dudley clinical commissioning group board - Dudley CCG

DUDLEY CLINICAL COMMISSIONING GROUP BOARD AGENDA Thursday 12 May 2016 1.00pm – 4.00pm rd Boardroom, 3 Floor, Brierley Hill Health & Social Care Centre, Venture Way, DY5 1RU QUORACY Meetings of the governing body will be quorate when four elected GP clinical members and two other governing body members (one from the lay members or secondary care doctor and one from the Chief Accountable Officer, Chief Finance Office or Chief Quality and Nursing Officer) are present, (provided that if the Chair is not present, then either the Accountable Officer or Chief Finance Officer must be present). Time

Agenda Item

Attachment

Presented By

1pm

1.

Apologies

1pm

2.

Declarations of Interest To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration for discussion or vote on any questions relating to that item.

1pm

3.

Minutes from Board held on 10 March 2016

Enclosed

Dr D Hegarty

1.05pm

4.

Minutes from Extraordinary Board held on 31 March 2016

Enclosed

Dr D Hegarty

1.05pm

4.

Matters Outstanding

Enclosed

Dr D Hegarty

5.

Public Voice

1.10pm

5.1

Mrs J Jasper

1.15pm

5.2

1.20pm

5.3

Questions from the Public Verbal To respond to questions from members of the public received prior to the Board, in writing, on the provision of health care to the population served by the CCG. Feet on the Street: ‘What one thing would you change to Presentation improve health in Dudley Borough?’ Public Update Enclosed

1.30pm

6.

Chairman & Chief Executive Officer Report

Verbal

Mr P Maubach

7.

Strategy

1.40pm 1.50pm 1.55pm

7.1 7.2 7.3 8.

Corporate Objectives Partnership Board Report Sustainability and Transformation Plan (STP). Quality & Safety

Enclosed Enclosed Enclosed

Mr M Hartland Mrs S Cartwright Mr M Hartland

2.05pm

8.1 9.

Quality and Safety Committee Report. Governance

Enclosed

Dr R Edwards

2.15pm 2.20pm 2.25pm 2.35pm 2.45pm 2.55pm 3.05pm

9.1 9.2 9.3 9.4 9.5 9.6 9.7

Report from Audit Committee Audit Committee Annual Report 2015/16 Constitution Update Combined Board Assurance Framework and Risk Register Declarations of Interest Staff Survey Report from Remuneration Committee BREAK

Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed

Mrs J Jasper Mrs J Jasper Mr M Hartland Mrs J Jasper Mr M Hartland Mrs S Cartwright Mrs S Cartwright

Dr D Hegarty Mrs L Broster

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Time

Agenda Item 10.

Attachment

Presented By

Finance and Performance

3.10pm

10.1 Report from Finance, Performance & Business Intelligence Committee 11. Acute & Community Commissioning

Enclosed

Mr M Hartland

3.15pm 3.25pm 3.30pm

11.1 11.2 11.3 12.

MCP Procurement Report from Commissioning Development Committee Integrated Commissioning Executive Report Primary Care Commissioning

Enclosed Enclosed Enclosed

Mr N Bucktin Dr S Mann Mr N Bucktin

3.35pm

12.1 Report from Primary Care Commissioning Committee

Enclosed

Mr S Wellings

3.40pm

13.

Reflection Time

14.

Exclusion of the Press and Public

15.

That under the Public Bodies (Admission to Meetings) Act 1960, the public and representatives of the press and broadcast media be excluded from the meeting during the consideration of the following items of business as publicity would be prejudicial to the public interest because of the confidential nature of the business to be transacted. Date and Time of Next Meeting Thursday 14 July 2016 1pm – 4pm Boardroom, BHHSCC

A Glossary of terms is included at the end of the papers

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD PUBLIC MINUTES MINUTES OF THE MEETING HELD IN PUBLIC ON THURSDAY 10 MARCH 2016 AT BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE ATTENDEES: Members Dr D Hegarty Mrs C Brunt Dr J Darby Dr C Handy Mr M Hartland Dr M Heber Mrs J Jasper Dr R Lewis Dr S Mann Mr P Maubach Dr R Tapparo

Chair & GP Board Member – Dudley CCG Chief Nurse – Dudley CCG Clinical Executive – Dudley CCG Lay Member for Quality and Safety – Dudley CCG Chief Operating and Finance Officer – Dudley CCG Secondary Care Clinician – Dudley CCG Lay Member for Patient & Public Engagement – Dudley CCG GP Board Member – Dudley CCG Clinical Executive & GP Board Member – Dudley CCG Chief Executive Officer – Dudley CCG GP Board Member – Dudley CCG

Non-Voting Members Ms J Emery Dr R Gee Dr T Horsburgh Miss K Jackson Mr D King

Chief Executive – Healthwatch GP Engagement Lead – Dudley CCG LMC Representative – Dudley LMC Deputy Director of Public Health – Dudley MBC (on behalf of Ms D Harkins) Head of Membership Development & Primary Care – Dudley CCG

In Attendance: Mrs L Broster Mr N Bucktin Mrs S Cartwright Ms S Johnson Mrs T Downton CCG024/2016

Head of Communications and Public Insight – Dudley CCG Head of Commissioning – Dudley CCG Head of Organisational Development and Human Resources – Dudley CCG Deputy Chief Finance Officer – Dudley CCG Minute Taker – Dudley CCG APOLOGIES

Apologies were received from: Dr R Edwards Dr M Mahfouz Mr T Oakman Mr S Wellings CCG025/2016

Clinical Executive, Dudley CCG GP Board Member – Dudley CCG Strategic Director, People – Dudley MBC Lay Member for Governance/Vice Chair – Dudley CCG DECLARATIONS OF INTEREST

Members were asked to disclose any interest they may have, direct or indirect, in any of the items to be considered during the course of the meeting and to note that those Members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. 1|Page

Mrs Jasper declared her standing interest as Chair of the Audit Committee, Sandwell and West Birmingham CCG and also in agenda item 9.3 (Auditor Panel). Dr Heber declared she was employed by Shrewsbury and Telford Hospital. Lay Members declared an interest in agenda item 9.4 (Report from Remuneration Committee). CCG026/2016

MINUTES FROM BOARD HELD ON 7 JANUARY 2016

The minutes of the meeting held on 7 January 2016 were accepted as a true and accurate record Resolved: 1) The Board accepted the minutes from the 7 January 2016 as a true and accurate record CCG027/2016

MATTERS OUTSTANDING

CCG008/2016 – Chairman and Chief Executive Officer Report (Clinical Forum) It was noted that a Primary and Secondary Care Clinical Forum was in the process of being arranged. CCG008/2016 – Chairman and Chief Executive Officer Report (Quality Report) Mrs Brunt informed the Board that she had requested Dudley Group NHS Foundation Trust to share their Quality Report at the earliest opportunity but the Trust had declined and advised that it would be shared once it was a completed document in May/June. The Board requested Mrs Brunt obtained clarification from Dudley Group Foundation Trust on whether a completed document was classed as when it was formally published, or when it was in the public domain. Dr Darby entered the meeting

CCG010/2016 – Health Inequalities Ms Harkins had provided a summary of the financial implications in relation to the Public Health Budget as a tabled document. Miss Jackson was in attendance at the Board on behalf of Ms Harkins, who was on long term sick leave. Mr Hartland asked for some assurance that the £1,045m identified as investment efficiencies in Public Health commissioning arrangements would not be in the areas which form part of the CCG Assurance Framework next year, areas such as childhood obesity and smoking. Miss Jackson agreed to provide some assurance in readiness for the Assurance Framework next year. CCG019/2016 – Report from Clinical Development Committee Mr Bucktin advised that work was ongoing with the System Resilence Group on how services are grouped and aligned to work to the same outcome objectives. PUBLIC VOICE CCG028/2016

QUESTIONS FROM THE PUBLIC

Mrs Jasper reported that no questions had been received from the public in advance of the Board. Resolved: 1) The Board noted that no questions had been received from the Public CCG029/2016

FEET ON THE STREET: PUBLIC ACTIVATION

Mrs Codd introduced Feet on the Street and informed the Board that as part of the listening exercises which had taken place, Healthwatch Dudley had been commissioned to carry out some different activities which go beyond the traditional engagement to support the Five Year Forward View. The Activate Sessions worked with people to gain their knowledge and skills and to ask what assets they could offer to help with some of the issues within the health system. This highlighted good ideas and it was noted that there had been national interest in the exercises, and the Police had also expressed an interest. 2|Page

Mrs Brunt asked how the Activate and listening exercise would feed into the new care model. Mrs Codd advised that Healthwatch Dudley had been commissioned to carry out an analysis at the end of the listening events, including the Activate sessions and would produce a full report to be presented to the Partnership Board in April. A Vanguard Engagement Group had also been established who would look in more detail at the report to identify and concentrate on any gaps. It was noted that the Activate sessions were open to both children and adults but as part of the listening exercises, engagement had been made with the young Dudley health researchers. Resolved: 1) The Board received the presentation for assurance CCG030/2016

PUBLIC UPDATE

Mrs Broster spoke to this item and advised the Board on the following key areas: Listening Exercise Mrs Broster thanked her team for organising and attending the Listening Exercises and events. It was noted that there had been over 40 events which had taken place and this was more than any other organisation had carried outas part of a listening exercise, which was not a formal consultation. The Activate sessions had identified some of the key things which make patients’ health and care better and make them more resilient. Future work needs to be carried out with regards the informal networks and how people can be supported before they get to their GP and other health services. Mrs Broster also thanked Healthwatch Dudley, Spaghetti and Dudley CVS for their input. Patient Online All practices are required to have coded records available to their patients by 31 March 2016. At the time the report was prepared there were 10 out of 46 practics who were enabled and it was reported that as at 10 March 2016 that had increased to 35 out of 46 practices. Mrs Broster confirmed that they were confident that 100% would be reached by the deadline as some practices had advised they were waiting until the end of March due to work being carried out with patients concerning the content of their records and wanted to ensure the information was right. National Media Coverage There was National media coverage from Primary Care Today and the Nursing Times with regards to Dudley’s New Care Model. Periscope The Board were asked whether there was any interest in periscoping the Board meetings to enable members of the public or those who are unable to attend, to view the Board via a video link. Although there was an agreement to explore the option further, some consideration would be given to how comments are restricted as this would not be ideal during a Board meeting, it was agreed that there also needed to be some thought given to publicising and evaluating it. Healthwatch Update Ms Emery reported that Healthwatch had changed the way they updated and tabled the quarterly report which identified outcomes and activities for October – December 2015. Healthwatch Dudley had taken part in the Listening and Activate sessions and the ideas being drawn from them are imaginative and innovative. Further information would be detailed in the report being produced for the Partnership Board in April and the Board would receive it at its May meeting. Ms Emery and Mrs Codd attended a Healthwatch England event which related to the value of engaging with people in service change and they had an opportunity to present. Positive feedback had been received from this event and the New Models of Care team had expressed an interest in spending some time in Dudley to look at how the community work is being developed. It was noted that the Activate sessions had been promoted through bulletins, PPGs and POPs and that Activate packs would be going online to enable people to download them. There would not be a cut off date to this exercise and it would be used further moving forward. 3|Page

Dr Handy made reference to the Vanguard Engagement Group and was encouraged by the number of expressions of interest that had been received. Resolved: 1) The Board noted the report for assurance Mr Maubach left the meeting

CHAIRMAN AND CHIEF EXECUTIVE OFFICER REPORT CCG031/2016

REPORT

Dr Hegarty updated the Board on the following: Notices and Acknowledgements Deborah Harkins Ms Harkins was currently on leave due to a long term illness and the Board requested that Miss Jackson extend to her their best wishes for a full recovery. New Appointments – GP Board Members Following an election process, Dr Fiona Rose from Castle Meadows Surgery and Dr Matthew Read from Woodsetton Medical Practice were both elected as Board members un-opposed. They would represent Sedgley, Coseley and Gornal Locality and start in post from Monday 4 April 2016. Dr Jonathan Darby had also been re-elected as a Board Member representing Halesowen and Quarry Bank Locality for a further three years commencing on Monday 4 April 2016. The NHS Trust Development Authority had announced that they had appointed Mr Ben Reid as the Chair of Dudley and Walsall Mental Health Partnership NHS Trust who would start in post from 8 April 2016. Ms Danielle Oum, current Chair, had been appointed to the role of Chair at Walsall Healthcare NHS Trust. Recent and Upcoming Events Clinical Executive Roles A consultation process had been completed with the membership through Locality meetings on the recruitment process for Clinical Executive Roles and recruitment would commence in April. Value Proposition A Value Proposition had been submitted to NHS England for additional resources to support the development of our new care model and the results should be received by the end of March 2016. CCG Assurance Dudley CCG is rated as outstanding by NHS England through their performance assurance process however, the measures for assurance will be changed next year and will become more dependent on how other organisations are performaing. This would be reviewed by the Finance Performance & Business Intelligence Committee. New Models of Care The involvement with the new care model team at NHS England was very productive and they have responded positively to a request to establish a learning network for CCGs that are commissioning the new care models and as a consequence Dudley would be working with them to commission facilitation support for this CCG network. Dudley has also been selected as one of the six vanguard to participate in an accelerated work programme to scope the detaied requirements for the new contracts. Having spoken to Ian Dodge, National Director for Commissioning Strategy, NHS England, he reported that when he hears of Dudley, it is always well regarded and that the CCG is performing to a high level. Members Event Feedback was presented at the January Members event following the consultation process with GP practices in Dudley with regards to their preferred options for working together, both with each other and with the CCG. It was concluded that they wish the CCG to explore how Future Proof Health Ltd can be 4|Page

used as the main mechanism for their development support. Future Proof Health Ltd A paper had been anticipated which set out the CCG’s engagement to date with Future Proof Health Ltd, however the CCG are awaiting Future Proof Health Ltd returns in response to the due diligence assessment. This is required in order to engage with them for this piece of work. It was noted that this had been requested seven times. Visits to the CCG Ian Dodge visited the CCG in February who oversees the whole national programme for the development of the new care models. The CCG would be hosting a visit from the NHS Confederation in March, facilitating a number of organisations to learn from the work being carried out by Dudley. The CCG would also be hosting a visit from Cantebury and Coastal CCG in March, to understand the work Dudley is doing with regards to the new care models. Sustainability and Transformation Plan (STP) In order to develop a five year STP NHS England are requiring CCGs to collaborate together across a wider footprint. Dudley has initially indicated their support for participating in a Black Country STP involving Sandwell & West Birmingham CCG, Walsall CCG, Wolverhampton CCG and the four local Councils and NHS providers based in our area. Dudley had indicated that the STP needed to be flexible in order to have arrangements into Wyre Forest to facilitate their change of direction and how they would work with acute services and utilising Dudley Group Foundation Trust. As commissioners, further discussion needs to be held on how that would be facilitated. Recent guidance received on guidance of the STPs from NHS England requires that priority will have to be given to managing provider deficits/performance, rather than transformation through the new care models in terms of financial surplus that the CCGs are required to produce. As part of the financial rules, the CCG is required to maintain a 1% surplus which cannot be commited to at the beginning of the financial year. Historically, when this resource has been released, it has been used for transformational work. It is now being defined that the resource will go to Providers within the STP footprint who have a deficit, for example, the money in Dudley could go to Walsall Hospital. The CCG has challenged this guidance with Alison Tonge, Director of Commissioning for NHS England and Dr Hegarty and Mr Maubach have also jointly written to Simon Stevens to inform him that the CCG think it is inappropriate. The effective use of NHS resources generally was recognised in the letter but raising the points that the CCG is required to take forward significant transformational change, drive a new model of care and innovate for the NHS nationally. The funds within the CCGs budget need to be allocated so assumptions have been made in order to move forward and if those areas are to be successful they need to be resourced in the appropriate way. Next Board Meeting An Extra-Ordinary Board meeting will be taking place on 31 March to correspond with the end of the financial year. Board members are required to attend to ensure quoracy as there is a requirement to approve the financial plan and a number of strategies for the next financial year. Dr Gee highlighted that he was on the Shadow Board of Governors for Dudley and Walsall Mental Health Partnership Trust when they were applying for Foundation Trust and felt it was very Walsall focused and that Dudley CCG needs to ensure representations to the Provider, on behalf of mental health services for Dudley patients, are robust. Resolved: 1) The Board noted the report for assurance

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STRATEGY CCG032/2016

COMMUNICATIONS AND ENGAGEMENT STRATEGY

Mrs Broster spoke to this item and highlighted that public involvement goes far beyond the need to consult on specific proposals for major service redesign. The strategy sets out the key principles to follow in order to engage the public in decision making and sets out the arrangements for CCG communications and engagement. It also sets out how the CCG will operationalise the priorities through the commissioning cycle and business planning process that are presented through Commissioning Development Committee. The Board was asked to endorse the principles set out in the strategy and to also approve the strategy, however Mrs Broster emphasised that the CCG would be held to account, following the Board’s decision, for any formal process moving forward. Therefore, there is a duty to have arrangements for engagement and involvement which the strategy sets out and the CCG would be adhering to. Members of the public had been consulted witih on the strategy and Mrs Jasper acknowledged some of the comments which had been received: ‘Seriously, congratulations on such a well presented study’ ‘As a lay reader I found it clearly presented and appropriately detailed’ ‘I feel the language used in this document is quite high level, so if it is aimed at the public, it would need simplifying or a shorter simpler version being produced’ Mrs Jasper assured the Board that a public facing, shorter document would be produced and the Communications Team would address all the comments raised by the public. Resolved: 1) The Board endorsed the principles set out in the Communications & Engagement Strategy 2) The Board approved the Communications & Engagement Strategy CCG033/2016

CORPORATE OBJECTIVES 2015/16 UPDATE

Mr Hartland spoke to this item and advised that the report reflects and updates the Board on the corporate objectives set for 2015/16 which have all been achieved with the proviso that the Board meeting at the end of March was to prepare for 2016/17. The Board was informed that objectives were being set for 2016/17 which, due to the position of the CCG, with regards the operational plan and working through the STP and new models, would be reported back to the Board in May. Resolved: 1) The Board received the report for assurance CCG034/2016

CCG DRAFT OPERATIONAL PLAN 2016/17

Mr Bucktin spoke to this item and reported that the Operational Plan represents the first year of the five year Sustainability and Transformation Plan. The document addresses the key issues set out in the national planning guidance and there are nine ‘must dos’ to address. In addition, the guidance also identifies three gaps; Health and Wellbeing care; quality and finance; and efficiency. Work has been carried out with the Office of Public Health with regards to health and wellbeing and although it was not identified within the document, this area of work has been targeted at locality and practice level and specific work will be carried out to ensure this improves. The draft Operational Plan had been submitted and feedback was awaited. The requirement thereafter is to update the plan to reflect the contract positon with a final submission to NHS England on 11 April 2016. If timescales are met, a final version would be presented to the Board on the 31 March. Dr Handy questioned the quality marks with regards to healthy living and the potential overlap with the Care Quality Commission. Miss Jackson advised that the CQC rating was more regulatory whereas the 6|Page

healthy living mark within the plan was not mandatory or regulated and it was to encourage practices to look at the wellbeing of patients. Mrs Jasper asked if there were any major elements identified which would stop the contract negotiations being concluded by 31 March. Mr Hartland advised that nationally, neither the draft contract or draft tariffs had been published by NHS England but the CCG are working to it’s best ability with the draft versions to agree with providers by the 31 March. Mrs Brunt identified that one of the key developments was concerning personal health budgets and there has been a significant change to the government tariff for next year. Mr Bucktin advised that personal health budgets would be built into the process and there was a requirement to publicise the personal health budget offer on the CCG website by 31 March 2016. This would be extended to cover maternity, and moving forward would also include long term conditions. Mrs Broster, with the approval from Board members, proposed that the draft Operational Plan be publicised on the CCG website to invite comments, following the Healthcare Forum recently, which discussed the plan in detail with members of the public. Dr Horsburgh raised concerns with regards the childhood obesity figures and felt that a task force would be required to look at the figures in more detail and suggest some innovative ways on how this can be improved moving forward. Mrs Brunt agreed with Dr Horsburgh and that it was a theme which was acknowledged within the community following the listening exercises which have taken place. Mrs Brunt had discussed the potential to establish a task and finish group in order to have an initial discussion across agencies recognising that there was a need for a long term planning approach. Dr Hegarty reported that on entry to school 25% of children are obese but by year 6 this increases to 40% and, following a presentation at the most recent Health and Wellbeing Board, they are trying to introduce the ‘mile a day’ concept in schools. The presentation received had identified 20 schools that had shown an interest and the Health and Wellbeing Board had been tasked to increase this number to 70% and to report back in three months time. Dr Hegarty suggested that Dr Horsburgh links into this piece of work, to encourage a cross organisation approach. It was also recognised that 14,000 children have their teeth removed in England due to poor diet and was the most common cause of admission to hospital which was an alarming statistic and was entirely preventable. There was a need to understand further as to whether Stourbridge was still unflouridated as historically Stourbridge was seen to be the most affluent township within the Dudley Borough but had the worst dental care, presumably due to it being unflouridated. Resolved: 1) The Board received the report for assurance 2) That the Draft Operational Plan be publicised on the CCG website to invite comments from members of the public CCG035/2016

PARTNERSHIP BOARD REPORT

Mrs Cartwright spoke to this item and updated the Board on matters discussed at the Partnership Board which had met on 23 December 2015, 26 January 2016 and 24 February 2016. The December meeting included a detailed presentation on the study tour to Spain to visit the Alzira model. The tour included Matthew Gamage from Dudley CCG, Matthew Bowsher from the Local Authority and Paul Bytheway from Dudley Group Foundation Trust. The feedback received was that whilst the model operates in a system which is different to England, learning from good practice can be taken where it is applicable. Also discussed at the December meeting was a detailed briefing on the communications workstream on the three month listening exercise and also discussions on the Value Proposition. The January meeting focused on the Value Proposition which was being submitted on 8 February 2016, and the level of investment requested and recommendations on priorities was discussed in detail. The February meeting discussed the Value Proposition which had been submitted on 8 February 2016 and the approval process. It also received a presentation from the study tour that visited the Buurtzorg 7|Page

model in the Netherlands. The tour included Janet Beddows, District Nurse Team Leader and Tapiwa Mtemachani, Commissioning Manager. The learning from the visit was about self managed teams, caseload management and the input of voluntary sector and communities into their model of care. There was also discussion on the future organisational model and a characteristics workshop has been held as a CCG to look at the characteristics of an MCP model. It was noted that although providers were invited to attend, they were stood down based on legal advice as there needed to be a divide between the CCG, in contracting for the model and the providers who may or may not participate in the competitive process to be the MCP provider in future. Feedback from the Value Proposition was due week commencing 14 March 2016 which should indicate what funding would be received. It was reported that Dudley CCG was leading the way on a number of national workstreams including communications, contracting, workforce, OD and also payments. A number of visits had been hosted by Dudley CCG and itwill continue to do so. Moving forward it has been suggested to have an afternoon every month where people are invited to network by either visiting or hosting conference calls and it was agreed that this would be taken forward. Mrs Cartwright reported that it had been 12 months since the Vanguard was launched and 14 MCPs were selected as part of the programme, three of which have been considered as leading the way, those three being Dudley, Whitstable and Modality. Dr Handy advised that the Partnership Board were concentrating on the issues relating to conflicts of interest and that this would be discussed further at the next meeting. It was also noted that the invitation had also been extended to Healthwatch Dudley and West Midlands Ambulance Service. Dr Horsburgh attended a Paediatric in Partnership meeting and highlighted that Birmingham had experienced similar issues with Providers and Conflicts of Interest and suggested that Mrs Cartwright spoke to them to gather some learning. Resolved: 1) The Board noted the report for assurance QUALITY AND SAFETY CCG036/2016

REPORT FROM QUALITY AND SAFETY COMMITTEE

Mrs Brunt spoke to this item and confirmed that the report summarised the key issues raised at the Quality and Safety Committees held on 19 January 2016 and 16 February 2016. Infection Prevention and Control At the last Board meeting, Mrs Brunt was requested to provide further information on Infection Prevention and Control and this was included as an appendix within the Quality and Safety Report. Antimicrobial Stewardship is also included as part of the Infection Prevention and Control Strategy which is across the system. The Board were assured that Infection Prevention and Control, from a contractual and performance aspect, is a key area moving forward and there is an ongoing focus which is system wide and Quality and Safety would be working with the Public Health Pharmacy Team. West Midlands Quality Review Service (WMQRS) Dementia Review A report was received by the Quality and Safety Committee which provided details of the review of dementia services which commended the progress made since the last review in 2012, whilst identifying areas for improvement which were in relation to diagnostic and assessment pathway; data collection and coordination of services. Maternity Services at Dudley Group NHS Foundation Trust Governance issues had been identified by NHS England during a benchmarking exercise in respect of Dudley Group maternity services. A detailed CCG assessment of the issues raised was ongoing and a full report would be provided to Board when it was available.

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Primary Care Quality A full report on the CQC inspection of Bath Street had been received in terms of their rating of ‘inadequate’. In addition the Waterfront Surgery had been rated as ‘inadequate’ but included a mechanism for special measures which had been publicised. Mr King reported that a process was in place to manage the situation when a practice was rated in these two categories and if they were deemed as being placed in special measures, the CCG would adhere to an NHS England framework for responding to CQC inspections which had been agreed through the Primary Care Commissioning Committee. He continued to explain that in such instances, the practice would be required to undergo a second CQC inspection within six months and within that time was contractually required to produce an improvement plan. When a practice was identified as being in special measures they were able to access additional support through NHS England and the Royal College of General Practitioners. The CCG also has a duty to provide practical support to include peer support, mentorship and training and education. In the event when it does happen, an agreement was made with NHS England that a visit to the practice was carried out in two weeks to take a full contractual review. This will be a joint visit between the CCG Primary Care and Quality & Safety Teams and NHS England and is due to take place on 11 March 2016. With regards to Antimicrobial Stewardship, Dr Mann asked if there was any evidence on the work being carried out by the acute trust. Mrs Brunt confirmed that work was ongoing with the pharmacy team that supports the CCG and the team supporting the acute service. Historically, when CQC inspections have been received as inadequate, GPs have left or retired, and Dr Mann asked Mr King whether there was any assurance that this would not happen in this instance. Mr King advised that with regards to Bath Street Surgery, the GP did retire and the CCG supported the practice through that transition with succession planning, a GP was recruited and the CCG continues to support them. With regards to the Waterfront Surgery, it was too early to report but would advise the Board further when this information became available. Dr Heber was disappointed on the figures relating to infection prevention and control and asked how Dudley is benchmarked nationally, if there was any concept of where we were going wrong and how it could be improved. Mrs Brunt was unsure of the national benchmark figure but highlighted that it was clear that there were issues across the West Midlands however, there are a number of things that could be done in terms of learning from the significant event reviews and root cause analysis that takes place. In addition, it appears that most of the services work in silos and work needs to be carried out on how this can be brought together to make a difference. It was noted that Taunton’s CDiff rate was ‘stark’ in comparison to the West Midlands and figures are incomparable. Mrs Brunt was open to receiving this data to look where Dudley was doing things differently. Mr Hartland asked whether the reductions in public health has an impact on infection control as this needed to be reinforced. Mrs Brunt would be meeting with public health to look at how resources have been taken out of the system generally in relation to this area. Resolved: 1) The Board noted the report for assurance 2) That the Board receive a verbal update with regards to the Waterfront Surgery when the information becomes available GOVERNANCE CCG037/2016

REPORT FROM AUDIT COMMITTEE

Mrs Jasper spoke to this item and confirmed that the report summarised the key issues discussed at the Audit Committee held on 4 February 2016. Information Governance There were two areas of concern with regards to training and the information asset register but the Board were advised that the number of people trained had now increased and were on target; and due 9|Page

to the amount of work that people had done on the information asset register, this was less of a concern. A report was due to go to the next Audit Committee with final numbers. The Committee signed off the Information Governance Handbook and an updated Subject Access Request Operating Procedure. Board Assurance Framework and Risk Register Under it’s delegated power, the Committee approved the closure of Risk 15 which was in relation to the failure to embrace or implement the CCG’s IT Strategy and health care technology. Mr Bucktin had attended the Committee and gave assurance in respect of the processes within the Commissioning Development Committee for managing the risks it was accountable for. External Audit Mr John Gregory has been appointed as the Engagement Lead for Dudley CCG and is the managing partner of the Contract with Grant Thornton. Internal Audit Signifcant assurance was received on the financial system and based on the work carried out to date, internal audit was predicting ‘significant assurance’ overall for the Head of Internal Audit Opinion. Evaluation of Consultant Contracts It was agreed at the last Board that the Audit Committee would share the details of the consultancy spend which was detailed within the report for any consultancy over £10,000. Annual Report and Accounts 2015/16 The Committee received a report on the Annual Report Planning for 2015/16 for assurance which the Committee approved subject to any further guidance from external audit. The Committee also received and approved an update on the preparation for the delivery of the Annual Accounts and approved the draft Accounting Policies under its delegated powers. Mrs Cartwright requested an amendment to the report under 3.1 which referred to the Social Media Policy in that the policy hadn’t been agreed by the Remuneration Committee as it had been deferred to its next meeting to be in line with the HR Policies. With regards to the consultancy spend, Dr Horsburgh highlighted that there was no indication of the total cost spent on consultancy and felt this was significant. Mr Hartland advised that the figures shown in the paper are what is reported to Audit Committee but the value of spend less than £10,000 was small however, all invoices received which are below £25,000 are available on the CCG website. Resolved: 1) The Board noted the report for assurance 2) The Board noted the decisions taken under delegated powers CCG038/2016

COMBINED BOARD ASSURANCE FRAMEWORK AND RISK REGISTER

Mrs Jasper spoke to this item and reported on the position as at 5 February 2016. The Board were advised that amendments had been made to the risk descriptions and there had been no change to the residual risk scores for this period. One new risk had been included: Risk 90 – The CCG has received its planned Resource Allocation for 2016/17 to 2020/21 however there are a number of uncertainties at this stage that do not enable an accurate confirmation of the impact on the CCG’s financial plan and could potentially add pressure to the CCG’s financial position. There were no proposed risks presented for closure.

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Risk 13 – Failure of the governing body to demonstrate appropriate leadership/clinical leadership may result in poor strategy and implementation, and thereby fail to meet statutory and regulatory responsibilities. It was proposed that this risk be routinely included within the report for review by the Board even though the risk had a initial score of 12 due to the accountability being with the governing body. It was noted that the Community Domiciliary risk had been reported through the Commissioning Development Committee and would be reported to Board should the score be above 16. Resolved: 1) The Board noted the report for assurance 2) The Board supported the decision for Risk 13 to be routinely included within this report Mr Maubach returned to the meeting

CCG039/2016

AUDITOR PANEL

Mrs Jasper had declared an interest in this item at the beginning of the Board and requested members to consider the items discussed at the Shadow Auditor Panel on 4 February 2016. The Board was advised at the January meeting that the CCG must have an Auditor Panel in place to advise on the appointment of ther external auditors. The Auditor Panel met in shadow form as the Board had to be in agreement with regards the format of the panel. The Terms of Reference were discussed and also required approval by the Board. All members of the panel were expected to declare any acquaintances with partners or members of an external audit firm. A collaborative procurement process was being considered at CFO level within the Birmingham, Black Country and Solihull CCGs in order to obtain economies of scale. It was noted that Birmingham South Central were leading on this process but Dudley would have a choice of who they appoint. Resolved: 1) The Board approved the establishment of the CCG’s Auditor Panel 2) The Board adopted the Auditor Panel Terms of Reference 3) The Board approved the appointment of Mrs Julie Jasper as the Chair and Mr Steve Wellings as the Vice Chair of the Panel 4) The Board noted the timeline for the procurement process 5) The Board agreed a collaborative approach for the procurement CCG040/2016

REPORT FROM REMUNERATION COMMITTEE

Mrs Cartwright spoke to this item and confirmed that the report summarised the key issues discussed at the Remuneration Committee held on 3 February 2016. Lay Members had declared an interest in the report due to the content on the Remuneration for Lay Members. HR/Workforce Metrics The main area of concern was sickness which is above the national guideline of 3% and was due to four areas of long term sickness. There had been issues with regards to the Electronic Staff Record (ESR) in terms of mandatory training and Personal Development Reviews (PDRs). Mandatory training should be significantly different at the next Committee as a Staff Development Session had took place and expect this figure to be closer to 100%. It was noted that the issue in relation to PDRs was they had not been recorded and not that they hadn’t taken place. Terms of Reference The Committee reviewed the Terms of Reference and made changes which were outlined in the report. Occupational Health and Staff Support The Committee are reviewing the current contractual arrangements for Occupational Health and Staff Counselling to a more local service as members of staff would currently have to travel to the centre of Birmingham to access both services. 11 | P a g e

TUPE Transfer In (Pharmacy Services) A TUPE transfer was agreed for six members of staff who had transferred into the Office of Public Health as part of the Medicines Management Team in the Local Authority. These six members will be transferring back to the CCG on 1 April 2016 and a transition plan has been put in place in order for this to happen. Staff Survey The results of the staff survey were received at the Committee and a full report would be presented to the Board at a future meeting. The decision was made at Committee that the Staff Forum should be engaged in reviewing the survey, together with recommendations. This was discussed at Staff Forum and a further confidential survey will be developed to investigate further some of the areas of concern which at this stage was around bullying and harassment and working hours. Overall, the survey results were positive and indicated that 92% of staff would recommend Dudley CCG as a place to work. Social Media Policy The Social Media Policy was received by the Committee but agreed to defer in order to align it with other HR policies. Remuneration for Lay Members The Lay Members stepped out of the Committee to consider this item. An audit was undertaken on the amount of time the Lay Members are spending in their roles and it was identified that they were all doing significantly more. It was agreed therefore to reflect the remuneration in line with the time they were spending carrying out their duties. Ms Johnson requested that the amended Terms of Reference be presented to the Board for their approval at the next Board meeting. Dr Hegarty recognised the work the Lay Members do and asked that this be recorded formally. Resolved: 1) The Board noted the report for assurance 2) The Board ratified the decision to increase the remuneration for Lay Members 3) The Board agreed to receive the latest Terms of Reference for approval at the next meeting. FINANCE, PERFORMANCE & BUSINESS INTELLIGENCE CCG041/2016 COMMITTEE

REPORT FROM FINANCE, PERFORMANCE & BUSINESS INTELLIGENCE

Mr Hartland spoke to this item and confirmed that the report summarised the key issues discussed at the Finance and Performance Committee held on 28 January 2016 and 25 February 2016. Statutory Financial Duties The CCG expects to meet all its financial duties in 2015/16 which means an end of year surplus of £6,337,000 to be carried forward into next year. The NHS Constitution aggregate standards are being achieved with the exception of six weeks diagnostics, mixed sex accommodation, MRSA and CDiff. CCG Assurance Dudley CCG continues to be rated as ‘outstanding’ by NHS England. An assurance planning meeting would take place on 11 March and the end of year review taking place in April. CCG Allocations 2016/17 to 2020/21 A report was received on notified CCG allocations for the next five years and the potential impact on the CCG’s financial plan. Guidance is awaited on the elements of growth and how it is intended to be utilised. The business rules have been discussed with regards to the long term transition reserve which would be reflected within the Budget Book report to be presented to the extra ordinary Board on 31 March 2016. 12 | P a g e

Transitional Support to Dudley Group Foundation Trust The Committee reviewed the process that had been followed with regards to DGFT transition and have agreed two additional conditions over and above those presented to Committee. These have been built into the Contract next year to ensure the conditions are undertaken. IT Procurement Update A presentation was made to Committee to approve the process for procurement for IT Services for the next three years. The Committee endorsed the recommendation of the IT Procurement Group to proceed to full tender for Dudley IT Services from 1 April 2017. Dr Mann raised the issue concerning transitional support to DGFT and noted that the original decision was not to support funding and it was clear that any conditions were to be non-negotiable. Dr Mann was concerned that it seemed the conditions attached to the request had not got the strong non-negotiatble condition attached to it as discussed. Mr Hartland advised that in the terms and conditions, these would be included in the contract, which DGFT had accepted and the pull back would be to the value of a sum given them for transition this year. A point was raised suggesting that DGFT may request funds to recruit nursing staff overseas but Mr Hartland assured the Board that this would not be supported. Dr Horsburgh queried the mixed sex accommodation breaches at DGFT which were in the Intensive Treatment Unit. Mrs Brunt confirmed there had been a change in the rules in that those patients who are fit on ITU should be moved to a ward, the timeframe had been tightened and if they don’t move within four hours, it would be identified as a breach. Resolved: 1) The Board noted the report for assurance ACUTE AND COMMUNITY COMMISSIONING CCG042/2016

REPORT FROM COMMISSIONING DEVELOPMENT COMMITTEE

Dr Mann spoke to this item and confirmed that the report summarised the key issues discussed at the Commissioning Development Committee held on 20 January 2016 and 17 February 2016. Local Improvement Schemes (LISs) The Committee approved the suspension of LISs for COPD, diabetes, care homes and palliative care in 2016/17, to enable the implementation of the new contractual framework for primary care. Dr Mann advised that the report implied that practices may not be providing those services but this is incorrect and all practices will still be providing those services. What? Centre The Committee agreed to continue funding for the What? Centre subject to review of mental health services generally. The Centre is based in Stourbridge but he confirmed there was a plan to open a branch surgery in Brierley Hill. Pathways Efficiencies The Committee received an update on the pathways in relation to MSK, ENT, Ophthalmology and Urology. It was noted that these were of limited success financially. Medicines Management The Committee approved to maintain the current practice based pharmacy team with regards to the enhanced primary care team for a further six months at a cost of approximately £100,000 and required approval from the Board. It was noted that the GP primary care prescribing budget was a total of £50m so would be a relatively small investment however there is potentially large investments attached to it depending on the outcome of the Value Proposition and an assessment of the impact on pharmacists. Dr Horsburgh asked if there was a breakdown of the overperformance in CAMHS. Mr Bucktin confirmed that this information would be reported to the Commissioning Development Committee but indicated that there were no inappropriate referrals to CAMHS and the issue was the availability of Tier 2 provision. 13 | P a g e

Resolved: 1) The Board noted the report for assurance 2) The Board approved the extension of practice based pharmacists for six months at a cost of £100,000 CCG043/2016

REPORT FROM INTEGRATED COMMISSIONING EXECUTIVE

Mr Bucktin spoke to this item and confirmed that the report summarised the key issues discussed at the Integrated Commissioning Executive held on 21 January 2016. Performance Report The Board agreed at its meeting in November 2015 that it agreed to underwrite the ‘pay for performance’ element of the Better Care Fund to the sum of £1.6m. Current performance, in relation to emergency admissions, equates to a potential saving of £400,000 which leaves a shortfall of £1.2m. BCF Plan 2016/17 Guidance has been received on how BCF plans are to be prepared for 2016/17 and an outline of the main areas to focus on are delayed transfers of care; integrated discharge pathway; support for care homes; falls and carers. A plan was in the process of being produced with the first iteration being submitted on 21 March and the final plan by 11 April. A draft will be presented to the extra ordinary Board on 31 March. It was noted that with the development of the Multi-Speciality Community Provider (MCP) in 2017, the integration of health and social care will accelerate during 2016/17 therefore in effect, 2016/17 will form the last year of the BCF. It was noted that the support for care homes was with regards to the frail elderly pathway and would include Malling Health. Resolved: 1) The Board noted the report for assurance PRIMARY CARE COMMISSIONING CCG044/2016

REPORT FROM PRIMARY CARE COMMISSIONING COMMITTEE

Mr King spoke to this item and confirmed that the report summarised the key issues discussed by the Primary Care Commissioning Committees held on 22 January 2016 and 19 February 2016. Primary Care Contracting The Committee considered two branch surgery closure applications; Market Street Surgery which was a branch surgery of Wordsley Green Medical Practice and Masefield Road Surgery which was a branch surgery of Lower Gornal Medical Practice. Mr King provided the Board with assurance that both practice had fully complied with NHS England policy on branch surgery closures and both the CCG and practices were commended by NHS England on the level of engagement and public consultation that had been undertaken. The Committee in February was held in Gornal and was run as a public meeting with 35 members of the public in attendance. The Primary Care Commissioning Committee approved both applications subject to review in six months time in terms of the impact of patient experience. It was noted that this was the first time the CCG have had to consider such applications and was a rare occurrence however, lessons were learnt from the process and a policy and toolkit have been produced to go through this exercise. New Contractual Framework The new contractual framework was being piloted in 2016/17 which consolidates the Quality and Outcomes Framework, Direct Enhanced Services and Local Improvement Schemes in one framework. The Committee agreed the outcome measures, signed off the evaluation criteria and EMIS template has been produced and was being piloted in 11 practices. Outstanding issues with regards rolling out the framework was on hold as they are waiting for a response from the LMC regarding the contract variation and NHS England have identified some

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technical issues which need to be resolved quickly as the intention is to offer the new contract as a formal variation before the end of March. Engagement of Primary Care Robert Barlam, Primary Care Lead at NHS England attended the January GP Members Event and his comment was that he had never seen such a good level of GP engagement across the country which was extremely positive. Dr Handy commented that more closures may happen so by having a robust process in place is essential and appropriate going forward. Dr Heber added to this by saying the problem arises when people attending the meetings are all opposed to closure of their branch surgery. Although a public consultation takes place, the Committee has to make the decision based on a number of issues and frustrations would be aired. Dr Lewis asked that should there be an adverse patient outcome after the six months what would happen. Mr King advised that the practices involved had gone over and above what they were expected to do and the comments received from their patients have been received and responded to and the practice have committed to, in terms of what they will do over the six months, for example Lower Gornal have commited to doing more home visits. The practices will present back to the Primary Care Commissioning Committee, through their PPGs to give an assurance they have fulfilled the commitments. Dr Hegarty highlighted the support which Mr King and his team had given to the practices in order for them to engage and consult above and beyond what they had done before which needed to be sighted on. Some consideration should be given on where investment needs to be made to support practices which enables them to do this more effectively and following that process and how the work is captured to understand the learning from it in order to consistently move forward. Resolved: 1) The Board noted the report for assurance CCG045/2016

REFLECTION TIME

Members agreed the meeting had been more focused and key points were highlighted appropriately. It was noted that papers being tabled at the Board doesn’t allow enough time for members to consider the content and should be noted for future meetings. EXCLUSION OF THE PRESS AND PUBLIC That under the Public Bodies (Admission to Meetings) Act 1960, the public and representatives of the press and broadcast media be excluded from the meeting during the consideration of the following items of business as publicity would be prejudicial to the public interest because of the confidential nature of the business to be transacted. DATE AND TIME OF NEXT MEETING Thursday 31 March 2016 (Extra Ordinary Board) 1pm – 5pm Boardroom, Brierley Hill Health and Social Care Centre MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD Name

