Transforming Lives delivery model in Blackburn
with Darwen”.
8) Recommendation
The Governing Body is requested to note the content of the report.
Mr Iain Fletcher
Head of Corporate Business
5th January 2015
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 16 of 29
Appendix A
Meeting held on Thursday 25 September 2014
Meeting room 231, Second Floor, Preston Business Centre,
Watling Street Road, Fulwood, Preston PR2 8DY
Present:
Dr Chris Clayton (Chair) Blackburn
Dr Ann Bowman – Greater Preston
Dr Tony Naughton – Fylde & Wyre
Dr Amanda Doyle – Blackpool
In attendance:
Mrs Linda Riley - LCSU
Mr Carl Ashworth – LCSU
Ms Samantha Nicol – Healthier
Lancashire Programme (item 3)
Mr Martin Clayton – Area Team (item 6)
Mrs Jan Ledward - Greater
Preston/Chorley & South Ribble
Mr Peter Tinson – Fylde & Wyre
Mr Mike Maguire – West Lancashire
Mr David Bonson – Blackpool
Mr Mark Youlton – East Lancashire
Mrs Jill Truby – Network (minutes)
1. Welcome, apologies for absence and declarations of interests
Dr Chris Clayton welcomed everyone to the meeting. Apologies for absence were received from Dr
Mike Ions, Dr John Caine, Dr Gora Bangi, Dr Alex Gaw, Mrs Debbie Nixon, Mr Andrew Bennett, Ms
Karen Sharrocks and Mr Andy Roach. It was noted that there was no representation from Lancashire
North; therefore the meeting was not quorate. There were no declarations of interests in relation to
agenda items.
2. Minutes of meeting held on 28 August 2014
Minute 2.2 Specialised Commissioning – final sentence to read “Mrs Ledward informed the group that
the National Commissioning Specialised Services Task and Finish Group was meeting ………………”
Minute 4 Network Governance
Following sentence to be added after “A wide ranging discussion followed. Mr Maguire suggested that
contribution to Lancashire collaborative schemes should be proportional to the contract financial
values not per head of population wherever possible. Various opinions were expressed ……………..”
Subject to the above amendments the minutes of the meeting held on 28 August 2014 were accepted
as an accurate record.
3. Matters arising and action sheet
The Chairman sought and obtained confirmation that the actions from the previous meeting were
either complete or in hand.
4. Healthier Lancashire
Dr Clayton welcomed Ms Samantha Nicol to the meeting. Dr Clayton reported that regular meetings
were being held and it was noted that the next Leadership forum scheduled for 2 October would be in
the format of workshops. Ms Nicol introduced herself and gave a presentation on Healthier
Lancashire. Highlights of the presentation included:
Background:
• Historic timeline and key milestones that have been undertaken in the last 12 months.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 17 of 29
•
The case for a ‘Health and Care Strategy for Greater Lancashire’ was promoted by the
Lancashire Leadership Forum throughout 2013.
• Strategic workshops took place end 2013.
• Followed up by a paper presented to key partners and the 3 Health & Well Being Boards.
• Key work streams were set up March 2014 to establish some foundations for the programme.
• Substantive Programme Director, in place from September 2014.
Commitment:
• Taken from the draft Strategic Framework – due to be released on 30 October 2014
This reminded members of what they have already agreed to.
Progress so far:
• Lancashire Leadership Forum meeting quarterly and Healthier Lancashire Executive in place
• Enabling projects:
o Digital Health
o Listening to Lancashire
o Leadership Collaboration
• Operational Projects:
o In-hospital
o Out of Hospital
o Neighbourhood Pilots
o Third Sector
• Sustainability Assessment Framework (SAF)
• Programme Management Office in set up phase
• Initial key stakeholder conversations underway
System management – creating a programme
• Phases and outputs
• Timeline
• Process for services change
The Healthier Lancashire Programme will be structured into five stages
• Mobilisation
• Design
• Implementation
• Delivery
• Procurement, contracting and delivery
• At the end of each phase there will be a clear commitment point before moving into the next
one
Illustration of the process for system wide services reconfiguration:
• The process for whole system reconfiguration is about ensuring recommended preferred
options are based on the whole system reconfiguring, including primary care.