Title

Signed

Date

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD PUBLIC MINUTES MINUTES OF THE EXTRAORDINARY BOARD MEETING HELD IN PUBLIC ON THURSDAY 31 MARCH 2016 AT BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE ATTENDEES: Members Dr D Hegarty Mrs C Brunt Dr R Edwards Dr P D Gupta Dr C Handy Mr M Hartland Dr M Heber Mrs J Jasper Dr R Lewis Dr S Mann Mr P Maubach Dr R Tapparo Mr S Wellings

Chair & GP Board Member – Dudley CCG Chief Nurse – Dudley CCG GP Board Member – Dudley CCG GP Board Member – Dudley CCG Lay Member for Quality and Safety – Dudley CCG Chief Operating and Finance Officer – Dudley CCG Secondary Care Clinician – Dudley CCG Lay Member for Patient & Public Engagement – Dudley CCG GP Board Member – Dudley CCG Clinical Executive & GP Board Member – Dudley CCG Chief Executive Officer – Dudley CCG GP Board Member – Dudley CCG Lay Member for Governance/Vice Chair – Dudley CCG

Non-Voting Members Ms J Emery Dr R Gee Dr T Horsburgh Dr D Pitches

Chief Executive – Healthwatch GP Engagement Lead – Dudley CCG LMC Representative – Dudley LMC Consultant in Public Health – Dudley MBC (on behalf of Ms D Harkins)

In Attendance: Mrs L Broster Mr N Bucktin Mrs S Cartwright Ms S Johnson Mrs T Downton CCG046/2016

Head of Communications and Public Insight – Dudley CCG Head of Commissioning – Dudley CCG Head of Organisational Development and Human Resources – Dudley CCG Deputy Chief Finance Officer – Dudley CCG Minute Taker – Dudley CCG APOLOGIES

Apologies were received from: Dr J Darby Ms D Harkins Mr D King Dr M Mahfouz Mr T Oakman CCG047/2016

Clinical Executive – Dudley CCG Director of Public Health Medicine – Office of Public Health Head of Membership Development & Primary Care – Dudley CCG GP Board Member – Dudley CCG Strategic Director – People, Dudley MBC DECLARATIONS OF INTEREST

Members were asked to disclose any interest they may have, direct or indirect, in any of the items to be considered during the course of the meeting and to note that those Members declaring an interest would 1|Page

not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. Mrs Jasper declared her standing interest as Board Member for Sandwell and West Birmingham CCG and in respect of the agenda item on the Sustainability and Transformation Plan (STP). Dr Hegarty advised that he had been asked to re-establish what was previously the Black Country Senate to provide a Clinical Forum for influencing and informing the STP process across the Black Country. CCG048/2016

CHIEF EXECUTIVE OFFICER UPDATE

Mr Maubach updated the Board on the following: Notices and Acknowledgements The Medicines Management Team members, who were currently employed by Dudley MBC, would be transferring to Dudley CCG on 1 April 2016. Dr Mary Heber’s tenure would be finishing at the end of April 2016 and the Board formally noted the work she had contributed to the CCG and wished her every success in the future. Recent and Upcoming Events Value Proposition The sum of the Value Propositions across the country was significantly oversubscribed and the New Care Models Team has therefore requested the CCG submit a revised, summarised proposition by 15 April 2016. It was anticipated that the outcome of the submission would be received by the end of April. CCG Assurance Dudley CCG would be attending the formal assurance review meeting with NHS England on 6 April 2016. An update would be provided to the Board at the next meeting. FutureProof Health Dudley CCG has been looking at the arrangements with FutreProof Health and a full report would be presented to the Audit Committee. One of the issues was for FutureProof Health to undertake a due diligence exercise which they have failed to comply with, which means it is unlikely that the CCG would invest in them whilst that continues to be the situation. CCG Seal It was noted that the CCG Seal had not been used during the year 2015/16. Resolved: 1) The Board received the report for assurance Dr Mann entered the meeting

CCG049/2016

FINANCIAL PLAN/BUDGET BOOK 2016/17

Mr Hartland spoke to this item and presented the proposed financial budget for 2016/17 financial year for approval by the Board. He advised that it had been presented to the Finance and Performance Committee and had also been approved by NHS England as being sufficient in terms of meeting the indicators and metrics that they would want to see. The Board was asked to note that the budget book sets a plan that achieves the statutory financial duties for next year which is a £6.3m surplus and forms a key part of the performance indicators that the CCG are assessed against by NHS England. There is a five year allocation where there are three years of detailed allocations and two years of estimated allocations which has allowed the CCG to plan with more robustness over the next five years. Mr Hartland advised that 2016/17 is going to be a challenging year financially for three main reasons: the pressures within the provider sector; growth in activity; and the change in business rules. The latter being the biggest financial risk for the CCG. 2|Page

Dr Heber entered the meeting

The CCG was informed that nationally it has a 1% reserve but it cannot be committed which means there is £4.5m additional financial risk. This will not allow the CCG to call on reserves and Mr Hartland stressed it is essential that the budgets being approved were managed and met in year by budget holders and the CCG remains within the contracts it has. A consequence is that the QIPP target has been increased to £14m, part of which is productivity improvements which the CCG is expected to meet and justify. A contributing factor to this is that £5m of QIPP has been met, subject to signature, on the contract with Dudley Group NHS Foundation Trust and other providers for next year which mitigates the risk for the CCG. This has been done by making some assumptions on QIPP and taking them out of the contract at the start of the year. However, there are still initiatives that need to be focused on in year in order to achieve financial balance. The budgets remain split between programme and administration and it was noted that for the first time, the CCG has a £79m notional specialised services budget. The CCG will receive information throughout the year with regards to the proportion of spend for Dudley patients on specialised services, which would be reported to Board. Dr Gupta highlighted the budget increase of 3.7% for months 9-12 only which he felt overall would be quite challenging. Mr Hartland stated that by bringing the Medicines Management Team into the CCG Dr Gupta as Clinical Lead would receive more operational support than previously. Mr Hartland also advised that the CCG would be looking to reduce the drug spend in hospital where it contributes to the increase in primary care. Dr Gupta welcomed the move of the Medicines Management Team to the CCG. Dr Horsburgh stressed that the specialised commissioning budget is currently uncontrollable and the CCG has to be sighted on spend. Mr Hartland advised that, through the working group, it had been requested that the CCG have transparency and reporting to the level which is currently in place in order for the CCG to hold a notional budget for specialised services. In addition to this, through the STP work, the request had been made that the CCG have more control of specialised services and to have a work programme specifically for that. Mr Maubach reported that Dudley CCG was in a better financial position than that of neighbouring organisations and was meeting most of its financial standards. He explained that the reason Dudley was unable to spend the 1% reserve was due to failings within other systems and the expectation of needing support them. However, he highlighted that in terms of long term planning for Dudley CCG, there was a need to focus on the projections and whether they were required. He noted that with the exception of some community services, there was uniform growth across the system but, moving towards a new model of care, the profile of investment would need to move more towards primary care rather than to acute secondary care to meet the rising demand of the population. This would require a fundamental piece of work in how the shift was enacted, to look at the long term modelling forecast for the system as a whole with a clear message to providers on how the shift would transpire. Mr Maubach requested the Board to also consider a recommendation to ensure the long term modelling took place within the first quarter of the year. Dr Mann highlighted that he was not aware that Dudley wanted to be part of the Black Country STP as it restricts flexibility and whether this should be considered. Dr Hegarty reported that the STP footprint had been defined nationally. Dr Mann also asked for some assurance with regards to the £5m QIPP assumptions and where the risk would sit. Mr Hartland confirmed that the risk would sit with Dudley Group NHS Foundation Trust. Mr Wellings acknowledged that the CCG was a financially well managed organisation and meets the targets required. However, if the CCG loses the 1% non-recurrent reserve, this would make the financial situation worse and the CCG is in effect being penalised for its good financial management and effectiveness. Mr Maubach added that due to an agreement between NHS England and NHS Improvement, the new contract that the CCG is required to use removes the ability to fine the Trust. This has been one of the key levers used to correct performance failure as the fines were applied and reinvested. With this mechanism being removed it will inevitably impact on the CCG’s ability to deliver. 3|Page

Resolved: 1) The Board approved the budgets for the CCG for the 2016/17 financial year 2) The Board noted the request to add an additional recommendation to go through a process of financial modelling to see how it predicts against the alternations of balance of services moving towards an MCP approach CCG050/2016

CCG OPERATIONAL PLAN 2016/17

Mr Bucktin spoke to this item and reported to the Board that the final Operational Plan would be submitted to NHS England by 11 April 2016. Feedback had been received from NHS England on the draft plan that was submitted and two points were raised. These were to make revisions in relation to the CCGs plans to improve the dementia diagnosis rate and to reflect the process around the Black Country System Transformation Plan. Once these revisions had been made the CCG would submit the final plan and the Board was requested to delegate authority to Mr Maubach to approval the final Operational Plan for submission. Resolved: 1) The Board agreed for Mr Maubach to have delegated authority to approve the final Operational Plan to be submitted to NHS England by 11 April 2016 CCG051/2016

BUSINESS CONTINUITY PLAN

Mr Hartland spoke to this item and reported that as part of the Corporate Objectives the CCG was required to complete a Business Continuity Plan. The paper informed the Board that the Business Continuity Policy, associated Strategy and Plan were presented to Audit Committee on 17 March and were approved in full under its delegated authority. It was noted that the Plan would feed into EPRR and there would be an action plan which the Audit Committee would manage. The Committee expected a refresh in July. Mr Wellings added that although the Committee approved the Plan, it made the observation that there were aspects of business continuity which related to how the Board operates and therefore approved it subject to this being included in the refresh. Dr Hegarty looked for some assurance with regards to inter-dependencies that sit across other organisations for emergency response. In particular what currently sits with the Local Authority and how the CCG assesses whether other organisations are fit for purpose. Mr Hartland advised that this was being considered by the Quality and Safety Committee. Resolved: 1) The Board received the report for assurance CCG052/2016

SUSTAINABILITY AND TRANSFORMATION PLAN

Mr Maubach spoke to this item and requested Board approval of the Memorandum of Understanding (MOU) which would support the Sustainability and Transformation Plan (STP). Since producing the MOU, guidance had been released by NHS England with regards to the use of the 1% reserve. Mr Maubach made the Board aware that there was a move on the part of the regulators for the STP to become more than a mechanism for producing a larger scale plan. However it does not refer to governance or delegated authority, only other than to produce a plan. Mr Maubach questioned what the benefits might be of becoming a Black Country STP. He reported that the CCG’s main objective and priority for next year was to produce a new model of care and most of the neighbouring systems appear to be moving in that direction as their preferred model. This could provide an opportunity to influence and encourage other CCGs. In addition, given the financial constraints, it seems that the current organisation of secondary care was not sustainable and there needed to be collaboration between the Acute Trusts on a Black Country footprint. The potential for an STP is to enable the CCG to work with partners and engage with NHS England and the Acute Trusts to achieve a sustainable solution for not just primary and community services but also for secondary and specialist care 4|Page

Mr Wellings supported Mr Maubach in his comments and added that the CCG cannot go forward with reduced resources and not recognise that there are services that need to be provided regionally and sub-regionally. Whilst services for primary and community care can be developed more locally in Dudley, some of the more specialised services cannot be provided everywhere and it was Mr Wellings’ view that they needed to be provided in the right place so that they can be accessed equally. Board members understood the benefits but were also conscious of the risks that could be presented to Dudley as a CCG. It was also recognised that it was about the culture of the organisation involved in terms of the clinical input and the need to consider the Dudley population and although the priorities were there it was difficult to see them being delivered in such a structure. Dr Hegarty recognised this point and that Mr Maubach had driven the requirements for a clinical structure to look at where the care and quality gaps are across the economies and how it would align with the proposed STP model. Dr Hegarty therefore suggested the establishment of a modified Black Country Clinical Senate which he would lead on the process. Dr Hegarty took the comments on board and explained that the Black Country STP had been defined nationally by NHS England and was not for negotiation. He highlighted that if Dudley was not part of the process it would jeopardise the provision of care across primary, secondary and mental health services for the population of Dudley so the CCG has to be part of the process in order to influence it. He also emphasised that if the CCG moved to sustainability across a bigger footprint and the model being developed was the correct model, the CCG should influence and enable other health economies across the Black Country to adopt it. Discussion took place in relation to the new build in Sandwell and West Birmingham and there were questions raised around how the planning for the provision of secondary care services made a number of years ago, now aligned to an STP process for the Black Country, and whether the building of the hospital is still what is required for the population. Acknowledging the new model of care in terms of where activity takes place in a community footprint, there could be an argument to say it does not. It was therefore agreed by the Board that a formal request be made to NHS England asking if they have discussed with the Commissioner and also the Provider about whether they have tested their modelling across the STP requirements and if they have, what the response had been. Resolved: 1) The Board considered the Memorandum of Agreement and noted that it would be considered further at a future Board CCG053/2016

PROCUREMENT STRATEGY

Mr Hartland spoke to this item and requested the Board to approve the revised CCG Procurement Strategy. It was noted that the structure of the strategy remains unchanged but there were some key changes which the Board were asked to note. These related to OJEU thresholds which would increase to £164,000 before a full OJEU compliant competitive process took place; the adjustment of the internal scheme of delegation which would increase to £50,000 before obtaining competitive quotes; there will be a ‘light touch’ procurement process from 18 April which relates to cross boundary procurements; and finally there will be an expectation to be more explicit with regards to Annex 4 for each procurement where there is a potential that primary care could be a provider. Dr Handy supported the proposals but asked, under the social value act provisions, how much scope the CCG has to encourage local purchasing and whether this could be explored. Mr Hartland reported that Dudley tried to make it a criteria to adopt when it was a PCT, but it could not be included in a framework for procurement and was therefore quite limited on how it can be privileged and prioritised. Mr Maubach agreed with Dr Handy and recognised there was a need to ensure local purchasing became part of the key criteria for any healthcare procurement. Mr Maubach highlighted that under section 4, Dudley CCG Priorities, should be updated to make reference to the CCG Strategic Priorities as set out in the strategic and operating plans in order to reference the most up to date position, otherwise the Strategy could be outdated against the priorities. Mr Maubach also 5|Page

commented that there should be a clear definition on what a mini-tender process looks like with regards to non-healthcare services procurement as this was currently missing from the strategy. Mr Maubach then questioned Tender Waivers and asked how the ‘no tender’ decisions which represent the decision of the organisation rather than an individual, would be tested and suggested adding the waiver documentation so the process was made very clear. Dr Hegarty raised the issue with regard to FutureProof Health and noted that as part of the information and communication they had had with their membership, one of the opinions they had shared was that the CCG would never have been in a legal position to offer them a contract to carry out a piece of work in terms of support to primary care. Dr Hegarty highlighted that Mr Maubach had been explicit at Members events, on more than one occasion, that this sum of money was for a piece of work to support primary care with regards to defined areas of need and the resource was going to go to individual practices to do that. It was for those individual practices to collaborate and identify they wanted FutureProof Health to be the vehicle by which those services were provided, rather than a contract going out to tender, and for primary care and individuals to decide how they put individual sums of money together to gain economies of scale. It was also noted that the CCG has a duty to ensure FutureProof Health is a safe organisation which should have been achieved through a due diligence process which they have failed to follow. Resolved: 1) The Board approved the Procurement Strategy with the suggested changes; to include the organisational priorities; how the mini-tender process is defined; and how the testing of the tender waiver is put in place = CCG054/2016 IT PROCUREMENT Mr Maubach spoke to this item and reported that Dudley CCG would be looking to go out to tender for a new IT Service and asked the Board to support the paper and delegate final sign off to the Finance and Performance Committee, giving approval to proceed with the tender as planned. Mrs Broster highlighted that this procurement excludes the current service provision that the Dudley IT Service provides in respect of the website and intranet so a separate procurement process would have to be entered into for those particular items. The reason for these not being included was that the paper being presented related to the infrastructure to support IT moving forward whereas the web service was separate to this and out of scope.This would mean that the procurement totalled £1.1m and the web element was about £18,000. It was noted that the specification which had been drafted would put a cost pressure on the CCG of over £100,000 but Mr Maubach stressed that there needed to be an IT infrastructure which supported primary care and the MCP moving forward and had to be fit for purpose. It was also noted that Dudley Group NHS Foundation Trust, who run Dudley IT Services were invited to join Dudley CCG to find a solution for an integrated IT infrastructure however they declined the invitiation. In addition, some of the reasons for going through a procurement process was due to the quality of service being delivered and the contract was due for renewal. The Board asked for assurance that there would be no breakdown of service provision whilst going through the procurement process. Mr Maubach advised that the contract with Dudley IT Services had been extended and the aim was for the tender process to be completed with a long lead in time prior to a handover therefore if there were any issues towards the end of the contract, the new provider would already be in place. Dr Lewis raised her concern with regards to the roll out of the new Long Term Conditions Framework which she had been informed may take up until June and the potential impact it could have on primary care during the procurement process. Dr Hegarty recognised that if there was a failure to provide the service from the current provider during the transition, however the new provider may say they are incurring additional costs in terms of rectifying the issues which needed to be considered. Resolved: 1) The Board supported the paper and gave approval to proceed with the Tender as planned 6|Page

2) The Board agreed for Finance and Performance Committee to be given final sign off of the key documents (ITT and Scoring Matrix) CCG055/2016

MCP PROCUREMENT

Mr Bucktin spoke to this item and informed the Board that the intention was to present a report at the July meeting which would define exactly what the Multispeciality Community Provider (MCP) would look like. In order to oversee the procurement process, a Project Board and Project Team would be established and it was proposed that the Project Board be given delegated authority to oversee the process, particulary for the launch of the procurement and to approve who the final contract is let to. The Board was asked to delegate responsibility to the Audit Committee to authorise the final Terms of Reference for the Project Board and that a Non-Executive Director be appointed. As a point of clarification, it was noted that the Project Team would meet on a weekly basis and the Project Board on a monthly basis. Mr Maubach made reference to the membership of the Project Board, particularly in relation to the Clinical Lead post and highlighted that if the Clinical Lead was a GP, that person would be conflicted from the outset and throughout and would have to exclude themselves from any decisions being made. Dr Mann questioned why, this issue had not been highlighted before and Mr Maubach stressed that this was in line with the Conflicts of Interest policy. If the contract was awarded which involved practices and a GP had been involved in the process, it could undermime the whole procurement process. Dr Hegarty emphasised that the paper was focussing onthe procurement of the MCP and not its formation. He felt that clinical input could be provided through a GP who is not on the Performers List, or equally it could be a secondary care clinican which is a role which already sits on the CCG Board. This would not be in isolation but there is obviously a need to have an understanding of primary care. It was noted that the procurement process had been discussed at a recent Partnership Board and one of the undertakings was that the CCG would have a specific conversation, outside the procurement process, with providers in the system. This would be individually to discuss risks, mitigations and issues for their organisation in relation to the MCP. It was felt that a similar mechanism was required with primary care in order to gain their feedback. Dr Mann stressed the importance of handling the process correctly with regards to the GP membership and Mr Maubach pointed out that there has to be a distinction between the GPs represented in developing the MCP versus the procurement and the reason was to allow GPs to be an active part of the conversation. Dr Horsburgh felt there could be an opportunity to have both an external secondary care and primary care clinician as part of the Project Board. In conclusion, it was recognised that the Clinical Lead should not be on the Dudley Performers List in the foreseeable future; the possibility of reciprocal arrangements across other Vanguards but noting they may be in a position to bid for the tender; the need to utilise the Non-Executive Director to pick up the secondary care role and recognising the importance of needing primary care input which is fundamental in the process. Resolved: 1) The Board approved the establishment of the Project Board to oversee the management of the MCP procurement process 2) The Board gave approval for the Audit Committee to approve the full terms of reference for the Project Board 3) The Board agreed that the Non-Executive Director to serve on the Project Board be a Secondary Care Clinician CCG056/2016

ANY OTHER BUSINESS

DGFT Quality Report Mrs Brunt advised the Board that following correspondence with Dudley Group Foundation Trust, they had provided the Quality Report and would take on the CCG comments.

7|Page

DATE AND TIME OF NEXT MEETING Thursday 12 May 2016 1pm – 5pm Boardroom, Brierley Hill Health and Social Care Centre MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD Name

Title

Signed

Date

8|Page

DUDLEY CLINICAL COMMISSIONING GROUP BOARD MATTERS OUTSTANDING THURSDAY 12 MAY 2016 – PUBLIC BOARD MEETING ITEM NO

AGENDA ITEM

Report from Quality and CCG036/2016 Safety Committee – Primary Care Quality

ACTION TO BE TAKEN/UPDATE

ACTION FOR

DEADLINE

The Board to receive a verbal update with regards to the Waterfront Surgery when the information becomes available relating to the CQC Inspection

Mr King

May 2016

COMPLETED

1|P a g e

Public Update Introduction This report is presented with the aim of keeping Board Members up to date with important Communications and Engagement issues and ‘hot topics’. It is also produced with the specific aim of further strenghtening the patient voice at our board meetings by including sections dedicated to feedback from our Patient Participation Groups (PPGs), Patient Opportunity Panel (POP) and Healthwatch Dudley.

The Feet on the Street section of today’s Board meeting is repeating a question that we asked one year ago – ‘What one thing would you change to improve health in Dudley Borough?’ In May 2015, people interviewed told us that being able to get an appointment with their GP or being able to get through to the surgery on the telephone would make the biggest difference. The Board made a commitment to repeat the question a year on to see whether there had been any improvement.

Listening Exercise – Dudley’s biggest conversation ever about health and social care Mid April marked the end of our Listening Exercise. Over 50 groups had taken part with around 700 people turning up. The Doodle Ad proved popular with people understanding the message easily and appreciating a local accent. There was opportunity for people to share positive and negative experiences and on the spot problem solving. The approach around New Care Models and the idea of a Multi-Specialty Community Provider were well received but people did want further information on how this would affect them personally or what the changes really meant when they happened. A draft report has been written by Healthwatch Dudley as they were commissioned to engage further and produce a report. The report needs further analysis and some amendments and a commitment has been made by the engagement team to share the report with all groups involved in the listening exercise as well as being made widely available

Vanguard Engagement Group (VEG) 1

In April we organised an event for the Vanguard Engagement Group to meet the clinical & commissioning leads for MCP work streams. We are keen to explore a co-production and co-design approach. The purpose of the event was to create an opportunity for VEG to meet with the leads and understand their work streams so they could see where they wanted to be involved. Over 20 people joined us and chose their top 3 preferred areas. Details have been shared with commissioning leads for further involvement and co-production. Already we have 2 VEG members sitting on the monthly MCP Procurement Board and strong input into our communications and involvement work. Patient Opportunity Panel (POP) Meeting The POP group met in April in Halesowen with approximately 20 people representing different PPGs around the borough. An update was provided on New Care Models and the MCP with a promise of further conversations around the direction of travel from a member of the senior team. The PPG purse fund and the POPs budget were discussed. Only 14 PPGs had applied for funding which left over £30k in the purse. In addition POPs had not spent any of their £3k budget. Some PPGs who had used all of their funding wanted an opportunity to apply for more and it was agreed that the team approach all PPGs and practice managers to ascertain whether there was intention of using the PPG Purse fund and take back to the next meeting. PPG Navigation Guide We have worked with several PPGs now using the PPG Navigation Guide. Using the health check section we have facilitated sessions with PPGs to help them to develop further and explore their aims and objectives and develop action plans. All PPGs have found the sessions useful and have given positive feedback. Dudley Borough Healthcare Forum The HCF in March focused on the journey so far starting with the Five Year Forward View and updating on the direction of travel. The Operating Plan was also discussed to agree where the priorities lay for the year ahead. 80 people joined us with the opportunity to ask questions. The next HCF takes place on 7 July 2016, 2.30pm until 4.30pm at Brierley Hill Civic Hall and is followed by the Annual Generasl Meeting. Kingswinford, Amblecote & Brierley Hill (KAB) POD (group of PPGS) The last KAB meeting took place in March. 5 PPGs were represented and updates were shared on New Care Models, recent branch closures and the future of estates. The group were in agreement with the idea of having one main hub per locality and would be interested to be involved or hear more when the estates strategy is available. #Me Festival 2016 Planning continues and a decision has been made to focus on younger children. We will be approaching all of the local primary schools and asking if some of their Year 6 students would like to join us. A task and finish group involving partners continues to meet to discuss.

The Social Care Institute for Excellence (SCIE) 2

Work continues with SCIE around End of Life Care. Conversations are currently taking place with key stakeholders and we anticipate a workshop will be organised to bring local people and stakeholders together to explore the issue further.

In March the CCG was selected as a finalist at the national Patient Experience Network awards in the category of commissioning for patient experience. While we did not win the award a lot of the work we have been doing over the last 18 months was recognised as an area of best practice. We are pleased to report that the style of reporting we have developed with The Dudley Group NHS Foundation Trust will continue and we have embedded an information requirement into the contract to support this positive change. It is important to note that this style of reporting has supported a real positive shift towards openness that has allowed us to be a lot more transparent and work together to improve the experiences of services for patients. During the quarter we have engaged most practice managers through the Dudley Practice Managers Alliance at how we can improve the response rate in Friends and Family Test along with the MI Experience rollout. All practices will now have received their communications resource pack and will be contacted in the next few weeks when the second iteration of the app goes live and patients will be able to leave feedback about all commissioned services. Finally it has been identified that the CCG has an ambitious target as part of the quality premium, the CCG is required to have a 3% increase in the total number of “good” responses for overall experience of making a GP appointment. This will challenging as it will require some practices to have a 21% increase in the total number of good responses.

A full report of Healthwatch Dudley outcomes and activities for January – March 2016 is now available to download at: http://www.healthwatchdudley.co.uk/reports

The biggest conversation about health and social care As part of Healthwatch Dudley’s involvement in the biggest conversation about heath and care, we hosted a series of seven Activate events over seven weeks around the 3

Dudley borough engaging more than 150 people in conversations during March and early April. This activity complemented CCG listening event activities some of which were also supported by the Healthwatch Dudley team. Healthwatch Dudley has been asked by the All Together Better Partnership Board to compile learning from all activities into a forthcoming evidence based report. Detailed below are some of our early findings. CCG listening events: More than 50 groups and over 700 people were engaged through CCG led activities. There was a focus on gathering and understanding people’s views on health and wellbeing matters at the CCG listening events. Participants were asked how they might shape how the healthcare landscape and new models of care could look in the future. Some of the groups and organisations that participated in this work are listed in the table below.

Organisation Access in Dudley Dudley Carers Forum Dementia Support Group NHS Retirement Group Dudley Rotary Club Dudley Stroke Association Gornal Community Forum Netherton and Quarry Bank Community Forum Woodsetton Patient Participation Group Carers in Partnership with Mental Health Stourbridge Township Meeting Macular Society Lapal Medical Practice Breast Care Group Coseley and Sedgley Community Forum Stourbridge Community Forum Brierley Hill Community Forum

Rethink - Carer Mental Health Forum Living Hope Church Coffee Afternoon Dudley Women’s Forum Neurology Support Group Learning Disabilities Provider Forum Dudley Voices for Choice Halesowen Community Forum Amblecote and Cradley Community Forum Fibromyalgia group Dudley Youth Council Mind Matters Event Dudley and Walsall Mental Health Youth Forum My Time Over 50 Kingswinford Community Forum Castle and Priory Community Forum Belle Vale Community Forum

At the start of each listening event a doodle advertisement (short video) was shown. It was a summary of the main issues affecting health and social care services and proposed plans for the future (such as services being more joined up and having clearer pathways for accessing services). People were then asked to give their views on what they had seen as well as providing more general thoughts on health and social care matters and services. What people were saying: People’s views on health and social care matters gathered at the listening event are categorised under the positive and negative themes listed below.

Positive Themes Communications Services

Use of text messaging by doctors surgeries, computer and information systems that talk to each other, someone available to talk to on the phone Multidisciplinary team working and effective community care, social 4

Hospitals Access General Practitioners

services, pharmacy and prescription services Well-functioning specialist wards and ambulance services Use of the internet for repeat prescriptions and booking appointments, one click one call No waiting times, quick referrals to secondary care, the idea of telephone consultations seems sensible

Negative Themes Communications

Services

Hospitals

Access

General Practitioners

Referral mistakes, lack of knowledge of patient groups, lack of consultation with carers and service users, lack of feedback, lack of communication between services Lack of integration, lack of specialist training for professionals (such as in dementia care), issues with the make-up and getting access Multidisciplinary Teams, issues with young people’s services and social services, a lack of adequate mental health services Issues to do with hospital discharge processes, people not having care plans, long waiting lists for specialist care, the layout of the accident and emergency department, issues with appointments, car parking, lack of beds and bed blocking, lack of services for the hard of hearing Mistrust of the proposed one click one call service, worries that accessing services in community rather than the doctors surgery or hospital could be detrimental to people seeking help with healthcare matters, issues with transport to doctors surgeries and hospitals, issues with the 111 telephone advice service, lack of availability of specialist doctors at certain times in hospitals, internet based healthcare services not good for people without access to the internet Not being able to get appointments, long waiting times for appointments, more weekend services needed, lack of knowledge on what services are and are not available at surgeries, concerns about a shortage of doctors, lack of opportunity to see the same clinician, issues with prescription services, poor attitudes of staff

Feedback from all of the listening events is currently being further analysed to identify specific themes and trends. Opportunities: The outcomes from the listening events subsequently informed thinking about the Healthwatch Dudley led Activate sessions. The aim was to better understand how people could be involved in finding solutions to problems relating to health services and health and wellbeing. During Activate sessions, people set the scene and stimulated discussion about opportunities to explore how community assets and people’s organising and project skills, could be used to coproduce ideas on new models of care and ways to stay healthy and cared for. Who took part? People from 32 organisations took part in the Activate sessions - as well as individuals attending events of their own accord. This variety of participants meant that the Activate process was experienced by people bringing a range of interests and perspectives to discussions. They also provided rich insights into the challenges they face in moving forward with ideas about how they might better use community assets. Some of the organisations that were represented are listed in the table below. 5

Organisation East Coseley Big Local Dudley Metropolitan Borough Council Ridgeway Surgery Patient Participation Group Nehemiah United Churches Housing Association Dudley Voices for Choice – supporting people with learning disabilities and autism Citizens Advice Bureau Queen’s Cross Deaf Support Service Sickle Cell and Thalassemia Support Stourbridge Soroptimist’s Dudley Library Service Age UK Dudley Black Country Partnership NHS Foundation Trust Diabetes UK Dudley Stroke Association We Love Carers Disability in Action

Dudley Clinical Commissioning Group Dudley Council for Voluntary Service Cranstoun – Switch Dudley (alcohol and drug service Churches Housing Association of Dudley and District (CHADD) Alzheimers Society St. Michaels Church, Netherton Dudley Deaf Group Macular Society Dudley Centre for Independent Living (CIL) Highfield Care Home, Kingswinford Dudley Mind Beacon Centre for the Blind Woodside Day Centre Fit Food Fit Life Community Interest Company Queens Cross Network Dudley Group NHS Foundation Trust

Activate session findings: At the start of each Activate session people were asked, ‘for you personally, what does being healthy and cared for mean?’ The following themes emerged.

Not being unwell Able to self-manage Someone to contact when things go wrong Able to get around

Theme Having a hobby Access to basic necessities Having positive emotions Not being lonely

A second question was asked, ‘what helps you to be healthy, well and cared for?’. The following emerging themes emerged:

Healthy eating Hobbies (helping others) Easy access to services Positive mental health

Theme Exercise Support from friends and family Having enough money Having a job

A third question was asked ‘what hinders you from being healthy, well and cared for?’. The following themes emerged.

Lack of Independence Lack of getting around Personal demons/issues Lack of health and exercise

Personal Themes Pressure and Stress Family and Friends Time to do things 6

Service Themes Lack of knowledge of services Long waiting times and delays in getting access to services Lack of the resources needed to provide good Lack of integration and communication within services and between services An approach to service provision that forgets Finding it difficult to get access to services about the person The ‘how might we? questions were a way of getting people to think of an issue that they felt was a barrier to achieving or maintaining community cohesion and communications. Each Activate session came up with a question that started with ‘how might we?’ and ended by elaborating on a particular issue that they had identified. The different questions that emerged are listed below.

How might we? Communicate with older people about useful technologies and groups Better support families to improve health and wellbeing Help people to achieve a sense of belonging and shared purpose in their community Support people who are not accessing health services but should be Use public and other spaces in better ways Have digital products that connect and facilitate the sharing of community assets Help people to know about what it means to be disabled Ensure there is accessible information and support for people when it is needed Ensure everyone is viewed as an individual and not defined by their status or condition Help people who have health problems and their carers to have an active social life Improve the identification of the care needs of people being discharged from hospital Enable people to be more informed, independent, and make healthy lifestyle choices Raise awareness of the communication issues that deaf people face Improve or maintain healthy lifestyles for people in social care homes Bring people together to find out who needs help A common theme that emerged was centred on the idea of better connecting groups and individuals in communities with each other. This might, in part, be achieved through improved support mechanisms, especially in areas where there is a significant amount of disadvantage. Information giving to communities and individuals was also identified as being important and it was felt new advances in technology could help with this and finding ways to better connect communities and people with each other to undertake activities that help to improve quality of life and wellbeing. Participants at the Activate sessions then started to think about what they would need to successfully implement their ‘how might we?’ questions. The items are listed below.

Needs People Technology

Spaces Secret ingredients

Resources Guidelines

Spaces: people looked to community centres, spaces and hubs in which they could base their project. They could include church halls, community and voluntary organisation premises and facilities in parks. Alternatively, they might be spare space in a doctor’s surgery or health centre. 7

People: Some people felt that for them to make their project work they would need the help of staff employed by organisations already involved in delivering services in communities. They might be involved in activities related to health or housing. Managers in community centres and other specialist teams could offer to help communities to deal with some of the matters to do with organising project work. Resources: Many people felt technological resources could be used to facilitate community inspired project work. This technology could include computers and smart phones. Some people felt income generation would be necessary through, for example, fundraising, to ensure a project remained financially stable. The idea of external resources being brought into a project by people themselves was also popular. This could be as simple as supplies of tea and coffee. Technology: People mentioned computers (desktop and laptops), smart phones (and access to email), Skype and Facetime applications. Some people indicated they were aware that not everyone was familiar with these different types of technology - it may be important to have someone in a project who can help others on how to use them. Most people were enthusiastic about using technology to inform and support people through making communications easier. Secret Ingredient: For those indicating a potential secret ingredient that would help to ensure a project was successful they tended to be concerned with a passion for the work being undertaken, resilience, understanding each other and an enthusiasm to work together. Guidelines: Some people commented on what project guidelines would look like. They would ensure there was a fair sharing of workload to all project members and there would be a risk assessment carried out to try to anticipate how future events might impact on project aims. Project policies, procedures and protocols would also need to be established. Further analysis: Findings from both sets of engagement activities are in the process of being examined in depth and will be compiled into a report that will be presented to the All Together Better Board. The All Together Better Communications and Involvement group will lead on feeding back to all participants that attended, the Vanguard Engagement Group and developing an action plan based on report findings. Our journey in tweets and images!

8

This section of the report includes updates on proactive and reactive media activity and any other current issues. Developing New Models of Care in Dudley This work is a key priority for the team both in terms of raising awareness for Dudley as a Vanguard and in seeking the views of local people on the principles that our model is based on. Media- Dudley has been receiving some national media coverage on our Model as follows: • • •

Dudley Vanguard does away with walls – Primary Care Commissioning Doodle ad to launch listening exercise in Dudley – The Academy of NHS Fab Stuff Supporting people to become more involved, connected and active in their communities - The Academy of NHS Fab Stuff 9

• •

Practices may be able to retain GMS alongside new voluntary contract (MCP vanguards employing GPs) – Pulse Magazine Practices may be able to retain GMS alongside new voluntary contract – Practice Business

Visits As a Vanguard, Dudley is getting many requests for visits from national teams and other organisations. Since the last board meeting we have arranged the following visits and telephone calls to talk through our model: •

•

•

• • • •

•

The NHS Confederation bought several members from different CCGs and Trusts from across the UK to visit Dudley on 26 April. We have received very positive feedback from the visit. Dr Don Berwick, the renowned international authority on health care quality and improvement management, has been appointed by The King’s Fund with NHS England to help support Vanguard sites in developing the New Models of Care set out in the 5YFV. Dr Berwick will be visiting us on the 8 June 2016. The senior team have shared the Dudley New Care Model and our learning to date with the following organisations: Healthy London Partnership Workforce Programme, Gloucestershire Clinical Commissioning Group, NHS Leeds South & East CCG, Shropshire CCG, East London NHS Foundation Trust, NHS Southend Clinical Commissioning Group, One Herefordshire, John Radcliffe Hospital, Walsall CCG, Mid Essex CCG and Social Care Institute for Excellence. Bedfordshire and Hertfordshire LMC Ltd contacted us and are visiting us on 17 August 2016. Social Care Institute of Excellence contacted us regarding our Locality Link Officers. Health Foundation, also works with Horsham and Mid Sussex and Crawley CCGs are visiting us on 11 May 2016. NHS England have are arranging a Lunch n’ Learn webex session with Steph Cartwright and Laura Broster to inform NHS England staff in the West Midlands of the work other partners are doing outside of NHS England and across the West Midlands. Royal College of Psychiatrists have contacted us and are awaiting the set-up of the Mental Health MDT.

Conference talks and sharing opportunities There have been many opportunities over the last few months for the CCG to share our work at conferences and events. a few of these are listed below: • • • •

Mrs Stephanie Cartwright spoke at the Nursing Times Conference Mrs Laura Broster spoke at the Communications Network on behalf of the New Care Models Team Mr Paul Maubach is speaking in the Local Systems Transformation Zone at Health+Care at Excel in June Mrs Joanne Taylor spoke at the Primary Care Commissioning Conference

Research & Benchmarking Project

10

Explain Market Research were commissioned to deliver a research and benchmarking programme which was required to gain an understanding of how the population currently viewed health and social care services in Dudley to feed into the proposed new models of care. The research programme was developed with two key strands; the first to understand the trust and confidence that local people feel in the health and care services in the area, and the second to investigate perceptions around the proposed new models of care, more specifically the single patient portal. The trust and confidence strand of the research is now complete, with 900 telephone interviews completed across a range of postcode areas in Dudley. Explain have shared the initial findings in a detailed report. The Single Patient Portal & Data Sharing strand is now complete as of the 22nd April. Explain have carried out the following: • • •

Focus Groups – 6 profile groups to gain deeper insight into SPP and Data Sharing. Employee Online Survey – Over 380 completed online surveys. In Depth Stakeholder Interviews – 11 out of 15 in depth interviews with key stakeholders.

Explain are now in the process of pulling together the key findings from the trust and confidence report and the initial analysis of the in-depth phone interviews, as well as the finding form the focus groups and staff survey. The combined results and analysis of this research will be presented to the team on Tuesday 24th May 2016. Explain will facilitate a social marketing workshop to help translate the research outcomes and recommendations into an action plan. Invitations have been sent to the Communications & Involvement Work Stream and the Dudley Partnership Board. All Together Better Website We have commissioned Midlands and Lancashire Commissioning Support Unit (CSU) to design and build a new All Together Better website. We have been working with the Design and Digital team to build a new website based on our design brief. The team provided a number of concepts which were shared for discussion at the Comms & Involvement Workstream meeting in April, the workstream agreed the concept below. The team are now working to secure a URL and a live link is expected by the end of Aril 2016. Operational Plan Consultation We published our Operational Plan 2016-17 on the website in April inviting feedback from the public. Despite publicising this opportunity on our news page and through our social media channels, to date we have received no feedback. Our Operational Plan has now been finalised and submitted to NHS England. Annual Report We have produced a draft annual report and accounts which were submitted to NHS England on the 22nd April 2016. This is now with the auditors and designers and will be resubmitted to NHS England on the 26th May once finalised. Spring Tool Kit 11

We are now supporting the national ‘Stay Well’ campaign over spring. Artwork and toolkits are shared weekly by the national team and on the Office of Public Health website. These are being used to plan our local weekly activity. Proactive and Reactive Media Activity We have received over £31k of media coverage for March and April 2016. The table in appendix 1 gives a breakdown and hyperlinks to recent media activity for the CCG.

Patient Online The CCG now has 100% of practices offering online services. This is a great achievement for Dudley people. The aim now is to get 10% of patients registered to use these services by the summer. The Communications and Public Insight team are helping practices to achieve this for their patients. Accessible Information Standard All GP practices and other organisations providing NHS or adult social care will be required to follow the new Accessible Information Standard known officially as SCCI1605 Accessible Information, by 31 July 2016. The standard aims to ensure that people who have a disability, impairment or sensory loss receive information that they can easily read or understand, for example in large print, braille or via email, and professional support if they need it, for example from a British Sign Language interpreter. This is not a GMS contractual requirement but a legal obligation under the Health & Social Care Act 2012 , this is a legal requirement and must be followed. If practices fail or refuse to comply there is an overarching clause in the contract that could be used as a lever. The team have developed information with Practice Managers for display in all practices. Printed copies of these have been sent out and they have also been added to the Envisage screens. We have also developed a request form which practices will be handing out to all new contacts and to those patients that are already known to practices to have specific communication needs. If our practices do need translation services we have reminded them of the contact details for our provider.