• In phase one, mobilisation, a commitment is needed from all statutory organisations involved to
work together collaboratively. This leads into the need for a robust case for change – a public
facing document that creates the momentum for change. Prior to beginning the co-design of
services in the new system it is vital that quality standards are set. They are another way of
showing what needs to change and why and they enable the setting of priorities for action and
are a way of engaging with a larger constituency. The co-design requires the right people to be
together to design the possible service models and a particularly important part for the inhospital group is the work on the clinical interdependencies. This process looks at many
aspects.
• A vast array of options is necessary.
• The process sets out the key activities, but is based on the psychology of co-design and of the
need to engage people and more importantly to not close down options before it is necessary,
leading to a high level of innovation and improvements.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 18 of 29
Next steps:
Governance Structure
• Establish Programme, Clinical and Stakeholder Boards
• Define ‘purpose’ and develop narrative and visual identify
• Agree finance and resource needed
• Set up PMO and put processes in place
• Re-launch work streams
• Collaborative Leadership – progress, incorporate ‘cultural change’ element
• Develop programme plan
• Agreement to mobilise
General discussion ensued and it was agreed that Healthier Lancashire would become a standing
item on future Network agendas and detailed information around resources would be on the October
agenda.
In response to a question from Mr Maguire, Ms Nicol confirmed that the programme included mental
health for all residents regardless of age.
5. Collaborative Commissioning Board governance arrangements
Mr Peter Tinson reported that the terms of reference had been shared and would be signed off at the
first meeting of the Collaborative Commissioning Board (CCB). There was some discussion around
future meeting dates and these would be agreed at the first meeting.
6. Primary care costs
Further to a request at the July meeting of the Network, members received financial information
relating to primary care costs split by CCG. Mr Martin Clayton attended from the area team and took
questions from members relating to the information provided. It was noted that all CCGs would receive
details of the models available, budgets and the various options of support. There would also be
proposed models for conflict of interest and performance. It had been agreed to extend ability to
change constitutions to end of December. Members agreed that it would be useful to have a model
constitution.
Mr Clayton took the opportunity to update the Network around the NHS England organisational
alignment capability programme. Mr Clayton was thanked for attending and updating the Network.
6.1 Conflicts of interest
Deferred to await national conflicts of interests policy.
7. Network governance update
It was considered that the Network governance would continue as originally agreed based on the
CCB.
8. Stroke update
Mrs Ledward presented a stroke update.
Introductory briefings will be prepared that will give people, particularly those who have not engaged
as yet, time to catch up with the overall aims of the review, background context and progress to date.
In addition to this early engagement process, there is further work to ensure continuing communication
and consultation with CCG membership, other representative bodies, such as voluntary organisations,
practice-based patient participation groups and locality forums and links to groups that are hard to
reach. A detailed communications plan will be developed which will set out the basis for on-going
communication and engagement between the programme, CCGs and key stakeholders including
statutory bodies, provider organisations, public, patients and carers.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 19 of 29
CSU is looking at options, numbers, travelling time etc. A GP from Blackburn with Darwen has been
appointed to the clinical senate primary/secondary work stream for Lancashire. Dr Doyle agreed to
share Blackpool’s work.
The Network:
• Noted the contents of the report
9. Individual Patient Activity Programme Board update
Mrs Linda Riley updated members in relation to the current status of IPA services provided by the
CSU across the Lancashire CCGs footprint.
The CCGs had advised the following to be taken forward which was agreed at the Customer Forum:
• The CCGs to take ownership of the IPA Programme Board with immediate effect
• To secure independent external expertise to work with us to further review areas of concern
• To work jointly to look at alternative options for service provision of Lancashire CCG IPA
services.
The CSU is keen to work with CCGs to secure the above outcomes but has so far not been able to
secure CCG chair ownership to the programme Board in order to progress the above areas.
All elements of the service will continue to be updated and provided through the IPA programme
Board with necessary and appropriate updates to the CFO and / or Customer Forum.