Laura Broster Director of Communications & Public Insight

12

13

Appendix 1 Media Update- Mar/ Apr 2016

Communications and Engagement – Media Monitoring – March 2016 Title/weblink

Summary

Dudley Vanguard does away with walls Dudley CCG Invites Public to attend Board Meeting CQC places The Waterfront Surgery in Dudley into Special Measures Doodle ad to launch listening exercise in Dudley

Coverage of Interview Press Release

Release Coverage (with links where available) Date 01.03.201 Primary Care Commissioning 6 http://www.pcc-cic.org.uk/sites/default/files/comm_excellence_march_2016_web.pdf 02.03.201 6 Release

Media Enquiry

09.03.201 Andrew Turton – Express & Star 6 Response

Media Story

09.03.201 The Academy of NHS Fab Stuff – Web 6 Article

Supporting people to become more involved, connected and active in their communities Thinking FAST to help out charity

Media Story

09.03.201 The Academy of NHS Fab Stuff 6 Article

Media Story

09.03.201 Dudley News 6 Article

GP Federations

Media Enquiry

09.03.201 Sofia Lind – Pulse 14

Dudley

6

Charity provides support for families after a stroke

Media Story

Response 10.03.201 Stourbridge News 6 Article

Brierley Hill GP practice put into special measures

Coverage of Media Enquiry

13.03.201 Express & Star - Web 6 Article

GP practice put into special measures

Coverage of Media Enquiry

13.03.201 Express & Star – Main 6 Article

Waterfront Surgery – Special Measures

Media Enquiry

14.03.201 Kelly Harris - Stourbridge News 6 Response

Partnership to Press Release Improve Local Health and Care Services Celebrates First Anniversary GP surgery put into Coverage of special measures Media Enquiry

15.03.201 6 Release

Talented Dudley youngsters are hitting the airwaves

Media Story

18.03.201 Dudley, Stourbridge, Halesowen News & All Chronicles 6 Article

New opportunity for people in Dudley to beat

Press Release

22.03.201 6

18.03.201 6 Article

15

diabetes Opening Times for Pharmacies in Dudley Over the Easter Bank Holiday Weekend Chemists Open During Holiday GPs' surgery is dubbed as 'inadequate'

Press Release

22.03.201 Release 6

Coverage of Press Release Coverage of Media Enquiry

23.03.201 Article 6 24.03.201 Stourbridge News 6 Article

Dudley CCG Invites Public to attend Extraordinary Board Meeting Invite to attend healthcare talks

Press Release

29.03.201 6

Coverage of Press Release

30.03.201 Express & Star (All Main) 6 Article

Have your say on borough's health services at CCG meeting

Coverage of Press Release

30.03.201 Halesowen News , Dudley News, Stourbridge News 6 Article

Release

Communications and Engagement – Media Monitoring – April 2016 16

Title/weblink

Summary

Release Coverage (with links where available) Date 06.04.201 Express & Star 6 Article

Toughest year ahead warns health chief

Media Story

Leadership needed to help NHS

Media Story

06.04.201 Express & Star 6 Article

GP practices to be trained in QOF alternatives under CCG plans MCP vanguards employing GPs

Media Story

06.04.201 Pulse 6 Article

Media Enquiry

07.04.201 Sophia Lind – Pulse 6 Response

Urgent Care Centre

Media Enquiry

11.04.201 Express & Star 6 Response

Helping GP partners (who wish to do so) become employed (MCP) Practices may be able to retain GMS alongside new voluntary contract Practices may be able to retain GMS alongside new voluntary contract

Media Enquiry

12.04.201 Sophia Lind – Pulse 6 Response

Response to Media Enquiry

13.04.201 Pulse Magazine 6 Article

Response to Media Enquiry

13.04.201 Practice Business 6 Article 17

Transformation Funding

Media Enquiry

14.04.201 HSJ 6 Response

Russells Hall Baby Story

Media Enquiry

14.04.201 Richard Guttridge - Express & Star 6 Response

Will gardening spark your hay fever? CQC Report – Dudley Partnerships for Health CQC places Dudley Partnerships for Health LLP in Dudley into Special Measures SURGERY RATED AS INADEQUATE

Press Release

15.04.201 6

Media Enquiry

15.04.201 Kelly Harris – Stourbridge News 6 Response

Coverage of Media Enquiry

15.04.201 Sintons Healthcare News 6 Article link

Media Story following CQC Report

18.04.201 Express & Star 6 Article CCG not approached for comment

Health Chiefs Tough Year

Media Story

56,000 treated at urgent care centre

Coverage of Media Enquiry

Stourbridge Chronicle Article 18.04.201 Express & Star 6 Article 18

Call for review over wrong tag on baby

Coverage of Media Enquiry

18.04.201 Express & Star 6 Article

Will gardening spark your hay fever?

Press Release

18.04.201 6 Release

Health chiefs' tough year

Media Story

19.04.201 Halesowen Chronicle 6 Article

Pilot scheme by CCG cuts prescribing costs

Media Story

21.04.201 The MJ (Municipal Journal) (Supplement) 6 Article

Hospital investigates baby name tag blunder

Coverage of Media Enquiry

21.04.201 All Local Chronicles 6 Article

Surgery rated inadequate by inspectors

Coverage of Media Enquiry

21.04.201 All Local Chronicles 6 Article

Developing MCP Contract Private Treatment

Media Interview

28.04.201 HSJ 6 28.04.201 Heather Large - Express & Star 6 Response

Media Enquiry

19

DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Corporate Objectives Agenda item No: 7.1 TITLE OF REPORT:

Corporate Objectives

PURPOSE OF REPORT:

For the Board to review and approve the CCG’s Corporate Objectives 2016/17

AUTHOR OF REPORT:

Mr Matthew Hartland, Chief Finance & Operating Officer

MANAGEMENT LEAD:

Mr Paul Maubach, Chief Executive Officer

CLINICAL LEAD:

Dr David Hegarty, Chair

KEY POINTS:

• • • • •

RECOMMENDATION: •

Nine key objectives for 2016/17 presented Main tasks aligned to Executive and Clinical Executive Leads Detailed tasks for completion in quarters 1 and 2 are listed in the Appendix A number of questions are posed to the Board about the objectives and priorities That the Board consider the responses to the questions posed and agree whether any changes to the Corporate Objectives as presented should be made That the Board approve the Corporate Objectives 2016/17 subject to any agreed changes

FINANCIAL IMPLICATIONS:

None

WHAT ENGAGEMENT HAS TAKEN PLACE:

None

ACTION REQUIRED:



Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 12 MAY 2016 CCG OBJECTIVES 2016/17 1.0

INTRODUCTION

The purpose of this paper is for the Board to set out the objectives of the CCG for 2016/17 and its execution through the committees. The intention is to give some clear direction to the executive of the CCG and the committees on the main priorities for the year in order to ensure timely delivery of the objectives and effective reporting and assurance through to the governing body throughout the year. Given the challenges to financial and human resources and the inherent risk this implies, this paper also poses a number of questions to the Board. 2.0

KEY OBJECTIVES

The Chief Executive Officer has identified nine key objectives for 2016/17 as follows: 1. 2. 3. 4. 5. 6. 7. 8. 9.

Procure the MCP Primary Care Contract Public engagement on model and procurement Develop the CCG - Fit for purpose for the Future Performance Management of the system and VP Implementation Assure ongoing safety and performance of the system Actively participate in the Black Country STP Ensure appropriate procurement of secondary services Primary Care and MCP development in-year

To support the delivery of these objectives, Executive and Clinical Executive leads have been identified against the main tasks. These are set out in the table below: Task Performance Management of system. In particular new performance framework for urgent care linked to MDTs, admission avoidance, MCP VP and DTOCs System assurance – ongoing assurance but also determine how to implement proactive (non-passive) assurance. MCP contract. Procurement of the MCP by April 2017 - including incorporation of Social Services Primary Care contract Primary Care Assurance and full implementation of the new outcomes framework CCG organisational development and HR - day to day and managing the transition to MCP and new commissioning arrangements Public engagement on the model outcomes and MCP procurement options Secondary Care Contracts - develop contract to align to MCP

Developing Primary Care leadership to lead primary care development and enable primary care to engage in the development of the MCP

Clinical Executive Role Finance, Performance & Business Intelligence Quality & Safety Multi-Specialty Community Provider Primary Care Organisational Development Public Accountability Elective Pathways New Primary Care Development

Executive Lead Mr Matthew Hartland

Mrs Caroline Brunt Mr Neill Bucktin Mr Dan King Mrs Stephanie Cartwright Mrs Laura Broster Mr Neill Bucktin (in the interim) No post in structure 2|P a g e

The appendix breaks these overarching tasks into secondary tasks and the Executive Leads have identified priorities for quarter 1 and 2 of the financial year. Clinical leads will be aligned to the objectives following the Clinical Executive recruitment process, but they wll have dual responsibility and accountability with management leads for delivery.

3.0

RUNNING COSTS

This programme of work needs to be set within the constraints of the CCG’s Running Cost allowance. The budget available is recurrently fully committed and already includes a vacancy factor and assumptions regarding income for posts. In headline terms this is described below:

Actual Vacancy Factor Secondments (assumption) TOTAL RUNNING COSTS

£k 7,290 (251) (250) 6,789

There are two factors, however, that are currently being tested to assist the running cost position: 1. An assessment of vacancies, expected start dates and comparison by team to the existing vacancy factor. 2. The accounting treatment of income the CCG is due to receive from NHS England for the Value Proposition. Both of the above items are expected to provide some flexibility, but the value is unknown until we have final confirmation of the Value Proposition. 4.0

CONSIDERATIONS FOR THE BOARD

When considering approval of these objectives a number of questions are posed to the Board as follows: 1. 2. 3. 4.

5.0

Does the Board agree that the 9 key objectives are correct? Does the Board confirm the secondary objectives as described in Appendix 1? What is the Board’s view on prioritisation if slippage occurs? What is the Board’s approach to managing risk of non-delivery?

RECOMMENDATION

5.1 That the Board consider the responses to the questions posed and agree whether any changes to the Corporate Objectives as presented should be made. 5.2 That the Board approve the Corporate Objectives 2016/17 subject to any agreed changes

Appendix 1 – Detailed Corporate Objectives Quarter 1 & Quarter 2 Timelines

Mr Matthew Hartland Chief Finance & Operating Officer May 2016

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Appendix 1 – Detailed Objectives with Quarter 1 and Quarter 2 Timelines Finance, Performance & Business Intelligence - Mr Matthew Hartland Objective

Quarter 1

Quarter 2

Performance Management of system. In particular new performance framework for urgent care linked to MDTs, admission avoidance, MCP VP and DTOCs STP development. Lead on financial modelling; Clinical Quality Group, New Care Models development Corporate operations coordination of organisational management, governance and objectives; update governance review in preparation for potential commissioning changes Assurance engagement with NHSE - ensuring we meet our targets Estate strategy development

Scoping of requirements with MDT's, SRG, partner organisations. Development of framework and operating practices for delivery

Data submissions/reporting implemented

Lead STP finance group. Quality Group met. June submission to NHSE.

As required by Sponsoring Group and NHSE.

Corporate Objectives agreed by Board. Reporting mechanisms in place

Ongoing reporting to Board

Monthly NHSE reporting. Management of CCG Financial and Performance duties Strategy agreed - move to implementation mode. Agree procurement model for Kingswinford scheme. 1617 priorities agreed. Launch IT procurement Agree initiatives for evaluation. Agree methodology and programme.

Ongoing reporting to NHSE and Board

IT strategy implementation (including IT procurement) Evaluation of all key initiatives

Consider any developments from Primary Care team for Gornal scheme Implementation Commence evaluation in line with agreed programme.

Quality & Safety - Mrs Caroline Blunt Objective

Quarter 1

Quarter 2

System assurance - ongoing assurance but also determine how to implement proactive (non-passive) assurance.

Engagement with commissioners regarding updating service specifications/commissioning cycle to create opportunities for proactive assurance

Define annual plan for Q&S involvement in the commissioning/contracting cycle for all providers to improve/create opportunities for proactive assurance

Identification/mapping of activities in contracting and commissioning (utilising a business intelligence function) which increases proactive assurance through triangulation of information/data Transition from Head of Commissioning. Involvement in systems resilience group/planning enhanced strategic approach to DTOC.

Develop a data set that offers insight into a triangulated perspective of provider quality & safety

System Resilience. Resolving DTOCs and integration of assessment processes (linking to MDTs)

Implementation of strategic plan

1

Children's safeguarding and response to Ofsted

Maternity Review including review of SI processes and associated governance

Adult safeguarding

Nursing and Midwifery Revalidation - education strategy

To progress actions defined within planned response to Ofsted report.

Paper to Board in July to share progress

Define ‘Recognition of Vulnerability Framework’ and shared with contracting and commissioning teams to inform all commissioning cycles and MCP procurement process. Establishment of the quality improvement Board and progress against detailed action plan in place within the contract

Utilisation of Recognition of Vulnerability Framework within the contracting commissioning processes.

Define ‘Recognition of Vulnerability Framework’ and shared with contracting and commissioning teams to inform all commissioning cycles and MCP procurement process. Initiate roll out of training for online revalidation tool

Demonstrate improved performance against KPIs/action plan by close of Q2 (state % improvements expected) Utilisation of Recognition of Vulnerability Framework within the contracting commissioning processes.

Ongoing roll out of revalidation tool.

Establish an educational steering group aligned with workforce development strategy

Establish a training needs analysis process to inform educational programme/workforce development

Objective

Quarter 1

Quarter 2

MCP contract. Procurement of the MCP by April 2017 including incorporation of Social Services

Agree scope of inclusion of social care services in MCP model and implications for health and social care integration

MCP - Mr Neill Bucktin

QIPP Implementation NHS 111 procurement & SPP development Medicines Management 'procurement' and integration into MCP model Final clarification of all commissioning objectives into scoping / outcome measures Strategic engagement on the new care models (through H&WBB) Agreement with DMBC on MCP scope/health and social care integration

Agree specification for SPP to be included in MCP procurement documentation Agree basis upon which practice based pharmacist support is included in MCP procurement process Agree scope of prescribing support services to be resourced on basis of VP outcome and commission

Complete NHS 111 procurement Complete additional practice based pharmacist procurement

2

Primary Care - Mr Daniel King Objective

Quarter 1

Quarter 2

Primary Care contract Primary Care Assurance and full implementation of the new outcomes framework

Contracting - commence primary care contract review visits. Commissioning - offer Dudley Outcomes for Health Framework, commence pilot, develop and sign off business rules and evaluation framework. Primary care support offer developed and made to member practices. GP champions identified, steering group formed. Memorandum of understanding developed. Primary Care Commissioning Committee to have received formal evaluation of winter pressures extended access scheme. Estates operational and strategy group to have developed and prioritised primary care infrastructure proposals in line with estates strategy. Prioritised submission on all proposals to made to NHS England.

Contracting - on-going assurance and support of contract review and CQC inspections. Commissioning monitoring commences, audits developed, costing for indicators commences. Steering group formed, support team identified and in place. MOU project plan in place, implementation commenced.

GP performance management in line with VP

Development of plan for 7-day services (locality solution)

Estates implementation support to practices on current and proposed in-year developments

Sense.ly kiosk development

Primary Care Development development of MOU between practices to facilitate collaborative working.

Oversight and reporting of project into Primary Care Commissioning established. Primary care operational needs scoped and tested. Primary care support offer developed and made to member practices. GP champions identified, steering group formed. Memorandum of understanding developed.

Primary Care Commissioning Committee to have scoped development of a 7-day solution for access to routine GP appointments. Implementation of infrastructure proposals approved by NHS England including: business case development for the Kingswinford Hub, and facilitation and planning with the Gornal Hub to identify additional practices for the development. Primary Care Commissioning Committee to have oversight and approval of evaluation, testing and roll out to implementation. Steering group formed, support team identified and in place. MOU project plan in place, implementation commenced.

OD - Mrs Stephanie Cartwright Objective

Quarter 1

Quarter 2

CCG organisational development and HR - day to day and managing the transition to MCP and new commissioning arrangements

Preparation of processes and plan for any aligned staff. Staff health and wellbeing plan. Recruitment of support post. Achieve clear differentiation of procurement and development of MCP. Ongoing development of CCG (particularly sustainability) and provision of HR service. Weekly engagement with NCM Account Manager. Preparation for reviews. Maintain link from

Preparation of processes and plans for any aligned staff. Achieve clear differentiation of procurement and development of MCP. Ongoing development of CCG (particularly sustainability) and provision of HR service.

CCG management lead for Vanguard and coordinator of ongoing engagement with

Weekly engagement with NCM Account Manager. Preparation for reviews. Maintain link from

3

NCM team

CCG corporate business management and administration Oversight of NCM Programme Management and Partnership Board

System workforce development and OD strategy (with input from CB)

Implementation of 16/17 VP; and production of 17/18 VP Oversight of MCP development until ready for handover

NCM team through to project leads. Provide personal input on workforce, OD and leadership national groups. Recruitment and induction of Business Support Manager.. Recruitment of business support vacancies. Weekly meetings with Programme Management office to- Review of Partnership Office actions / priorities - Update following engagement with the national team - Programme delivery / critical path update / readiness assessment - Risks & Issues update - Financial update - Performance update - Preparation for forthcoming meetings o NCMIG o Partnership Board - Actions & priorities for the next week. Agree contractual mechanism for programme management support. Continued support and development of Partnership Board. Workshop with Health Education West Midlands on developing a System Workforce Development Plan. Local team involvement with national team on project specific workforce development areas. Health check on all MDTs. Introduction of mental health MDTs into the model of care. Production of revised delivery plan detailed with quarter by quarter activity. Continual development of the model through NCM Implementation Group and MDT Implementation Group. Specific programme area development (eg. generic workforce, proof of concept MDT, evaluation, expansion of Integrated Plus, mental health MDTs, frequent attenders and performance reporting).

NCM team through to project leads. Provide personal input on workforce, OD and leadership national groups. Ensure team are fit for purpose. Develop smarter working plan for the CCG. Weekly meetings with Programme Management office to- Review of Partnership Office actions / priorities - Update following engagement with the national team - Programme delivery / critical path update / readiness assessment - Risks & Issues update - Financial update - Performance update - Preparation for forthcoming meetings o NCMIG o Partnership Board - Actions & priorities for the next week. Review of Partnership Board alongside procurement timetable.

Production and sign off of system workforce development plan. Continual review and development of MDT model.

Regular review of expenditure and progress against delivery plan. Continual development of the model through NCM Implementation Group and MDT Implementation Group. Specific programme area development (eg. generic workforce, proof of concept MDT, evaluation, expansion of Integrated Plus, mental health MDTs, frequent attenders and performance reporting).

4

Public Accountability - Mrs Laura Broster Objective

Quarter 1

Quarter 2

Public engagement on the model outcomes and MCP procurement options

Listening events & activate feedback to Partnership Board. appoint public reps to procurement board, engage public in outcome setting. Legal advice on process and if it adheres to CCG strategy. commission consultation institute, agree procurement timetable elements, arrange 5 events in June and publish, launch website and public materials Identify regulator contacts at : Clinical senate, CQC, NHS Improvement, NHS England. Establish a meeting of regulators to describe our approach to procurement. Seek responses from them to the process ahead of CCG Board

Report to CCG board on public involvement and conversation in June with advice from Consultation institute. HCF to sign off process for engagement to date.

Research into current outcome measures used, research into options for patient reported measures

Development of specification and agreed route to procurement

Schedule into MCP procurement describing our expectations

Qs in ITT to test new providers on this

Quarter 1

Quarter 2

Quantified the risks to secondary care from the MCP plans; and identified the key pathways where there is significant variation (eg: right care)

Have clear plans in place for addressing key variations in pathways; and we need to have confirmed the proposed change in business rules needed in response to the MCP

Regulator assurance on the MCP procurement

Day to Day management of functions : Communications Patient Ex Reporting Patient Involvement Network Complaints FOI/team Admin/My PA Develop a portal for Dudley people which enables them to feedback on experiences and allows them to complete standardised forms that set their expected outcome measures. Empowering people and communities as a key characteristics of new MCP contract. Vanguard national lead for communications

Get Regulator responses to CCG process to include in CCG board paper

Pathways Objective Public engagement on the model outcomes and MCP procurement options Development of triage / pathway model Resolve gaps and limitations of the existing specifications

5

New Primary Care Development Objective

Quarter 1

Quarter 2

Developing Primary Care leadership to lead primary care development and enable primary care to engage in the development of the MCP Develop Primary Care leadership capacity for primary care development package and for MCP representative engagement Project management, OD, finance & contract support for primary care development programme emerging MCP work Governance advice to the MCP development (includes CQC registration, organisational form development, etc) Implement the frail elderly pathway/older adults mental health model/key focus on meeting dementia diagnosis target Implement new Mental Health MDTs / MH Model Transition CCG GPs across to primary care development and MCP engagement work Develop Children's Service model

Steering group established with a project plan to understand the use of the development funds. MOU established Ensure that GP champions in place

Ensure that ‘arms-length’ team are fully established and the plan is in operation

6

DUDLEY CLINICAL COMMISSIONING GROUP BOARD MEETING Date of Report: 12 May 2016 Report: Update from Partnership Board Agenda item No: 7.2 TITLE OF REPORT:

Update from Partnership Board

PURPOSE OF REPORT:

To update the Board on the developments of the Partnership Board.

AUTHOR OF REPORT:

Mrs Stephanie Cartwright, Director of Organisational Development and Human Resources

MANAGEMENT LEAD:

Mrs Stephanie Cartwright, Director of Organisational Development and Human Resources

CLINICAL LEAD:

Dr David Hegarty, Chair •

KEY POINTS:

Since the last report the Partnership Board has met three (March and April 2016 and an additional extraordinary meeting to discuss the Value Proposition) The Partnership Board includes representatives from all organisations involved in implementing the new model of care. The development of the new model of care in Dudley continues to receive very positive national support. Governance arrangements will reflect the separation of procurement of the MCP from development of the MCP.

• • •

RECOMMENDATION:

That the CCG Board notes the progress of the Partnership Board to date.

FINANCIAL IMPLICATIONS:

None

WHAT ENGAGEMENT HAS TAKEN PLACE:

There is a specific workstream dedicated solely to communications and engagement on the new models of care that includes representation from all organisations involved. This workstream has undertaken an extensive piece of work undertaking listening exercises out in the community which was presented to the Partnership Board in April.

ACTION REQUIRED: √

Decision Approval Assurance

1|Page

DUDLEY CLINICAL COMMISSIONING GROUP BOARD - 12 MAY 2016 PARTNERSHIP BOARD

1.0

INTRODUCTION

1.1

The Dudley New Model of Care Partnership Board includes representation from all organisations included in developing the Dudley Multi-speciality Community Provider. These organisations are as follows: • • • • • • •

Dudley Clinical Commissioning Group (lead organisation) Dudley Metropolitan Borough Council Dudley Group Foundation NHS Trust Dudley and Walsall Mental Health Partnership NHS Trust Dudley Council for the Voluntary Sector Black Country Partnership NHS Foundation Trust Dudley Primary Care Providers

2.0

REPORT

2.1

The Partnership Board continues to meet on a monthly basis to review the progress of implementation of the new model of care and to provide opportunity to raise robust challenge and to air issues that require partnership debate and discussion. The Partnership Board has met twice since the last report to the Board which was in March 2016.

2.2

The March meeting of the Partnership Board focussed on the evaluation of the model of care and a discussion around the governance arrangements moving forward. The evaluation of the model included the recent publication of our logic model and the impact that the logic model would have on the difference that the model is and will make. The governance paper and discussion explored the separation required between procurement of the MCP and development of the MCP. The future role of Partnership Board was discussed and agreed as necessary to ensure pace of development. Procurement discussions and decisions will be taken outside of the Partnership and will be led by the CCG.

2.3

An additional extraordinary Partnership Board was called early in April to review the resubmission of the Value Proposition with partners. During the meeting the original submission was reviewed line by line and adjustments made based on the reduced funding allocation.

2.4

The April meeting of the Partnership Board discussed the updated position on IT, the programme report, associated risks and received a report on the engagement programme that has been taking place over the last four months. The IT workstream is gathering good pace and is currently reflecting its priorities given the reduction in funding from the Value Proposition (Dudley will receive half of the funding requested). There is now good attendance at the meetings but challenges continue around data sharing and enabling some of the platforms required particularly around the interface of systems with Emis. The programme report outlined areas of risk for example the perceived lack of vision and strategy of the model moving forward and a description of the end point. Partnership Board discussed why these perceptions may be held, how they can be alleviated and agreed on the requirement to do something differently to enable sustainability of the system. Staff engagement was particularly discussed recognising all partners will be delivering staff engagement events during May. Healthwatch colleagues presented on the significant engagement that has taken place during the last four months

with patients and the public including an innovative tool for enabling engagement described as Activate. Engagement (and consultation where necessary and possible) will continue throughout the development of the new model of care. 2.5

Point to note: The delivery programme for the MCP is being refreshed to reflect the reduction in funding that will be received from the Value Proposition.

3.0

RECOMMENDATION The Board is asked to note the contents of this report for assurance.

Mrs Stephanie Cartwright Director of Organisational Development and Human Resources Vanguard Management Lead April 2016

DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Sustainability and Transformation Plan (STP) Agenda item No: 7.3 TITLE OF REPORT:

Sustainability and Transformation Plan (STP)

PURPOSE OF REPORT:

To advise the Board on progress with the Black Country Sustainability and Transformation Plan (STP) footprint.

AUTHOR OF REPORT:

Mr M Hartland, Chief Operating and Finance Officer

MANAGEMENT LEAD:

Mr M Hartland, Chief Operating and Finance Officer

CLINICAL LEAD:

Dr D Hegarty, Chair • • • •

KEY POINTS:

• •

RECOMMENDATION:

• •

In March 2016 Board agreed to be part of the STP footprint. A sponsoring group has been established with three lead subgroups. The CCG is represented on all workstreams. Initial planning submission made in April 2016. Further submission required in June 2016, which will include more detailed financial analysis and progress on implementation. NHS England requires all submissions to be approved by constituent Boards. As Dudley CCG Board does not meet in advance of the deadline it is asked to delegate authority for the Chair, Chief Executive Officer and Chief Operating and Finance Officer to approve the submission. To note progress to date on the STP, including the April submission To delegate authority to the Chair, Chief Executive Officer and the Chief Operating and Finance Officer to approve the June STP submission.

FINANCIAL IMPLICATIONS:

None

WHAT ENGAGEMENT HAS TAKEN PLACE:

None

ACTION REQUIRED:

√ √

Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 12 MAY 2016 SUSTAINABILITY AND TRANSFORMATION PLAN (STP) 1.0

INTRODUCTION The Board agreed in March to be a part of the Black Country Sustainability and Transformation Plan (STP) footprint. This paper advises the Board on progress to date.

2.0

UPDATE

2.1

STP footprints include NHS commissioners and providers within defined locality boundaries, and the organisations within the Black Country STP are:• • • • • • • • • • • • • • • • • •

Black Country Partnership NHS Foundation Trust Birmingham City Council Birmingham Community Healthcare NHS Foundation Trust Dudley CCG Dudley Group Foundation NHS Trust Dudley Metropolitan Borough Council Dudley & Walsall Mental Health Partnership Trust NHS England Royal Wolverhampton Hospitals NHS Trust Sandwell and West Birmingham CCG Sandwell and West Birmingham Hospitals NHS Trust Sandwell Metropolitan Borough Council Walsall CCG Walsall Metropolitan Borough Council Walsall Healthcare NHS Trusts Wolverhampton City Council Wolverhampton CCG West Midlands Ambulance Service

2.2

The STP process has a nationally defined framework and timescales, but the method of delivery is for STP footprints to determine. It should be remembered that the objective for NHS England in the STP process is that the current position of a health sector in deficit is not sustainable and local system solutions are required.

2.3

A Sponsoring Group has been established with 3 lead sub-groups (Triple Aim):• • •

Closing the health and well-being gap Closing the care and quality gap Closing the efficiency gap.

Further sub-groups are to be established to support the Triple Aim workstreams as required. 2.4

The STP was required to submit its initial planning submission in April, included as an appendix in this report. Key highlights from the submission are: • • • • •

Governance structure confirmed Key areas of focus have been identified by the Sponsoring Group Initial analysis of financial plans has indicated a recurrent gap of £159.5m in 2016/17, rising to £476.5m in 2020/21 Indicative strategies for closing the gap Emerging priorities to be taken forward in the STP. 2|P a g e

2.5

The CCG has agreed, and is required to be, a key constituent in the STP process. We will need to identify leads for inclusion in workstreams and take a lead role where appropriate. Such requirements are still in the scoping stage.

2.6

A further submission is required in June 2016 that will include a more detailed financial analysis and progress on implementation. NHS England has requested that June submissions are approved by constituent Boards. As the Board does not meet in advance of the deadline it is asked to delegate authority for approval of the submission to the Chair, Chief Executive Officer and Chief Operating and Finance Officer.

3.0

RECOMMENDATION (i) (ii)

To note progress to date, including the April submission to NHS England To delegate authority to the Chair, Chief Executive Officer and the Chief Operating and Finance Officer to approve the June STP submission.

M Hartland Chief Operating and Finance Officer May 2016

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4th Floor Rear Kingston House, 438-450 High Street, West Bromwich, B70 9LD Fax: 0121 612 1560

DELIVERING THE FIVE YEAR FORWARD VIEW: NHS PLANNING GUIDANCE 2016/17 – 2020/21 Key messages for STPs from Planning Guidance o o o o

Create a clear overall vision and plan for the area System wide local financial sustainability plan Reflecting the collective response to 16/17 must do’s Responding to the indicative national challenges  Closing the health and well-being gap  Plans for radical upgrade in prevention, patient activation, choice and control and community engagement  Closing the care and quality gap  Plans for new care model development  Improving against clinical priorities  Rollout of digital healthcare  Closing the finance and efficiency gap  Achieve financial balance and improve the efficiency of the

https://www.england.nhs.uk/wp-content/uploads/2015/12/planning-guid-16-17-20-21.pdf

Please fill in key information details below

Name of footprint and no: Black Country (STP 16) Region: Midlands & East Nominated lead of the footprint including organisation/function: Andy Williams, Accountable Officer, Sandwell & West Birmingham CCG Contact details (email and phone): [email protected] 0121 612 1432 Organisations within footprints: Wolverhampton City Council Royal Wolverhampton NHS Trust Wolverhampton CCG Walsall MBC Walsall Healthcare NHS Trust Walsall CCG Dudley MBC Dudley Group NHS Foundation Trust Dudley and Walsall Mental Health Partnership NHS Trust Dudley CCG Sandwell MBC Birmingham City Council Sandwell & West Birmingham Hospitals NHS Trust Birmingham Community Healthcare NHS Foundation Trust Black Country Partnership NHS Foundation Trust West Midlands Ambulance Service Sandwell & West Birmingham CCG NHS England

1

Section 1: Leadership, governance & engagement

Sponsoring Group Operational Group

Health & Wellbeing

Care & Quality

Finance & Efficiency

Integrated primary, community & social care

Urgent Care

Maternity Services

Mental Health and Learning Disabilities

Elective Care

Cancer

Children’s Services

Specialised Services

• Collaborative leadership and decision-making. • Sponsoring Group (All CEO’s (or nominated representative) • 3 Triple Aim Gap Workstreams with named leads to identify the challenges • Transformation Groups to identify solutions • Operational Group to ensure delivery • Memorandum of Understanding in place to support collective decision making, Information Sharing agreement under development • 4 key principles: subsidiarity, mutuality, added value and no boundaries

• An inclusive process. • Engagement and communications group inclusive of all partners being established • Considering how to best achieve patient representation on Sponsoring Group • Engagement Plan to consider: Patient groups, Healthwatch, public meetings, listening exercise • Subsidiarity: Local HWBBs, SRGs which have wider representation and reach

• Local government involvement. • All local authorities across the footprint are actively engaged • All providers across the footprint are actively engaged • NHS England is actively engaged • Members of the Sponsoring Group act as the link into Health & Wellbeing Boards

• Engaging clinicians and NHS staff. • The Care & Quality group will act as a clinical reference group to oversee clinical models • Engagement events held and further events planned • Disseminate early messages from analyses and review of evidence • Seek views • Process for feedback

2

Section 1 - Hypothesis Integration Social Care 1⁰ Care 2⁰ Care 3⁰ Care Mental Health Community Staying Well

Integration

Need to rebalance Transformation the system

Sustainability

Section 2a: Improving the health of people in your area Challenge 

Emotional wellbeing and mental health o Child and adolescent mental health o Adult mental health o Dementia



Diabetes prevention o Obesity o Healthy eating o Physical activity



Maternity care and preventing disability o Infant mortality o Smoking in pregnancy o Healthy maternity pathway



Respiratory Health o COPD o Asthma o Workplace health initiatives



Cancer Services o Early diagnosis

Opportunity • Strategy • Prevention at the heart of all partners’ strategies, policies and procedures • Black Country wide population level prevention strategy • Black Country Communication Strategy informed by social marketing and optimising digital communication opportunities • Approaches • Target evidence-based preventive interventions through a population segmentation approach • Learn and share from vanguards, MCP’s and PACS to facilitate integrated approaches to commissioning and delivery • Develop and support self management groups across the Black Country • Utilise personal health budgets to support staying well • Workforce • Implement staff health and wellbeing strategies in all partner organisations • Promote Making Every Contact Counts and Five Ways to Wellbeing through partner workforces • Black Country approach to education and development of primary care workforce • Pathways and Commissioning • Maximise the opportunities of the National Diabetes Prevention Programme roll out across Black Country • Collaborative/joint commissioning of services e.g. Children and young people, maternity, health visiting, development of Black Country Healthy Pregnancy Service • Partnerships • Support and develop voluntary sector as key partners in the health agenda • Engage with the Local Economic Partnership to optimise health outcomes • Engage with Combined Authority on wider determinants of health e.g sustainable travel, air pollution

Section 2b: Improving care and quality of services Challenge

Opportunity

Transformation of general practice

• • • •

Achieving and maintaining core standards and improving quality & safety

• Identify what has worked well across the Black Country and share it • Learning and sharing from a focus on commonality of regulatory inspection reports e.g. maternity, A&E, RTT. • Focus on demand management including primary care access • Review operational patterns e.g. conveyances, spikes and bunching • Develop single understanding of plans and evaluations for emergency admission reductions • Stronger collective focus on preventing emergency admissions • Agree to concentrate capacity with site specific delivery for identified procedures • Focus on availability of rapid access diagnostics

Action on key clinical priorities

• • • • • •

Focus on cancer waits and treatment share best practice approaches Deliver Transforming Care Plans Deliver CAMHS Transformation Plans Collaborative approach to maternity pressures across the Black Country Share best practice on dementia diagnosis Share best practice on neo-natal deaths

Right Care

• • • •

Black Country wide review Common priorities identified - Service transformation; QIPP opportunities Cross reference to JSNA’s and HWBB Strategies Priorities identified

5

Learn and share from vanguards, MCP’s, PACS, MERIT Common approach to developing primary care Standardised approach e.g. enhanced services, referral management Prevention focussed service delivery

Section 2b: Improving care and quality of services(Con’t) Challenge

Opportunity

New Care Models

• • • • • • • • • • •

Key Enablers

• • • • • •

Genuine focus on integration Black Country Alliance MERIT Wolverhampton PACS Healthy Walsall Partnership Dudley Vanguard Modality Vanguard Right Care Right Here and delivery of Midland Met Hospital Transforming Care Together Partnership Leading redesign and procurement of NHS111 and OOH Leading WMUECN and transformation change of urgent care Focus on Electronic Health Records Recruiting together as a system including health and social care Joined up workforce planning Improved skill mix Developing creative new roles Health Futures University Technical College

Section 2c: Improving productivity and closing the local financial gap – Calculating the gap • The Table below identifies the counterfactual ‘do nothing’ position for the Footprint over the FYFV planning cycle • As can be seen, if zero action were taken the existing recurrent gap 0f £159m would rise to £476m by 2020/1 • £88.7m (2016/17) and £395m (2020/21) respectively is attributable entirely to services to Footprint residents Organisations in Footprint

2016/17

2017/18

2018/19

2019/20

2020/21

£m

£m

£m

£m

£m

NHS Providers

(68.0)

(119.8)

(170.0)

(238.4)

(292.0)

NHS Commissioners

(12.7)

(23.5)

(39.1)

(54.5)

(44.8)

Local Authorities

(78.8)

(110.1)

(131.2)

(139.7)

(139.8)

Total Annual

(159.5)

(253.4)

(340.3)

(432.5)

(476.5)

Cumulative Total

(159.5)

(412.8)

(753.1)

(1,185.6)

(1,662.1)

Section 2c: Improving productivity and closing the local financial gap – Closing the gap DEMAND SIDE INITIATIVES: • Right Care Savings Opportunities identified of £72m • Better Care fund • QIPP & Other demand related initiatives

SUPPLY SIDE INITIATIVES: NHS Provider CIP of £93m, 4.1% signed off for 2016/17 Local Authority savings Plans signed off for 2016/17 Carter Savings Opportunities being scoped & planned by NHS Providers Midland Metropolitan Hospital Plans

STP TRANSFORMATION PROGRAMME 8

Section 3: Your emerging priorities Please discuss your emerging thinking on what the key priorities are to take forward in your STP, and why:

• • • • • • • • • • • •

Create open, clear and fast paced decision making through strong leadership and governance Baseline assessment of current position, plans and strategies for LTC’s, primary care, new care models Developing a single Black Country view on prevention Consider establishing a Black Country self care programme Consider developing a single approach to personal health budgets across the Black Country with a particular focus on maternity and EOLC Complete a full and comprehensive review of Right Care packs and test the outcomes and assumptions Consider single commissioning approaches to major pathways and conditions e.g. children and young people, mental health Maximising efficiency through provider collaboration Transformation of the urgent care system Sharing learning and embedding best practice from high performers and new care models with a view to wider roll out Consider single approach to workforce planning and recruitment Developing a Black Country strategy for specialised services

Big Decisions • Pooling of resources? • What does collaborative commissioning mean ultimately? • How can we maximise the opportunities from provider collaboration? • How do we manage the system to ensure the sustainability of its constituents? 9

Section 4: Support you would like Please discuss your emerging thinking in the following areas:

• Clear and consistent communication • Support for proposals for local application and management of 1%

10

DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Quality & Safety Committee Report Agenda item No: 8.1 TITLE OF REPORT:

Report from the Quality & Safety Committee

PURPOSE OF REPORT:

To provide on-going assurance to the Governing Body regarding Quality and Safety in accordance with the CCG’s statutory duties

AUTHOR(s) OF REPORT:

Ms Marcia Minott, Head of Quality & Safety Dr Ruth Edwards, Clinical Executive Lead for Quality

MANAGEMENT LEAD:

Mrs Caroline Brunt, Chief Nurse

CLINICAL LEAD:

Dr Ruth Edwards, Clinical Executive Lead for Quality Report of the Quality & Safety Committee from meetings held in March 2016 and April 2016. This report contains key updates on issues discussed by the Committee to include:

KEY POINTS:

• • • • • • • •

Infection Prevention and Control - New Framework for HCAI Update on Ofsted Inspection – Safeguarding CAMHS update Dudley Group Maternity Services - Quality Improvement Board agreed Primary Care Quality issues Clinical Quality Review Meeting - Urgent Care Centre Quality Accounts Risk Register Update

The Board is asked to: RECOMMENDATION:

Accept this report as a source of on-going assurance that the CCG Quality & Safety Committee continues to maintain rigorous oversight of all clinical quality standards in line with the CCG’s statutory duties.

FINANCIAL IMPLICATIONS:

None

WHAT ENGAGEMENT HAS TAKEN PLACE:

User experience is an essential component of quality assurance and surveillance and as such public views and feedback form part of the triangulation of hard and soft intelligence.

ACTION REQUIRED:

 Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 12 MAY 2016 QUALITY & SAFETY COMMITTEE REPORT TO GOVERNING BODY 1.0

INTRODUCTION

1.1

The CCG Quality & Safety Committee meets monthly and is chaired by Dr Ruth Edwards, Clinical Executive Lead for Quality. This report is a material summation of the Committee’s meetings in March and April 2016.

1.2

The Governing Body will be briefed on any contemporaneous matters of consequence arising after submission of this report at its meeting.

2.0

KEY ISSUES DISCUSSED

2.1

Infection Prevention and Control

2.1.1

The committee received a comprehensive assurance framework to support the reduction in Healthcare associated infections (HCAI). The framework has been prepared in response to the commitment from the Infection Prevention and Control team to reduce the risk of HCAI and to foster a zero tolerance approach to HCAI in Dudley. It was advised that the CCG consider this Framework as it follows the national guidance (NICE) and includes key indicators, considers contractual requirements, assists in the assurance process and contains comprehensive guidance for all providers.

2.1.2

The document will be shared widely with all partner organisations. A draft action plan to address the challenges identified has been prepared to support the process.

2.1.3

An update was provided to the Committee around the progress regarding legionella in the water system at Bushey Fields Hospital. The level of contamination within the system has begun to decrease. As part of D&WMHT’s Water Safety Plan, water samples are being taken by an external environmental agency. The DWMHT Estates department continue to complete and carry out tests to monitor progress and achieve agreed targets. The Trust advises that they are working to ensure the safety of patients throughout this period.

2.2

Safeguarding

2.2.1

Local Authority OFSTED report published

2.2.2

The completed inspection of services for children in need of help and protection, looked after children and care leavers has been published. The local authority has received an overall Inadequate rating.

2.2.3

The CCG as part of the Children’s Improvement Board are currently working with the Local Authority to address the issues raised by OFSTED. An action plan is being developed highlighting all health related issues that require a response and will be presented to the CCG at a future board by the Chief Nurse.

2.2.4

The Safeguarding Team work closely and collaboratively with all our partners in all agencies to deliver a high quality safeguarding service that is focused on the prevention agenda and assists in the protection of vulnerable children young people and adults in Dudley. Recently published Serious Case Reviews (SCRs) and Safeguarding Adult Reviews (SARS) have highlighted the need for all agencies to listen to the voices of young people, children and adults and share information which will support patients. Our key objectives must focus on improving:

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• • • •

Engagement and Communication Assurance and Audit Mental Capacity Act and Deprivation of Liberty training to include appropriate application Professional Support for practitioners to include supervision and appraisal

2.3

CAMHS – lack of Tier 4 beds

2.3.1

There have been 2 under 18 admissions to adult mental health beds in Bushey Fields during April 2016. These admissions have occurred as a result of the ongoing difficulties in identifying suitable placements for this group of young patients. Whilst the acute hospital setting was considered to be the most appropriate placement to manage the clinical risks in the short/medium term this created risks for other patients which are being managed. The lack of Tier 4 accommodation remains a national issue. Plans to introduce Tier 3 plus services (intensive therapeutic support in the community) within the Dudley borough is intended to reduce the need for Tier 4 accommodation for some children. Concerns regarding the lack of provision have been escalated to NHS England, the committee has asked for the lack of access to appropriate services to be entered onto our risk register.

2.4

Dudley Group Maternity Services

2.4.1

The CCG is currently reviewing the learning from serious incidents (SIs) and root cause analyses (RCAs) in respect of maternity services at Dudley Group NHS Foundation Trust including the reviews undertaken through The Local Supervisory Midwifery Office at NHS England

2.4.2

The Committee received an update from the Chief Nurse on proposals to establish a clinically led Maternity Service Quality Improvement Board. A joint Maternity Service Quality Improvement Board was agreed between DGFT and DCCG; the first meeting will be held on 6 May 2016.

2.5

Root Cause Analysis and associated governance framework

2.5.1

The Quality and Safety team have arranged a series of meetings with DGFT aimed at supporting the improvement of their RCAs following SIs. Improvements are required to ensure cases are appropriately investigated with rigour and transparency.

2.5.2

The Quality and Safety team have produced a comprehensive joint action plan with DGFT which has been incorporated in to the new 2016/17 contract; improvement in this area of risk management will be assessed against a series of key performance indicators and will link to the work being undertaken within the Maternity Services Quality improvement Board.

2.6

Primary Care Quality

2.6.1

The Quality and Safety Committee received a report on quality across primary care.

2.6.2

Three CQC inspection reports have been published in April 2016, the updated outcomes are contained in Appendix 1

2.6.3

The rating for Stourside Medical Practice is rated as ‘Requires Improvement’ overall The rating for Lower Gornal Medical Practice is rated as ‘good’ overall. The Dudley Partnership for Health has been rated as ‘Inadequate’ The Quality and Safety team are working with practices to ensure remedial actions are taken 3|P a g e

to enhance quality and safety where gaps are identified. 2.6.4

The Quality and Safety team have closed two SIs and are actively involved in monitoring a further two SIs.

2.6.5

As a result of the SI reported at the Limes Practice in August 2015, Conflict Resolution Training has been sourced and commissioned for primary care staff by the CCG. The training will be delivered by ‘Stand2’ who have offered a flexible approach which meets the training needs of up to 150 staff in primary care settings. The training will be available during this financial year.

2.6.6

A Primary Care dashboard has been developed and contains detail around a number of clinical and proxy quality indicators. These include CQC inspection outcomes, NHS choices, Friends and Family data, Infection Prevention Audits and patient experience. Additional detail will be added as data becomes available and the system evolves. Plans for full roll out in June 2016.

2.7

Nurse Training Needs Assessment & Revalidation

2.7.1

Online training needs analysis has now been completed by 70 nurses and will inform future training and educational programmes for nurses across primary care.

2.7.2

Dudley CCG has procured an online tool, HeART (Healthcare e-Portfolio for Appraisal) and the tool is now being rolled out across primary care settings to enable practice nurses to access this resource to support their revalidation.

2.8

Urgent Care Centre

2.8.1

The first formal Clinical Quality Review Meeting has taken place with Malling Health Urgent Care Centre (UCC). A review of mandatory training and workforce planning has been identified as the focus for the first meeting. The quality and safety team were assured that this area is receiving oversight by Malling Health

2.8.2

Dates for future meetings throughout 16/17 and terms of reference have now been agreed.

2.8.3

UCC has agreed to undergo a review of its services using the pilot standards designed by West Midlands Quality Review Services (WMQRS); the review is planned for June.

2.9

Quality Accounts

2.9.1

The Committee has had sight of the proposed quality accounts from BCPFT and DGFT. The CCG has a statutory responsibility to comment on the contents and to include feedback on the achievements and challenges during 2015/16. Responses have been forwarded. The quality account for DWMHT will be available for comment in May 2016.

2.10

Risk Register

2.10.1

The Committee reviewed the risk register in depth during the April 2016 Committee Meeting. Two new risks are to be added. • Under 18 Admissions of children to adult mental health wards. Direct result of a lack of Tier 4 placement resources for children with complex mental health problems in Dudley. • Identified risks in relation to lessons learnt following Root Cause Analysis investigations

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3.0

Recommendations

3.1.1

Accept this report as a source of on-going assurance that the CCG Quality & Safety Committee continues to maintain detailed oversight of all clinical quality standards in line with the CCG’s statutory duties.

The Quality and Safety Committee would like to take this opportunity to thank Mary Heber for all the work that she has done during the last 3 years with the CCG as a Non Executive Director (Secondary Care Clinician). Mary has been with the CCG since its inception in April 2013, her contribution has been invaluable, and we wish her well on her retirement.

Ruth Edwards Clinical Executive Lead for Quality 20 April 2016

Appendix 1 – Primary Care, CQC Inspections Update

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APPENDIX A: Overview of CQC inspections (as of 26/04/16)

Visit Date

Report Published

Overall rating

Safe

Effective

Caring

Responsive

Well Led

Keelinge House

06/01/2015

11/06/2015

Good

Goo d

Go od

Go od

Go od

Go od

Netherton Health Centre

13/01/2015

11/06/2015

Good

Goo d

Go od

Go od

Go od

Go od

Central Clinic

14/01/2015

27/08/2015

RI

RI

RI

Go od

Go od

RI

Lion Health

14/01/2015

31/03/2015

Good

Goo d

Go od

Go od

Go od

Go od

Chapel Street Surgery

20/01/2015

11/06/2015

Good

Goo d

Go od

Go od

Go od

Go od

Bilston Street Surgery

27/01/2015

16/07/2015

Good

RI

Go od

Go od

Go od

Go od

St James Medical Practice (Dr White)

27/01/2015

16/04/2015

Good

Goo d

Go od

Go od

Go od

Go od

Meadowbrook Surgery

28/01/2015

27/08/2015

Good

Goo d

Go od

Go od

Go od

Go od

Alexandra Medical Practice

05/05/2015

06/08/2015

Good

Goo d

Go od

Go od

Go od

Go od

Bean Road Surgery

07/07/2015

03/09/2015

Good

Goo d

Go od

Go od

Go od

Go od

Castle Meadows Surgery

21/07/2015

01/10/2015

Good

RI

Go od

Go od

Go od

Go od

Norton Medical Practice

04/08/2015

08/10/2015

Good

RI

Go od

Go od

Go od

Go od

Crestfield Surgery

18/08/2015

15/10/2015

Good

Goo d

Go od

Go od

Go od

Go od

High Oak Surgery

01/09/2015

29/10/2015

Good

RI

Go od

Go od

Go od

Go od

Summerhill Surgery

30/09/2015

03/12/2015

Good

RI

Go od

Go od

Go od

Go od

Thorns Road Surgery

14/10/2015

17/12/2015

Good

RI

Go od

Go od

Go od

Go od

Pedmore Road Surgery

22/10/2015

14/01/2016

RI

Inad

Go od

Go od

Go od

Go od

Steppingstones Surgery

28/10/2015

17/12/2015

Good

Goo d

Go od

Go od

Go od

Go od

Rangeways Road Surgery

12/11/2015

07/01/2015

Good

Goo d

Go od

Go od

Go od

Go od

Bath Street Surgery

24/11/2015

28/01/2016

Inad

Inad

Ina d

Go od

RI

Ina d

Woodsetton Medical Practice

08/12/2015

04/02/2016

Good

RI

Go od

Go od

Go od

Go od

Bilston Street Surgery – follow up

09/12/2015

14/03/2016

Good

RI

Go od

Go od

Go od

Go od

Lapal Medical Centre

15/12/2015

11/02/2016

Good

Goo d

Go od

Go od

Go od

Go od

The Waterfront Surgery

17/12/2015

03/03/2016

Inad

Inad

RI

Ina d

RI

Ina d

The Limes Medical Centre

13/01/2016

11/02/2016

Good

RI

Go od

Go od

Go od

Go od

Moss Grove Surgery

19/01/2016

10/03/2016

Practice Name



Visit Date

Report Published

Overall rating

Safe

Effective

Caring

Responsive

Well Led

Central Clinic - follow up

02/02/2016

03/03/2016

Good

Goo d

Go od

Go od

Go od

Go od

Dudley Partnerships for Health

10/02/2016

14/04/2016

Inad

Inad

RI

RI

RI

Ina d

Stourside Medical Practice

16/02/2016

04/04/2016

RI

RI

Go od

RI

Go od

Go od

Lower Gornal Medical Practice

01/03/2016

06/04/2016

Good

RI

Go od

Go od

Go od

Go od

Practice Name

Key: Good Requires Improvement

Inadequate



Outstanding

DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Audit Committee Report Agenda item No: 9.1 TITLE OF REPORT:

Audit Committee Report

PURPOSE OF REPORT:

To advise the Board of the key issues discussed and agreed at the Audit Committee meetings and Auditor Panels on 17 March and 28 April 2016

AUTHOR OF REPORT:

Mr M Hartland, Chief Operating and Finance Officer

MANAGEMENT LEAD:

Mr M Hartland, Chief Operating and Finance Officer Mrs J Jasper, Chair – Audit Committee.

CLINICAL LEAD:

Dr J Darby, Clinical Lead for Systems Redesign • • • •

KEY POINTS:

• • • • • •

IG Toolkit submitted with overall score of 91% Combined BAF & Risk Register up to 7 March 2016 reviewed. Risks 57, 68 and 74 approved for closure. Risk 58 to be presented separately to Board for approval of closure Operational Internal Audit Plan 2016/17 approved. Head of Internal Audit Opinion 2015/16 received with significant assurance External Audit Plan 2015/16 and Informing the Audit Risk Assessment received for assurance Anti-Fraud Annual Report 2015/16 and Draft Anti-Fraud Work-Plan 2016/17 approved Draft Annual Report & Accounts 2015/16 received Business Continuity Policy, Strategy and Plan approved EMIS Web Policy Approved A number of actions agreed by the Auditor Panel Other matters considered-FOI Report; Monitoring compliance with Prime Financial Policies; CCG’s Operational Scheme of Delagation amended

The Board is asked to: RECOMMENDATION:

• •

FINANCIAL IMPLICATIONS:

None

WHAT ENGAGEMENT HAS TAKEN PLACE:

None

ACTION REQUIRED:

Decision Approval  Assurance

Receive this report for assurance Note the decisions taken under delegated powers

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 12 MAY 2016 AUDIT COMMITTEE REPORT 1.0

INTRODUCTION The report summarises the key issues discussed at the Audit Committee meetings on 17 March and 28 April 2016.

2.0

KEY INDICATOR SUMMARY The following items are indicators of the current position in relation to the main responsibilities and obligations of the Committee as defined in the CCG Constitution and Terms of Reference. 1.

Indicator Regulation and Control CCG Governance Arrangements – Constitution

Scheme of Delegation Compliance with Prime Financial Policies Board & Committee Effectiveness

2.

Annual Report and Accounts 2015/16

3.

Operational & Risk Management Anti-Fraud and Security

Risk Management Arrangements – Combined BAF & Risk Register in place; Chairs/Management Leads of committees attending & updating Audit Committee; Report newly commissioned services

External Audit Internal Audit

4.

-

Other Policies

-

Other Policies – Business Continuity Policy

Information Governance

Information Governance Group established

Compliance with Information Governance toolkit Information Asset Management structure to be established with IAOs and IAAs identified from CCG staff IG Policy 2015/16 Freedom of Information requests (FOIs)

Position Good progress Constitution submitted to NHSE in November for approval. Formal approval received January. Updated Operational Scheme of Delegation approved 17 March 2016. No issues Governance action plan revised into themes and considered at October Audit Committee. Plan currently being updated. Draft Annual Report & Accounts approved and submitted by national deadlines. Audit progressing well. Good Progress Anti-Fraud Annual Report 2015/16 received; draft 2016/17 Anti-Fraud work-plan approved; draft Security Management Plan 2016/17 approved; Updates received. BAF & Risk Register updated monthly and actively managed. Board Development session planned on BAF. Procurement Strategy & reporting being updated to reflect new managing conflicts of interest guidance.

RAG

Final audit 2015/16 underway. Internal Audit Plan approved by March Committee. Audits progressing with significant assurance overall. 3 revised policies approved November 2015 Business Continuity Strategy & Plan presented to and approved by Board 31 March 2016 Board. Transfer from Midlands & Lancashire CSU to GEM & Arden (wef 1 April 2016) progressing well with local onsite presence. Met informally as work on information asset register progressed. To be established formally in 2016/17. Toolkit submitted with overall score of 91%. IG mandatory training at 97% IAOs & IAAs identified and trained. Information asset register populated. Overarching IG Policy updated and approved. All responded to within required timescale 2|P a g e

3.0

ITEMS DISCUSSED – 17 MARCH 2016

3.1

Information Governance (IG) The Committee received the IG Annual Report. The annual IG Toolkit return required the CCG to demonstrate evidence and compliance against four areas - IG management (scored at 93%); Confidentiality and Data Protection Assurance (scored at 95%); Information Security Assurance (scored at 86%) and Clinical Information Assurance (scored at 100%). The overall assessment against these areas identified that the CCG would achieve 91% by 31 March 2016. Internal audit had reviewed the IG Toolkit and identified gaps in assurance/evidence. It was understood that some of this was due to timing and that the issues had now been addressed. It was noted that the CCG had recorded a large number of information assets, which was a tremendous effort by staff over the last few weeks. The Committee was also pleased to note that 97% of staff had completed their IG training. It was confirmed that from 1 April 2016 the CCG would obtain IG services from Arden and GEM CSU although the Information Governance Support Officer (IGSO) would remain with Midlands and Lancashire CSU. The Committee recorded their thanks to the IGSO for her support and hard work during her time in the CCG. Following the discussion the Committee noted that although the CCG was not yet at 91% it would be at this target by 31 March 2016 once the outstanding evidence had been uploaded. On this basis the Committee formally approved the overall IG Toolkit submission at 91% and each of the subrequirements. The Committee received a report on FOI requests for the period 01/01/16 – 29/02/16 and noted that all 42 requests received in the period had been responded to within the required timeframe.

3.2

Board Assurance Framework and Risk Register The Committee received the Combined Board Assurance Framework (BAF) and Risk Register as at 7 March 2016 for assurance. The Committee noted the following changes since it last met and considered the BAF & Risk Register as at 7 January 2016: • changes in initial risk scores – increase to risk 50, reduction to risk 76 • changes to residual scores – reduction to risks 34 and 76 • addition of 4 new risks – 87, 88, 89 and 90 • risks closed following Board approval – none • risks closed following Audit Committee approval – 15 The Committee also approved the closure of risk 68 under its delegated authority following a recommendation from the Primary Care Commissioning Committee. This risk was in relation to the failure of the CCG and NHS England to ensure safe handover and transition of functions as part of delegated commissioning arrangements. A separate report to the Board based on the Board Assurance Framework (i.e. risks 16 and over) as at 7 April 2016 reflects these changes and provides a further update.

3.3

External Audit The Committee received the 2015/16 Audit Plan and the ‘Informing the Audit Risk Assessment’ report for assurance and confirmed that management’s responses were consistent with their understanding. The Committee considered the report ‘Benchmarking 2014/15 Annual Report’. It agreed some of the areas where the CCG appeared to be an outlier would be taken into account when preparing the CCG’s 2015/16 Annual Report.

3.4

Internal Audit The Committee received a report on progress against the internal plan and the position on the recommendation tracker. It was noted that two additional reviews had been added at additional cost and the reviews on partnership working and the Better Care Fund had been deferred to April 2016. 3|P a g e

The draft Annual Report and Head of Internal Audit Opinion on the effectiveness of the system of internal control within the CCG for the year ended 31 March 2016 currently indicated significant assurance. A number of management letters and reports were received for assurance: • Final 2015/16 audit report on Financial Management & QIPP Arrangements, where Financial Management had been given full assurance, QIPP significant assurance. • Primary Care Commissioning Arrangements Phase 1 management letter where no specific issues were identified. • Commissioning Arrangements for the Urgent Care Centre 2015/16 gave significant assurance. • Business Intelligence Systems 2015/16 report which gave significant assurance. The Committee approved the draft 2016/17 Operational Internal Audit Plan with the addition of 10 days contingency. 3.5

Local Anti-Fraud The Committee received an Anti-Fraud update for 2015/16 for assurance. This included activities against each of the expected deliverables for the year to date and outturn against planned activity. The Committee also approved the Draft Anti-Fraud Work-Plan for 2016/17 and received a report on the Review of NHS Protect’s Functions and Services.

3.6

CCG and Audit Committee Policies The Committee received and subject to some final changes discussed at the meeting, approved the following under its delegated powers for Business Continuity: • Business Continuity Policy • Business Continuity Strategy • Business Continuity Plan including Crisis Management Plan

3.7

Annual Report and Accounts 2015/16 The Committee received the draft national template for the Annual Governance Statement 2015/16 for information.

3.8

Operational Scheme of Delegation The Committee approved updates to the CCG’s Operational Scheme of Delegation under its delegated powers. These mostly related to changes in the OJEU financial limits.

3.9

Other Issues The Audit Committee considered and received updates and assurance in respect of: • • • • • • • •

Governance Action Plan Brief on maternity services review Legal advice on TUPE transfer issues Future Proof Health (FPH) Ltd Selection and appointment of a particular Consultancy firm Financial Control Environment Assessment Monitoring compliance with Prime Financial Policies Declarations of Interest

4.0

ITEMS DISCUSSED – 28 APRIL 2016

4.1

Information Governance (IG) The Audit Committee was introduced to a representative of the IG team at the new service provider, Arden & GEM CSU. The Committee received a report on FOI requests for the period 01/03/16 – 31/03/16 and noted that 16 of the 17 requests received in the period had been responded to within the required timeframe. One request took longer as it was referred for a Public Interest Test but an extension was agreed with the requestor.

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4.2

Board Assurance Framework and Risk Register The Committee received the Combined Board Assurance Framework (BAF) and Risk Register as at 7 April 2016 for assurance. The Committee noted the following changes since it last met and considered the BAF & Risk Register as at 7 March 2016: • • • •

changes to residual scores – reduction to risk 75, increase to risk 81 addition of 1 new risk – 91 risks closed following Board approval – none risks closed following Audit Committee approval – 68

The Committee also approved the closure of risks 57 and 74 under its delegated authority following recommendations from the Quality & Safety Committee. These risks related to Non-Medical Prescribing nurses working out of GP Practices and School Health Adviser Provision. The Committee also recommended the closure of risks 58 to the Governing Body. These risks relate to the JAC electronic system and delays in signing contracts with providers. A separate report to the Board based on the Board Assurance Framework (i.e. risks 16 and over) as at 7 April 2016 reflects these changes and seeks Governing Body Approval. 4.3

Internal Audit The Committee received a report on progress against the internal plan and the position on the recommendation tracker. The Committee also received the Final Annual Internal Audit Report and Head of Internal Audit Opinion 2015/16 which gave significant assurance. The Committee approved the updated Internal Audit Plan 2016/17 and the Draft Security Management Workplan 2016/17. A number of management letters and reports were received for assurance: • Assessment of Assurance Framework 2015/16 • IG Toolkit arrangements and compliance 2015/16 • Review of CCG governance processes in respect of the maternity serious incidents process

4.4

Local Anti-Fraud The Committee approved the Anti-Fraud Annual Report for 2015/16 It also received Fraud Self-Assessment Reviews for its local providers for assurance and the results of a staff survey on Fraud.

4.5

CCG and Audit Committee Policies The Committee approved the EMIS Web Policy under its delegated authority for IG and received an update on policies.

4.6

Annual Report and Accounts 2015/16 The Committee received and considered the Draft Annual Report & Accounts (ARA) 2015/16 that had been submitted to NHS England by the national deadlines. The Chief Accountable Officer attended to present the draft Annual Governance Statement for 2015/16. The Declaration of Interests as at 31 March 2016 and the draft Audit Committee Annual Report 2015/16 were presented to the Committee. These were intended to provide assurance in respect of the content of the Annual Report & Accounts and its future approval.

4.7

CCG Constitution The Committee considered proposed changes in respect of GP Practice names; GP closures and Committee name changes for recommendation to the Board. It agreed that any additional changes to be recommended would be agreed by the Chair of the Audit Committee. 5|P a g e

4.8

NHS England draft Revised Statutory Guidance in respect of Managing Conflicts of Interest The Committee considered this draft guidance and agreed to respond to the consultation.

4.9

Other Issues The Audit Committee considered and received updates and assurance in respect of: • • • • •

5.0

Governance Action Plan Legal advice on TUPE transfer issues Future Proof Health (FPH) Ltd Primary Care Support Offer Monitoring compliance with Prime Financial Policies

AUDITOR PANEL At its meeting on the 10th March 2016 the Board approved the establishment of the CCG’s Auditor Panel. The CCG Auditor Panel met separately on the 17th March and 28th April where it: • Approved the establishment of the Auditor Panel • Adopted the Auditor Panel Terms of Reference • Approved the appointment of Mrs Julie Jasper as Chair and Mr Steve Wellings as Vice-Chair of the Auditor Panel • Noted the timeline for the procurement process • Agreed a collaborative approach for the procurement across Birmingham, Black Country and Solihull, but with the ability for each CCG to select their own auditors

6.0

DECISIONS TAKEN UNDER DELEGATED POWERS 17 March 2016 - Approval of: • IG Toolkit submission at 91% and each of its sub-requirements • Closure of Risk 68 in the BAF & Risk Register • Draft 2016/17 Operational Internal Audit Plan • Draft Anti-Fraud Work-Plan for 2016/17 • Business Continuity Policy • Business Continuity Strategy • Business Continuity Plan including Crisis Management Plan • Updates to the CCG’s Operational Scheme of Delegation 28 April 2016 – Approval of: • Closure of Risks 57 & 74 in the BAF & Risk Register • Updated 2016/17 Operational Internal Audit Plan • Anti-Fraud Annual Report 2015/16 • EMIS Web Policy

7.0

DECISIONS REFERRED TO THE BOARD • None

8.0

RECOMMENDATIONS The Board is asked to: • Receive this report for assurance and note the decisions taken under delegated powers

APPENDICES • None Mr M Hartland Chief Operating and Finance Officer May 2016

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Audit Committee Annual Report 2015/16 Agenda item No: 9.2 TITLE OF REPORT:

Audit Committee Annual Report 2015/16

PURPOSE OF REPORT:

To present the Annual Report 2015/16 from the Audit Committee and provide assurance that the committee has discharged its responsibilities and met its terms of reference

AUTHOR OF REPORT:

Mr M Hartland, Chief Finance Officer

MANAGEMENT LEAD:

Mr M Hartland, Chief Finance Officer Mrs J Jasper, Chair – Audit Committee

CLINICAL LEAD:

Dr J Darby, Clinical Executive for Systems Redesign

KEY POINTS:

The report summarises the committee’s work during the year and confirms that: • The CCG’s system of risk management is adequate in identifying risks and allowing the Board to understand the appropriate management of those risks • The committee has reviewed and used the assurance framework and believes that it is fit for purpose and that the comprehensiveness of the assurances and the reliability and integrity of the sources of assurances are sufficient to support the Board’s decisions and declarations • The are no areas of significant duplication or omission in the CCG’s systems of governance that have come to the committee’s attention • Highlights the main areas the committee has reviewed and any particular concerns or issues it has addressed

RECOMMENDATION:

•

FINANCIAL IMPLICATIONS:

None

WHAT ENGAGEMENT HAS TAKEN PLACE:

None

ACTION REQUIRED:

Decision Approval  Assurance

The Board is asked to receive this report for assurance

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NHS DUDLEY CLINICAL COMMISSIONING GROUP (CCG) Audit Committee Annual Report 2015/16 Background The Audit Committee is established under Governing Body delegation with approved terms of reference that are aligned with the NHS Audit Committee Handbook published by HFMA in June 2014. These terms of reference were reviewed and updated by the Committee with formal approval by the Governing Body in January 2015. The CCG Governing Body has delegated specific responsibilities to the Audit Committee in it’s Constitution, as follows: -

Approve the group’s operational scheme of delegation that underpins the group’s ‘overarching scheme of reservation and delegation’ as set out in its constitution. Approve the group’s annual report and annual accounts. Approve the group’s counter fraud and security management arrangements. Approve the group’s risk management arrangements. Approve a comprehensive system of internal control, including budgetary control, which underpins the effective, efficient and economic operation of the group. Approve the group’s arrangements for business continuity Approve arrangements for ensuring appropriate safekeeping and confidentiality of records and for the storage, management and transfer of information and data.

The Committee consists of three lay members (one of whom is chair) and the secondary care doctor. It has met 7 times during the financial year 2015/16 and has discharged its responsibilities for scrutinising the management of risk and controls which affect all aspects of the organisation’s business. Principal review areas Governance, risk management and internal control The Committee has reviewed the Annual Governance Statement to ensure it reflects the committee’s view on the CCG’s system of internal control. It has sought assurance from the Head of Internal Audit Opinion, has received regular updates during the year from external audit and received other appropriate independent assurances in order to gain a view of the CCG’s system of internal control. The Committee considers that the governance statement is consistent with the Committee’s view on the CCG’s system of internal control and can be supported by the Governing Body. The Governing Body approved a Risk Management Strategy and the Risk Register at its meeting on 2nd May 2013. Since then the Audit Committee has overseen the development of a Combined Board Assurance Framework and Risk Register under its delegated responsibility for risk management arrangements. This has been in place since October 2013 and has been considered at each Audit Committee with appropriate clinical and management leads in attendance to provide assurance. The Governing Body receives assurance on all red risks. The Committee believes that while adequate systems for risk management are in place, there needs to be a renewed focus on risk in 2015/16 given the challenging and complex environment in which the Clinical Commissioning Group now operates. This will include a review and update of its Risk Management Strategy and a development session for Governing Body members on the Board Assurance Framework and Risk. Internal Audit’s assessment of the Assurance Framework 2015/16 confirms that an Assurance Framework has been established which is designed and operating to meet the requirements of the

2015/16 AGS and provide reasonable assurance that there is an effective system of internal control to manage the principal risks identified by the organisation. Information Governance (IG) Under its delegated responsibility for information governance (IG), the Committee has received reports and updates from Midlands and Lancashire CSU information governance. This includes progress in meeting the requirements of the IG Toolkit; the Committee was pleased to note that this was submitted at the end of the year with a score of 91%. The appointment of an Information Governance Support Officer early in the financial year and a local presence enhanced the support and advice to the Committee. Additionally an IG development session was delivered to Governing Body members. Unfortunately, the level of support the CCG received towards the end of the financial year reduced due to staff changes. Following a procurement exercise it was confirmed that the service would transfer to a new CSU provider from 1st April 2016. Internal Audit Throughout the year the Committee has worked effectively with CW Audit Services as its internal audit provider to strengthen the CCG’s internal control processes. Additional days were built into the internal audit operational plan in March 2015 to reflect the work required when Primary Care Commissioning was delegated to the CCG from 1st April 2015 and arrangements around the Better Care Fund. Additional days were agreed towards the end of 2015/16 to support a review of local governance arrangements in respect of serious incidents. The Committee has placed great emphasis on the findings of internal audit and timely implementation by management of actions to address these findings. It has requested that any delays in management responses or implementation of recommendations be brought to its attention so that it can seek assurances from management. The Committee was advised of revised arrangements in respect of the internal controls work to be undertaken by Deloitte for Midlands and Lancashire CSU for the financial year. The Committee agreed to work with colleagues at other local CCGs to procure an internal audit service provider with effect from 1st April 2017. External Audit The Committee received the report from Grant Thornton as its external auditor on its audit findings for the year ended 31 March 2015 at its meeting on 28th May 2015. The auditors issued an Unqualified Opinion and Value for Money Conclusion noting there were no adjusted or unadjusted misstatements nor misclassifications & disclosure changes that required reporting. The report also confirmed that a one-off penetration test and vulnerability assessment by the CCG’s IM&T provider had been undertaken and noted that the provider had confirmed it would be contracting for this routinely in future. The Committee has reviewed and agreed the external audit plan for 2015/16. The Committee has established an auditor panel to take forward the requirement to appoint external auditors with effect from 1st April 2017. The CCG has agreed to work with colleagues at other local CCGs to share the costs and workload of doing this.

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Financial Reporting The Committee was advised by Internal Audit that it was able to report full assurance following its review of Financial Management, and significant assurance for Financial Systems; QIPP Delivery; and Financial & Performance reporting. The Committee received regular assurances in respect of the Annual Report and Accounts preparation. This included a detailed timetable and progress report; consideration of the content of the Annual Report; update and approval of the Accounting Policies; and progress on audit matters. The Committee has reviewed the draft Annual Report and Accounts for 2015/16 and will receive the audited Annual Report and Accounts for consideration and approval at its meeting on the 26th May 2016. Management The Committee has challenged the assurance process during the year and has requested and received assurance reports from CCG management and various other sources both internally and externally throughout the year. This has included attendance by Clinical Executives and Senior Officers to provide assurance on the management of risks and other matters such as the use of consultancy staff and the reporting of serious incidents. The Committee has also continued to monitor the performance of the commissioning support service provided by Midlands and Lancashire Commissioning Support Unit and has been seeking assurance from management that improvements in service delivery have been experienced. Other matters worthy of note Within its wide remit, the Audit Committee’s agenda is considerable. Some of the matters it has considered routinely or as required by circumstances are listed below: •

• • • • • • •

Agreed the anti-fraud plan 2015/16, receiving updates through the year, and approved the updated counter fraud, bribery & corruption policy. It was advised of the outcome of the National Fraud Initiative. There were no significant issues to raise in this context. Regularly monitored compliance with the prime financial policies. Received regular reports on Freedom of Information Requests (FOIs) Approved the Business Continuity Policy, Strategy & Plan under its authority delegated by the Governing Body. Considered and recommended changes to the CCG’s Constitution. Approved relevant policies, mostly IG and related to standards of business conduct. Undertook a national Financial Control Environment Assessment for NHS England. Participated in a national Conflicts of Interest Audit (one of 10 CCGs) undertaken by Deloitte on behalf of NHS England.

Effectiveness of the Audit Committee The Committee has been active during the year in carrying out its duty in providing the CCG Governing Body with assurance that it is an effective committee. Specifically the Committee has: • • • •

Reviewed and updated its Terms of Reference Assessed its performance against the work-plan for 2014/15 and agreed a work-plan for 2015/16. Taken forward the recommendations from the review of committee effectiveness & committee processes undertaken by Paul Capener in his role as an independent governance advisor. Taken forward some of the recommendations from the Governing Body and Committee effectiveness review run by the Good Governance Institute (GGI).

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Value for Money An assessment has been made of the cost of the operation and administration of the Committee throughout the year. This is based upon the attendance of individuals as shown in the attached appendix. The cost is calculated based on the average hourly cost of each individual at an estimated 3 hours per Committee (CSU and external organisations are excluded). The notional cost for 2015/16 is £7,924 and based upon the outcomes achieved by the Committee as described above, this has been viewed as an effective use of public funds. Looking Forward In looking forward to 2016/17 and developing its work-plan, the Audit Committee will build on the good progress that has been made since the CCG was established. It recognises that one of its key priorities will be to recommend changes and provide assurance in respect of conflicts of interest, reinforced by the recently issued draft revised statutory guidance by NHS England. However there are a number of existing responsibilities where further progress and action will be required including progressing implementation of arrangements for business continuity; internal audit contract arrangements; future appointment of external auditors; integrated governance and risk management; and implications of the Governing Body and Committee effectiveness reviews. Conclusion In conclusion, the Committee is of the opinion that this annual report is consistent with the draft governance statement, Head of Internal Audit opinion, and that there are no matters that the Committee is aware of at this time that have not been disclosed appropriately.

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AUDIT COMMITTEE ATTENDANCE 2015/16 NAME

ROLE

30/04/15

28/05/15

23/07/15

01/10/15

25/11/15

04/02/16

17/03/16

VOTING MEMBERS Mrs Julie Jasper

Lay Member & Chair















Mr Steve Wellings

Lay Member & Vice-Chair







x







Mr Chris Handy

Lay Member











x

x

Dr Mary Heber

Secondary Care Doctor

x





x



x



Mr Matthew Hartland

Chief Operating & Finance Officer







x







Dr J Darby

Clinical Executive-Systems Redesign







Ms Sue Johnson

Deputy Chief Finance Officer











Mr Paul Maubach

Chief Accountable Officer





Mrs L Broster

Head of Communications & Public Insight





IN ATTENDANCE

Communications & Public Insight representative





  





Information Governance

x

x











External Audit









x





Internal Audit















Local Counter Fraud

x













CCG Chair



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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Review of Dudley CCG Constitution Agenda item No: 9.3 TITLE OF REPORT:

Review of Dudley CCG Constitution

PURPOSE OF REPORT:

To provide a high level outline of the areas of the Constitution that will be subject of review in readiness for submission of a revised Constitution to NHS England in June 2016

AUTHOR OF REPORT:

Mr M Hartland, Chief Operating and Finance Officer

MANAGEMENT LEAD:

Mr M Hartland, Chief Operating and Finance Officer

CLINICAL LEAD:

Dr D Hegarty, Chair •

• • KEY POINTS: •

•

• • • RECOMMENDATION:

• • •

The Constitution can be varied where the CCG applies to NHS England and the application is granted. The CCG can make a submission to NHS England at two points in each year. The next submission deadline is June 2016. A number of changes are proposed for approval including GP Practice names; GP closures; and Committee names. It is proposed that the Constitution be reviewed and amended to reflect current legislation and guidance and to align with the current Committee Terms of Reference. Other proposed changes are presented including Clinical Executive titles, responsibilities & appointment; potential changes to support the contract award in respect of NHS 111; update of references to government guidance relating to Public Involvement The deadline for submission to NHS England in June is before the Governing Body next meets and therefore authority to approve the revisions for submission will need to be delegated and the revisions outlined to the meeting after submission. The Board approve the proposed changes to the Constitution in respect of GP Practice name; GP Practice closures; and Committee names. The Board approve the proposed change of title to the Clinical Executive for Pathways of Care and confirms other titles are appropriate The Board approve the proposed changes to the process and eligibility for recruitment of Clinical Executives The Board confirms changes are necessary to support the NHS 111 contract award The Board agrees that the Public Involvement section, 5.2.1 should be updated The Board delegates authority to the Chief Accountable Officer following consultation with the CCG Chair to approve any revisions to the Constitution arising from recommendations 2) to 5) for submission to NHS England. 1|P a g e

FINANCIAL IMPLICATIONS:

None

WHAT ENGAGEMENT HAS TAKEN PLACE:

None

ACTION REQUIRED:

 

Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 12 MAY 2016 REVIEW OF DUDLEY CCG CONSTITUTION 1.0

INTRODUCTION Under the establishment of Clinical Commissioning Groups, there is an opportunity at two points in the year to submit revisions to the CCG Constitution to NHS England. The next opportunity is in June 2016.

2.0

PROPOSED REVISIONS TO THE CONSTITUTION

2.1

GP Practice Names As of the 1st February 2016, the practice Netherton Surgery (19) has been renamed Links Medical Practice. This amendment will be reflected in Appendix B in the Constitution which lists the member practices.

2.2

GP Practice Closures St Thomas’ Medical Practice (15) closed on the 18th December 2015 with most of its patients transferred to Bean Road Surgery (17) Market Street Surgery (27a) which is part of Wordsley Green Branch closed on the 14th March 2016 Masefield Road Surgery (8a) which is part of Lower Gornal Surgery closes on the 1st May 2016 All these amendments will be reflected in Appendix B to the Constitution which lists the member practices.

2.3

Committee Name Changes It is recommended that the Audit Committee is renamed to Audit & Governance Committee to better reflect its role and function within the organisation. It is also recommended that the Remuneration Committee is renamed to Remuneration & Human Resources Committee to better reflect the scope that the committee covers in respect of human resource related issues.

3.0

POTENTIAL FURTHER REVISIONS

3.1

Legislative & Governance Requirements Prior to submission for approval by NHS England, the Constitution will be reviewed and amended as necessary to reflect current legislation and guidance and to ensure that the Constitution and revised Governing Body and Committee Terms of Reference are aligned. This will include considering the impact of the revised draft statutory guidance on managing conflicts of interest issued by NHS England in April 2016.

3.2

Clinical Executives – Titles, Responsibilities & Appointment Defining the role and responsibilities of the Clinical Executives and their appointment is key to supporting the Clinical Commissioning Group’s challenging agenda over the next few years.

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3.2.1

The current Clinical Executive titles are listed below. • • • • •

Clinical Executive for Finance, Performance & Business Intelligence Clinical Executive for Elective Pathways Clinical Executive for the Multispecialty Community Provider (MCP) Clinical Executive for Quality and Safety Clinical Executive for Primary Care Commissioning

It is proposed that the Clinical Executive for Elective Pathways be revised to Clinical Executive for Pathways of Care. The Board is asked to approve this change and confirm that all of the titles remain appropriate. 3.2.2

The composition of the Governing Body makes it clear that Clinical Executives are recruited from within the elected GP representatives in the first instance and there are currently five. Additionally, any Clinical Executive must be on the Dudley GP Performers List. Currently the process for recruiting a Clinical Executive is described as follows in the CCG’s Constitution: “should more than 1 eligible elected GP representative apply for the same Clinical Executive role, then an interview process will be held to determine the appointee. The interview panel and process will be overseen by a Sub-Committee of the Remuneration Committee. If only 1 eligible elected GP representative member of the CCG Governing Body is nominated, then they will be appointed to the role. In circumstances where the role is advertised to all Dudley GPs, then a competitive recruitment process will be held, overseen by an independent committee, accountable to the Remuneration Committee;” The Board is asked to consider whether this process and the eligibility requirements be revised to recruit from outside the Dudley GP performers list in certain circumstances. In making this decision the Board needs to be assured that members have been fully engaged in relation to this proposed change.

3.3

Potential changes to support the contract award in respect of NHS 111 The procurement process for the new NHS 111 integrated urgent care service is now underway with contract award due to take place in July 2016. This item is to be discussed fully in the Private section of the Board. Due to the complexity of the contracting process and financial value of the collaborative contract, the lead CCG for the procurement process is recommending a ‘Committee in Common’ is established to award the contract. However to be able to do this the CCG’s Constitution will need to be revised, mainly in respect of delegation. These changes are still to be worked through and will depend on the outcome of the decisions made by the Board in the private session.

3.4

Public Involvement – update references to government guidance Section 5.2.1 of the Constitution on Public Involvement refers to the Cabinet Office’s Code of Practice on Consultation which is an out of date document. It is proposed that this is amended to either refer to more up to date guidance or include a more general statement about using appropriate and current government guidance.

4|P a g e

4.0

RECOMMENDATIONS 1) The Board approve the proposed changes to the Constitution in respect of GP Practice name; GP Practice closures; and Committee names. 2) The Board approve the proposed change of title to the Clinical Executive for Pathways of Care and confirms other titles are appropriate 3) The Board approve the proposed changes to the process and eligibility for recruitment of Clinical Executives 4) The Board confirms changes are necessary to support the NHS 111 contract award 5) The Board agrees that the Public Involvement section, 5.2.1 should be updated 6) The Board delegates authority to the Chief Accountable Officer following consultation with the CCG Chair to approve any revisions to the Constitution arising from recommendations 2) to 5) for submission to NHS England.

Mr M Hartland Chief Operating and Finance Officer May 2016

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Combined Board Assurance Framework and Risk Register Agenda item No: 9.4 TITLE OF REPORT:

Combined Board Assurance Framework and Risk Register

PURPOSE OF REPORT:

To update the Board on the combined Board Assurance Framework (BAF) and Risk Register and present it as at 7 April 2016

AUTHOR OF REPORT:

Mr M Hartland, Chief Operating and Finance Officer

MANAGEMENT LEAD:

Mr M Hartland, Chief Operating and Finance Officer

CLINICAL LEAD:

Dr D Hegarty, Chair

KEY POINTS:

• • • •

Update on combined BAF & Risk Register Summary of risks as at 7 April 2016 presented Risk 58 presented for consideration for closure by the Board Note Risk 13 as a standing item

• • •

The Board is asked to receive the report for assurance The Board is asked to approve the closure of risk 58 The Board is asked to consider the key controls, gaps in control and assurance, and the actions and agree an update.

RECOMMENDATION:

FINANCIAL IMPLICATIONS:

None direct. Potential consequence if risks materialise

WHAT ENGAGEMENT HAS TAKEN PLACE:

None

ACTION REQUIRED:

Decision  Approval  Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 12 MAY 2016 COMBINED BOARD ASSURANCE FRAMEWORK (BAF) AND RISK REGISTER 1.0

INTRODUCTION In accordance with the CCG’s Risk Management Strategy, the combined BAF and Risk Register for those risks scored 16 and over (which comprise the Board Assurance Framework) is presented to the CCG Board. This is based on the position as at 7 April 2016. The Audit Committee considered the overall combined BAF and Risk Register as at 7 April 2016 at its meeting on 28 April 2016.

2.0

COMBINED BOARD ASSURANCE FRAMEWORK (BAF) & RISK REGISTER Those risks with an initial or residual score (after actions having been taken and controls implemented) of 16 or higher are presented to the Board in detail at Appendix 1. These risks are also summarised in the table below. Initial Risk

Residual Risk

Accountable Committee

Failure of a main provider (Dudley Group NHS FT) due to financial pressures will result in inadequate care for the local population (note: this accounts for legacy risk brought forward from Cluster regarding failure to manage demand, creating financial pressures within the local health system). Failure of the health economy to work together to implement service changes which will adversely impact commissioning and delivery of health services. Failure of the governing body to demonstrate appropriate leadership/ clinical leadership may result in poor strategy and implementation, and thereby fail to meet statutory and regulatory responsibilities Tensions between innovation, quality and financial pressures could limit the innovation shown by the CCG Failure to ensure meaningful public engagement including with the Health Overview and Scrutiny Committee will prevent effective commissioning and patient centred services The impact of significant individual performance issues in relation to primary medical services that could result in removal of GP member from the Performers' List Failure to achieve whole of Quality Premium resulting in lost income and reputational damage. Failure to deliver significant QIPP targets in 15/16 puts the future financial stability of the CCG at risk.

20

20

Finance, Performance & Business Intelligence

16

12

Commissioning Development

12

9

Risks 16 or higher as at 7 April 2016 6.

10.

13.

17.

Governing Body

16

12

16

8

Commissioning Development

16

2 Down from 6

Primary Care Commissioning

16

16

25

12

48. Failure of Black Country Partnership FT due to financial pressures will result in inadequate care for the local population.

20

15

50. Failure of member practices to meet the standards of the Care Quality Commission risks continuity of service provision in member practices.

16 Increase in Initial risk from 12

9

Commissioning Development Finance, Performance & Business Intelligence Finance, Performance & Business Intelligence Primary Care Commissioning

19.

34.

36. 43.

Commissioning Development

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Initial Risk

Residual Risk

Accountable Committee

58. The JAC electronic system is not operating efficiently which has resulted in an unspecified number of Discharge Letters not being received by GPs. This risk affects patients returning to primary care following changes in treatment medication. Detail to medication changes following review, in some cases, inaccurate. Proposed for Closure 71. DGFT CIP PROGRAMME 2015/16 is challenging the plan includes the removal of up to 200 posts from its workforce (in addition to the 200 removed in 2014/15) - this could have significant impact on the quality of services. 75. NURSING REVALIDATION - The Nursing and Midwifery Council covering all registrants across England, Scotland, Northern Ireland and Wales intend to introduce nursing and midwifery revalidation from 1 April 2016. This is a three year process and more onerous than current practice requirements - many nurses are stating their intention to take early retirement rather than go through the process. For the CCG there is particular concern about the resilience of practice nurse workforce particularly given the age profile of the current nurses working in Dudley. 77. Failure to realise financial savings outlined in the value proposition because the MCP care model is not implemented. 82. HEALTH VISITOR TRANISTION FROM REGISTRANT TO RESIDENT POPULATION i.e. transfer of children in the care of a Health Visitor (HV) from being with a GP to where they live (their home address) - this creates risk regarding the number of children whose health visitor will change (700 out and 1200 in). The risk is that there are robust processes in place to transfer care and records out of borough but this is not replicated for those children transferring into the borough, particularly the transfer of their records. This is is also a safeguarding concern as children could be 'lost' to the HV service. 83. Provider of non-emergency patient transport commissioned by the CCG is unable to deliver the quality KPI's in the contract and have given notice on the contract. 84. Failure to identify and deliver significant QIPP savings targets in 16/17 puts the future financial stability of the CCG at risk.