A detailed action plan had been put in place following the review by KPMG. Mrs Riley reported that the
next scheduled meeting of the programme board is to be cancelled and used as a workshop.
Members agreed that it was not about money/numbers but interfacing with the most vulnerable
patients Lancashire is responsible for. Mrs Riley confirmed that in future quality indicators would be
submitted to the Network.
Members also received a copy of a monthly report advising on the highlights of work stream
performance within the Individual Patient Activity Function of NHS Midlands and Lancashire
Commissioning Support Unit. Members noted the contents of the report.
10. CSU services
Members received a copy of a letter sent by Blackpool CCG on behalf of all Lancashire CCGs in
relation to commissioning intentions for the CSU services in 2015/16. Representatives from each of
the Lancashire CCGs had met on 5 September to obtain a collective view of their respective
commissioning intentions for CSU services from April 2015. The Network was informed that this
would be the only item at the next customer forum.
11. 111 Procurement
Mr David Bonson gave an update around progress of NHS 111 service. CCGs were asked for their cooperation in delivering their CCGs approval to the procurement to enable implementation of the new
contract before winter 2015. Item to be included on next CCB agenda.
12. CAMHS SRO
Following the departure of the SRO for the CAMHS programme there was a need to consider the SRO
function moving to another CCG. After discussion it was agreed in principle that Dr Ann Bowman
would continue as clinical support and that Blackburn with Darwen would consult as to what was
required. Dr Clayton to ask Mrs Nixon and Mr Hopley to action.
13. Minutes from other meetings
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 20 of 29
13.1 CAG
The minutes of the Collaborative Arrangements Group meeting held on 9 September 2014 were noted
for information.
13.2 Quality Surveillance 10/7/14
The minutes of the Quality Surveillance meeting held on 10 July 2014 were noted for information.
14. Any other business
14.1 Community Equipment Store – an update from Hilary Fordham, Lancashire North to be
circulated.
15. Date of next meeting – 30 October 2014, Meeting room 1, Conference Suite, Floor 1, Preston
Business Centre, Area Team/Specialised Commissioning in attendance.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 21 of 29
Appendix B
Ratified Minutes
Meeting held on Thursday 30 October 2014
Meeting room 231, Second Floor, Preston Business Centre,
Watling Street Road, Fulwood, Preston PR2 8DY
Present:
Dr Gora Bangi (Chair) Chorley and South Ribble
Dr Ann Bowman – Greater Preston
Dr Mike Ions – East Lancashire
Dr Amanda Doyle – Blackpool
Dr John Caine – West Lancashire
Dr Alex Gaw – Lancashire North
In attendance:
Mrs Linda Riley - LCSU
Miss Samantha Ruthven-Hill – LCSU
Mr Declan Hadley (item 4)
Mr Stewart Bond (item 4)
Ms Samantha Nicol – Healthier Lancashire
Programme (item 5)
Mrs Jennifer Aldridge (item 9)
Mrs Jean Rollinson (item 9)
Mrs Alice Marquis-Carr (item 9)
Mrs Jan Ledward - Greater
Preston/Chorley and South Ribble
Mr Mike Maguire – West Lancashire
Mr David Bonson – Blackpool
Mrs Debbie Nixon – Blackburn with Darwen
Mrs Sarah Camplin – Fylde and Wyre
Mrs Hilary Fordham – Lancashire North
Mr Mark Youlton – East Lancashire
Mr Gary Raphael – Blackpool
Ms Karen Sharrocks – Chorley and South Ribble
Ms Kathryn Chester – Chorley and South Ribble
1. Welcome, apologies for absence and declarations of interests
Dr Gora Bangi welcomed everyone to the meeting. Apologies for absence were received from Dr
Chris Clayton, Dr Tony Naughton, Mr Andrew Bennett, Mr Peter Tinson, Mr Carl Ashworth, Mr Iain
Crossley, Mr Iain Stoddard, Mr Roger Parr, and Mr Paul Kingan. There were no declarations of
interests in relation to agenda items.