20

12

Quality & Safety

16

12

Quality & Safety

16

9 Down from 12

Quality & Safety

16

9

Commissioning Development

16

16

Quality & Safety

20

15

Quality & Safety

25

20

90. The CCG has received its planned Resource Allocation for 2016/17 to 2020/21 however there are a number of uncertainties at this stage that do not enable an accurate confirmation of the impact on the CCG’s financial plan and could potentially add pressure to the CCG’s financial position.

16

16

Finance, Performance & Business Intelligence Finance, Performance & Business Intelligence

Risks 16 or higher as at 7 April 2016

3.0

RECENT AMENDMENTS TO THE BAF AND RISK REGISTER The following amendments to risks 16 and over have been made since the Board received the BAF and Risk Register as at 6 February at its meeting on 10 March 2016: Review & Updates – Updates were received from the leads for the Primary Care Commissioning Committee, Quality & Safety Committee and Commissioning Development. 3|P a g e

The leads for the Finance, Performance & Business Intelligence Committee and Remuneration Committee reported no changes. The Board is requested to review risk 13 (in respect of its leadership) for which it is directly responsible and update as appropriate. 3.1

Risk Description, related controls, assurances, actions and comments Risk 82: The timescale for actions against this risk has been amended to June 2016.

3.2

Changes to the Initial Risk Scores Risk 50: Following recent adverse CQC reports exceptionally the Initial Risk impact has been increased from 3 to 4, taking the overall risk rating to 16 rather than 12 thus bringing it into the Board Assurance Framework.

3.3

Changes to the Residual Risk Scores Risk 34: The impact from this risk, which relates to performance issues where an individual GP might be removed from Performers list, has been reduced from 3 to 1. This is based on the level of support arrangements that have been put into place locally since the CCG took delegated responsibility for Primary Care Commissioning. The overall residual risk has reduced from 6 to 2. Risk 75: The timescale for actions against this risk has been amended to June 2016. The impact from this risk relating to nursing revalidation has been reduced from a 4 to a 3 residual risk. The nurses have been supported through the revalidation process and the CCG has procured an electronic registration system for the nurses to register their details. This has reduced the probability of the residual risk to 9.

3.4

New Risks No new risks that score 16 and over.

3.5

Risks Proposed for Closure Risk 58: The Quality & Safety Committee reviewed the risk around the JAC system. The JAC system has been switched on, electronic letters are being sent and an audit has confirmed 96% accuracy. In May 2016 the JAC should be able to deliver electronic double signing. The Audit Committee recommends closure of this risk to the Governing Body on the basis that the Quality & Safety Committee have carried out two further Audits of the system now in place and had an achievement of 96% accuracy.

4.0

RECOMMENDATIONS 1) 2) 3)

5.0

The Board is asked to receive the report for assurance. The Board is asked to approve closure of risk 58 The Board is asked to consider the key controls, gaps in control and assurance, and the actions and agree an update. APPENDICES Appendix 1 – Combined BAF & Risk Register as at 7 April 2016 (risks 16 and over & Risk 13)

M Hartland Chief Operating and Finance Officer March 2016

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Dudley CCG Combined Board Assurance Framework and Corporate Risk Register 2015/16 07-Apr-16 CORPORATE OBJECTIVES 1. Reducing health inequalities 2. Delivering best possible outcomes 3. Improving quality and safety 4. System effectiveness

6

Original Date

01/05/2013

Last Review (Committee Date)

24/03/2016

Last Update (Risk Amended)

28/05/2015

Risk Description LINK TO CORPORATE OBJECTIVE (SEE KEY ABOVE)

ID

NOTE: TREND IN RESIDUAL RISK AGAINST PREVIOUS MONTH IS SHOWN //=

2

Failure of a main provider (Dudley Group NHS FT) due to financial pressures will result in inadequate care for the local population (note: this accounts for legacy risk brought forward from Cluster regarding failure to manage demand, creating financial pressures within the local health system)

Accountable Committee

F&P

Accountability Sponsor & Owner

Dr Jonathan Darby

Management Lead

Matt Hartland

P

4

I

5

Initial Risk Score (PxI) Score before any controls are in place.

20

Key Controls What controls/systems are in place to assist in securing delivery of our objective. Such as strategies, policies and procedures

Robust contract management via contract review meetings, performance management, joint strategic planning. Financial Plan and contracts agreed with providers. Financial Assurance KPIs reported to Board. Joint monthly payment reconciliation process including validation of activity.

Gaps in Control Where are we failing to put controls/ systems in place. / Where are we failing in making them effective. For example lack of training or no regular review of performance

(R) P (R) I Residual Gaps in Assurance Where are we failing to gain Risk Score evidence that our controls/ (PxI) systems, on which we place Score reliance, are effective. Such following as no assurance a strategy or controls put policy is effective in place

Review of methods to mitigate financial risk to provider and CCG.

5

4

20

Risk Trend

=

10

01/05/2013

16/03/2016

07/04/2016

2

CDC

Neill Bucktin

Neill Bucktin

4

4

16

Development of Commissioning Plan subject to endorsement by Health and Wellbeing Board. Series of joint strategies beneath JSNA overseen by Partnership Bodies/Boards BCF Section 75 Agreement.

None

01/05/2013

11/01/2016

04/09/2013

2

17

01/05/2013

16/03/2016

07/03/2016

2

Tensions between innovation, quality and financial pressures could limit the innovation shown by the CCG

19

34

36

01/05/2013

22/04/2013

16/05/2013

16/03/2016

18/03/2016

16/03/2016

07/03/2016

07/03/2016

07/03/2016

2

Failure to ensure meaningful public engagement including with the Health Overview and Scrutiny Committee will prevent effective commissioning and patient centred services

2

The impact of significant individual performance issues in relation to primary medical services that could result in removal of GP member from the Performers' List

3

Failure to achieve whole of Quality Premium resulting in lost income and reputational damage.

GOVERNING BODY

CDC

CDC

PCC

CDC

Dr David Hegarty

Paul Maubach

3

4

12

Organisational Development plan. Clinical leadership structure is Governing body development being reviewed events

Dr Jonathan Darby

Neill Bucktin

4

4

16

£200k to be invested in innovation pilots for 2013-14. Innovation bid process to be handled through localities

16

Communications & Engagement Strategy Health Care Forum Individual Service User Groups, Business case process, Compact with local community, Relationship with Overview & Scrutiny Committee. Regular attendance at OSC meetings by the Clinical Chair; CCG participation in agenda setting meetings Additional control- Engagement Manager to attend CDC to pick up engagement issues that fall outside of the business case process.

16

GP Contracts / Appraisals Peer Review Audit Training and Education GMC Registration None identified. GP under performance referred to the NHS England Professional & Practice Information Gathering Group (PIGG)

16

Plans for local targets mostly in place and on track, but still significant risk of not achieving national domains 1 and 5 (PYLL and HCAI)

Dr Steve Mann

Steve Wellings

Neill Bucktin

Neill Bucktin/Laura Broster

Dan King

Neill Bucktin

4

4

4

4

4

4

Business cases / service change proposals need to identify that appropriate engagement has taken place

Successful plans for domain 1 and 5 need to be put in place

Timescales Date action will be completed

COMMENTS

Ensure contracts are compliant with PbR Review of health economy financial position

On-going

Committee has confirmed the risk continues to exist and is discussed at each F&P committee. Increased uncertainty on DGFT financial position.

Financial Modelling of vanguard programme Incentivise Quality

4

3

12

=

OD plan delivery is not being reported upon yet

3

3

9

=

None

Implement OD plan delivery reporting to Remuneration Committee

Sep-13

4

3

12

=

reports to CDC

Significant innovation programme in Operational Plan.

Jun-16

=

Report to Commissioning Development Committee through business cases, assurance that engagement is taking place to Comms & Engagement Committee.

Establish revised business case process. Ensure clear exposition of engagement process is followed before recommendations to Board through the revised business case process input into governance review to check committee responsibility for engagement taking place.

The Business Case documentation includes a Jun-16 requirement to identify what engagement procersses have taken place



Primary Care Operational Group reporting into Primary Care Commissioning Committee and Quality and Safety Committee

=

Quality Premia achievement reporting to None CDC and governing body

Commissioning intentions, Change Meetings with providers

13

AT review, Monitor financial rating-under formal review due to deficit position in financial plans, Internal Audit review. Regular CLT meetings Formation and representation of CCG and DGFT on Vanguard Partnership Board

Actions To improve control, ensure delivery of principal objectives, gain assurance

Regular updates to CCG governing body on wider stakeholder engagement as appropriate

Memorandum of Understanding with Public Health, membership of H&W Board, contribution to JSNA

Failure of the governing body to demonstrate appropriate leadership/ clinical leadership may result in poor strategy and implementation, and thereby fail to meet statutory and regulatory responsibilities

Reports to F&P & Q&S, Board reports - minutes of CRM and QRM meetings. Performance report across a range of KPIs. Monthly meetings between CCG and DG FT Senior Manager Teams now being held. Board to Board (including lay member only) meetings being held. Monthly finance meetings between both organisations.

External Assurances Internal and External Audit Reports, CQC Reports

1.Develop and implement service improvement development plans with JHWS External peer plans with all providers.. 2. Health and Social Care Leadership Group to be QIPP reporting to CDC Internal and external responsible for audit reviews and governing body. major system Report to Board on CCG Review of Performance change: - Urgent Care with Health and contribution to HWB Wellbeing Board, Internal - Service Integration activity. CCG 3. Reporting compliance with JHWS Audit review mechanism on Better Care Fund implementation to be agreed. 4. Reports to be made to CDC along with Outcome Ambitions and Better Care Fund.

QIPP plan and implementation. Joint approach to QIPP development with Dudley Group. Service Improvement Delivery Plans in place with providers. Collaborative Leadership Teams DGFT and DWMHPT Health and Social Care Leadership Group. BCF Section 75 Agreement. Failure of the health economy and social care to engage and work together to implement service changes which will adversely impact commissioning and delivery of health services.

Internal Assurances Board Reports, Minutes of meetings

Reporting on proper engagement through the business case process

None identified

None

2

2

4

4

1

4

8

2

16

Health Watch, Overview & Scrutiny Committee Minutes of OSC, newspaper coverage from meetings

GMC Registration Two way communication between the CCG PCOG and the PIGG at NHS England

GP / Nurse Mentoring Commissioning of Services for Primary Care GP Education, training and Development

Regular report on actions and performance to CDC linked to Outcome Ambitions and Better Care Fund.

Jul-16 Partnership Board established.

On-going

Original risk no longer remains, Jun-16 however, risk renewed in respect of current year's performance

43

48

Original Date

05/12/2013

05/06/2014

Last Review (Committee Date)

24/03/2016

24/03/2016

Last Update (Risk Amended)

07/12/2015

28/05/2015

Risk Description LINK TO CORPORATE OBJECTIVE (SEE KEY ABOVE)

ID

2

2

Failure to deliver significant QIPP targets in 15/16 puts the future financial stability of the CCG at risk.

Failure of Black Country Partnership FT due to financial pressures will result in inadequate care for the local population.

Accountable Committee

F&P

F&P

Accountability Sponsor & Owner

Dr Jonathan Darby

Dr Jonathan Darby

Management Lead

Matt Hartland

Matt Hartland

P

5

4

I

5

5

Initial Risk Score (PxI) Score before any controls are in place.

25

20

Key Controls What controls/systems are in place to assist in securing delivery of our objective. Such as strategies, policies and procedures

Gaps in Control Where are we failing to put controls/ systems in place. / Where are we failing in making them effective. For example lack of training or no regular review of performance

The QIPP challenge process is robust and the CCG has a history of delivery. The process was enhanced in 14/15 with project plans required for schemes; monthly challenge meetings; and creation of a QIPP reserve. The revised process reflects internal None identified. audit recommendations. QIPP challenge days focus on the entire commissioners portfolio including performance and financial elements. They are attended by the CO&FO and Head of commissioning and meetings actions are fully minuted.

Performance management. CQRM Not determined at this stage. to monitor quality.

(R) P (R) I Residual Gaps in Assurance Where are we failing to gain Risk Score evidence that our controls/ (PxI) systems, on which we place Score reliance, are effective. Such following as no assurance a strategy or controls put policy is effective in place

Risk Trend

Internal Assurances Board Reports, Minutes of meetings

External Assurances Internal and External Audit Reports, CQC Reports

QIPP challenge process; F&P Committee oversight; internal audit reviews. Gap in 2014/15 was covered non recurrently. The QIPP target for 2015/16 has been reduced and proposals for new schemes have been agreed by CDC.

None identified

Not determined at this stage.

3

3

4

5

12

15

=

=

Actions To improve control, ensure delivery of principal objectives, gain assurance

Timescales Date action will be completed

COMMENTS

Final QIPP plan has been agreed.

Challenge meetings with commissioners actions Reports to NHS England. are logged. Additional Schemes Forms part of internal have been identified audit process review. which includes care home and elective pathways CDC through the new financial framework are taking a more active role in QIPP delivery. Responsibility for developing QIPP schemes for 16/17 for MCP, Primary Care & Elective Pathways is given to the 'Teams without walls' CCG CAO has met the FT CE and agreed a number of actions to ensure the CCG receives regular updates and assurance. Monitor action plan and The LTFM across the Dudley Health Economy oversight. has been reviewed and presented to local providers.

Commissioners to deliver against existing QIPP schemes. QIPP delivery to monitored against plan until the end of the year.

Mar-16

Contract Review Review of health economy financial position Financial Modelling of vanguard programme

On-going

Incentivise quality

BCP is a member of the partnership board

50

58

71

04/08/2014

07/10/2014

14/07/2015

18/03/2016

15/03/2016

15/03/2016

07/04/2016

07/04/2016

15/12/2015

2

3

3

Failure of member practices to meet the standards of the Care Quality Commission risks continuity of service provision in member practices.

The JAC electronic system is not operating efficiently which has resulted in an unspecified number of Discharge Letters not being received by GPs. This risk affects patients returning to primary care following changes in treatment medication. Detail to medication changes following review, in some cases, inaccurate.

DGFT CIP PROGRAMME 2015/16 is challenging - the plan includes the removal of up to 200 posts from its workforce (in addition to the 200 removed in 2014/15) - this could have significant impact on the quality of services.

PCC

Q&S

Q&S

Steve Wellings

Dr Ruth Edwards

Dr Ruth Edwards

Dan King

Caroline Brunt

Caroline Brunt

4

4

4

4

5

4

16

20

16

Relationship with the Link Inspector at the CQC who is invited to attend the Primary Care Operational Group (PCOG). Training and Development with Practices to help them manage inspections. Blue Stream online academy. Quality Assurance Manager for Primary Care appointed and in post. PCOG and PCC following NHS England "Framework for responding to CQC inspections of GP practices". CCG has support process and package in place for all practices.

Further develop the working arrangements with NHS None identified England Professional & Practice Information Gathering Group.

Electronic letters are no longer sent out to patients or GPs. Patients are being provided with paper copies of discharge details and medication to share with GPs to support treatment. Letters are additionally being sent to GPs by post

Assurance that QIA process is embedded at the Trust

Patients with inaccurate detail relating to prescribing not yet identified. Provider to carry out retrospective review. CCG and provider taking part in reviewing the changes to the use of interim system.

Evidence of the process in action at the Trust

3

4

4

3

3

3

9

12

12

=

=

=

All CQC inspection reports considered in the Primary Care CQC Reports and Operational Group and associated action plans coordinated actions in from GP Practices. place between CCG, NHS England and CQC.

Escalated to trust risk register

Medicines management team continues to monitor high risk medicines; DGH FT have placed on their Risk Register and risk monitored through Board. Manual sign-off remains in place.

Board reports to Q&SC Challenge through Collaborative Leadership Team meetings and Monitor reports Board to Boards . CQC reports Quality oversight is maintained through the monthly Clinical Quality Review Meetings.

Develop a quality framework and Care Quality Review Meeting (CQRM) for Priamry Care

Following recent CQC reports the Initial Risk impact has been increased from 3 to 4, taking the overall risk rating to 16 rather than Mar-16 12. The Residual Risk probability and impact have both been increased from 3 to 4 taking the Overall risk rating from 9 to 16.

1. Review of this risk in QSC, agreed that the risk no longer remains, agreement to recommence electronic letters. JAC has been switched on and audit achieved satisfactory target. In May 2016 JAC should be able to deliver on electronic double signing. Risk to be removed

Electronic discharge letters were re-instated in July 2015. The situation will be closely monitored and quality checked. A paper copy is also given to the patient to share with their GP. The paper copy will continue until the electronic system has been audited for further assurance - this should be completed by December 2015. Action Completed and agreement Jan-16 reached to discontinue the use of paper copies. Audit results confirm 96% accuracy. Two audits have been carried out and Clinical Executive is satisfied that the risk is no longer and issue - therefore request for Audit Committee to recommend to Board its closure in May 2016

Final QIPP plan has been agreed. Additional QIPP schemes to be identified by the commissioning team. Commissioners to deliver against existing QIPP schemes. QIPP delivery to monitored against plan until the end of the year.

Quality oversight is through the monthly CQRM and which concerns are flagged in addition to the monthly Collaborative Mar-16 Leadership Team meetings between the provider and the CCG. Chief Nurse attends CLT and has oversight of key issues which affect Quality & Safety

Original Date

Last Review (Committee Date)

Last Update (Risk Amended)

Risk Description LINK TO CORPORATE OBJECTIVE (SEE KEY ABOVE)

ID

75

14/07/2015

15/03/2016

07/04/2016

3

77

22/07/2015

16/03/2016

22/07/2015

1, 2, 3, 4

82

05/10/2015

15/03/2016

83

06/11/2015

16/03/2016

84

90

07/12/2015

17/01/2016

24/03/2016

24/03/2016

07/04/2016

3

07/03/2016

3

17/01/2016

17/01/2016

3

4

Accountable Committee

Accountability Sponsor & Owner

Management Lead

P

I

Initial Risk Score (PxI) Score before any controls are in place.

Key Controls What controls/systems are in place to assist in securing delivery of our objective. Such as strategies, policies and procedures

Gaps in Control Where are we failing to put controls/ systems in place. / Where are we failing in making them effective. For example lack of training or no regular review of performance

NURSING REVALIDATION - The Nursing and Midwifery Council covering all registrants across England, Scotland, Northern Ireland and Wales intend to introduce nursing and midwifery revalidation fro 1 April 2016. This is a three year process and more onerous than current practice requirements - many nurses are stating their intention to take early retirement rather than go through the process. For the CCG there is particular concern about the resilience of practice nurse workforce particularly given the age profile of the current nurse working in Dudley.

Q&S

Dr Ruth Edwards

Caroline Brunt

4

4

16

Close links with regional and national revalidation boards. Support from the CCG Chief Nurse for all registrants going through the revalidation process. Revalidation briefings and regular updates provided by the CCG Chief Nurse. Workforce planning is weak. Explore the use and deployment of an electronic tool to support portfolio Ensure practice nurses are included in the workforce planning work-stream to support future resilience. Management for practice nurses.

Failure to realise financial savings outlined in the value proposition because the MCP care model is not implemented.

CDC

Dr Steve Mann

Neil Bucktin

4

4

16

Accountability framework including its Terms of Reference agreed by None Partnership Board

HEALTH VISITOR TRANISTION FROM REGISTRANT TO RESIDENT POPULATION i.e. transfer of children in the care of a Health Visitor (HV) from being with a GP to where they live (their home address) - this creates risk regarding the number of children whose health visitor will change (700 out and 1200 in). The risk is that there are robust processes in place to transfer care and records out of borough but this is not replicated for those children transferring into the borough, particularly the transfer of their records. This is also a safeguarding concern as children could be 'lost' to the HV service.

Provider of non-emergency patient transport commissioned by the CCG is unable to deliver the quality KPI's in the contract and has given 12 months notice on the contract.

Failure to identify and deliver significant QIPP savings targets in 16/17 puts the future financial stability of the CCG at risk.

The CCG has received its planned Resource Allocation for 2016/17 to 2020/21 however there are a number of uncertainties at this stage that do not enable an accurate confirmation of the impact on the CCG’s financial plan and could potentially add pressure to the CCG’s financial position

Q&S

Dr Ruth Edwards

Caroline Brunt

4

4

16

The Dudley HV Supervisor has set up exemplary processes to Lack of records / processes manage the transfers in and out of from other CCGs transferring the borough and is in close liaison children into Dudley with colleagues in other LA areas. All HV teams are fully briefed.

CDC

Dr Steve Mann

Neill Bucktin

5

4

20

Terms of the Contact between the provider and commissioner

25

The QIPP challenge process is robust and the CCG has a history of delivery. Internal audit recommendations have been reflected in the processes and QIPP challenge days focus on the entire commissioner portfolio which includes both financial and None performance elements. Greater accountability is placed on the commissioner to ensure delivery following the new financial framework. Meeting actions are fully minuted and are attended by the head of financial management – commissioning and head of commissioning.

F&P

F&P

Dr Jonathan Darby

Dr Jonathan Darby

Matt Hartland

Matt Hartland

5

4

5

4

16

Potential gap in robustness of the procurement process

The CCG finance team are currently producing 5 year financial plans based upon guidance issued None by NHS E and raising issues directly with the local team as necessary.

(R) P (R) I Residual Gaps in Assurance Where are we failing to gain Risk Score evidence that our controls/ (PxI) systems, on which we place Score reliance, are effective. Such following as no assurance a strategy or controls put policy is effective in place

Confirmation of external performance management arrangements

Risk Trend

Internal Assurances Board Reports, Minutes of meetings

3

3

9



Board reports Q&SC reports PCCC reports Updates at professional nurses forum Revalidation sessions for CCG nurses and Practice Nurses have been facilitated by the CCG Chief Nurse. Preparation materials have been shared with all nurses.

3

3

9

=

Reports to Board

Lack of records / processes from other CCGs transferring children into Dudley

4

4

16

=

Board reports Q&SC reports PCCC reports CQRM meetings

None

5

3

15

=

CQRM meetings with the provider at which complaints received from all sources.

None identified

4

5

20

=

External Assurances Internal and External Audit Reports, CQC Reports

Actions To improve control, ensure delivery of principal objectives, gain assurance

Support for all staff going through the revalidation process. Revalidation briefings and regular updates provided by the CCG Chief Nurse. Explore the use and deployment of an Reports to national board electronic tool to at NHSE and NMC support portfolio management for practice nurses CCG nurses can use ESR. Ensure practice nurses are included in the workforce planning workstream to support future resilience.

Performance Monitoring NCM Team

Approval of the economic case across the Local Health Economy

The HV Supervisor at BCPT has put in place robust processes to transfer care records out to the LA of residence. Reports from NHSE and The supervisor is trying to establish LA regarding transition from registered to processes with other resident situation i.e. LA's to ensure transfer of children in the paper records for care of a HV from being those transferring in with a GP to their home are received. It address. cannot be established at this This risk is also on the LA stage how long it risk register. will take to be assured that Dudley Borough has received all the names and care records of children transferring into the borough. Re-Procurement of CQRM meetings with the the service provider at which complaints received from Reviewing finance all sources. and activity Discussions with Coelements of any Commissioner about its future procurement Monitoring Processes process

Monthly QIPP challenge process. Challenge meetings with commissioners actions are logged. F&P committee oversight. Internal audit reviews. Reports to NHS England. CDC through the new financial framework take Forms part of internal audit process reviews an active role in QIPP delivery.

Timescales Date action will be completed

COMMENTS

CCG have procured an electornic system and have invited nurses to Jun-16 register their details on the site. This has reduced the propbility of the risk.

May-16

The risk is that there are robust processes in place to transfer care and records out of borough but this is not replicated for those children transferring into the borough. All records have now successfully transferred, there remains an average of 3-4 Jun-16 referrals per month that are transferring to Dudley. This will remain a safeguarding concern. The situation is being tracked by the Chief Nurse and reported to the Q&SC. An update will be provided to the Februrary 2016 Q&SC.

Mar-16

Identification and sign off of robust PID’s and schemes for 16/17.

PID's are still under development and are to be prodced by March Mar-16 following the revised QIPP target and the assumptions assumed within the Value Proposition

Outcomes of discussions with NHS E on assumptions to be applied to financial modelling / plans before final submission.

Jun-16

QIPP away day had taken place on 5th Janaury to scope savings programme for 16/17.

New policy commitments and assumptions included in the allocation for 2016/17 requires further clarification.

4

4

16

=

CCG Financial plans for 2016-2021 are currently Financial plans will be being constructed and presented to NHS E for will be presented to F&P local assurance. committee in March

Three iterations of the financial plan are due to be submitted to th

NHS E for assurance on 8 Feb,

2nd Mar and 11th Apr

DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Declarations of Interest for Dudley CCG Governing Body Agenda item No: 9.5

TITLE OF REPORT:

Declarations of Interest for Dudley CCG Governing Body

PURPOSE OF REPORT:

To inform the Board of Declarations of Interest made by Governing Body members during the period 1 April 2015 to 31 March 2016

AUTHOR OF REPORT:

Mr M Hartland, Chief Operating and Finance Officer

MANAGEMENT LEAD:

Mr M Hartland, Chief Operating and Finance Officer

CLINICAL LEAD:

Dr D Hegarty, Chair

KEY POINTS:

•

Declarations of Interest for Governing Body members for period 1 April 2015 to 31 March 2016

•

Register shows the position as at 31 March 2016

•

In future, quarterly reminders will be sent to all members of the Governing Body asking for any updates

•

Governance processes will be reviewed and updated to ensure declarations of interest are embedded into the culture of the CCG

RECOMMENDATION:

The Board is asked to receive the report for assurance.

FINANCIAL IMPLICATIONS:

None

WHAT ENGAGEMENT HAS TAKEN PLACE:

None

ACTION REQUIRED:

Decision Approval  Assurance

1|Page

DUDLEY CLINICAL COMMISSIONING GROUP BOARD Declaration of Interests 1 April 2015 – 31 March 2016 Below are the declarations of interest for the Dudley Clinical Commissioning Group Board Date Declaration Received

Title

First Name

Surname

Designation

Interest

Dr

Gibran

Ali

Board Member

• None

Mrs

Laura

Broster

Head of Communications & Public Insight

•

Mrs

Caroline

Brunt

Chief Quality & Nursing Officer

• None

23/11/2015

Mr

Neill

Bucktin

Head of Commissioning

• Chairman Elect of the Corporation, Heart of Worcestershire College • Member of Mangers in Partnership

31/03/2016

Mrs

Stephanie

Cartwright

Head of Organisational Development & HR

• None

31/03/2016

Cartwright

Clinical Executive for Partnership & Integration

• GP, Keelinge House Surgery • Shareholder, Future Proof Health Limited (via practice shareholding)

Dr

Stephen

LEFT THE BOARD SEP 2015

Director of Shrops Hire Solutions Ltd

23/09/2015 31/03/2016

14/01/2015

LEFT THE BOARD AUG 2015

Mrs

Trisha

Curran

Interim Chief Quality & Nursing Officer

• Managing Director of Trisha Curran Consulting Limited

08/01/2015

LEFT THE BOARD NOV 2015

Dr

Jonathan

Darby

Board Member

Dr

Ruth

Edwards

Board Member/Clinical Executive for Quality & Safety

• • • • •

Principal in General Practice Senior Partner GP, St Margarets Well Surgery BBC Drama, Birmingham Director Manor Abbey Investments Shareholder, Future Proof Health Limited (via practice shareholding) • GP Partner - AW Surgeries • Shareholder, Future Proof Health Limited (via practice shareholding)

02/03/2016

05/04/2016 1|Page

Title

First Name

Surname

Designation

Interest

Date Declaration Received

Mrs

Jayne

Emery

Chief Officer of Dudley Healthwatch

• None

31/03/2016

Dr

Richard

Gee

GP Engagement Lead

Dr

Purshotam

Gupta

Board Member

Dr

Christopher

Handy

Lay Member for Quality & Safety

Mr

Matthew

Hartland

Chief Operating & Finance Officer

Dr

Mary

Heber

Secondary Care Clinician

Dr

David

Hegarty

Chair

• Appointed member of Dudley Group Foundation Trust Council of Governors • Part time GP at Netherton Surgery • Member of Labour Party • Shareholder, Future Proof Health Limited (via practice shareholding) • Chief Executive, Accord Group • Board Member of: − Black Country LEP Board − Matrix − Redditch Co-operative Homes − Black Country Consortium − Birmingham Chamber of Commerce − Health for Living Board − Walsall Housing Regeneration Agency − Direct Health • Director of Whitbrook Management Company • Director of Dudley Infracare Lift LTD • Member of Chartered Institute of Public Finance and Accountancy • Employed by Shrewsbury and Telford Hospital NHS Trust • Sister is CEO of PACE, a school/organisation charity dedicated to the education and development of children with Cerebral Palsy. • GP Partner - Wychbury Medical Group • Director of DM Hegarty Ltd • Chairman, West Midlands Clinical Senate • Partner an employee of Central Midlands and Lancashire CSU • Shareholder, Future Proof Health Limited (via practice shareholding)

31/03/2016

31/03/2016

31/03/2016

31/03/2016

31/03/2016

31/03/2016

2|Page

Title

First Name

Surname

Designation

Dr

Tim

Horsburgh

LMC Representative

Ms

Deborah

Harkins

Director of Public Health

Mrs

Julie

Jasper

Lay Member – Patient & Public Involvement

Mr

Daniel

King

Head of Membership Development and Primary Care

Dr

Rebecca

Lewis

Board Member

Dr

Mona

Mahfouz

Board Member

Dr

Steve

Mann

Board Member/Clinical Executive for Acute & Community Commissioning

Mr

Paul

Maubach

Chief Executive Officer

Mrs

Sarah

Norman

Chief Executive of Dudley Metropolitan Borough Council

Interest • • • • •

Sessional GP - Netherton Health Centre. Member of the Local Medical Committee Clinical Lead for Partners in Paediatrics Director – Deborah Harkins Consulting Ltd Visiting Professor - University of Central Lancashire • Lay Member - Sandwell and West Birmingham CCG • Managing Director of Westland’s Associates Ltd • Member of CIPFA • None

• GP Partner – Feldon Practice • Shareholder, Future Proof Health Limited (via practice shareholding) • GP Partner, Keelinge House Surgery • Member of LMC • Shareholder, Future Proof Health Limited (via practice shareholding) • GP Partner - Lion Health. • Sister – Dr Rebecca Mann who provides the Paediatric Triage Service • Shareholder, Future Proof Health Limited (via practice shareholding) • Member of Dudley Health & Wellbeing Board • Member of CIPFA • Member of Managers in Partnership • Zofja Zolna, who is a past acquaintance, runs her own consultancy business providing consultancy including mental health planning and commissioning • None

Date Declaration Received 02/04/2016

17/03/2015

31/03/2016

08/01/2015 31/03/2016

07/04/2016

31/03/2016

19/01/2015

16/01/2015

LEFT THE BOARD JAN 2016

3|Page

Title

First Name

Surname

Designation

Interest

Date Declaration Received

Mr

Tony

Oakman

Strategic Director – People Metropolitan Borough Council

• None

07/04/2016

Board Member/Clinical Executive for Finance & Performance

• Castle Meadows Surgery (member practice) • Shareholder, Future Proof Health Limited (via practice shareholding) • Daughter is nursing sister at Russells Hall Hospital. • Daughter is a medical registrar at Russells Hall (Sep 2014 – Sep 2015)

Dr

Jaswant

Rathore

08/01/2015

LEFT THE BOARD DEC 2015

Dr

Ruth

Tapparo

Board Member

Mr

Steve

Wellings

Lay Member - Governance

• GP Partner - Three Villages Medical Practice • Shareholder, Future Proof Health Limited (via practice shareholding) • Director of Wellimprove Associates LTD • Wife employed by Dudley MBC Housing Department • Two Nieces employed by DGFT as nurses • Member of CIPFA

08/01/2015

31/03/2016

4|Page

DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Staff Survey Agenda item No: 9.6 TITLE OF REPORT:

Staff Survey

PURPOSE OF REPORT:

To inform the Board of the findings from the 2015 Staff Survey and agree actions to be taken forward.

AUTHOR OF REPORT:

Mrs Stephanie Cartwright, Director of Organisational Development and Human Resources

MANAGEMENT LEAD:

Mrs Stephanie Cartwright, Director of Organisational Development and Human Resources

CLINICAL LEAD:

Dr David Hegarty, Chairman • •

KEY POINTS:

• • •

Dudley CCG participated in the national NHS Staff Survey as opposed to developing our own survey. Only 46 CCGs across the country participated in the national staff survey as the questions are very provider focussed. The results are excellent and at a standard the organisation should be proud of. There are three areas of concern that should lead to areas for improvement that are discussed within this paper. A deep dive into the areas of concern has been undertaken.

RECOMMENDATION:

That the Board notes the contents of the staff survey and agrees the areas for improvement.

FINANCIAL IMPLICATIONS:

None.

WHAT ENGAGEMENT HAS TAKEN PLACE:

The summary results of the staff survey have been discussed at Staff Forum and as a result a deep dive into the areas of concern has also been undertaken.

ACTION REQUIRED: 

Decision Approval Assurance

1|Page

DUDLEY CLINICAL COMMISSIONING GROUP BOARD - 12 MAY 2016 STAFF SURVEY 1.0

INTRODUCTION

1.1

The last CCG staff survey results reflected excellent feedback from staff, however the results could not be nationally recognised as it was our own locally implemented survey. Therefore for the 2015 survey, the organisation made the decision to participate in the national NHS staff survey in order for our results to be recognised as part of the national statistics.

1.2

Our staff survey took place during September and October last year and the results were received in February 2016. A verbal report was provided to Remuneration Committee in February 2016 with agreement to undertake more in depth analysis into areas of concern. A summary of the staff survey was also discussed with Staff Forum in March 2016 and agreement sought from staff as to the process to be undertaken to obtain more detailed feedback. A summary of the in depth analysis on the areas concerned will be shared within a private meeting of the Board due to the confidential nature of comments made and the assurance given to staff that these comments will remain confidential.

2.0

REPORT AND CONSIDERATIONS

2.1

The full results are attached to this report. other NHS organisations are: • • • •

2.2

Areas where the CCG has done significantly better than

92% of staff feel that care of patients/service users is the organisations top priority 96% of staff feel that the organisation acts on concerns raised by patients and service users 92% of staff would recommend this organisation as a place to work 85% of staff would be happy with the standard of care provided by this organisation for a friend or relative

Our top five ranking scores were as follows: • • • • •

Quality of non mandatory training, learning and development Staff confidence and security in reporting unsafe clinical practice Staff satisfaction with the quality of work and patient care they are able to deliver Staff recommendation of the organisation as a place to work or receive treatment Staff motivation at work

2.3

All of the above areas are in line with our top scoring areas in the last staff survey and are areas for the organisation and Board to be very proud of. We have worked hard to ensure that the organisation provides an environment where staff enjoy coming to work and strive to be an employer of choice. The results from the staff survey and our exceptionally low turnover rate reflect this.

2.4

There are however areas of concern that arise from the survey. The five worst ranking scores for the organisation are as follows: • • • • •

2.5

Percentage of staff working extra hours Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 months Percentage of staff feeling pressure in the last 3 months to attend work when feeling unwell Percentage of staff witnessing potentially harmful errors, near misses or incidents in the last 12 months Percentage of staff experiencing harassment, bullying or abuse from staff in the last 12 months

The above areas have been discussed with both Staff Forum and our Clinical Executive team with an agreement to undertake a further short survey with specific questions aimed to obtain more in depth 2

information on these areas of concern. The results of this in depth analysis will be shared in a private environment with the Board due to the assurance given to staff that comments would remain confidential. 2.6

The results of the staff survey were also considered by our Remuneration Committee in April. The recommendations from Remuneration Committee are summarised below.

3.0

RECOMMENDATIONS

3.1

That the Board agrees a series of areas of improvement recommendations made by Remuneration Committee in April in relation to the areas of concern identified through the staff survey as follows: • • • •

The OD and HR team to look at ways in which smarter working can be encouraged across the organisation. Training for managers around how to manage effectively and carrying out effective personal development reviews. A staff development session to be dedicated to discussing the areas of concern in the survey. This has been arranged to take place at the end of May and will use theatrical presentation to explore the perception of bullying and the culture of the organisation. A discussion at a future Board Development session on how to relieve some of the pressures on staff given the work to be undertaken by the organisation in at least the next twelve months.

Mrs Stephanie Cartwright Director of Organisational Development and Human Resources April 2016

3

2015 National NHS staff survey Results from NHS Dudley CCG

Table of Contents 1: Introduction to this report

3

2: Overall indicator of staff engagement for NHS Dudley CCG

5

3: Summary of 2015 Key Findings for NHS Dudley CCG

6

4: Full description of 2015 Key Findings for NHS Dudley CCG (including comparisons with the organisation’s 2014 survey and with other CCGs)

12

5: Workforce Race Equality Standard (WRES)

19

6: Key Findings by work group characteristics

20

7: Key Findings by demographic groups

23

8: Work and demographic profile of the survey respondents

28

Appendix 1: Key Findings for NHS Dudley CCG benchmarked against other CCGs

31

Appendix 2: Changes to the Key Findings since the 2014 staff survey (including indication of statistically significant changes)

34

Appendix 3: Data tables: 2015 Key Findings and the responses to all survey questions (including comparisons with other CCGs in 2015, and with the organisation’s 2014 survey)

35

Appendix 4: Other NHS staff survey 2015 documentation

45

2

1. Introduction to this report This report presents the findings of the 2015 national NHS staff survey conducted in NHS Dudley CCG. In section 2 of this report, we present an overall indicator of staff engagement. Full details of how this indicator was created can be found in the document Making sense of your staff survey data, which can be downloaded from www.nhsstaffsurveys.com. In sections 3, 4, 6 and 7 of this report, the findings of the questionnaire have been summarised and presented in the form of 32 Key Findings. In section 5 of this report, the data required for the Workforce Race Equality Standard (WRES) is presented. These sections of the report have been structured around four of the seven pledges to staff in the NHS Constitution which was published in March 2013 (http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution) plus three additional themes:

•

Staff Pledge 1: To provide all staff with clear roles and responsibilities and rewarding jobs for teams and individuals that make a difference to patients, their families and carers and communities.

•

Staff Pledge 2: To provide all staff with personal development, access to appropriate education and training for their jobs, and line management support to enable them to fulfil their potential.

•

Staff Pledge 3: To provide support and opportunities for staff to maintain their health, well-being and safety.

•

Staff Pledge 4: To engage staff in decisions that affect them and the services they provide, individually, through representative organisations and through local partnership working arrangements. All staff will be empowered to put forward ways to deliver better and safer services for patients and their families.

•

Additional theme: Equality and diversity

•

Additional theme: Errors and incidents

•

Additional theme: Patient experience measures

Please note, the questionnaire, key findings and benchmarking groups have all undergone substantial revision since the previous staff survey. For more detail on these changes, please see the Making sense of your staff survey data document. As in previous years, there are two types of Key Finding: -

percentage scores, i.e. percentage of staff giving a particular response to one, or a series of, survey questions

-

scale summary scores, calculated by converting staff responses to particular questions into scores. For each of these scale summary scores, the minimum score is always 1 and the maximum score is 5

Responses to the individual survey questions can be found in Appendix 3 of this report, along with details of which survey questions were used to calculate the Key Findings.

3

Your Organisation The scores presented below are un-weighted question level scores for questions Q21a, Q21b, Q21c and Q21d and the un-weighted score for Key Finding 1. The percentages for Q21a – Q21d are created by combining the responses for those who “Agree” and “Strongly Agree” compared to the total number of staff that responded to the question.

Q21a, Q21c and Q21d feed into Key Finding 1 “Staff recommendation of the organisation as a place to work or receive treatment”.

Q21a Q21b Q21c Q21d

KF1.

"Care of patients / service users is my organisation's top priority" "My organisation acts on concerns raised by patients / service users" "I would recommend my organisation as a place to work" "If a friend or relative needed treatment, I would be happy with the standard of care provided by this organisation" Staff recommendation of the organisation as a place to work or receive treatment (Q21a, 21c-d)

Your Organisation in 2015

Average (median) for CCGs

92%

83%

96%

82%

92%

76%

85%

65%

4.35

3.95

4

2. Overall indicator of staff engagement for NHS Dudley CCG The figure below shows how NHS Dudley CCG compares with other CCGs on an overall indicator of staff engagement. Possible scores range from 1 to 5, with 1 indicating that staff are poorly engaged (with their work, their team and their organisation) and 5 indicating that staff are highly engaged. The organisation's score of 4.29 was above (better than) average when compared with organisations of a similar type.

OVERALL STAFF ENGAGEMENT

This overall indicator of staff engagement has been calculated using the questions that make up Key Findings 1, 4 and 7. These Key Findings relate to the following aspects of staff engagement: staff members’ perceived ability to contribute to improvements at work (Key Finding 7); their willingness to recommend the organisation as a place to work or receive treatment (Key Finding 1); and the extent to which they feel motivated and engaged with their work (Key Finding 4). The table below shows how NHS Dudley CCG compares with other CCGs on each of the sub-dimensions of staff engagement, and whether there has been a change since the 2014 survey. Change since 2014 survey OVERALL STAFF ENGAGEMENT

Ranking, compared with all CCGs

--

Above (better than) average

--

Above (better than) average

--

Above (better than) average

--

Above (better than) average

KF1. Staff recommendation of the organisation as a place to work or receive treatment (the extent to which staff think care of patients/service users is the organisation’s top priority, would recommend their organisation to others as a place to work, and would be happy with the standard of care provided by the organisation if a friend or relative needed treatment.)

KF4. Staff motivation at work (the extent to which they look forward to going to work, and are enthusiastic about and absorbed in their jobs.)

KF7. Staff ability to contribute towards improvements at work (the extent to which staff are able to make suggestions to improve the work of their team, have frequent opportunities to show initiative in their role, and are able to make improvements at work.)

Full details of how the overall indicator of staff engagement was created can be found in the document Making sense of your staff survey data.

5

3. Summary of 2015 Key Findings for NHS Dudley CCG 3.1 Top and Bottom Ranking Scores This page highlights the five Key Findings for which NHS Dudley CCG compares most favourably with other CCGs in England. TOP FIVE RANKING SCORES KF13. Quality of non-mandatory training, learning or development

KF31. Staff confidence and security in reporting unsafe clinical practice

KF2. Staff satisfaction with the quality of work and patient care they are able to deliver

KF1. Staff recommendation of the organisation as a place to work or receive treatment

KF4. Staff motivation at work

6

This page highlights the five Key Findings for which NHS Dudley CCG compares least favourably with other CCGs in England. It is suggested that these areas might be seen as a starting point for local action to improve as an employer. BOTTOM FIVE RANKING SCORES ! KF16. Percentage of staff working extra hours

! KF25. Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months

! KF18. Percentage of staff feeling pressure in the last 3 months to attend work when feeling unwell

! KF28. Percentage of staff witnessing potentially harmful errors, near misses or incidents in last month

! KF26. Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months

For each of the 32 Key Findings, the CCGs in England were placed in order from 1 (the top ranking score) to 53 (the bottom ranking score). NHS Dudley CCG’s five lowest ranking scores are presented here, i.e. those for which the organisation’s Key Finding score is ranked closest to 53. Further details about this can be found in the document Making sense of your staff survey data.

7

3.2. Summary of all Key Findings for NHS Dudley CCG KEY Green = Positive finding, e.g. better than average. Red = Negative finding, e.g. worse than average. Grey = Average. For most of the Key Finding scores in this table, the higher the score the better. However, there are some scores for which a high score would represent a negative finding. For these scores, which are marked with an asterisk and in italics, the lower the score the better.

Comparison with all CCGs in 2015

8

3.2. Summary of all Key Findings for NHS Dudley CCG KEY Green = Positive finding, e.g. better than average. Red = Negative finding, e.g. worse than average. Grey = Average. For most of the Key Finding scores in this table, the higher the score the better. However, there are some scores for which a high score would represent a negative finding. For these scores, which are marked with an asterisk and in italics, the lower the score the better.

Comparison with all CCGs in 2015 (cont)

9

3.3. Summary of all Key Findings for NHS Dudley CCG KEY !

-*

Green = Positive finding, e.g. better than average, better than 2014. Red = Negative finding, e.g. worse than average, worse than 2014. 'Change since 2014 survey' indicates whether there has been a statistically significant change in the Key Finding since the 2014 survey. Because of changes to the format of the survey questions this year, comparisons with the 2014 score are not possible. For most of the Key Finding scores in this table, the higher the score the better. However, there are some scores for which a high score would represent a negative finding. For these scores, which are marked with an asterisk and in italics, the lower the score the better.

Change since 2014 survey

Ranking, compared with all CCGs in 2015

STAFF PLEDGE 1: To provide all staff with clear roles, responsibilities and rewarding jobs. KF1. Staff recommendation of the organisation as a place to work or receive treatment

--

Above (better than) average

KF2. Staff satisfaction with the quality of work and patient care they are able to deliver

--

Above (better than) average

KF3. % agreeing that their role makes a difference to patients / service users

--

Above (better than) average

KF4. Staff motivation at work

--

Above (better than) average

KF5. Recognition and value of staff by managers and the organisation

--

Above (better than) average

KF8. Staff satisfaction with level of responsibility and involvement

--

Above (better than) average

KF9. Effective team working

--

Above (better than) average

KF14. Staff satisfaction with resourcing and support

--

Above (better than) average

STAFF PLEDGE 2: To provide all staff with personal development, access to appropriate education and training for their jobs, and line management support to enable them to fulfil their potential. KF10. Support from immediate managers

--

Above (better than) average

KF11. % appraised in last 12 mths

--

Above (better than) average

KF12. Quality of appraisals

--

Above (better than) average

KF13. Quality of non-mandatory training, learning or development

--

Above (better than) average

STAFF PLEDGE 3: To provide support and opportunities for staff to maintain their health, well-being and safety. Health and well-being KF15. % of staff satisfied with the opportunities for flexible working patterns

--

Above (better than) average

* KF16. % working extra hours

--

! Above (worse than) average

* KF17. % suffering work related stress in last 12 mths

--

Below (better than) average

* KF18. % feeling pressure in last 3 mths to attend work when feeling unwell

--

! Above (worse than) average

KF19. Org and mgmt interest in and action on health / wellbeing

--

Above (better than) average

10

3.3. Summary of all Key Findings for NHS Dudley CCG (cont) Change since 2014 survey

Ranking, compared with all CCGs in 2015

Violence and harassment * KF22. % experiencing physical violence from patients, relatives or the public in last 12 mths

--

Below (better than) average

* KF23. % experiencing physical violence from staff in last 12 mths

--

Below (better than) average

KF24. % reporting most recent experience of violence

--

* KF25. % experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 mths

--

* KF26. % experiencing harassment, bullying or abuse from staff in last 12 mths

--

KF27. % reporting most recent experience of harassment, bullying or abuse

--

-! Above (worse than) average Average ! Below (worse than) average

STAFF PLEDGE 4: To engage staff in decisions that affect them, the services they provide and empower them to put forward ways to deliver better and safer services. KF6. % reporting good communication between senior management and staff

--

Above (better than) average

KF7. % able to contribute towards improvements at work

--

Above (better than) average

--

Average

--

Above (better than) average

* KF28. % witnessing potentially harmful errors, near misses or incidents in last mth

--

! Above (worse than) average

KF29. % reporting errors, near misses or incidents witnessed in the last mth

--

KF30. Fairness and effectiveness of procedures for reporting errors, near misses and incidents

--

Above (better than) average

KF31. Staff confidence and security in reporting unsafe clinical practice

--

Above (better than) average

--

Above (better than) average

ADDITIONAL THEME: Equality and diversity * KF20. % experiencing discrimination at work in last 12 mths KF21. % believing the organisation provides equal opportunities for career progression / promotion ADDITIONAL THEME: Errors and incidents

--

ADDITIONAL THEME: Patient experience measures KF32. Effective use of patient / service user feedback

11

4. Key Findings for NHS Dudley CCG 51 staff at NHS Dudley CCG took part in this survey. This is a response rate of 69%1 which is below average for CCGs in England. This section presents each of the 32 Key Findings, using data from the organisation's 2015 survey, and compares these to other CCGs in England and to the organisation's performance in the 2014 survey. The findings are arranged under seven headings – the four staff pledges from the NHS Constitution, and the three additional themes of equality and diversity, errors and incidents, and patient experience measures. Positive findings are indicated with a green arrow (e.g. where the organisation is better than average). Negative findings are highlighted with a red arrow (e.g. where the organisation’s score is worse than average). An equals sign indicates that there has been no change.

STAFF PLEDGE 1: To provide all staff with clear roles, responsibilities and rewarding jobs. KEY FINDING 1. Staff recommendation of the organisation as a place to work or receive treatment

KEY FINDING 2. Staff satisfaction with the quality of work and patient care they are able to deliver

1

Questionnaires were sent to all 74 staff eligible to receive the survey. This includes only staff employed directly by the organisation (i.e. excluding staff working for external contractors). It excludes bank staff unless they are also employed directly elsewhere in the organisation. When calculating the response rate, questionnaires could only be counted if they were received with their ID number intact, by the closing date.

12

KEY FINDING 3. Percentage of staff agreeing that their role makes a difference to patients / service users

KEY FINDING 4. Staff motivation at work

KEY FINDING 5. Recognition and value of staff by managers and the organisation

KEY FINDING 8. Staff satisfaction with level of responsibility and involvement

KEY FINDING 9. Effective team working

13

KEY FINDING 14. Staff satisfaction with resourcing and support

STAFF PLEDGE 2: To provide all staff with personal development, access to appropriate education and training for their jobs, and line management support to enable them to fulfil their potential. KEY FINDING 10. Support from immediate managers

KEY FINDING 11. Percentage of staff appraised in last 12 months

KEY FINDING 12. Quality of appraisals

14

KEY FINDING 13. Quality of non-mandatory training, learning or development

STAFF PLEDGE 3: To provide support and opportunities for staff to maintain their health, well-being and safety. Health and well-being KEY FINDING 15. Percentage of staff satisfied with the opportunities for flexible working patterns

KEY FINDING 16. Percentage of staff working extra hours

KEY FINDING 17. Percentage of staff suffering work related stress in last 12 months

KEY FINDING 18. Percentage of staff feeling pressure in the last 3 months to attend work when feeling unwell

15

KEY FINDING 19. Organisation and management interest in and action on health and wellbeing

Violence and harassment KEY FINDING 22. Percentage of staff experiencing physical violence from patients, relatives or the public in last 12 months

KEY FINDING 23. Percentage of staff experiencing physical violence from staff in last 12 months

KEY FINDING 25. Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months

KEY FINDING 26. Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months

16

KEY FINDING 27. Percentage of staff / colleagues reporting most recent experience of harassment, bullying or abuse

STAFF PLEDGE 4: To engage staff in decisions that affect them, the services they provide and empower them to put forward ways to deliver better and safer services. KEY FINDING 6. Percentage of staff reporting good communication between senior management and staff

KEY FINDING 7. Percentage of staff able to contribute towards improvements at work

ADDITIONAL THEME: Equality and diversity KEY FINDING 20. Percentage of staff experiencing discrimination at work in last 12 months

KEY FINDING 21. Percentage of staff believing that the organisation provides equal opportunities for career progression or promotion

17

ADDITIONAL THEME: Errors and incidents KEY FINDING 28. Percentage of staff witnessing potentially harmful errors, near misses or incidents in last month

KEY FINDING 30. Fairness and effectiveness of procedures for reporting errors, near misses and incidents

KEY FINDING 31. Staff confidence and security in reporting unsafe clinical practice

ADDITIONAL THEME: Patient experience measures KEY FINDING 32. Effective use of patient / service user feedback

18

5. Workforce Race Equality Standard (WRES) The scores presented below are the un-weighted question level score for question Q17b and un-weighted scores for Key Findings 25, 26, and 21, split between White and Black and Minority Ethnic (BME) staff, as required for the Workforce Race Equality Standard. Note that for question 17b, the percentage featured is that of “Yes” responses to the question. Key Finding and question numbers have changed since 2014. In order to preserve the anonymity of individual staff, a score is replaced with a dash if the staff group in question contributed fewer than 11 responses to that score. Your Organisation in 2015

Average (median) for CCGs

Your Organisation in 2014

KF25 Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months

White

16%

6%

-

BME

-

7%

-

KF26 Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months

White

18%

14%

-

BME

-

27%

-

KF21 Percentage of staff believing that the White organisation provides equal BME opportunities for career progression or promotion

95%

92%

-

-

73%

-

Q17b In the 12 last months have you personally experienced discrimination at work from manager/team leader or other colleagues?

White

5%

3%

-

BME

-

7%

-

19

6. Key Findings by work group characteristics Table 6.1 show the Key Findings at NHS Dudley CCG broken down by work group characteristics: occupational groups. Technical notes:

•

As in previous years, there are two types of Key Finding: -

percentage scores, i.e. percentage of staff giving a particular response to one, or a series of, survey questions

-

scale summary scores, calculated by converting staff responses to particular questions into scores. For each of these scale summary scores, the minimum score is always 1 and the maximum score is 5

•

For most of the Key Findings presented in table 6.1 the higher the score the better. However, there are some Key Findings for which a high score would represent a negative result. For these Key Findings, marked with an asterisk and shown in italics, the lower the score the better.

•

Care should be taken not to over interpret the findings if scores differ slightly. For example, if for 'KF11. % appraised in the last 12 months' staff in Group A score 45%, and staff in Group B score 40%, it may appear that a higher proportion of staff in Group A have had appraisals than staff in Group B. However, because of small numbers in these sub-groups, it is probably not statistically significant. A more sensible interpretation would be that, on average, similar proportions of staff in Group A and B have had appraisals.

•

Please note that, unlike the overall organisation scores, data in this section are not weighted.

•

Please also note that all percentage scores are shown to the nearest 1%. This means scores of less than 0.5% are displayed as 0%.

•

In order to preserve anonymity of individual staff, a score is replaced with a dash if the staff group in question contributed fewer than 11 responses to that score.

20

Table 6.1: Key Findings for different occupational groups

STAFF PLEDGE 1: To provide all staff with clear roles, responsibilities and rewarding jobs. KF1. Staff recommendation of the organisation as a place to work or receive treatment

4.33

KF2. Staff satisfaction with the quality of work and patient care they are able to deliver

4.19

KF3. % agreeing that their role makes a difference to patients / service users

95

KF4. Staff motivation at work

4.39

KF5. Recognition and value of staff by managers and the organisation

3.95

KF8. Staff satisfaction with level of responsibility and involvement

4.11

KF9. Effective team working

3.91

KF14. Staff satisfaction with resourcing and support

3.90

STAFF PLEDGE 2: To provide all staff with personal development, access to appropriate education and training for their jobs, and line management support to enable them to fulfil their potential. KF10. Support from immediate managers KF11. % appraised in last 12 mths

3.95 88

KF12. Quality of appraisals

3.67

KF13. Quality of non-mandatory training, learning or development

4.19

STAFF PLEDGE 3: To provide support and opportunities for staff to maintain their health, well-being and safety. Health and well-being KF15. % of staff satisfied with the opportunities for flexible working patterns

88

* KF16. % working extra hours

88

* KF17. % suffering work related stress in last 12 mths

20

* KF18. % feeling pressure in last 3 mths to attend work when feeling unwell

40

KF19. Org and mgmt interest in and action on health / wellbeing Number of respondents

3.92 25

Due to low numbers of respondents, no scores are shown for the following occupational groups: Adult / General Nurses, General Management, Admin & Clerical and Central Functions / Corporate Services.

21

Table 6.1: Key Findings for different occupational groups (cont)

Violence and harassment * KF22. % experiencing physical violence from patients, relatives or the public in last 12 mths

0

* KF23. % experiencing physical violence from staff in last 12 mths

0

KF24. % reporting most recent experience of violence

-

* KF25. % experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 mths

12

* KF26. % experiencing harassment, bullying or abuse from staff in last 12 mths

12

KF27. % reporting most recent experience of harassment, bullying or abuse

-

STAFF PLEDGE 4: To engage staff in decisions that affect them, the services they provide and empower them to put forward ways to deliver better and safer services. KF6. % reporting good communication between senior management and staff

64

KF7. % able to contribute towards improvements at work

92

ADDITIONAL THEME: Equality and diversity * KF20. % experiencing discrimination at work in last 12 mths

4

KF21. % believing the organisation provides equal opportunities for career progression / promotion

96

ADDITIONAL THEME: Errors and incidents * KF28. % witnessing potentially harmful errors, near misses or incidents in last mth KF29. % reporting errors, near misses or incidents witnessed in the last mth

4 -

KF30. Fairness and effectiveness of procedures for reporting errors, near misses and incidents

4.13

KF31. Staff confidence and security in reporting unsafe clinical practice

4.22

ADDITIONAL THEME: Patient experience measures KF32. Effective use of patient / service user feedback Overall staff engagement Number of respondents

4.33 25

Due to low numbers of respondents, no scores are shown for the following occupational groups: Adult / General Nurses, General Management, Admin & Clerical and Central Functions / Corporate Services.

22

7. Key Findings by demographic groups Tables 7.1 and 7.2 show the Key Findings at NHS Dudley CCG broken down by different demographic groups: age group and gender. Technical notes:

•

As in previous years, there are two types of Key Finding: -

percentage scores, i.e. percentage of staff giving a particular response to one, or a series of, survey questions

-

scale summary scores, calculated by converting staff responses to particular questions into scores. For each of these scale summary scores, the minimum score is always 1 and the maximum score is 5

•

For most of the Key Findings presented in tables 7.1 and 7.2, the higher the score the better. However, there are some Key Findings for which a high score would represent a negative result. For these Key Findings, marked with an asterisk and shown in italics, the lower the score the better.

•

Care should be taken not to over interpret the findings if scores differ slightly. For example, if for 'KF11. % appraised in the last 12 months' staff in Group A score 45%, and staff in Group B score 40%, it may appear that a higher proportion of staff in Group A have had appraisals than staff in Group B. However, because of small numbers in these sub-groups, it is probably not statistically significant. A more sensible interpretation would be that, on average, similar proportions of staff in Group A and B have had appraisals.

•

Please note that, unlike the overall organisation scores, data in this section are not weighted.

•

Please also note that all percentage scores are shown to the nearest 1%. This means scores of less than 0.5% are displayed as 0%.

•

In order to preserve anonymity of individual staff, a score is replaced with a dash if the demographic group in question contributed fewer than 11 responses to that score.

23

Table 7.1: Key Findings for different age groups Age group

STAFF PLEDGE 1: To provide all staff with clear roles, responsibilities and rewarding jobs. KF1. Staff recommendation of the organisation as a place to work or receive treatment

4.42

4.36

4.19

KF2. Staff satisfaction with the quality of work and patient care they are able to deliver

-

-

-

KF3. % agreeing that their role makes a difference to patients / service users

-

100

92

KF4. Staff motivation at work

4.15

4.35

4.28

KF5. Recognition and value of staff by managers and the organisation

3.91

4.02

3.93

KF8. Staff satisfaction with level of responsibility and involvement

4.15

4.08

4.32

-

4.01

4.10

4.11

3.85

3.52

KF9. Effective team working KF14. Staff satisfaction with resourcing and support

STAFF PLEDGE 2: To provide all staff with personal development, access to appropriate education and training for their jobs, and line management support to enable them to fulfil their potential. KF10. Support from immediate managers

4.09

4.26

4.08

KF11. % appraised in last 12 mths

100

94

80

KF12. Quality of appraisals

3.67

3.58

3.67

-

4.33

4.10

KF13. Quality of non-mandatory training, learning or development

STAFF PLEDGE 3: To provide support and opportunities for staff to maintain their health, well-being and safety. Health and well-being KF15. % of staff satisfied with the opportunities for flexible working patterns

91

88

73

* KF16. % working extra hours

91

88

93

* KF17. % suffering work related stress in last 12 mths

9

13

40

* KF18. % feeling pressure in last 3 mths to attend work when feeling unwell

-

50

53

4.05

4.32

3.79

11

16

15

KF19. Org and mgmt interest in and action on health / wellbeing Number of respondents

In order to preserve anonymity of individual staff, scores are not shown if there are fewer than 11 respondents. This means that no analysis by staff aged 16-30 is shown.

24

Table 7.1: Key Findings for different age groups (cont) Age group

Violence and harassment * KF22. % experiencing physical violence from patients, relatives or the public in last 12 mths

0

0

0

* KF23. % experiencing physical violence from staff in last 12 mths

0

0

0

KF24. % reporting most recent experience of violence

-

-

-

* KF25. % experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 mths

9

19

20

* KF26. % experiencing harassment, bullying or abuse from staff in last 12 mths

9

6

33

KF27. % reporting most recent experience of harassment, bullying or abuse

-

-

-

STAFF PLEDGE 4: To engage staff in decisions that affect them, the services they provide and empower them to put forward ways to deliver better and safer services. KF6. % reporting good communication between senior management and staff

64

69

60

KF7. % able to contribute towards improvements at work

91

94

93

0

0

13

100

93

92

0

7

20

KF29. % reporting errors, near misses or incidents witnessed in the last mth

-

-

-

KF30. Fairness and effectiveness of procedures for reporting errors, near misses and incidents

-

4.08

3.83

4.18

4.22

4.37

-

-

-

4.31

4.28

4.28

11

16

15

ADDITIONAL THEME: Equality and diversity * KF20. % experiencing discrimination at work in last 12 mths KF21. % believing the organisation provides equal opportunities for career progression / promotion ADDITIONAL THEME: Errors and incidents * KF28. % witnessing potentially harmful errors, near misses or incidents in last mth

KF31. Staff confidence and security in reporting unsafe clinical practice ADDITIONAL THEME: Patient experience measures KF32. Effective use of patient / service user feedback Overall staff engagement Number of respondents

In order to preserve anonymity of individual staff, scores are not shown if there are fewer than 11 respondents. This means that no analysis by staff aged 16-30 is shown.

25

Table 7.2: Key Findings for other demographic groups Gender

STAFF PLEDGE 1: To provide all staff with clear roles, responsibilities and rewarding jobs. KF1. Staff recommendation of the organisation as a place to work or receive treatment

4.53

4.23

-

4.14

100

86

-

4.26

KF5. Recognition and value of staff by managers and the organisation

4.44

3.77

KF8. Staff satisfaction with level of responsibility and involvement

4.47

4.06

-

4.13

4.08

3.73

KF2. Staff satisfaction with the quality of work and patient care they are able to deliver KF3. % agreeing that their role makes a difference to patients / service users KF4. Staff motivation at work

KF9. Effective team working KF14. Staff satisfaction with resourcing and support

STAFF PLEDGE 2: To provide all staff with personal development, access to appropriate education and training for their jobs, and line management support to enable them to fulfil their potential. KF10. Support from immediate managers

4.50

4.06

92

93

KF12. Quality of appraisals

4.15

3.64

KF13. Quality of non-mandatory training, learning or development

4.36

4.09

KF11. % appraised in last 12 mths

STAFF PLEDGE 3: To provide support and opportunities for staff to maintain their health, well-being and safety. Health and well-being KF15. % of staff satisfied with the opportunities for flexible working patterns

83

82

100

82

* KF17. % suffering work related stress in last 12 mths

8

21

* KF18. % feeling pressure in last 3 mths to attend work when feeling unwell

25

67

4.25

4.07

12

28

* KF16. % working extra hours

KF19. Org and mgmt interest in and action on health / wellbeing Number of respondents

In order to preserve anonymity of individual staff, scores are not shown if there are fewer than 11 respondents. This means that no analysis by disability and ethnic background are shown.

26

Table 7.2: Key Findings for other demographic groups (cont) Gender

Violence and harassment * KF22. % experiencing physical violence from patients, relatives or the public in last 12 mths

0

0

* KF23. % experiencing physical violence from staff in last 12 mths

0

0

KF24. % reporting most recent experience of violence

-

-

* KF25. % experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 mths

8

18

* KF26. % experiencing harassment, bullying or abuse from staff in last 12 mths

8

18

KF27. % reporting most recent experience of harassment, bullying or abuse

-

-

STAFF PLEDGE 4: To engage staff in decisions that affect them, the services they provide and empower them to put forward ways to deliver better and safer services. KF6. % reporting good communication between senior management and staff

83

54

KF7. % able to contribute towards improvements at work

100

93

0

4

100

92

0

11

KF29. % reporting errors, near misses or incidents witnessed in the last mth

-

-

KF30. Fairness and effectiveness of procedures for reporting errors, near misses and incidents

-

3.86

4.38

4.20

-

-

4.50

4.24

12

28

ADDITIONAL THEME: Equality and diversity * KF20. % experiencing discrimination at work in last 12 mths KF21. % believing the organisation provides equal opportunities for career progression / promotion ADDITIONAL THEME: Errors and incidents * KF28. % witnessing potentially harmful errors, near misses or incidents in last mth

KF31. Staff confidence and security in reporting unsafe clinical practice ADDITIONAL THEME: Patient experience measures KF32. Effective use of patient / service user feedback Overall staff engagement Number of respondents

In order to preserve anonymity of individual staff, scores are not shown if there are fewer than 11 respondents. This means that no analysis by disability and ethnic background are shown.

27

8. Work and demographic profile of the survey respondents The occupational group of the staff survey respondents is shown in table 8.1, other work characteristics are shown in table 8.2, and demographic characteristics are shown in table 8.3.

Table 8.1: Occupational group of respondents Number questionnaires returned

Percentage of survey respondents

Registered Nurses - Adult / General

2

4%

Registered Nurses - Mental Health

1

2%

Other Registered Nurses

1

2%

Commissioning managers / support staff

25

53%

Admin and Clerical

4

9%

Central Functions / Corporate Services

9

19%

General Management

5

11%

Did not specify

4

Occupational group

Nurses, Midwives and Nursing Assistants

Other groups

Sums of percentages may add up to more than 100% due to rounding, and do not include 'did not specify' responses

28

Table 8.2: Work characteristics of respondents Number questionnaires returned

Percentage of survey respondents

Full time

48

96%

Part time

2

4%

Did not specify

1

Full time / part time

Length of time in organisation Less than a year

10

21%

Between 1 to 2 years

13

27%

Between 3 to 5 years

6

13%

Between 6 to 10 years

6

13%

Between 11 to 15 years

2

4%

Over 15 years

11

23%

Did not specify

3

Sums of percentages may add up to more than 100% due to rounding, and do not include 'did not specify' responses

29

Table 8.3: Demographic characteristics of respondents Number questionnaires returned

Percentage of survey respondents

Between 16 and 30

7

14%

Between 31 and 40

11

22%

Between 41 and 50

16

33%

51 and over

15

31%

Did not specify

2

Age group

Gender Male

12

30%

Female

28

70%

Did not specify

11

Ethnic background White

45

92%

Black and minority ethnic

4

8%

Did not specify

2

Disability Disabled

5

10%

Not disabled

43

90%

Did not specify

3

Sums of percentages may add up to more than 100% due to rounding, and do not include 'did not specify' responses

30

Appendix 1 Key Findings for NHS Dudley CCG benchmarked against other CCGs Technical notes:

•

The first column in table A1 shows the organisation's scores for each of the Key Findings. The same data are displayed in section 3 and 4 of this report.

•

The second column in table A1 shows the 95% confidence intervals around the organisation's scores for each of the Key Findings.

•

The third column in table A1 shows the average (median) score for each of the Key Findings for CCGs. The same data are displayed in section 3 and 4 of this report.

•

The fourth and fifth columns in table A1 show the thresholds for below and above average scores for each of the Key Findings for CCGs. The data are used to describe comparisons with other trusts as displayed in section 3 and 4 of this report.

•

The sixth column in table A1 shows the lowest score attained for each of the Key Findings by an CCG.

•

The seventh column in table A1 shows the highest score attained for each of the Key Findings by an CCG.

•

For most of the Key Findings presented in table A1, the higher the score the better. However, there are some Key Findings for which a high score would represent a negative score. For these Key Findings, marked with an asterisk and shown in italics, the lower the score the better.

•

Please note that the data presented in table A1 are rounded to the nearest whole number for percentage scores and to two decimal places for scale summary scores.

31

Table A1: Key Findings for NHS Dudley CCG benchmarked against other CCGs Your organisation

Response rate

69

-

National scores for CCGs

82

75

86

58

100

STAFF PLEDGE 1: To provide all staff with clear roles, responsibilities and rewarding jobs. KF1. Staff recommendation of the organisation as a place to work or receive treatment

4.35

[4.18, 4.52]

3.95

3.80

4.04

3.08

4.52

KF2. Staff satisfaction with the quality of work and patient care they are able to deliver

4.14

[3.95, 4.33]

3.82

3.73

3.89

3.12

4.25

91

[82, 99]

80

78

84

50

97

4.29

[4.12, 4.45]

3.96

3.91

4.03

3.62

4.42

KF5. Recognition and value of staff by managers and the organisation

3.97

[3.76, 4.18]

3.83

3.73

3.89

3.38

4.39

KF8. Staff satisfaction with level of responsibility and involvement

4.20

[4.03, 4.36]

3.92

3.82

4.02

3.46

4.39

4.09

[3.86, 4.31]

3.86

3.79

3.99

3.47

4.42

3.82

[3.63, 4.01]

3.60

3.48

3.70

3.10

4.07

KF3. % agreeing that their role makes a difference to patients / service users KF4. Staff motivation at work

KF9. Effective team working KF14. Staff satisfaction with resourcing and support

STAFF PLEDGE 2: To provide all staff with personal development, access to appropriate education and training for their jobs, and line management support to enable them to fulfil their potential. KF10. Support from immediate managers KF11. % appraised in last 12 mths KF12. Quality of appraisals KF13. Quality of non-mandatory training, learning or development

4.18

[3.96, 4.39]

4.06

3.97

4.13

3.52

4.49

92

[84, 100]

84

78

87

42

100

3.77

[3.47, 4.07]

3.38

3.30

3.54

2.82

4.19

4.21

[4.05, 4.37]

4.01

3.97

4.05

3.44

4.24

STAFF PLEDGE 3: To provide support and opportunities for staff to maintain their health, well-being and safety. Health and well-being KF15. % of staff satisfied with the opportunities for flexible working patterns

82

[72, 93]

79

75

81

31

96

* KF16. % working extra hours

90

[82, 98]

73

70

80

49

92

* KF17. % suffering work related stress in last 12 mths

20

[9, 31]

30

25

32

9

45

* KF18. % feeling pressure in last 3 mths to attend work when feeling unwell

51

[37, 65]

44

41

49

27

58

4.11

[3.89, 4.33]

3.91

3.80

4.07

3.20

4.46

KF19. Org and mgmt interest in and action on health / wellbeing

32

Table A1: Key Findings for NHS Dudley CCG benchmarked against other CCGs (cont) Your organisation

National scores for CCGs

Violence and harassment * KF22. % experiencing physical violence from patients, relatives or the public in last 12 mths

0

[0, 0]

0

0

0

0

6

* KF23. % experiencing physical violence from staff in last 12 mths

0

[0, 0]

0

0

0

0

4

KF24. % reporting most recent experience of violence

-

[-, -]

-

-

-

-

-

* KF25. % experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 mths

14

[4, 24]

5

4

8

0

24

* KF26. % experiencing harassment, bullying or abuse from staff in last 12 mths

16

[6, 26]

15

12

17

0

37

KF27. % reporting most recent experience of harassment, bullying or abuse

9

[0, 26]

36

27

42

9

69

STAFF PLEDGE 4: To engage staff in decisions that affect them, the services they provide and empower them to put forward ways to deliver better and safer services. KF6. % reporting good communication between senior management and staff

66

[53, 79]

52

45

64

18

85

KF7. % able to contribute towards improvements at work

92

[84, 100]

84

80

86

66

97

* KF20. % experiencing discrimination at work in last 12 mths

4

[0, 10]

4

2

5

0

19

KF21. % believing the organisation provides equal opportunities for career progression / promotion

96

[90, 100]

91

86

95

63

100

8

[1, 16]

7

4

8

0

24

-

[-, -]

83

82

89

79

94

KF30. Fairness and effectiveness of procedures for reporting errors, near misses and incidents

4.09

[3.90, 4.28]

3.84

3.73

3.95

3.35

4.39

KF31. Staff confidence and security in reporting unsafe clinical practice

4.29

[4.12, 4.46]

3.96

3.88

4.05

3.51

4.38

[3.89, 4.51]

3.96

3.84

4.05

3.56

4.36

ADDITIONAL THEME: Equality and diversity

ADDITIONAL THEME: Errors and incidents * KF28. % witnessing potentially harmful errors, near misses or incidents in last mth KF29. % reporting errors, near misses or incidents witnessed in the last mth

ADDITIONAL THEME: Patient experience measures KF32. Effective use of patient / service user feedback

4.20

33

Appendix 2 Changes to the Key Findings since the 2014 staff survey The organisation did not participate in the 2014 survey.

34

Appendix 3 Data tables: 2015 Key Findings and the responses to all survey questions For each of the 32 Key Findings (Table A3.1) and each individual survey question in the core version of the questionnaire (Table A3.2), this appendix presents your organisation’s 2015 survey response, the average (median) 2015 response for CCGs, and your organisation’s 2014 survey response (where applicable). In Table A3.1, the question numbers used to calculate the 32 Key Findings are also listed in the first column. In Table A3.2, the responses to the survey questions are presented in the order that they appear within the core version of the 2015 questionnaire. Technical notes:

•

In certain cases a dash (-) appears in the ‘Your Organisation in 2014’ column in Tables A3.1 or A3.2. This is because of changes to the format of survey questions or the calculation of the Key Findings so comparisons with the 2014 score are not possible.

•

In certain cases a dash (-) appears in Tables A3.1 or A3.2. This is in order to preserve anonymity of individual staff, where there were fewer than 11 responses to a survey question or Key Finding.

•

Please note that the figures reported in tables A3.1 and A3.2 are un-weighted, and, as a consequence there may be some slight differences between these figures and the figures reported in sections 3 and 4 and Appendix 2 of this report, which are weighted according to the occupational group profile of a typical CCG.

•

More details about the calculation of Key Findings and the weighting of data can be found in the document Making sense of your staff survey data, which can be downloaded from: www.nhsstaffsurveys.com

35

Table A3.1: Key Findings for NHS Dudley CCG benchmarked against other CCGs Question number(s)

Your Organisation in 2015

Average (median) for CCGs

STAFF PLEDGE 1: To provide all staff with clear roles, responsibilities and rewarding jobs. KF1. Staff recommendation of the organisation as a place to work or receive treatment

Q21a, 21c-d

4.35

3.95

KF2. Staff satisfaction with the quality of work and patient care they are able to deliver

Q3c, 6a, 6c

4.14

3.82

Q6b

91

80

Q2a-c

4.29

3.96

Q5a, 5f, 7g

3.97

3.83

Q3a, 3b, 4c, 5d, 5e

4.20

3.92

Q4h-j

4.09

3.86

Q4e-g, 5c

3.82

3.60

KF3. % agreeing that their role makes a difference to patients / service users KF4. Staff motivation at work KF5. Recognition and value of staff by managers and the organisation KF8. Staff satisfaction with level of responsibility and involvement KF9. Effective team working KF14. Staff satisfaction with resourcing and support

STAFF PLEDGE 2: To provide all staff with personal development, access to appropriate education and training for their jobs, and line management support to enable them to fulfil their potential. KF10. Support from immediate managers

Q5b, 7a-e

4.18

4.06

Q20a

92

84

KF12. Quality of appraisals

Q20b-d

3.77

3.38

KF13. Quality of non-mandatory training, learning or development

Q18b-d

4.21

4.01

KF11. % appraised in last 12 mths

STAFF PLEDGE 3: To provide support and opportunities for staff to maintain their health, well-being and safety. Health and well-being KF15. % of staff satisfied with the opportunities for flexible working patterns

Q5h

82

79

Q10b-c

90

73

Q9c

20

30

* KF18. % feeling pressure in last 3 mths to attend work when feeling unwell

Q9d-g

51

44

KF19. Org and mgmt interest in and action on health / wellbeing

Q7f, 9a

4.11

3.91

* KF16. % working extra hours * KF17. % suffering work related stress in last 12 mths

36

Table A3.1: Key Findings for NHS Dudley CCG benchmarked against other CCGs (cont) Question number(s)

Your Organisation in 2015

Average (median) for CCGs

Q14a

0

0

* KF23. % experiencing physical violence from staff in last 12 mths

Q14b-c

0

0

KF24. % reporting most recent experience of violence

Q14d

-

42

* KF25. % experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 mths

Q15a

14

5

* KF26. % experiencing harassment, bullying or abuse from staff in last 12 mths

Q15b-c

16

15

Q15d

9

33

Violence and harassment * KF22. % experiencing physical violence from patients, relatives or the public in last 12 mths

KF27. % reporting most recent experience of harassment, bullying or abuse

STAFF PLEDGE 4: To engage staff in decisions that affect them, the services they provide and empower them to put forward ways to deliver better and safer services. KF6. % reporting good communication between senior management and staff

Q8a-d

66

52

Q4a-b, 4d

92

84

Q17a-b

4

4

Q16

96

91

* KF28. % witnessing potentially harmful errors, near misses or incidents in last mth

Q11a-b

8

7

KF29. % reporting errors, near misses or incidents witnessed in the last mth

Q11c

-

100

KF30. Fairness and effectiveness of procedures for reporting errors, near misses and incidents

Q12a-d

4.09

3.84

KF31. Staff confidence and security in reporting unsafe clinical practice

Q13b-c

4.29

3.96

Q21b, 22b-c

4.20

3.97

KF7. % able to contribute towards improvements at work ADDITIONAL THEME: Equality and diversity * KF20. % experiencing discrimination at work in last 12 mths KF21. % believing the organisation provides equal opportunities for career progression / promotion ADDITIONAL THEME: Errors and incidents

ADDITIONAL THEME: Patient experience measures KF32. Effective use of patient / service user feedback

37

Table A3.2: Survey questions benchmarked against other CCGs Your Organisation in 2015

Average (median) for CCGs

58

48

76 88 94

63 75 82

90 92 90

78 89 79

90

82

90

86

82

66

82 62

74 48

86

77

59

46

76 78

76 72

80

81

73 80 84 90 88 71 76 82

69 79 86 78 74 62 58 79

100

75

91

80

64

59

Contact with patients Q1

% saying they have face-to-face contact with patients / service users as part of their job

Staff motivation at work Q2a Q2b Q2c

% saying often or always to the following statements: "I look forward to going to work" "I am enthusiastic about my job" "Time passes quickly when I am working"

Job design Q3a Q3b Q3c

% agreeing / strongly agreeing with the following statements: "I always know what my work responsibilities are" "I am trusted to do my job" "I am able to do my job to a standard I am personally pleased with"

Opportunities to develop potential at work Q4a Q4b Q4c Q4d Q4e Q4f Q4g Q4h Q4i Q4j

% agreeing / strongly agreeing with the following statements: "There are frequent opportunities for me to show initiative in my role" "I am able to make suggestions to improve the work of my team / department" "I am involved in deciding on changes introduced that affect my work area / team / department" "I am able to make improvements happen in my area of work" "I am able to meet all the conflicting demands on my time at work" "I have adequate materials, supplies and equipment to do my work" "There are enough staff at this organisation for me to do my job properly" "The team I work in has a set of shared objectives" "The team I work in often meets to discuss the team's effectiveness" "Team members have to communicate closely with each other to achieve the team's objectives"

Staff job satisfaction Q5a Q5b Q5c Q5d Q5e Q5f Q5g Q5h

% satisfied or very satisfied with the following aspects of their job: "The recognition I get for good work" "The support I get from my immediate manager" "The support I get from my work colleagues" "The amount of responsibility I am given" "The opportunities I have to use my skills" "The extent to which my organisation values my work" "My level of pay" "The opportunities for flexible working patterns"

Contribution to patient care Q6a Q6b Q6c

% agreeing / strongly agreeing with the following statements: "I am satisfied with the quality of care I give to patients / service users" "I feel that my role makes a difference to patients / service users" "I am able to deliver the patient care I aspire to"

38

Your Organisation in 2015

Average (median) for CCGs

76

80

88

81

82 70

73 72

92 78

85 79

86 100 74

82 97 58

66

52

68

52

% saying their organisation definitely takes positive action on 53 health and well-being % saying they have have experienced musculoskeletal problems 4 (MSK) in the last 12 months as a result of work activities % saying they have have felt unwell in the last 12 months as a 20 result of work related stress % saying in the last three months they had gone to work despite 51 not feeling well enough to perform their duties If attended work despite not feeling well enough (YES to Q9d), % saying they... ...had felt pressure from their manager to come to work 4 ...had felt pressure from their colleagues to come to work 16 ...had put themselves under pressure to come to work 100

42

Your managers Q7a Q7b Q7c Q7d Q7e Q7f Q7g Q8a Q8b Q8c Q8d

% agreeing / strongly agreeing with the following statements: "My immediate manager encourages those who work for her/him to work as a team" "My immediate manager can be counted on to help me with a difficult task at work" "My immediate manager gives me clear feedback on my work" "My immediate manager asks for my opinion before making decisions that affect my work" "My immediate manager is supportive in a personal crisis" "My immediate manager takes a positive interest in my health and well-being" "My immediate manager values my work" "I know who the senior managers are here" "Communication between senior management and staff is effective" "Senior managers here try to involve staff in important decisions" "Senior managers act on staff feedback"

Health and well-being Q9a Q9b Q9c Q9d

Q9e Q9f Q9g

13 30 47

16 13 95

Working hours Q10a Q10b Q10c

% working part time (up to 29 hours a week) % working additional PAID hours % working additional UNPAID hours

4 10 86

16 6 72

2

3

9

4

-

100

Witnessing and reporting errors, near misses and incidents Q11a Q11b Q11c

% witnessing errors, near misses or incidents in the last month that could have hurt staff % witnessing errors, near misses or incidents in the last month that could have hurt patients / service users If they witnessed an error, near miss or incident that could have hurt staff or patients / service users (YES to Q11a or YES to Q11b), % saying the last time this happened, either they or a colleague had reported it

39

Your Organisation in 2015

Average (median) for CCGs

Fairness and effectiveness of procedures for reporting errors, near misses or incidents Q12a Q12b Q12c

Q12d

% agreeing / strongly agreeing with the following statements: "My organisation treats staff who are involved in an error, near miss or incident fairly" "My organisation encourages us to report errors, near misses or incidents" "When errors, near misses or incidents are reported, my organisation takes action to ensure that they do not happen again" "We are given feedback about changes made in response to reported errors, near misses and incidents"

78

64

96

83

83

75

77

52

100

94

94

78

88

74

Raising concerns about unsafe clinical practice Q13a

Q13b Q13c

% saying if they were concerned about unsafe clinical practice they would know how to report it % agreeing / strongly agreeing with the following statements: "I would feel secure raising concerns about unsafe clinical practice" "I am confident that the organisation would address my concern"

Experiencing and reporting physical violence at work

Q14a Q14a Q14a Q14a Q14a Q14b Q14b Q14b Q14b Q14b Q14c Q14c Q14c Q14c Q14c Q14d

% experiencing physical violence at work from patients / service users, their relatives or other members of the public in last 12 months... Never 100 100 1 to 2 times 0 0 3 to 5 times 0 0 6 to 10 times 0 0 More than 10 times 0 0 % experiencing physical violence at work from managers in last 12 months... Never 100 100 1 to 2 times 0 0 3 to 5 times 0 0 6 to 10 times 0 0 More than 10 times 0 0 % experiencing physical violence at work from other colleagues in last 12 months... Never 100 100 1 to 2 times 0 0 3 to 5 times 0 0 6 to 10 times 0 0 More than 10 times 0 0 (If YES to Q14a, Q14b or Q14c) % saying the last time they 58 experienced an incident of physical violence, either they or a colleague had reported it

Experiencing and reporting harassment, bullying and abuse at work

Q15a Q15a Q15a Q15a Q15a

% experiencing harassment, bullying or abuse at work from patients / service users, their relatives or other members of the public in last 12 months... Never 86 95 1 to 2 times 6 4 3 to 5 times 4 0 6 to 10 times 0 0 More than 10 times 4 0

40

Your Organisation in 2015

Q15b Q15b Q15b Q15b Q15b Q15c Q15c Q15c Q15c Q15c Q15d

% experiencing harassment, bullying or abuse at work from managers in last 12 months... Never 90 1 to 2 times 8 3 to 5 times 2 6 to 10 times 0 More than 10 times 0 % experiencing physical violence at work from other colleagues in last 12 months... Never 88 1 to 2 times 4 3 to 5 times 6 6 to 10 times 2 More than 10 times 0 (If YES to Q15a, Q15b or Q15c) % saying the last time they experienced an incident of harassment, bullying or abuse, either they or a colleague had reported it

Average (median) for CCGs

90 6 2 0 0 91 7 2 0 0 39

Equal opportunities Q16

% saying the organisation acts fairly with regard to career progression / promotion, regardless of ethnic background, gender, religion, sexual orientation, disability or age

96

91

2

0

4

4

0 0 0 0 0 0 4

0 0 0 0 0 0 1

Discrimination Q17a

Q17b

Q17c Q17c Q17c Q17c Q17c Q17c Q17c

% saying they had experienced discrimination from patients / service users, their relatives or other members of the public in the last 12 months % saying they had experienced discrimination from their manager / team leader or other colleagues in the last 12 months % saying they had experienced discrimination on the grounds of: Ethnic background Gender Religion Sexual orientation Disability Age Other reason(s)

Job-relevant training, learning and development Q18a

Q18b Q18c Q18d Q19

% having received non-mandatory training, learning or 85 76 development in the last 12 months % who had received training, learning and development in the last 12 months (YES to Q18a) agreeing / strongly agreeing with the following statements: "It has helped me to do my job more effectively" 93 85 "It has helped me stay up-to-date with professional 89 82 requirements" "It has helped me to deliver a better patient / service user 86 75 experience" % who had received mandatory training in the last 12 months 100 98

Appraisals Q20a

% saying they had received an appraisal or performance development review in the last 12 months

92

84

41

Your Organisation in 2015

Q20b Q20c Q20d Q20e Q20f

Q20g

Average (median) for CCGs

If (YES to Q20a) had received an appraisal or performance development review in the last 12 months: % saying their appraisal or development review definitely helped 36 23 them to improve how they do their job % saying their appraisal or development review definitely helped 53 45 them agree clear objectives for their work % saying their appraisal or development review definitely made 49 37 them feel their work was valued by the organisation % saying the values of their organisation were definitely 52 35 discussed as part of the appraisal % saying their appraisal or development review had identified 79 77 training, learning or development needs If (YES to Q20a) had received an appraisal or performance development review AND (YES to Q20f) training, learning or development needs identified as part of their appraisal or development review: % saying their manager definitely supported them to receive 78 63 training, learning or development

Your organisation Q21a Q21b Q21c Q21d

% agreeing / strongly agreeing with the following statements: "Care of patients / service users is my organisation's top priority" "My organisation acts on concerns raised by patients / service users" "I would recommend my organisation as a place to work" "If a friend or relative needed treatment, I would be happy with the standard of care provided by this organisation"

92 96

83 82

92 85

76 65

Patient / service user experience measures Q22a

Q22b Q22c

% saying 'Yes' "Is patient / service user experience feedback collected within 90 75 your directorate / department?" If patient / service user feedback collected (YES to Q22a), % agreeing or strongly agreeing with the following statements: "I receive regular updates on patient / service user experience 76 63 feedback in my directorate / department" "Feedback from patients / service users is used to make 75 75 informed decisions within my directorate / department"

BACKGROUND DETAILS Q23a Q23a Q23b Q23b Q23b Q23b Q24 Q24 Q24 Q24 Q24 Q24

Gender Male Female Age group Between 16 and 30 Between 31 and 40 Between 41 and 50 51 and over Ethnic background White Mixed Asian / Asian British Black / Black British Chinese Other

30 70

25 75

14 22 33 31

10 24 34 30

92 0 4 2 0 2

92 1 4 2 0 0

42

Q25 Q25 Q25 Q25 Q25 Q25 Q26 Q26 Q26 Q26 Q26 Q26 Q26 Q26 Q26 Q27a Q27b

Q28 Q28 Q28 Q28 Q28 Q28 Q29 Q29 Q29 Q29 Q29 Q29 Q29 Q29 Q29 Q29 Q29 Q29 Q29 Q29 Q29 Q29 Q29 Q29 Q29

Sexuality Heterosexual (straight) Gay Man Gay Woman (lesbian) Bisexual Other Preferred not to say Religion No religion Christian Buddhist Hindu Jewish Muslim Sikh Other Preferred not to say Disability % saying they have a long-standing illness, health problem or disability If long-standing disability (YES to Q27a and if adjustments felt necessary), % saying their employer has made adequate adjustment(s) to enable them to carry out their work Length of time at the organisation (or its predecessors) Less than 1 year 1 to 2 years 3 to 5 years 6 to 10 years 11 to 15 years More than 15 years Occupational group Registered Nurses and Midwives Nursing or Healthcare Assistants Medical and Dental Allied Health Professionals Scientific and Technical / Healthcare Scientists Social Care staff Emergency Care Practitioner Paramedic Emergency Care Assistant Ambulance Technician Ambulance Control Staff Patient Transport Service Public Health / Health Improvement Commissioning staff Admin and Clerical Central Functions / Corporate Services Maintenance / Ancillary General Management Other

Your Organisation in 2015

Average (median) for CCGs

92 0 0 0 0 8

91 0 0 0 0 6

20 67 0 2 0 0 2 0 8

31 54 0 0 0 0 0 1 8

10

15

-

100

21 27 13 13 4 23

18 24 19 17 8 9

9 0 0 0 0 0 0 0 0 0 0 0 0 53 9 19 0 11 0

8 0 1 0 6 0 0 0 0 0 0 0 0 53 8 9 0 6 2

43

Q30a Q30b Q30b Q30b Q30b

Team working % working in a team (If YES to Q30a): Number of core members in their team 2-5 6-9 10-15 More than 15

Your Organisation in 2015

Average (median) for CCGs

98

98

10 46 29 15

28 31 25 9

44

Appendix 4 Other NHS staff survey 2015 documentation This report is one of several ways in which we present the results of the 2015 national NHS staff survey: 1) A separate summary report of the main 2015 survey results for NHS Dudley CCG can be downloaded from: www.nhsstaffsurveys.com. The summary report is a shorter version of this feedback report, which may be useful for wider circulation within the organisation. 2) A national briefing document, describing the national Key Findings from the 2015 survey and making comparisons with previous years, will be available from www.nhsstaffsurveys.com in March 2015. 3) The document Making sense of your staff survey data, which can be downloaded from www.nhsstaffsurveys.com. This includes details about the calculation of Key Findings and the data weighting method used. 4) A series of detailed spreadsheets are available on request from www.nhsstaffsurveys.com. In these detailed spreadsheets you can find: • responses of staff in your organisation to every core survey question • responses in every organisation in England • the average responses for each major organisation type (e.g. all acute trusts, all ambulance trusts) • the average organisation responses within each strategic health authority • the average responses for each major occupational and demographic group within the major organisation types

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Remuneration Committee Report Agenda item No: 9.7 TITLE OF REPORT:

Remuneration Committee Report

PURPOSE OF REPORT:

To provide assurance to the Board regarding key issues discussed and approved by the Remuneration Committee held on 6th April 2016.