2. Minutes of meeting held on 25 September 2014
Agenda item 2 (Network Governance) CCG Network minutes from 2 September 2014 was queried by
Mr Mike Maguire, with reference to the contribution to Lancashire collaborative schemes being
proportional to the contract financial values and not per head of population wherever possible. It was
noted that a discussion had taken place but no decision made.
Subject to the above amendments, the minutes of the meeting held on 25 September 2014 were
accepted as an accurate record.
3. Matters arising and action sheet
The Chairman sought and obtained confirmation that the actions from the previous meeting were
either complete or in hand.
4. Healthier Lancashire
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 22 of 29
Dr Bangi welcomed Ms Samantha Nicol to the meeting. Ms Nicol updated members on the Healthier
Lancashire Programme. Copies of the presentation had been circulated and members were asked for
any comments and/or questions.
Ms Nichol outlined the Healthier Lancashire process and why it is being undertaken:
• Healthier Lancashire is about creating an environment across Lancashire to deal with
transformation issues and barriers, work collaboratively, whilst also allowing CCGs to develop
independently.
• Healthier Lancashire will ensure resources are organised in a way to achieve better health
outcomes.
• On 27/11/2014 a document will be published that will include input and information received
during Healthier Lancashire discussions.
• The document will include the vision, values, principles, commitment, and scope of the
Healthier Lancashire programme.
• CCGs will be able to review and provide feedback on the document
• The decision making process will be clearly defined within the document.
Further discussions are required to confirm the leadership and decision making process for Healthier
Lancashire.
5. GP IT Strategy
Mr Declan Hadley and Mr Steward Bond outlined the potential areas for collaboration around digital
health across the Lancashire CCGs. The proposed initiatives aim to bring together the Healthier
Lancashire Digital Health Programme, the emergent CCG IT Strategies and the Informatics Work Plan
of the Commissioning Support Unit. Fourteen potential areas for collaboration have been identified.
CCGs were asked to prioritise the areas they wished to collaborative on. The following actions were
agreed:
• Approach providers and other stakeholders to establish how their priorities align
• Develop a detailed proposal based on the emergent priorities
• Consolidate this revised plan into the Healthier Lancashire governance structure
• Link with the North West Coast AHSN to share good practice and innovation
• Indicate whether they wish to collaborate on a low, medium or high level
Further information was requested in order to progress this collaboration, particularly capital charges
and finance issues.
Some of the collaboration areas will be easier to implement than others, and it was agreed to
commence these areas first.
It was agreed that a financial strategy was required in order to progress the GP IT Strategy. The
financial strategy should include modelling, affordability, pros and cons, what we are doing now
against opportunities for the future, timelines, and mapping of the next steps.
It was agreed that a more comprehensive GP IT Strategy plan should be prepared and submitted to
the CCG Network meeting on 18th December.
CCGs to complete template forms and return to Mr Declan Hadley by mid-November.
6. Mental Health reconfiguration
Mrs Debbie Nixon verbally updated members in relation to the Mental Health Inpatient reconfiguration:
• This is on track to deliver by the deadline of 2017/18 and efficiency savings will be achieved.
• There is an encouraging trend of reduced out of area placements.
• Delayed discharge is currently being reviewed.
• The Crisis Acute Pathway is also being reviewed.
• The Task Finish Group have agreed to continue with funding.
Mrs Nixon will produce a paper to be submitted to the Collaborative Commissioning Board. The CCGs
can then present the paper to their Governing Bodies.
7. CSU contracts for 2015/16
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 23 of 29
Mrs Linda Riley verbally updated members in relation to CSO Contracts for 2015/16.
The 2015/16 CSU contracts are being negotiated, and CCGs have been provided with pricing
information.
A table has been produced by service line advising of what is included and the prices.
The Lead Provider Framework with prices will be ready for January 2015. However there are some
uncertainties due to a number of CCGs indicating significant reductions in contracts with CSU. The
impact needs to be understood and business cases developed to be considered by NHS E area team.
8. Differences between Lancashire and GM financial planning assumptions
Discussion ensued around arrangements following the merger of the area teams in Lancashire and
Greater Manchester and the possible consequences for Lancashire CCGs.
It was agreed that the Collaborative Commissioning Board would take this forward at its meeting on 11
November in liaison with Healthier Lancashire.
9. Multi-Agency Safeguarding Hub (MASH)
Mrs Jennifer Aldridge, Mrs Alice Marquis-Carr and Mrs Jean Rollinson gave a verbal presentation on
the future involvement of health into Lancashire’s Multi-Agency Safeguarding Hub (MASH). The six
CCGs across the Lancashire County Council footprint have been asked to consider and support a
proposal for a continued health presence within the Lancashire MASH. The CCG Network was asked
to receive the CCG responses to the recommendations within the paper and to agree to consider the
proposal and the commissioning responsibilities to the Lancashire Commissioning Board.
After general discussion members agreed that there was a need to understand the complexity of the
arrangements and it was proposed and agreed to set up a task and finish group. Mrs Ledward agreed
to lead this group and to bring back to the Collaborative Commissioning Board meeting a paper
detailing current arrangements and proposed options going forward.
10. Minutes from other meetings
10.1 The draft minutes from the Collaborative Commissioning Board held on 15 October 2014 were
noted.
11. Any other business
11.1 CAMHS SRO
A paper was presented proposing that Blackburn with Darwen CCG becomes the CAMHS SRO.
Blackburn with Darwen CCG is already the lead contractor for the LCFT Mental Health contract,
overseeing all elements of the contract including CAMHS. The COO in BwD is also the SRO for major
reconfiguration of Adult and Older Adult specialised inpatient services, and leads on the co-ordinating
of the commissioning intentions and required service redesign, monitoring arrangements and
transition. The commissioning of CAMHS services is supported by the CSU but ultimately accountable
to current SRO (East Lancashire CCG). Due to the number of different arrangements currently within
CCGs it was agreed that the CSU be tasked with incorporating all arrangements into a proposal for
presenting to the CCB. It was noted that Dr A Bowman was the Network’s clinical lead for CAMHS. It
was also noted that a paper re CAMHS was being considered at the Lancashire HWB.
11.2 LCA letter re CHC Rates
It was established the all Lancashire CCGs had received this letter and Mrs Riley on behalf of the
CSU agreed to draft a response on behalf of Lancashire.
11.3 Primary Care Co-commissioning
Dr Doyle referred to an email from Mr Martin Clayton regarding preparing for co-commissioning of
primary medical services. Mr Clayton had proposed that a sub-group of the CCB be set up to manage
this issue going forward. Dr Bangi volunteered to Chair this group and CCGs were asked to send
nominations for the group to Dr Doyle.
11.4 Telestroke
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 24 of 29
Mrs Ledward reported that following analysis of providers she would bring back a paper
recommending a decision on the outcome of the negotiation of the services following the termination
of the contract by North Cumbria. She advised this was an urgent issue due to the contract ending in
December.
12. Date of next meeting – 27 November 2014, Meeting room 231, Floor 2, Preston Business Centre,
Area Team/Specialised Commissioning in attendance.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 25 of 29
Appendix C
Meeting held on Thursday 27 November 2014, 09:00 to 12:00
Meeting room 231, Second Floor, Preston Business Centre,
Watling Street Road, Fulwood, Preston PR2 8DY
Present:
Dr Chris Clayton (Chair) – Blackburn with Darwen
Dr Ann Bowman – Greater Preston
Dr Mike Ions – East Lancashire
Dr John Caine – West Lancashire
Dr Tony Naughton – Fylde and Wyre
Mr Andrew Bennett – Lancashire North
Mrs Jan Ledward – Greater Preston/Chorley
and South Ribble
Mr Mike Maguire – West Lancashire
Mr David Bonson – Blackpool
Mr Peter Tinson – Fylde and Wyre
In attendance:
Mrs Linda Riley - LCSU
Mr Carl Ashworth - LCSU
Ms Samantha Nicol – Healthier Lancashire
Programme (Item 3)
Mr Richard Jones – NHS England
Ms Preeti Sud – NHS England (Item 2)
Mr Peter Elton – NHS England (Item 2)
Ms Kathryn Chester – Greater Preston/Chorley
and South Ribble (Minutes)
1. Welcome, Apologies for Absence and Declarations of Interests
Dr Chris Clayton welcomed everyone to the meeting. Apologies for absence were received from Dr
Gora Bangi, Dr Amanda Doyle, Mrs Debbie Nixon, Ms Susan Warburton, Dr Alex Gaw, Ms Jenny
Scott, and Ms Karen Sharrocks. There were no declarations of interests in relation to agenda items.