AUTHOR OF REPORT:

Mrs S Cartwright, Director of Organisational Development and Human Resources

MANAGEMENT LEAD:

Mrs S Cartwright, Director of Organisational Development and Human Resources

CLINICAL LEAD/LAY MEMBER:

Mr S Wellings, Lay Member for Governance

KEY POINTS:

• • • • • •

Workforce Dashboard 2016/17 Pay Award Occupational Health and Staff Counselling Services Staff Forum Terms of Reference Staff Survey Remuneration Committee Terms of Reference

The Board to note the report for assurance. RECOMMENDATION:

The Board is asked to ratify the revised Terms of Reference (attached).

FINANCIAL IMPLICATIONS:

Within financial plan

WHAT ENGAGEMENT HAS TAKEN PLACE:

n/a

ACTION REQUIRED: 

Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 12 MAY 2016 REMUNERATION COMMITTEE REPORT

1.0

INTRODUCTION

1.1

This report provides assurance to the Board with regard to key issues discussed and approved by the Remuneration Committee on 6th April 2016. The following items are a description of the current position in relation to the main responsibilities and obligations of the Committee as defined by the CCG Constitution and Terms of Reference.

1.2

Due to the nature of the Committee, there is not a set of key indicators to report to Board.

2.0

ITEMS DISCUSSED

2.1

HR/Workforce Metrics The Committee receives regular updates on HR and workforce metrics applicable to the CCG. This includes analysis of vacancies, banding/skill-mix ratios, sickness, Personal Development Review completion and mandatory training compliance. Highlights to report to the Board include that the level of sickness absence still remains of concern and continues to be above the 3% national guideline. Reasons for this level of absence are five members of staff who have been on long term sick leave although one has recently returned to work. We are continuing to support these staff as well as the staff who have had prolonged sickness issues. Compliance with mandatory training requirements has improved significantly over the last quarter with the only members of staff not compliant being on either sick leave or maternity leave. Compliance with Personal Development Review has also reached the expected level.

2.2

Terms of Reference As discussed at the last Board meeting, the terms of reference for the Committee were reviewed in February. As a reminder, the following amendments were recommended: • • • • • •

Change of name from Remuneration Committee to Remuneration and Human Resources Committee. The two elected GP members will be the Chair of the CCG and the Clinical Executive for Finance, Performance and Business Intelligence. The Director of Organisational Development and Human Resources has been added to the attendance list. There will be a rolling approach to managing conflicts of interest with the Chair of the Committee changed when necessary. Remuneration considerations to include the Chief Quality and Nursing Officer in future. Remove the section under “relationship with the governing body” that states minutes will be presented to the governing body for information. The Terms of Reference have been reviewed and will be ratified by the Board at the July meeting.

2.3

2016/17 Pay Award The Remuneration Committee received a report detailing the national pay award which has been agreed as follows for 2016/17: • • •

All staff to receive a 1% consolidated pay increase The increment freeze for senior managers pay will be lifted All redundancies and exit payments for public sector will be capped at £95,000 2|P a g e

•

Band 8c – 9 have to annually earn their pay point and can receive a reduced salary for poor performance.

For the last two years the CCG has stepped away from the national pay award and offered a local pay award to offer equality for all staff. It is considered that this year there is no need to step away from the national pay award as it offers equality for all staff to receive a 1% consolidated increase, the capped redundancy payment has already been previously acknowledged by our Remuneration Committee and the earning of annual pay points is already included in our PDR policy. The Committee therefore agreed that the 2016/17 national pay award would be applied. 2.4

Occupational Health and Staff Support A review of the provision of our occupational health and staff counselling service in order to commission a more locally accessible service as currently staff have to travel into Birmingham for both services has been undertaken and was presented to the Committee. The Committee agreed that the options should be extended to include NHS providers within the geographical area. The options of providers will then be discussed by Staff Forum and consideration given to running a mini tender to identify the best provider for the service. It was also agreed that Staff Forum can have responsibility for proposing the health and wellbeing options for staff for presentation to the next committee meeting in June. Remuneration Committee also agreed an allocation of up to £5,000 from the OD budget to support staff health and wellbeing and also agreed for a corporate day involving all staff and the board to be arranged in either June or September.

2.5

Staff Survey Dudley CCG participated in the national staff survey this year to enable the results to be included in the national figures for staff satisfaction in relation to their employment. Only 46 CCGs in the country participated in the national survey as the questions are mainly provider specific and our results have been compared to other similar organisations. The results of the staff survey were shared with the Committee and agreed that the results are excellent which the organisation should be proud of. There were however some areas of concern (surrounding bullying, harassment, coming to work when not feeling well and the amount of additional hours worked) so a further survey was undertaken to deep dive into these areas. The results of the deep dive were shared with the Committee and recommendations made as followed: • • • •

The OD and HR team to look at ways in which smarter working can be encouraged. Training for managers around how to manage effectively and carrying out effective personal development reviews A staff development session to be dedicated to discussing the areas of concern in the survey A discussion at the next Board Development session on how to relieve some of the pressures on staff

A more detailed paper on the contents of the 2016 staff survey will be presented to Board on 12 May 2016. 2.6

Staff Forum Terms of Reference The committee ratified the updated Terms of Reference for Staff Forum with the changes as follows: • • •

Senior Manager representative will be the Director of Organisational Development and Human Resources All teams have representation on Staff Forum Purpose amended to include “to discuss all new and existing policies” 3|P a g e

2.7

Extraordinary Remuneration Committee The committee met on an extraordinary basis on 19th April 2016 to discuss a confidential staff issue.

3.0

RECOMMENDATION The Board to note the report for assurance.

Mrs Stephanie Cartwright Director of Organisational Development and Human Resources April 2016

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Finance and Performance Committee Report Agenda item No: 10.1 TITLE OF REPORT:

Finance and Performance Committee Report

PURPOSE OF REPORT:

To advise the Board of key issues discussed at the Finance and Performance Committee on 24 March 2016 and 28 April 2016.

AUTHOR OF REPORT:

Mr M Hartland, Chief Operating and Finance Officer

MANAGEMENT LEAD:

Mr M Hartland, Chief Operating and Finance Officer

CLINICAL LEAD:

Dr J Darby, Clinical Lead for Systems Redesign • • • •

KEY POINTS: • • • •

Based on the pre audited year end accounts the CCG met all financial duties in 2015/16 The CCG reported a year end underspend of £6,378,000 slightly over-achieving its year end control total of £6,337,000 as agreed with the NHS England. All NHS England financial assurance indicators were met. All NHS Constitution standards are being achieved at headline level with the exception of 62 day Cancer Waits and Ambulance Response. There are also performance exceptions to note for Ambulance Handovers, MRSA, C.Difficile and Dementia, which are monitored by NHS England for the purpose of CCG Assurance. The committee approved the contract extension with IT services and the issuing of a notice of termination of the contract in April 2016 for the contract end in 31 March 2017. The committee endorsed the recommendation of the IT procurement Group to proceed as planned with the procurement of IT Services from 1 April 2017. The Committee agreed to non-recurrently underwrite the Urgent Care Centre (UCC) contract for 2016/17 due to premise issues. The Committee approved advance funding of £1.2m to commence UCC premises improvements.

RECOMMENDATION:

The Board is asked to receive the report for assurance

FINANCIAL IMPLICATIONS:

As outlined in report and key points above

WHAT ENGAGEMENT HAS None TAKEN PLACE: ACTION REQUIRED:

Decision Approval  Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 12 MAY 2016 FINANCE, PERFORMANCE AND BUSINESS INTELLIGENCE COMMITTEE REPORT 1.0

INTRODUCTION The report summarises the key issues discussed by the Finance and Performance Committee at its meetings on 24 March 2016 and 28 April 2016.

2.0

KEY INDICATOR SUMMARY The table below identifies the CCG’s performance against key financial and performance indicators for 2015/16. This represents February performance information and the pre audited year-end financial information. It is followed by exception reporting and an explanation of key issues where required. The data is sourced from published data and not as indicators which have been published nationally.

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3.0

STATUTORY FINANCIAL DUTIES The Committee heard that the CCG ended the financial year with an annual budget of £447,697,000. This reflected the notified allocation from NHS England and CCG anticipated allocations. The CCG achieved a surplus on its Revenue Resource Limit of £6,378,000 in line with our financial plan and meeting the control total agreed with NHS England. Capital budgets, Cash Limits and the CCG’s programme and administration expenditure targets were all achieved. At a summary level, there are three distinct areas of expenditure within the CCG, for which budget responsibility has been delegated to appropriate Committees. These are commissioning expenditure (Commissioning Development Committee), running/staffing costs and reserves (Finance, Performance & Business Intelligence Committee) and primary care commissioning/membership development (Primary Care Commissioning Committee). The table below identifies the year-end financial position by Committee:

Clinical Development Committee Finance & Performance Committee Primary Care Commissioning Committee Surplus Total

Annual Budget

Year End Variance £

380.4m 21.0m 40.0m £6.3m 447.7m

4.1m (3.7m) (0.4m) (6.3m) (6.3m)

Whilst the Finance and Performance Committee retains oversight of the financial position of the organisation and advise the Board regarding any mitigating actions that may need to be taken, the 3|P a g e

clinical and management leads of appropriate Committees are responsible and accountable for financial performance of their delegated portfolio. The most significant financial pressures facing the CCG are in relation to contract overperformance. The Dudley Group Foundation Trust (DGFT) acute contract is reporting a year end over-performance of £1.55m consisting of over-performance against maternity, day cases, excluded drugs and emergency admissions. Ramsay Healthcare is reporting a year end over-performance of £0.99m caused by an increase in expenditure on day case and elective activity. We are also experiencing over-performance on CAMHS activity and an additional cost pressure for temporary assessment support for discharge. The impact of this over-performance is reflected in the Clinical Development Committee overspend shown above. Discussions on the respective financial positions have been held at the Clinical Development Committee and Primary Care Commissioning Committee, and reports to the Board from the Committees will outline their response to the presented position. 4.0

NHS CONSTITUTION STANDARDS/CCG ASSURANCE The CCG has met all NHS Constitution standards in February 2016 with the exception of 62 day Cancer Waits and Ambulance Response. The CCG continues to be rated as ‘outstanding’ by NHS England, one of the few CCGs in the country to achieve this rating. This will be re-assessed in June 2016 based on 2015/16 performance, but may be at risk due to underperformance against the Dementia diagnosis rate, described later in the report.

5.0

PERFORMANCE EXCEPTION REPORTING

5.1

62 day Cancer Waits After sustaining recovery in Quarter 3, DGFT failed to achieve 85% in January and February 2016, with performance of 81.67% and 84.34% respectively. This means that Quarter 4 is at risk of failing the national standard unless March’s performance demonstrates considerable improvement. Cancer Waits are contractually managed on a quarterly basis, therefore until the Quarter 4 position is confirmed a formal Contract Performance Notice (CPN) cannot be issued. However, regular meetings between DGFT and Dudley CCG continue to monitor progress and review locally agreed remedial actions.

5.2

Referral to Treatment (RTT) Although DGFT have consistently met the headline level for Referral to Treatment waiting times, Urology continues to underperform at specialty level. A Remedial Action plan is in place with a recovery date of April 2016 to meet the 92% standard. February’s performance was ahead of the monthly recovery trajectory of 85.6%.

5.3

Diagnostic Waits DGFT have sustained recovery of the 1% standard at headline level since December 2015, however failures at individual test level still exist in MRI, CT and Sleep Studies.

5.4

Ambulance Response The percentage of Category A Red 2 ambulance calls resulting in an emergency response within 8 minutes failed to achieve the 75% standard in February 2016. Although this indicator forms part of the Constitutional Standards for each CCG, it is Sandwell and West Birmingham (SWB) CCG who manage the contract with West Midlands Ambulance Service (WMAS) on behalf of all West Midlands CCGs. We continue to support SWB in the management of this element of the contract. 4|P a g e

6.0

NHS ENGLAND INDICATORS

6.1

Ambulance Handovers Handover breaches for both 30 & 60 minute waits reduced in February 2016 for the first time since November 2015, however the numbers are markedly higher than we would expect. This is due to Urgent Care demand pressures at DGFT, with A&E attendances and ambulance arrivals up to 22% higher than average during February. This will be managed through contractual mechanisms and progress monitored monthly at the Contract Review Meetings.

6.2

MRSA Three MRSA cases were confirmed in September 2015, which breached the 2015/16 zero threshold. This indicator will remain red for the remainder of 2015/16 although there have been no further cases since September.

6.3

C.Difficile There are 2 C.Difficile measures for the CCG; Secondary Care and CCG attributable. The nationally set threshold for Dudley CCG of 76 cases was exceeded with a 2015/16 year end position of 110 cases confirmed by the Office of Public Health. For Secondary Care there have been 44 cases for the same period. However, although there is a Secondary Care threshold of 29, only ‘attributable’ cases are counted, for which DGFT have had 12 cases (up to February 2016).

6.4

Dementia The diagnosis rate in February 2016 has marginally increased, however continues to underperform against the monthly trajectory agreed with NHS England to meet 62% at the end of March 2016. Dudley CCG continue to target those GP Practices with low diagnosis rates and recent correspondence will be followed up with Practice Mangers by GP integration leads, who will also be working to raise awareness of the range of services available to support diagnosed patients and their families.

7.0

QIPP 2015/16 AND 2016/17 The CCG has over-achieved the 2015/16 QIPP target of £7,190,000 by £110,000 giving total savings of £7,300,000. The Clinical Development Committee is reporting an under-achievement of £893,000 against its QIPP target as a result of reduced activity from the schemes relating to the Urgent Care Centre and Rapid Response Team. Actions have been developed for both areas to improve activity. Recurrent reductions in both property charges and running costs alongside an increase in prescribing rebates have enabled the CCG to achieve the QIPP target for this financial year. The revised QIPP position by Committee is therefore:-

Clinical Development Committee Finance and Performance Committee

Financial Plan

Actual £

Year end variance £

7.190m 0

6.297m 1.003m

0.893m (1.003m)

The CCG’s QIPP target for 2016/17 is £14m as reported in the financial plan presented to Board in March. Project Initiation Documents have been produced and will be monitored as part of the monthly QIPP challenge process. Where appropriate, savings assumptions have been applied to the contracts with our main providers.

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8.0

LOCAL INDICATORS

8.1

Better Care Fund There are a number of conditions the health economy must meet to achieve the performance payment associated with the Better Care Fund. Dudley is currently not achieving four of the five main indicators. The main issues relate to non-elective admissions not reducing and delays in transfers of care. Rectification plans for all indicators are being prepared, to be overseen by the System Resilience Group, in order to ensure the health economy meets the targets moving forward.

8.2

GP Balanced Scorecard The GP balanced scorecard metrics are split over four domains. At CCG level, all measures are being achieved within the Community Services and Primary Care domains, however ‘red’ ratings exist within the Secondary Care and Finance domains, notably in relation to high levels of Emergency Admissions and A&E attendances.

9.0

OTHER ITEMS DISCUSSED

9.1

Combined Board Assurance Framework and Risk Register The risks assigned to the Committee were reviewed and accepted. The Committee agreed that an additional risk be created relating to the Better Care Fund discharge to assess process in 2016/17.

9.2

Financial Plan / Budget Book 2016/17 The Committee agreed the CCG’s Financial Budgets 2016/17, which were subsequently approved by the Board on 31 March 2016. Total funding delegated to the CCG to be spent in 2016/17 is £457.9m. In addition, a notional allocation of £79.4m had been identified for Dudley for specialised services commissioning. Next year would be financially more challenging and require stringent controls on expenditure and performance management. It was noted that continuing health care and Personal Health Budgets were area’s under considerable pressure and reservations were expressed that the underlying budget was not sufficiently robust to cope. Concern was expressed regarding the impact of delayed transfers of care on the Better Care Fund budget. It was noted that the £1.625m previously used for the pay for performance element could be withdrawn if the flow of discharges from hospital were not achieved. It was suggested that an external review should be undertaken of systems and processes within social care. It was noted that due diligence work had started in the Local Authority from a financial perspective, but not a process perspective. The schedule of QIPP schemes was discussed. The main schemes were the triage of all outpatient referrals through the e-referral system; emergency admissions from care homes; prescribing and the expansion of the rapid response team service.

9.3

Egton / EMIS Issues Update The committee received an update on the issues experienced with various EMIS / Egton projects, the actions taken and the legal response on intellectual property rights / copyright for templates, protocols and concepts. EMIS are more engaged with the CCG however a high level meeting would be arranged to resolve the current issues being experienced.

9.4

Dudley IT Service Contract Extension A report on the proposed 12 month contract extension with Dudley IT Services was received and approved by the committee and would allow the continuation of IT services during the tender 6|P a g e

process for a new IT provider. The immediate issue of termination notice made in April 2016 for the services to end on 31 March 2017 was also approved on the basis that the tender process was on course. 9.5

IT Procurement Update A report was presented updating committee on the progress of the procurement of IT services for the CCG and GPs; The preparation of tender documentation was nearing completion with a target of releasing the advert and PQQ by the end of April; A decision was taken to partner with DWMHPT in order to leverage scale and create a consistent infrastructure template to support future collaborative working; Concern was expressed by the committee regarding the increased anticipated costs but supported the broader scope and improved service the new specification would offer the CCG and its member practices. The committee endorsed the recommendation of the IT procurement Group to proceed with the tender as planned for Dudley IT Services from 1 April 2017. It wss believed that the additional cost would be recovered by changes in working practices and this would be explored further over the coming months.

9.6

Urgent Care Centre Contract - Activity and Finance The committee received a report from the Urgent Care commissioner on the review of UCC activity and finance recommendations for 2016/17 contract negotiations. The report concluded with a request to underwrite in 2016/17, non-recurrently, the Dudley element of the contract for two reasons: the premises do not enable streaming of ambulance and minor injury patients and outstanding validation of activity assumptions used in the original scoping of the specification. The Committee agreed to such an underwriting, on a non-recurrent basis, with the aim to ensure the UCC is operating in line with the specification as soon as possible. Additional requests for underwriting were not approved.

9.7

Urgent Care Centre Premises As described above the full specification for the UCC cannot be delivered with the current premise solution at Russells Hall. In light of the above request to underwrite in 2016/17 the element of the contract related to premise issues, the Committee approved a proposal to advance funds to facilitate the commencement of building works as soon as possible. This would eradicate the need to underwrite the contract with the provider and ultimately be cost neutral for the CCG as we continue to bid for external funds. Dudley Group FT will still commit funds to their element of the refurbishment and contribute the balance of resource for intermediate works undertaken.

10.0

REPORTS FROM GROUPS ACCOUNTABLE TO THE COMMITTEE

10.1

IT Strategy Group The Committee received an update on the issues discussed by the IT Strategy Group and noted good progress on implementing projects within the strategy. The Committee discussed issues with EMIS capability, which was impacting on the delivery of ongoing local initiatives. Pressure was being maintained on EMIS/Egton to ensure commitments were adhered to and a meeting with Dell representatives had been scheduled for May to discuss hardware issues with the recent mobile devices.

10.2

Estates Strategy/Operational Group Issues discussed by the Estates Operational and Estates Strategy Groups were presented. In particular, the Committee noted that progress had been made obtaining expressions of interest from practices for the Primary Care Transformation Fund with prioritisation of schemes taking place in June for submissions to be made to NHS England.

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The operational group were progressing with estates rationalisation and identifying ‘quick wins’ for the properties that were under-utilised or vacant. Holly Hall had been sold at auction at the end of March and Podiatry, the only remaining health service in Coseley Health and Family Centre were looking for alternative premises to provide services with Coseley Medical Centre not suitable due to available space. The Committee was also updated on progress with the Estates Strategy following approval by Board on 31 March. 11.0

DECISIONS TAKEN UNDER DELEGATED POWERS The committee endorsed and approved the following under delegated powers:• • • •

12.0

The approval of the contract extension with Dudley IT services and the issuing of a notice of termination in April 2016 for the contract end in March 2017. Endorsed the recommendation of the IT procurement Group to proceed as planned with the procurement of Dudley IT Services from 1 April 2017. To underwrite non-recurrently the Dudley element of the contract for the Urgent Care Centre contract relating to premise and activity issues. To advance funding to facilitate the commencement of the required building works associated with the Urgent Care Centre

RECOMMENDATION The Board is asked to receive the report for assurance.

Mr M Hartland Chief Operating and Finance Officer May 2016

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Multi-Specialty Community Provider (MCP) Procurement – Progress Report Agenda item No: 11.1

TITLE OF REPORT:

Multi-Specialty Community Provider (MCP) Procurement – Progress Report

PURPOSE OF REPORT:

To advise the Board of progress with the procurement of the MCP

AUTHOR OF REPORT:

Mr Neill Bucktin – Director of Commissioning

MANAGEMENT LEAD:

Mr Neill Bucktin – Director of Commissioning

CLINICAL LEAD:

Dr Steve Mann – Clinical Executive – Acute and Community Services

KEY POINTS:

1. 2. 3. 4. 5.

RECOMMENDATION:

That progress with the procurement of the Multi-Specialty Community Provider be noted.

FINANCIAL IMPLICATIONS:

None arising directly from this report.

WHAT ENGAGEMENT HAS TAKEN PLACE:

Some limited engagement. The report describes planned engagement

ACTION REQUIRED:

 Decision  Approval  Assurance

Project Board and Project Team in place. Procurement timeline established. Key documents to be produced in readiness for July Board meeting. Market and public engagement to take place. Guidance expected on the MCP “framework and contract design”.

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 12 MAY 2016 MULTI-SPECIALTY COMMUNITY PROVIDER (MCP) PROCUREMENT – PROGRESS REPORT

1.0

BACKGROUND

1.1

The Board will recall that at its last meeting it agreed to establish a Project Team and Project Board to oversee the procurement of the MCP, prior to a report being presented to the Board in July 2016, in order to consider launching the procurement.

1.2

This report provided the Board with an update on progress.

2.0

PROJECT BOARD AND PROJECT TEAM

2.1

These have now been established and are meeting monthly and weekly respectively. The terms of reference for the Project Board will be submitted to the Audit Committee for approval.

2.2

Project management support and procurement support are being provided by the CSU. Legal advice is provided by Mills and Reeve.

3.0

KEY WORKSTREAMS

3.1

In order for the procurement to be advertised in the Official Journal of the European Union (OJEU) a number of “products” will be required as follows:• • • • • • • •

the MCP Prospectus including the expected “characteristics”; schedule of current services to be delivered by the MCP, including financial value, location and staff; outcomes to be commissioned; contract form; business rules and quality assurance framework; finance and activity modelling; phasing of other services coming within the scope of the MCP after letting of contract (e.g. social care); description of relationship of the MCP to other parts of the local system – voluntary sector, social care, intermediate care etc.

3.2

Work has commenced on these and they will be submitted to the Board in July 2016.

3.3

There are a number of other issues to be addressed over the next two months, at both a local and national level including:• • • •

engagement events; engaging with regulators; understanding the implications for remaining non-MCP contracts; Implications for pensions, indemnity, clinical negligence scheme, VAT.

4.0

MARKET SHAPING

4.1

The nature of the procurement process will depend upon the degree of contestability and the extent to which the process will become one of a dialogue with a preferred provider. In order to understand the implications of the procurement for each of our existing main providers and partners, a series of bilateral meetings will take place shortly. In addition we will be holding a specific “market place” event for all potential providers and engaging with the public through 5 locality based events.

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4.2

As a result of these events we will be in a position to judge the likely degree of interest in the procurement, the extent of contestability, and potential unintended risks.

5.0

NEXT STEPS

5.1

It should be noted that the tasks described are complex and involve contributions from the full range of CCG functions over an intensive period.

5.2

Guidance on the MCP contract design is expected imminently. The implications of the guidance will be considered more fully once published.

5.3

Following discussions with Dudley MBC colleagues, a briefing on the implications of the MCP will be given to the Council’s cabinet in June.

5.4

Further work will continue on the development of the products identified at 3.1 above and a report submitted to the Board in July 2016. It is anticipated that a significant portion of the agenda will need to be devoted to this item.

6.0

RECOMMENDATION

6.1

That progress with the MCP procurement be noted.

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Report of the Commissioning Development Committee Agenda item No: 11.2 TITLE OF REPORT:

Report of the Commissioning Development Committee

PURPOSE OF REPORT:

To advise the Board of matters considered by the Commissioning Development Committee at its meetings on 16 March and 20 April 2016

AUTHOR OF REPORT:

Mr Neill Bucktin – Director of Commissioning

MANAGEMENT LEAD:

Mr Neill Bucktin – Director of Commissioning

CLINICAL LEAD:

Dr Steve Mann – Clinical Executive – Acute and Community Services

KEY POINTS:

1. Contractual management in place with Dudley Group NHS FT due to failure to meet the referral to treatment time target for urology specialty. 2. Dudley Group NHS FT is likely to fail to meet the 62 day cancer wit target for quarter 4. 3. Dementia diagnosis rate continues to be below the planned trajectory. 4. Proposal to develop a “POD” – (Prescription Ordering Direct) – scheme for repeat prescriptions approved in principle. 5. Proposal to develop a CAMHS Tier 3 Plus service approved. 6. Proposal to develop a falls and fracture prevention service approved. 7. Additional investment in therapy services for special school pupils approved in principle. 8. Urology advice and guidance to be monitored in order to identify whether a third party is required to provide advice and guidance. 9. Direct access to community physiotherapy services to be secured through procurement of the Multi-Specialty Community Provider (MCP). Consideration to be given to a potential waiting list initiative.

RECOMMENDATION:

That the matters considered by the Commissioning Development Committee be approved.

FINANCIAL IMPLICATIONS:

None arising directly from this report

WHAT ENGAGEMENT HAS TAKEN PLACE:

Some engagement on individual service developments

ACTION REQUIRED:

 Decision  Approval  Assurance

1|Page

DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 12 MAY 2016 REPORT OF THE COMMISSIONING DEVELOPMENT COMMITTEE 1.0

PURPOSE OF REPORT

1.1

To advise the Board of matters considered by the Commissioning Development Committee at its meetings on 16 March and 20 April 2016.

2.0

BACKGROUND

2.1

The Commissioning Development Committee met on 16 March and 20 April 2016. This report sets out the main issues considered by the Committee.

3.0

PERFORMANCE

3.1

The Committee has noted that contractual management is in place with Dudley Group NHS FT due to a failure to meet the referral to treatment time target for the urology specialty. In addition, Dudley Group NHS FT is likely to fail to meet the 62 day cancer wait target for quarter 4.

3.2

The dementia diagnosis rate continues to be below the trajectory necessary to meet the national target. The Board will be aware that this is a key feature of the CCG’s assurance process with NHS England and further work will take place with individual practices, led by the GP Locality Leads, to improve performance.

4.0

PRESCRIPTION ORDERING DIRECT (POD)

4.1

The Committee has considered a proposal to develop a POD, designed to centralise the ordering of repeat prescriptions and reduce waste. A similar scheme operating in Coventry has generated significant savings.

4.2

The proposal has been approved in principle and a working group has been established to develop an implementation plan, prior to a further report being considered by the Committee.

5.0

CHILD AND ADOLESCENT MENTAL HEALTH SERVICE (CAMHS) – TIER 3 PLUS

5.1

The Committee has approved a proposal to develop a CAMHS tier 3 plus service. This is designed to manage patients in crisis and avoid the use of paediatric, adult mental health or tier 4 beds.

5.2

The Committee noted that a similar service in Walsall had resulted in 4 tier 4 admissions in 12 months compared to 17 during the previous 12 months. The availability of the service would also prevent existing CAMHS tier 3 clinical staff being required to devote time to patients in crisis situations, leading to a lengthening of waiting times. One patient has been inappropriately placed for in excess of 60 days.

5.3

The service would also enable patients to recover quickly and maintain their access to education, delivering a wider societal benefit.

6.0

FALLS PREVENTION AND FRACTURE LIAISON SERVICE

6.1

The Committee has approved a proposal to develop a falls prevention and fracture liaison service as part of the QIPP Programme.

6.2

The Committee has noted that the rate of falls related injuries in Dudley requiring emergency admission for the over 65s is much higher than comparator CCGs. In addition, our spend on falls related admissions is significantly higher.

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6.3

Existing services are reactive. This service will be proactive and aim to:• • • • • • •

prevent frailty promote bone health reduce accidents encourage safe physical activity promote a healthy lifestyle reduce unnecessary environmental hazards identify people at risk of falling

7.0

THERAPY SERVICES FOR SPECIAL SCHOOLS

7.1

The Committee has considered a report on the provision of occupational therapy and physiotherapy in Dudley’s special schools.

7.2

Current therapy provision is low consisting of a limited amount of speech and language therapy and physiotherapy. The Committee recognised the valuable contribution this support can make to preventing costly use of services in later life and supporting children with their educational attainment.

7.3

The Committee have supported a proposal to provide 1.0 wte occupational therapist and 1.0 wte physiotherapist, subject to additional resources being identified from within existing budgets.

8.0

UROLOGY – ADVICE AND GUIDANCE

8.1

The Committee have noted that advice and guidance for all specialties forms part of the 2016/17 contract with Dudley Group NHS FT. Consideration has been given to utilising a third party provider to carry out this function. In the light of the contractual requirement, the Committee has agreed to monitor the position and revisit the proposal to use a third party depending on performance.

9.0

COMMUNTY PHYSIOTHERAPY - FUTURE PROVISION

9.1

The Board will recall that in the CCG’s Commissioning Intentions for 2016/17 and 2018/19 it was stated that we wished to commission community physiotherapy on an open access basis. The usual route for doing this would be to enter into an “Any Qualified Provider” (AQP) procurement, commissioning from multiple providers on the basis of a common price and quality standard.

9.2

Given that, subject to the Board’s approval, a procurement process for the Multi-Specialty Community Provider (MCP) will begin in July, the Committee has agreed to conduct the procurement through one process rather than two parallel processes.

9.3

Establishing open access may require an initiative to reduce waiting times and work will take place to quantify this in activity and financial terms.

10.0

RECOMMENDATION

10.1

That the matters considered by the Clinical Development Committee be noted.

10.2

In line with the scheme of delegation the Board is required to ratify decisions of the CDC to approve business cases over £100,000 so the two cases below are requested to be approved: • •

CAMHS Tier 3 Plus Falls Prevention and Fracture Liaison

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Report of the Integrated Commissioning Executive Agenda item No: 11.3

TITLE OF REPORT:

Report of the Integrated Commissioning Executive

PURPOSE OF REPORT:

To advise the Board of matters considered by the Integrated Commissioning Executive

AUTHOR OF REPORT:

Mr Neill Bucktin – Director of Commissioning

MANAGEMENT LEAD:

Mr Neill Bucktin – Director of Commissioning

CLINICAL LEAD:

Dr Steve Mann – Clinical Executive Acute and Community Services

KEY POINTS:

1. Revised Section 75 Agreement signed. 2. Performance position affected by number of discharges from secondary care and financial impact on Dudley MBC. 3. Consideration to be given to how the performance dashboard is made available to MDTs as part of their developmental process. 4. Draft BCF Plan for 2016/17 considered prior to submission to NHS England.

RECOMMENDATION:

That the matters considered by the Integrated Commissioning Executive be noted.

FINANCIAL IMPLICATIONS:

None arising directly from this report.

WHAT ENGAGEMENT HAS TAKEN PLACE:

None

ACTION REQUIRED:

 Decision  Approval  Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 12 MAY 2016 REPORT OF THE INTEGRATED COMMISSIONING EXECUTIVE

1.0

PURPOSE OF REPORT

1.1

To advise the Board of matters considered by the Integrated Commissioning Executive.

2.0

BACKGROUND

2.1

The Board will recall that the Integrated Commissioning Executive was established to oversee the operation of the pooled budget which underpins the Better Care Fund (BCF) and its associated Section 75 Agreement.

2.2

This report sets out those matters considered by the Executive at its meeting in March 2016.

3.0

SECTION 75 AGREEMENT

3.1

The Section 75 Agreement which sets out the basis upon which the BCF operates has now been revised to reflect the Board’s decision to underwrite, in full, the £1.6m “pay for performance” element of the fund, regardless of non-elective activity performance.

3.2

A new Section 75 Agreement is now being drafted for 2016/17 to reflect the schemes that are being put in place (including support for carers, falls service redesign, support to care homes and a reviewed discharge pathway) and the fact that national policy no longer requires a pay for performance element to the fund. There is, however, a requirement to have an action plan in place to reduce delayed transfers of care and this will be a feature of the BCF Plan and the Section 75 Agreement.

4.0

PERFORMANCE

4.1

The Executive has noted that at Q3, Dudley MBC were reporting a negative variance of £ 3.5 million as a result of a larger than anticipated number of discharges from secondary care. The work on the discharge pathway, delayed transfers of care and the resources required to underpin this are designed to address this issue and achieve a proper equilibrium.

4.2

The Executive has also considered a proposed dashboard to be provided to each MDT that will enable them to monitor their own performance. This is regarded as critical to effective MDT performance.

5.0

BCF PLAN 2016/17

5.1

A BCF Plan for 2016/17 has been developed and submitted to NHS England for the first stage of their assurance process.

5.2

Feedback received has been positive and a small number of issues identified for further attention/clarification, prior to a second submission being made on 3rd May.

6.0

RECOMMENDATION

6.1

That the matters considered by the Integrated Commissioning Executive be noted.

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 12 May 2016 Report: Report from the Primary Care Commissioning Committee Agenda Item No: 12.1 TITLE OF REPORT:

Report from the Primary Care Commissioning Committee

PURPOSE OF REPORT:

To advise the Board on key issues discussed at the meeting of the Primary Care Commissioning Committee on 18 March and 15 April 2016

AUTHOR OF REPORT:

Mr D King, Head of Membership Development & Primary Care

MANAGEMENT LEAD:

Mr D King, Head of Membership Development & Primary Care

CLINICAL LEAD:

Dr T Horsburgh, Clinical Lead for Primary Care

KEY POINTS:

o

The Committee approved the annual report and provides assurance that the CCG has fulfilled and discharged its statutory and delegated functions for the commissioning of primary medical services

o

The Committee approved and offered the Dudley Outcomes for Health framework in March 2016. 39/46 practices have signed up to participate – providing 89% population coverage.

o

The Committee received an overview of CQC inspections as set out in the report. The Committee is adhering to the NHS England “Framework for responding to CQC inspections of GP practices” and has offered support packages to those practices identified as inadequate and placed into special measures by the CQC.

o

The Committee has achieved its financial targets for 2015/16 remaining within the resource limit delegated to it by the CCG Board

o

The Board is asked to note for assurance the issues discussed, and decisions taken by the Primary Care Commissioning Committee

o

The financial performance of the delegated primary care budget has been finalised, subject to audit, with a year-end underspend against budget of £819.

o

The financial position in respect of core commissioning budget was not finalised at the Committee meeting on 15 April, but initial workings were presented that indicated an under spend of £299,000 caused by an under spend against the primary care investments.

RECOMMENDATIONS:

FINANCIAL IMPLICATIONS:

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NHS England CQC Member practices Local Medical Committee

WHAT ENGAGEMENT HAS TAKEN PLACE:

o o o o

ACTION REQUIRED:

 Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 12 MAY 2016 REPORT FROM THE PRIMARY CARE COMMISSIONING COMMITTEE

1.0

INTRODUCTION

1.1

This report summarises the key issues discussed at the Primary Care Commissioning Committee on 18 March and 15 April 2016.

2.0

ITEMS DISCUSSED

2.1

PRIMARY CARE ANNUAL REPORT

2.2

The Committee received and approved the annual report covering the work of the Committee since taking on its delegated functions in relation to the commissioning of primary medical services. Specifically the Committee were assured that:o o o o o

The Committee has fulfilled its statutory functions in relation to its delegated functions from NHS England relating to the commissioning of primary medical services. The Committee has fulfilled its delegated functions in accordance with scheme of delegation as set out in the CCG constitution. The Committee has achieved the objectives set out in the application to NHS England take on delegated commissioning functions for primary medical services. The Committee has achieved its financial targets, remaining within the resource limit delegated to it by the CCG Board. The Committee has made significant progress in developing and improving the quality of primary medical services in Dudley.

2.3

The annual report of the Primary Care Commissioning Committee is appended to this report.

3.0

PRIMARY CARE CONTRACTING

3.1

The Committee received assurance from the Primary Care Operational Group (the Group)

3.2

The Committee accepted recommendations from the Group and approved a number of contractual changes relating the removal (retirement) and additions to practice partnerships.

3.3

The Committee rejected an application from Dr T Safdar of Central Clinic to close the practice list to new registrations. The application was considered in accordance with NHS England policy on list closures.

3.4

The Committee accepted the recommendations of the Group in working to the NHS England “Framework for responding to CQC inspections of GP practices”.

3.5

The Committee has agreed a CCG support package that will be offered to practices rated as inadequate by the CQC that will include GP, practice nurse and practice manager mentorship.