2. Respiratory Network for Lancashire
Ms Preeti Sud and Mr Peter Elton gave a presentation on respiratory care in Lancashire.
Specific highlights included:
• Lancashire has the worst premature mortality rate for lung disease in England.
• Respiratory emergency admissions feature strongly in the top 10 emergency admissions by
diagnosis in Lancashire.
• The average length of hospital stay for COPD in Lancashire is above the national average.
• The number of COPD non elective zero day admissions in Lancashire has reduced.
• In 2012/13 the Lancashire Area Team had 11,393 undiagnosed COPD cases, and 35,164
undiagnosed asthma cases.
• A national respiratory strategy has been published. There are NICE guidelines for COPD and
asthma. There are commissioning toolkits and other resources available, and a virtual network
is being established nationally (Respiratory Futures).
• Ms Sud agreed to help CCGs to take stock of the current situation and acknowledged the
challenges and opportunities for improving quality of respiratory services across Lancashire.
Action
• CCGs to confirm their respiratory lead and provide Ms Sud with this information.
3. Healthier Lancashire
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 26 of 29
Dr Clayton welcomed Ms Samantha Nicol to the meeting. Ms Nicol updated members on the Healthier
Lancashire Programme:
• Healthier Lancashire was covered on the agenda at the recent Executive Group meeting.
• A Healthier Lancashire Summit has recently taken place and was attended by 115 people.
• The Lancashire Leadership Forum is taking place on 27 November, and the Healthier
Lancashire draft Purpose Document will be presented at this meeting.
• Members to review the document over the next 2 weeks, and provide feedback to Ms Nichol.
An amended document will then be produced in January 2015.
• The next phase of Healthier Lancashire commences on 5 February 2015.
• The Purpose Document will confirm whether tasks are most suitable to be completed locally by
CCGs or whether they should be completed at a Lancashire level.
• Lancashire County Council Budget cuts could impact on Healthier Lancashire.
• Members requested further clarity regarding organisations that are supportive of Healthier
Lancashire, and those that are not supportive.
4. and 5. Primary Care Co-commissioning and Specialised Commissioning
Mr Richard Jones provided an NHS England update on primary care co-commissioning and
specialised commissioning:
• NHS England will be announcing new operational commissioning directors on 28th November.
• There will be a new appointment for the Lancashire and Greater Manchester area.
• There will be a 50% reduction in VSM appointments across the North of England, and a
voluntary redundancy package will be available.
• The new roles will go live at the end of January 2015.
• CCGs will be expected to take on some extra roles from NHS England.
• NHS England will monitor the performance of the new system and provide assurance. Should
any failure be identified, NHS England will be able to intervene and use its’ powers.
• NHS England’s 5 year forward view is to encourage local systems to build on existing work,
and co-commissioning to ensure the focus for Lancashire is not lost.
• Some specialised commissioning is returning to CCGs as part of Tier 3 services.
• These include neurology outpatients and referrals, renal dialysis, bariatric surgery and
specialised wheelchairs.
• CCGs will be advised as to who is providing these services, and co-commissioning will
commence in 2015.
• A national group has been created to review the budgets for specialised commissioning.
• The implementation of specialised commissioning services will be discussed at the CCB
meeting, and then discussed at the Network on 18th December.
• Specialised Commissioning Boards to be set up for Tiers 2 and 3 by February 2015, and South
Cumbria to be included in the planning.
Actions
• Members to identify any statutory actions that are required in order to implement specialised
commissioning.
• Co-commissioning Board to pick up the issue of specialised commissioning and raise
significant issues for the Network to consider.
6. Minutes of CCG Network Meeting Held on 30 October 2014
Mrs Linda Riley advised of an error within agenda item 7 on page 2 of the minutes. This should read
as the Lead Provider Framework with prices will be ready for January 2015 and not September 2015.
Subject to the above amendments, the minutes of the meeting held on 30 October 2014 were
accepted as an accurate record.
7. Matters Arising and Action Sheet
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 27 of 29
The Chairman sought and obtained confirmation that the actions from the previous meeting were
either complete or in hand.
8. IPA Update
Mrs Linda Riley provided an update on IPA:
In July 2014 CCGs made three requests in relation to IPA and CHC:
• CCGs to take ownership and chair the IPA Boards.
• Systems to be reviewed and CCGs to be given assurance.
• To jointly look at the alternative models of future care provision.
Following a meeting on 1 November with CCGs, 5 work streams have been identified and 2
representatives from each CCG have been agreed. A formal report from Ian Fletcher will be presented
to the Network on 18 December.
The concept of a clinical lead for IPA was further discussed and the specific requirements will be
considered by the Network.
9. Minutes from Other Meetings
The draft minutes from the Collaborative Commissioning Board held on 11 November 2014 were
noted.
AB drew the attention of the meeting to the item 9, Transforming Community Equipment
Services, and the resolution made by the CCB:
‘The TCES programme has been developed as a Lancashire-wide procurement of services. In
addition to the 6 CCGs within the programme, LCC is a key party to the process.
Through the CAG there has been an established agreement with ELCCG to request a variant bid,
in addition to the Lancashire-wide bid.
CCB is asked to support a continuation of the procurement process and the inclusion of the EL
variant bid.
ELCCG is asked to participate fully in the tender evaluation process and work with all partners to
secure the best tender outcome for all CCGs and LCC.’
It was noted that East Lancashire CCG had subsequently agreed this CCB resolution.
On this basis, JL agreed on behalf of GP/C&SR CCGs that the procurement could now progress to
PQQ. AB reported that the programme will progress to tender before Christmas.
10. Any Other Business
10.1 IFA and Non-Commissioned Procedures Policies
Dr Ann Bowman advised that individual CCGs have been writing their own policies rather than using
Lancashire policies.
The reasons for this needed to be discussed, as the CCG Network had previously agreed on joint
policies.
Mrs Jan Ledward advised that a meeting had been organised to discuss this matter but only Chorley
and South Ribble and Greater Preston attended this. The risk of not having any policies in place had
been identified, and processes were put in place due to the old policies being out of date.
Eleven draft policies written by Karen Slade have been approved, and it was suggested that these are
adopted across Lancashire.
It was agreed that a Lancashire approach to policy development is required.
10.2 Stroke Update
Mrs Jan Ledward provided a stroke update:
• Following a request for expressions of interest, two proposals have been received from
Blackpool CCG and East Lancashire CCG.
• Both CCGs have advised that the cost to continue with the service will be over £100,000.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 28 of 29
•
•
•
Both CCGs have been asked to justify this cost. East Lancashire has responded, advising that
there will be an improvement in quality. Blackpool is yet to respond, but needs to do so by
Monday 1 December 2014.
Rationale will be provided to support the decision when a CCG is chosen to provide the stroke
service.
There are CCGs who have not replied to confirm their agreement to the stroke service
specification. These CCGs will be emailed directly by Mrs Ledward.
Action
Mrs Ledward to email CCGs who have not yet confirmed their agreement to the stroke service
specification.
10.3 Neurology and Dermatology
Mrs Ledward presented a letter from Salford CCG advising that waiting times for neurology, spinal
surgery and dermatology at Salford Royal Foundation Trust are breaching the RTT standards for both
admitted and non-admitted. The letter requests that CCGs in Lancashire, Mersey and West Cheshire
support GP practices to consider Preston and Walton Neurology services before electing to refer to
SRFT.
Action
Mrs Ledward to prepare a letter to be sent to the specialised commissioning team for advice regarding
this matter.
11. Date of Next Meeting – 18 December 2014, 09:00 to 12:30, Meeting Room 1, Floor 1, Preston
Business Centre.
Governing Body Sub-Committees and Groups’ Summary – 14th January 2015
Page 29 of 29
Appendix D