3.6

The Committee approved the recommendations from the Group to commission an excluded patient scheme from Malling Health within the Urgent Care Centre with effect from 1st April 2016.

3.7

The Committee approved the recommendations from the Group to roll forward the specification and commissioning of the out of area registration: in hours urgent primary medical care (including home visits) enhanced service for 2016/17.

3.8

The Committee approved the quarter 4 self-certification assurance statement to NHS England. The submission provides assurance to NHS England that the CCG are operating in accordance with the functions delegated from NHS England.

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4.0

PRIMARY CARE COMMISSIONING – NEW CONTRACTUAL FRAMEWORK

4.1

The Committee approved the following in relation to the commissioning of the ‘Dudley Outcomes for Health’ framework being commissioned on a pilot basis with effect from the 1st April 2016:o o o

The pre-requirements and outcomes measures included in the framework. The participation agreement drafted by Mills and Reeve to be offered by the CCG to practices for participation in the framework The draft evaluation framework that has been developed by the project group responsible for overseeing the implementation of the new framework

4.2

The participation agreement, application and schedule of payments were circulated to all practices on 21st March 2016 with sign up deadline of 31st March 2016.

4.3

As at 31st March 2016 the position in respect of participation in the new framework is set out in the table below

Practices - number Practices - population Practices - population %

Participating 39 315600 89%

Not Participating 7 33307 11%

5.0

QUALITY

5.1

The Quality and Safety report to the Board will set out in more detail those areas and issues pertinent to primary care, including a table of CQC inspections for Dudley practices.

5.2

The Board will note that the there are two practices that have been rated as inadequate, and as a consequence have been placed into ‘special measures’ by the CQC.

5.4

The Committee operate in accordance with the “Framework for responding to CQC inspections of GP practices”. The Committee has agreed the following process for practices that are rated as inadequate and placed into ‘special measures’ by the CQC o

o o

The practice will receive a joint visit from the CCG and NHS England within two weeks publication of the CQC report to discuss contractual compliance against the GMS contract, the CQC action plan and a CCG support package that enables the action plan to be implemented. The CCG will undertake a full GMS contract review within one month of the publication The CCG has agreed a support package, fully funded by the CCG to those practices rated as inadequate as follows:  6 sessions of GP mentorship support  6 sessions of practice nurse mentorship support  40 hours of practice manager time

5.5

The Committee was assured by the Group that actions have been undertaken by Pedmore Road surgery to address the actions identified by the CQC.

5.6

The Committee was assured that a support package has been put in place with the Waterfront surgery, and that the CCG is monitoring the implementation of the practice CQC action plan.

5.7

The Committee was assured that a support package has been offered to Dudley Partnerships for Health, and that the CCG will be putting in place the monitoring of the practice CQC action plan.

5.8

The Committee was assured that a support package has been put in place with Bath Street surgery, and that a change in the GP partnership will result in CQC compliance.

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6.0

FINANCE

6.1

The budgets delegated to the Committee by the CCG Board for the financial year 2015/16 are as follows: o £38.1M for delegated primary medical services (GMS contracts) o £1.8M for core commissioning (staff costs, primary care winter investment)

6.2

The financial performance of the delegated primary care budget has been finalised, subject to audit, with a year-end underspend against budget of £819.

6.3

The financial position in respect of core commissioning budget was not finalised at the Committee meeting on 15 April, but initial workings were presented that indicated an under spend of £299,000 caused by an under spend against the primary care investments.

6.4

The Committee has achieved its financial targets for 2015/16 remaining within the resource limit delegated to it by the CCG Board.

7.0

RISK REGISTER

7.1

The Committee considered and approved a number of updates to the risk register. Those amendments and updated register are set out and reported in the Combined Board Assurance Framework and Risk Register.

8.0

RECOMMENDATIONS

8.1

The Board is asked to note for assurance the issues discussed, and decisions taken by the Primary Care Commissioning Committee on 18 March and 15 April 2016

Mr D King Head of Membership Development and Primary Care May 2016

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Appendix 1

Primary Care Commissioning Committee Annual Report 2015-16

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1.0

BACKGROUND

1.1

Dudley CCG has been fully delegated to commission primary medical services from 1st April 2015. In line with statutory guidance, the CCG has established a Primary Care Commissioning Committee (the Committee) as a corporate decision making body to make collective decisions on the review, planning and procurement of primary medical services in the Dudley borough.

1.2

The Committee is established in accordance with paragraph 6.9.3(h) of NHS Dudley Clinical Commissioning Group’s (CCG) constitution. The terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee.

1.3

The Committee was established to fulfil the functions that NHS England has delegated to the CCG to exercise its statutory duties in the commissioning of primary care. Those functions are set out in the delegation agreement signed between NHS England and the CCG.

1.4

The delegation agreement was signed on 30th March 2015. The CCG took on its delegated functions from the 1st April 2015.

1.5

The delegation agreement was conditional on resolving a number of issues related to the safe transition and handover of responsibilities from NHS England to the CCG by 30th June 2015. The Committee has managed and provided assurances to the CCG Board on all of the issues related to the transition and handover of responsibilities from NHS England that were completed by 30th June 2015.

2.0

PURPOSE

2.1

The Committee will recall that its stated purpose and application to NHS England to take on full delegated authority for the commissioning of primary medical services was predicated on three areas set out in the table below.

2.2

Table: Application to NHS England to take on delegated functions for commissioning primary medical services Area Outcome Comment

To effectively review and pilot new ways of Achieved commissioning outside of the core requirements of GMS – setting one set of outcome measures that will apply to all those services commissioned and working as part of an integrated population based health and wellbeing service with primary care at the heart of the model.

New contractual framework (Dudley Quality Outcomes for Health) developed and offered to practices in 2015/16 to replace QOF, DES and LISs.

To commission for shared outcomes across the Achieved whole system of integrated care to ensure that all the organisations working in Dudley are working to the same outcome objectives for our population.

Outcome measures within Dudley Quality Outcomes for Health being used as part in the MCP contract service specifications for the management of LTC.

To lead and manage the process for review and Achieved revising all GP contracted activity outside of GMS (so including QOF, enhanced services and PMS

All PMS contracts reviewed and concluded – all practices moved to 7|P a g e

resource allocations), and retain any surplus within Dudley to reinvest within Dudley to improve the quality of primary care services and support the delivery of our service integration model.

2.3

GMS contracts. PMS premium fully re-invested in General Practice through the new Dudley Quality Outcomes for Health contract.

Table: Functions delegated to the Primary Care Commissioning Committee as set out within the CCG Constitution

Policy Area

Decision

COMMISSIONING AND CONTRACTING FOR CLINICAL SERVICES

1.

Status

Determination of Achieved arrangements for the review, planning and procurement of primary care medical services (under delegated authority from NHS England). To include • GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action, such as issuing breach/remedial notices, and removing a contract); • Newly designed enhanced services (“Local Enhanced Services (LES)” and “Directed Enhanced Services (DES)”); • Design of local incentive schemes as an alternative to the Quality and Outcomes Framework (QOF); • The ability to establish new GP practices in an area; • Approving practice mergers; and • Making decisions on ‘discretionary’ payments (e.g., returner/retainer schemes).

Comments •

•

•

•

•

•

•

All PMS contracts reviewed and concluded in 2015-16 resulting in the return to GMS for all PMS practices. All DESs and LESs reviewed and incorporated in new Dudley for Quality for Health Outcomes contract developed in 2015/16. Full range of contractual issues (mergers, branch surgery closure applications) considered in full compliance with statutory duties and in accordance with the relevant policies and procedures of NHS England. GMS contractual review process developed and implemented in full compliance with statutory duties and in accordance with the relevant policies and procedures of NHS England. Winter pressures schemes developed and commissioned to support primary care and reduce demand on secondary care – including routine GP appointments and increased access at weekends. Primary Care Development organisational development programme commissioned and positively evaluated in 2015-16. Excluded patients scheme and out of area registrations (in hours urgent medical care) commissioned

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3.0

Governance

3.1

As part of the application and approval process NHS England confirmed that the CCG met the required conflict of interest management thresholds in line with their statutory guidance.

3.2

The Primary Care Commissioning meetings have been held in public session from June 2015 following conclusion of the safe handover and transition of functions from NHS England.

3.3

In establishing the Committee, the CCG acted upon advice from the Good Governance Institute regarding the constitution of the Committee. The membership of the Committee has been constituted to make sure that the majority is lay and executive members. No GP members are members of the Committee. The clinical input into the Committee is obtained through a secondary care clinician, the secretary of the LMC (who has no voting rights) and a local GP who represents GP members (the GP has not voting rights and is not a member of the CCG Board).

3.4

The commissioning and governance arrangements for Primary Care have been audited and assured in our first year of delegation, by the Good Governance Institute, internal audit and Deloitte on behalf of NHS England.

3.5

The table below provides a summary of the assurance and audit undertaken in 2015-16.

3.6

Table: Summary of assurance and audit undertaken in 2015-16 Organisation

Summary

Good Governance Institute

The Good Governance Institute was fully assured that the CCG had developed robust governance arrangements: these included a revised conflict of interest policy, standards of business conduct policy and amended constitution that has been agreed by the Governing Body.

Internal Audit

The audit did not highlight any weaknesses that would impact on the achievement of the system's key objectives. Some low level findings and associated risks have been identified and are being acted upon.

NHS England (Deloitte)

The audit has highlighted 15 improvement opportunities – most of which are low priority recommendations that “should be addressed when resources and time are available”. All of these opportunities have been reviewed and are being acted upon by the CCG.

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3.7

The statutory guidance reinforces the obligation to comply with section 14O of the National Health Service Act 2006 which sets out the minimum requirements in terms of what CCGs must do in terms of managing conflicts of interest as set out in the table below

3.8

Table: Summary of minimum statutory requirements for managing conflict of interests Area

Status

Notes

Maintain appropriate registers of interest

Compliant

•

The CCG maintains a Register of Interests which is published on the CCG website/made available for public access.

•

The CCG maintains a Register of Procurement Decisions detailing the decision made, who was involved in making the decision, a summary of any conflicts of interest in relation to the decision and how this was managed by the CCG. As above

Publish and make arrangements for the public to access those registers

Compliant

•

Make arrangements requiring the prompt declaration of interests by members and employees and ensure that these interests are entered into the relevant register

Compliant

•

• •

•

Have regard to guidance published by NHS England and Monitor on conflicts of interest

4.0

Compliant

• •

The CCG has produced its conflict of interest’s policy which details the processes to follow to manage conflicts of interest. The policy is publically available on the CCG website. The CCG has arrangements in place for continuing to manage any conflicts of interest post-decisions being made i.e. contract management processes. CCG members and officers have received appropriate training on conflicts of interest.

As above – all policies and processes are reviewed annually and are updated when required The CCG produces a quarterly selfassessment and assurance statement for NHS England with the approval of the Committee

Commissioning The CCG as directed by the Committee has:

4.1

Developed a new contractual framework with our GPs that has reformed the QOF locally, and consolidated DESs, LISs and public health commissioned services. This is the Dudley Quality Outcomes for Health Framework offered to practices in March 2016. 10 | P a g e

4.2

The Dudley Quality Outcomes for Health Framework has been over 12 months in development and has been the subject of extensive consultation with GPs, practice nurses, practice managers, patient groups, local medical committee, NHS England, Office of Public Health and Dudley MBC, National Clinical Leads within NHS England for Long Term Conditions and GP Development and Mills and Reeve Solicitors.

4.3

The development and introduction of the new contractual framework is innovative and unprecedented in any CCG that has delegated commissioning functions – and is the subject of much attention from other CCGs who have visited Dudley to learn about the approach to the commissioning and development of the Dudley Outcomes for Health Framework.

4.4

Suspended the current QOF in 2015-16 to prepare for the introduction of the new contractual framework in 2016-17.

4.5

Developed and commissioned winter pressure schemes in Primary Care including an extended access scheme for additional routine appointments provided at evenings and weekends, and a service to triage and provide home visits to those frail elderly patients in care homes with a view to reducing avoidable admissions.

4.6

Developed and commissioned a pilot for extended scope pharmacists – the pilot is currently subject to a formal evaluation but is expected to reduce GP workload and increase the prescribing efficiency within General Practice.

5.0

Contracting The CCG as directed by the Committee has:

5.1

Established the Primary Care Operational Group (PCOG) to review and monitor contractual performance and quality and safety in primary care. The PCOG reports to the Committee.

5.2

Expanded the Primary Care and Membership Development team, including a Primary Care Contracts Manager who is responsible for ensuring a safe and effective system of contracting with all 46 GP practices in Dudley.

5.3

Considered and approved a number of contractual variations (26) in full compliance with statutory duties and in accordance with the relevant policies and procedures of NHS England.

5.4

Considered an application to close a surgery (St Thomas) and two applications relating to the closure of branch surgery sites for Market Street (a branch surgery of Wordsley Green Surgery) and Masefield Road (a branch surgery of Lower Gornal Medical Practice).

5.5

The Committee has learnt a tremendous amount considering the applications in respect of practice closures. The CCG has established a process that fully complies with statutory duties considering such applications. It has supported the practices through the process to ensure that they comply with their statutory duties; in particular undertaking consultation with their patients, local councilors, MPs, Dudley MBC, local medical committee and the relevant community forums and Committees i.e. Health Overview and Scrutiny Committee. The process undertaken by the Committee has received positive feedback from NHS England who considers that the CCG has operated over and above its statutory functions in considering the applications.

5.6

Commissioned an out of area registration (in hours urgent medical care) enhanced service – a primary care service that was commissioned by NHS England and provided in Birmingham that is now 11 | P a g e

commissioned and provided in Dudley. This is a as a direct result of the CCGs delegated function, to commission for the patients of Dudley. 5.7

Commissioned a service for ‘excluded patients’ – patients with violent and aggressive behavior where the service was historically commissioned by NHS England was provided in Wolverhampton. The service is now commissioned and provided within Dudley.

5.8

Designed and commenced a contract review process in accordance with the delegated policies and procedures of NHS England.

5.9

Has taken a supportive and participative approach in managing and improving practice performance through the membership development team – this is reflected in the performance set out in this report, and that the CCG did not have cause to issue any breach of contract notices against Dudley practices.

6.0

Primary Care Development The CCG as directed by the Committee has:

6.1

Developed and implemented a Primary Care Development Programme – a quality improvement programme that has improved practice efficiency; improved knowledge and skills for clinical and nonclinical staff; improved the leadership and change management skills; improved communication, relationships and staff morale; created and embedded the skills within primary care to lead and manage change.

6.2

Extended the scope of the development programme in 2016-17 to give practices the capacity and skills to operate at scale – delivering improvements in efficiency and quality.

6.3

Supported all practices moving to EMIS to maximise the efficiency within its member practices: this has included developing standard protocols and searches across member practices and enhancing the use of risk stratification tools to identify and manage the frail elderly; reducing unplanned admissions, and coordinating physical, mental and social care in the community.

6.4

Developed, in house, an EMIS template to support the introduction of the new contractual framework. This has involved over 300 hours of development time. The template has been piloted in 11 of member GP practices and has informed the development of the final template that has been used to support the new contractual framework.

6.5

Increased the use of technologies within member practices, such as telecare/telehealth, online ordering of prescriptions and appointment booking. All member practices have online services enabled and all of the practices will be offering online services to patients by 31st March 2016.

6.6

Invested in the staff development and training for member practice staff, delivering care planning training to support the delivery of the unplanned admissions enhanced service; commissioning eLearning/online training packages to ensure CQC compliance.

6.7

Continued to invest in mentorship support for member GPs, practice nurses and practice managers. The CCG has dedicated GP and practice nurse mentors within the membership and primary care team, and have developed a practice manager buddying scheme that will be introduced in 2016-17.

6.8

Worked with the practice managers group to develop and implement an annual training programme that has provided annual updates for practice managers, nurses and HCAs. Topics have included CPR, safeguarding, infection control, information governance and employment law. 12 | P a g e

6.9

The practice nurse mentors have developed a practice nurse area of the intranet to support practice nurse revalidation.

7.0

Primary Care Engagement The CCG as directed by the Committee has:

7.1

Visited every GP principle in Dudley to discuss and understand the challenges faced by practices including o Workforce challenges – planned retirements o Workload challenges - sustainability o Income – personal and practice o Change appetite – level of interest in co-operation, federation or merger

7.2

Continued the annual programme of GP Engagement visits that have informed the way in which services are commissioned by the CCG on behalf of member practices

7.3

Developed the commissioning intentions for primary care, and the value proposition submitted to the new models of care team within NHS England for additional resources to support primary care development in the implementation of the Dudley MCP as a result of the significant engagement undertaken with member practices

7.4

Hosted several events for its members to discuss the future of primary care, and have had guest speakers including Dr Robert Varnam Head of General Practice Development at NHS England.

7.5

Continued to meet with the GP membership on a monthly basis through our locality meetings, and bimonthly with the wider membership. Achieved excellent levels of engagement – Dr Robert Varnam Head of General Practice Development at NHS England commented that he had not seen the level of GP engagement anywhere else in England.

7.6

Engaged with practice managers and the Dudley Practice Management Alliance to discuss the required steps to ensure compliance with the accessible information standard.

8.0

Primary Care Performance The CCG as directed by the Committee has:

8.1

Developed the Primary Care Analysis Tool (PCAT) to report performance to the Committee. The metrics were developed with GP input and will be developed further in the light of new assurance frameworks for NHS England and the Quality Premium.

8.2

The performance of Primary Care in Dudley is set out in the table below – the Committee has been assured over the course of 2015 regarding the high performance and quality of primary care in Dudley. In those cases where there are exceptions, these are reported, and the CCG has effective systems and processes in place to address performance issues through the activities of the membership engagement team.

8.3

Table: Summary of performance ratings reported to the Committee in 2015-16

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Performance Area

RAG Rating

Comment

Care Quality Commission

Green

CQC Ratings across 5 domains are scored 1 to 4 corresponding to ‘Inadequate’ to ‘Outstanding’. Individual Practice ratings are then aggregated to Locality and CCG averages. Averages of 1.4 and below are rated Red, 1.5 to 2.5 is amber and 2.6 and above is Green.

Quality and Outcomes Framework

Green

QOF achievement percentages at Practice level across Clinical, Public Health and Total achievement are plotted against national percentile achievements. Individual Practice ratings are then aggregated to Locality and CCG averages. Lower quartile performance is rated Red, below median is rated Amber and above the median is rated Green.

NHS Choices

Green

NHS Choices achievement is converted into a percentile achievement for each practice. Individual Practice ratings are then aggregated to Locality and CCG averages. Lower quartile performance is rated Red, below median is rated Amber and above the median is rated Green.

Friends and Family

Green

NHS Friends and Family achievement is converted into a percentile achievement for each practice. Individual Practice ratings are then aggregated to Locality and CCG averages. Lower quartile performance is rated Red, below median is rated Amber and above the median is rated Green.

GP Survey Results

Green

GP Survey results for each Practice are converted into a national percentile achievement. Individual Practice ratings are then aggregated to Locality and CCG averages. Lower quartile performance is rated Red, below median is rated Amber and above the median is rated Green. Note: Any outlier practice is reported for any of the metrics above.

8.4

The developing Multispecialty Community Provider (MCP) model for Dudley will also raise further monitoring and evaluation metrics that would merit inclusion in the PCAT. Further developments to PCAT in the first quarter of 2016/17 will be an updated version of the visualisation interface, data staging and automated updates. The number of user licenses will also be extended to 55. This will enable piloting remote use of the tool from GP Practices. 14 | P a g e

9.0

Primary Care Quality The CCG as directed by the Committee has:

9.1

Played a key role in ensuring that not only have there been no gaps in the quality assurance processes following the handover from NHS England, but that there is a continuous focus on quality improvement support for primary care through the activities of the quality and safety team.

9.2

Expanded the Quality & Safety team, including a Quality Assurance Manager dedicated to supporting Primary Care.

9.3

Maintained and further developed strong links with the NHS England Complaints department and ensured regular involvement in weekly Professional Performance Information Gathering Group (PPIG) meetings in order to ensure any potential poor performance issues are discussed and addressed.

9.4

Identified a small number of Serious Incidents (SIs) that have occurred within primary care and have supported practices to ensure that the root causes have been appropriately identified and that there is suitable learning and actions being taken to minimise the risk of reoccurrence. From this, we have also identified an opportunity to provide Root Cause Analysis (RCA) training for practices to help ensure highquality RCA investigations are carried out for all relevant incidents.

9.5

Provided on-going support to practices undergoing CQC inspections through helping to share best practice and learning from all inspections, as well as more intensive support to the small number of practices rated as inadequate. Where concerns have been raised by CQC we have put in place a robust system for assurance and support, working closely with NHS England, to ensure all appropriate actions are being taken to address the issues raised.

9.6

For the period 1st April 2015 to 23rd March 2016 the CQC have published reports for 27 practices in Dudley. This represents 59% of all the practices in Dudley. A summary of the findings from the reports are published in the tables below.

9.7

Summary of the CQC inspection results for Dudley CCG compared to National ratings

Dudley

National

0.00%

4.1%

85.2%

79.5%

7.4%

11.9%

7.4%

4.5%

Key Good Requires Improvement Inadequate Outstanding

15 | P a g e

9.8

In comparison to the National averages (provided by the CQC) Dudley has o A lower proportion of practices with an overall rating of outstanding o A higher proportion of practices with an overall rating of good o A lower proportion of practices with an overall rating of requiring improvement o A higher proportion of practices with an overall rating of inadequate

9.9

Table: CQC ratings for Dudley practices as at 23rd March 2016

Netherton Health Centre

13/01/2015

11/06/2015

Central Clinic

14/01/2015

27/08/2015

Lion Health

14/01/2015

31/03/2015

Chapel Street

20/01/2015

11/06/2015

Bilston Street Surgery - follow up

27/01/2015

16/07/2015

St James Medical Practice

27/01/2015

16/04/2015

Meadowbrook Surgery

28/01/2015

27/08/2015

Alexandra Medical Practice

05/05/2015

06/08/2015

Bean Road Surgery

07/07/2015

03/09/2015

Castle Meadows Surgery

21/07/2015

01/10/2015

Norton Medical Practice

04/08/2015

08/10/2015

Crestfield Surgery

18/08/2015

15/10/2015

High Oak Surgery

01/09/2015

29/10/2015

Summerhill Surgery

30/09/2015

03/12/2015

Thorns Road Surgery

14/10/2015

17/12/2015

Pedmore Road Surgery

22/10/2015

14/01/2016

Steppingstones Surgery

28/10/2015

17/12/15.

Rangeways Road Surgery

12/11/2015

07/01/15.

24/11/2015 & 26/11/2015

28/01/2016

Woodsetton Medical Practice

08/12/2015

04/02/2016

Bilston Street Surgery - follow up

09/12/2015

14/03/2016

Lapal Medical Centre

15/12/2015

11/02/2016

The Waterfront Surgery

17/12/2015

03/03/2016

The Limes Medical Centre

13/01/2016

11/02/2016

Moss Grove Surgery

19/01/2016

10/03/2016

Central Clinic follow up inspection

02/02/2016

03/03/2016

Bath Street Surgery

Well Led

11/06/2015

Responsive

06/01/2015

Caring

Keelinge House

Effective

Report Published

Safe

Visit Date

Practice Name

Overall rating

16 | P a g e

9.10

Developed and provided practical support packages to those practices rated as inadequate by the CQC. Operated in accordance with the NHS England “Framework for responding to CQC inspections of GP practices”. Specifically, members of the CCG from the quality and safety team and primary care team visit the practice with members from the contracting team of NHS England to undertake a contract review visit, and agree and provide the practice with a support package including sessions from the CCG GP and practice nurse mentors, and practice manager ‘buddies’ to assist the practice producing and implementing an action plan in preparation for CQC re-inspection.

9.11

Responded to a GP being physically assaulted by enabling a table-top discussion with a wide range of key stakeholders from across the region, which has identified a number of opportunities for improvement which the CCG are leading on and actively contributing resources to. This includes the development of a new clinical service for some of those more challenging patients outside the traditional general practice environment, and the provision of more comprehensive conflict resolution training.

9.12

Continued to identify improvements to the primary care quality management & assurance processes. This includes the development of a more comprehensive quality assurance framework, and the implementation of a dedicated nhs.net account for raising patient safety concerns regarding other providers.

9.13

Purchased the Datix incident management system and are currently working on making it available for practices to use to support their own internal clinical governance processes and to help enable wider learning between our practices

10.0

Finance

10.1

As the table below shows, Committee has successfully achieved its financial targets, remaining within the resource limit delegated to it by the CCG Board. The position in respect of Primary Care CoCommissioning is expected to break even, with small underspends against recurrent core CCG budgets and a larger underspend against the Primary Care Investment funds delegated to Committee in November.

Area Primary Care Co-Commissioning Primary Care Training Nurse Mentors and EVTS Practice Engagement LIS Primary Care Investments Total

10.2

Annual Budget £000's

Forecast Variance £000's

38,125

-

70

-

185

(28)

591

(47)

1,000

(224)

39,971

(299)

The underspend against the Primary Care Investments budget reflects the difficulties inherent In accurately forecasting expenditure against activity based schemes and taking corrective action late in the financial year. However, a key lesson learned for future years is the desirability of identifying additional value-for-money investments that can be made at short notice as underspends appear.

17 | P a g e

10.3

Value for Money An assessment has been made of the cost of the operation and administration of the Committee throughout the year. This is based upon the attendance of Committee members. The cost is calculated based on the average hourly cost of each individual at an estimated 2 hours per Committee. The notional cost for 2015/16 is £7,956 and based upon the outcomes achieved by the Committee as described above, this has been viewed as an effective use of public funds.

11.0

PATIENT AND PUBLIC ENGAGEMENT

11.1

The communications and engagement team have worked in support of the delegated commissioning of primary medical services in the following ways The CCG as directed by the Committee has:

11.2

New Contractual Framework o

Used patient feedback to inform the development of the outcome measures proposed in the new contractual framework;

o

Hosted workshops for people with long term conditions in Dudley to understand how those patients would like to access and receive care for the management of their condition from primary care

o

Hosted workshops with the carers forum to discuss the development of the outcome measures and understand what person centred care looks like from a carers perspective

11.3 o

Primary Care Contracting Supported three public consultations in relation to a the closure of St Thomas practice, and branch surgery closure applications from Market Street (branch of Wordsley Green) and Masefield Road (branch of Lower Gornal Medical Practice).

o

Ensured the practices fulfilled their statutory duties in undertaking full public consultation over a period of 12 weeks – in this time the ensuring that the following engagement and feedback was sought from o Patient participation groups o Community forums o Local councillors o MPs o Health Overview and Scrutiny Committee o Local Media

o

Provided assurance to the public and the Committee that all statutory duties were met when considering the practice applications 18 | P a g e

o

Organised and promoted a full public meeting of the Committee in Gornal to consider the branch surgery closure application – attracting 35 members of the public. The practice has listened and responded to the way in which they will be delivering services as a result.

Patient Experience o

Continued to develop and support all 46 member practice patient participation groups (PPG) – enabled each PPG access to £1000 development funding

o

Provided support and guidance to practice PPGs in making best use of funding for example

o Hosting a tea party as done by Three Villages Medical Practice to help encourage people who feel isolated to venture out and meet new people or join the PPG or give a view on a hot topic. o Hosting awareness and information days as done by Wychbury PPG to connect with local patients and communities and share information on different conditions from falls to diabetes to keeping warm in winter. Wychbury PPG has held 2 very successful health awareness events with their practice and other partners. They have hosted a prostate cancer session and a dementia awareness session which have both attracted a good turnout. The prostate cancer session offered PSA testing with clinicians on hand to provide results. o

Developed a patient experience report reported to the Committee on a quarterly basis. The report has informed the development of the outcome measures in the new contractual framework and enables the communications and engagement team, working with the primary care team, to identify and work with practices to improve the collection and reporting of friends and family test comments in General Practice

Dudley Enhanced Primary Care Development Programme o

Supported and developed the participation and involvement of PPGs in the development and implementation of the programme commissioned by the CCG

o

The culmination of the organisational development and change programme in primary care resulted in members of the PPG presenting the outcomes achieved at a celebration event for all of the practices that had successfully completed the programme

Future of Primary Care o

Hosted workshops within the Dudley Borough Healthcare Forum on the Future of Primary Care

o

Organised sessions with the patient opportunity panel where members of the Committee have presented and discussed the challenges facing primary care

o

Organised the listening exercise – a consultation with 50+ groups across Dudley on the new model of care in Dudley supported by members of the Committee discussing the challenges and solutions for Primary Care

Local Media o

Promoted the work of the Committee to the local press and media

o

Coached and prepared practices for dealing and responding to the media specifically supporting practices with press enquiries, responses and statements most recently in response to Care Quality Commission reports – reactive to the two inadequate reports, and proactive with one practice achieving an outstanding rating. 19 | P a g e

11.0

ATTENDANCE AND QUORACY

11.1

The Committee has met monthly, and in public since June 2015, between 1st April 2015 and 31st March 2016.

11.2

A meeting of the Committee is quorate provided that at least 4 members are present of which: • One must be either the Chair or Vice-Chair of the Committee • One must be the Chief Finance Officer or Chief Nursing Officer

11.3

A register of attendance is set out below. The Committee has been quorate for each meeting that has taken place between 1st April 2015 and 31st March 2016.

Title Members La y Member for Governa nce (Cha i r) Chi ef Nurs e Seconda ry Ca re Cl i ni ci a n Chi ef Fi na nce Offi cer Publ i c Hea l th Repres enta ti ve La y Member for Qua l i ty & Sa fety In Attendance Hea l thwa tch Dudl ey Pa ti ent Opportuni ty Pa nel Member LMC Repres enta ti ve HWBB Repres enta ti ve NHS Engl a nd Repres enta ti ve Quora te

Voting/Non Voting

17/04/2015 22/05/2015 19/06/2015 17/07/2015 21/08/2015 18/09/2015 16/10/2015 20/11/2015 18/12/2015 22/01/2016 19/02/2016 18/03/2016 Attendance

Percentage

Voti ng Voti ng Voti ng Voti ng Voti ng Voti ng

1 1 1 1 1 0

1 1 1 1 1 1

1 1 1 1 1 0

1 1 1 1 1 1

1 0 1 0 1 1

1 1 1 1 0 0

1 1 1 1 0 0

1 1 1 0 1 0

1 1 1 0 1 1

1 1 0 1 0 1

1 1 1 1 1 1

1 1 1 1 1 0

12 11 11 9 9 6

100% 92% 92% 75% 75% 50%

In In In In In

1 1 1 0

1 1 1 1

1 1 1 0

1 1 1 0

1 1 1 0

1 1 1 1

1 1 1 1

YES

YES

YES

YES

YES

1 1 1 0 1 YES

1 1 1 0 1 YES

1 1 0 0 0 YES

92% 100% 92% 25% 33%

YES

1 1 1 0 1 YES

11 12 11 3 4

YES

0 1 1 0 1 YES

a ttenda nce a ttenda nce a ttenda nce a ttenda nce a ttenda nce

12.0

DECISION REGISTER

12.1

In line with statutory guidance, the Committee as a corporate decision making body keeps a register of procurement decisions. The following key procurement decisions have been made by the Committee between 1st April 2015 and 31st March 2016 o

A procurement of a six month contract for the provision of an ‘out of area registrations’ in hours urgent primary care (including home visits) enhanced service.

o

A procurement of a twelve month contract for the provision of excluded patients (violent and aggressive patients) service

13.0

SUMMARY

13.1

The Primary Care Commissioning Committee considered and approved the Annual Report at its meeting on 15th April 2016.

20 | P a g e

GLOSSARY ABBREVIATIONS

Abbreviation

Meaning

#NOF

Fractured Neck of Femur

£K

£1,000 equivalent

A&E

Accident and Emergency

ABC / ABCD

Above and Beyond the Call of Duty (Local surveys which include praise for nominated staff members as well as assessment of services)

ACS

Acute Coronary Syndrome

AD

Assistant Director

AfC

Agenda for Change

AGM

Annual General Meeting

AHSN

Academic Health Science Networks

ALE

Auditors Local Evaluation

ALOS

Average Length of Stay (in hospital)

AMI

Acute Myocardial Infarction

AMMC

Area Medicines Management Committee

Anti-D

An antibody occurring in pregnancy

Anti-TNF

Drugs used in the treatment of rheumatoid arthritis and Crohn’s disease

ARIF

Aggressive Research Intelligence Facility

ASAP

As soon as possible

AVE

Advertising Value equivalent

BACs

Bank Automated Credit

BAF

Board Assurance Framework

BCC

Black Country Cluster

BCF

Better Care Fund

BCPFT

Black Country Partnership NHS Foundation Trust

BCUCG

Black Country Urgent Care Group

BFT

Behavioural Family Therapy

BMA

British Medical Association

BME

Black Minority Ethnic

BMJ

British Medical Journal

BPAS

British Pregnancy Advisory Board

BSCCP

British Society of Colposcopy and Cervical Pathology

1

CAB

Citizens Advise Bureau

CAO

Chief Accountable Officer

CAMHS

Children and Adolescent Mental Health Service

CASH

Contraception and Sexual Health

CCBT (CBT)

Computerised Cognitive Behavioural Therapy

CCG

Clinical Commissioning Group

CCRN

Comprehensive Clinical Research Networks

CDC

Clinical Development Committee

CDiff

Clostridium difficile

CEO

Chief Executive Officer

CFO

Chief Finance Officer

CHADD

The Churches Housing Association of Dudley & District Ltd

CHC

Continuing Healthcare

CHD

Coronary Heart Disease

CIS

Community Investment Strategy

CLT

Collaborative Leadership Team

CMO

Chief Medical Officer

CNST

Clinical Negligence Scheme for Trusts

CNT

Community Nursing Team

COSHH

Control of Substances Hazardous to Health Regulations 2002

CPA

Care Programme Approach

CPN

Community Psychiatric Nurse

CRL

Capital Resource Limit

CRRT

Community Rapid Response Team

CSU

Commissioning Support Unit

CT scan

Computer Topography

CQC

Clinical Quality Commission

CQNO

Chief Quality and Nursing Officer

CQUIN

Commissioning for Quality and Innovation

CQRM

Clinical Quality Review Meeting

CSG

Clinical Strategic Group

CVD

Cardio Vascular Disease

D&N

Dudley and Netherton (Locality)

DACHS

Directorate of Adult Children and Housing Services

DCS

Dudley Community Services

DCVS

Dudley Community Voluntary Service

DES

Directed Enhanced Service

DfES

Department for Education and Skills

DGFT

Dudley Group Foundation Trust

DMO

Designated Medical Officer

2

DNA

Did not attend

DoH

Department of Health

DoLS

Deprivation of Liberty Safeguards

DoS

Directory of Service

DPMA

Dudley Practice Managers Alliance

DSCB

Dudley Safeguarding Children’s Board

DTC

Diagnostic and Treatment Centre

DWMHPT

Dudley and Walsall Mental Health Partnership Trust

DXA

Dual X-ray Absorptiometry (measures bone density).

E&D

Equality and Diversity

EAU

Emergency Assessment Unit

ECA

Extra Care Area

ECM

Every Child Matters

ECT

Electroconvulsive Therapy

ED

Emergency Department

EI

Early Implementer

EI

Early Intervention

EMI

Elderly Mentally Ill

EMIS

Education Management Information System

EoL

End of Life

EPP

Expert Patients Programme

EPR

Electronic Patient Record

ERMA

Emergency Response & Management Arrangements

ERT

Enzyme Replacement Therapy

ESR

Electronic Staff Record

FCEs

Finished Consultant Episodes

FED

Forum for Education and Development

FFT

Friends and Family Test

FHS

Family Health Services

FMC

Facility Management Centre

FOI

Freedom of Information

FYE

Full Year Effect

FYFV

Five Year Forward View

GGI

Good Governance Institute

GMS

General Medical Services

GOWM

Government Office for the West Midlands

GP

General Practitioner

GPAQ

General Practice Assessment of Quality

GPwSI

GP with Special Interest

GU

Genito-urinary

3

GUM

Genito-urinary Medicine

H&QB

Halesowen and Quarry Bank (Locality)

HCAI

Healthcare Associated Infections

HCF

Healthcare Forum

HEE

Health Education England

HENIG

Health Economy NICE Implementation Group

HF

Heart Failure

HIC

Health Improvement Centre

HIV

Human Immunodeficiency Virus

HPA

Health Protection Agency

HPS/S

Health Promoting Schools / Service

HPU

Health Protection Unit

HR

Human Resources

HSC

Health and Safety Commission

HSCQC

Health and Social Care Quality Centre

HSE

Health and Safety Executive

HSMC

Health Services Management Centre

HT

Home Treatment

HV

Health Visitor

HWBB

Health and Well-being Board

IAPT

Improved Access to Psychological Therapies

IC

Infection Control

ICAS

Independent Complaints Advocacy Service

ICE

Integrated Commissioning Executive

ICNA

Infection Control Nurses Association

ICP

Integrated Care Pathway

IFR

Individual Funding Request

IG

Information Governance

IOSH

Institute of Occupational Safety and Health

IT

Information Technology

IUCD

Intrauterine Contraceptive Device

JCAB

Joint Clinical Advisory Board

JCC

Joint Consultative Committee

JD

Job Description

JSA

Joint Strategic Assessment

KAB

Kingswinford, Amblecote and Brierley Hill (Locality)

KLOE

Key lines of enquiry

KPI

Key Performance Indicators

LAA

Local Area Agreement

LAC

Looked After Children

4

LAT

Local Area Team

LD

Learning Disability

LDP

Local Delivery Plan

LEA

Local Education Authority

LIFT

Local Improvement Finance Trust

LIG

Local Implementation Group

LIT

Local Implementation Team

LMC

Local Medical Committee

LNG

Local Negotiating Committee

LPS

Local Pharmaceutical Scheme

LRF

Local Resilience Forum

LTC

Long Term Conditions

LVD

Left Ventricular Dysfunction

LVSD

Left Ventricular Systolic Dysfunction

MAPA

Management of Actual and Potential Aggression

MAU

Medical Assessment Unit

MBC

Metropolitan Borough Council

MCP

Multi-speciality Community Provider

MDT

Multi Disciplinary Team

MIMT

Major Incident Management Team

MIRE

Major Incident Response Executive

MLSOs

Medical Laboratory Scientific Officers

MRSA

Methicillin Resistant Staphylococcus Aureus

MSS

Medium Secure Service

NCA

Non contract activity

NCB

National Commissioning Board

NCM

New Care Model

NCRS

National Care Record System

NELHI

National Electronic Library for Health Information

NFI

National Fraud Initiative

NICE

National Institute for Clinical Excellence

NGMS

New General Medical Services

NHS

National Health Service

NHSCPT

NHS Community Practice Teacher

NHSCSP

NHS Cancer Screening Programme

NHSE

NHS England

NHSLA

NHS Litigation Authority

NHSP

National Healthy Schools Programme

NICE

National Institute for Clinical Excellence

NMC

New Model of Care/Nursing and Midwifery Council

5

NOF

New Opportunities Fund

NPfIT

National Programme for IT

NPSA

National Patient Safety Agency

NRF

Neighbourhood Renewal Fund

NRLS

National Reporting and Learning System

NSF

National Service Framework

OAT

Out of Area Treatment

OBD

Occupied Bed Day

OD

Organisational Development

ODM

Oesophageal Doppler Monitoring

OOH

Out of Hours

OPH

Office of Public Health

OSC

Overview and Scrutiny Committee

OT

Occupational Therapist

PACS

Primary and Acute Care Systems

PALS

Patient Advice and Liaison Service

PAF

Positive Assurance Framework

PAS

Patient Administration System

PAU

Paediatric Assessment Unit

PbR

Payment by Results

PC

Personal Computer

PCCC

Primary Care Commissioning Committee

PCOG

Primary Care Operational Group

PDF

Portable Document Format

PDR

Personal Development Review

PDS

Personal Dental Services

PDSA

Plan, Do, Study, Act

PDU

Professional Development Unit

PE

Pulmonary Embolism

PEAK

Database holding the main registered details of patients and associated referral, contact, caseload, outpatient, inpatient, MH Act and clinic information.

PEAT

Patient Environment Action Team

PEPP

Pooled Budget External Placement Panel

PFI

Private Finance Initiative

PGD

Patient Group Directives

PHE

Public Health England

PICU

Psychiatric Intensive Care Unit

PID

Project Initiation Document

PIN

Personal Identification Number

PMLD

Profound and Multiple Learning Difficulties

6

PMS

Primary Medical Services

POPs

Patient Opportunity Panels

PPA

Prescription Pricing Authority

PPG

Patient Participation Group

PSA

Public Service Agreement

PSHE

Personal and Social Health Education

PSIAMS

Personal Social Impact Action Measurement System

PTCA

Percutaneous Transluminary Coronary Angioplasty

Q&A

Questions and Answers

Q&S

Quality & Safety

QA

Quality Assurance

QIPP

Quality, Innovation, Productivity and Prevention

QMAS

Quality Management and Analysis System

QOF

Quality and Outcome Framework

QPDT

Quality and Practice Development Teams

RACPC

Rapid Access Chest Pain Clinic

RAS

Respiratory Assessment Service

RCA

Root Cause Analysis

RCGP

Royal College of General Practitioners

RES

Race Equality Scheme

RHH

Russells Hall Hospital

RIDDOR

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations

RMO

Responsible Medical Officer

RRL

Revenue Resource Limit

RTT

Referral to Treatment

SAP

Single Assessment Process

SCG

Sedgley, Coseley and Gornal (Locality)

SCIE

Social Care Institute for Excellence

SCR

Serious Case Review

SEPIA

Mental health computer system

SFBH

Standards for Better Health

SFI

Standing Financial Instructions

SIC

Statement of Internal Control

SLA

Service Level Agreement

SPA

Single Point of Access

SRE

Sex and Relationship Education

SRG

System Resilience Group

SSD

Social Services Department

SSDP

Strategic Services Development Plan

STI

Sexually Transmitted Disease

7

STRW

Support, Time & Recovery Worker

SWL

Stourbridge, Wollescote and Lye (Locality)

SWOT

Strength, Weakness, Opportunity and Threat

TB

Tuberculosis

TIA

Transient Ischaemic Attack

TP

Teenage Pregnancy

TPT

Teenage Pregnancy Team

TTO

To Take Out

UCC

Urgent Care Centre

UHBT

University Hospital Birmingham Trust

Vaccs & Imms

Vaccinations and Immunisations

WAN

Wide Area Network

WCC

World Class Commissioning

WIC

Walk in Centre

WMAS

West Midlands Ambulance Service

WMHTAC

West Midlands Health Technology Advisory Committee

WMSCG

West Midlands Strategic Commissioning Group

WMSSA

West Midlands Specialised Services Agency

WTE

Whole Time Equivalent

YHC

Young Health Champion

8