dudley clinical commissioning group board - Dudley CCG

DUDLEY CLINICAL COMMISSIONING GROUP BOARD AGENDA Thursday 10 March 2016 1.00pm – 4.00pm Boardroom, 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 7 January 2016

Enclosed

Dr D Hegarty

1pm

4.

Matters Outstanding

Enclosed

Dr D Hegarty

5.

Public Voice

1.05pm

5.1

Verbal

Mrs J Jasper

1.10pm 1.20pm

5.2 5.3

Questions from the Public 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: Public Activation Public Update

Presentation Enclosed

Dr D Hegarty Mrs L Broster

1.30pm

6.

Chairman & Chief Executive Officer Report

Verbal

Mr P Maubach

7.

Strategy

1.40pm 1.50pm 2.00pm 2.10pm

7.1 7.2 7.3 7.4 8.

Communications & Engagement Strategy Corporate Objectives 2015/16 Update CCG Draft Operational Plan 2016/17 Partnership Board Report Quality & Safety

Enclosed Enclosed Enclosed Enclosed

Mrs L Broster Mr M Hartland Mr N Bucktin Mrs S Cartwright

2.20pm

8.1 9.

Report from Quality and Safety Committee Governance

Enclosed

Mrs C Brunt

2.30pm 2.40pm 2.50pm 3.00pm

9.1 9.2 9.3 9.4

Report from Audit Committee Combined Board Assurance Framework and Risk Register Auditor Panel Report from Remuneration Committee

Enclosed Enclosed Enclosed Enclosed

Mrs J Jasper Mrs J Jasper Mrs J Jasper Mrs S Cartwright

Enclosed

Mr M Hartland

BREAK 10. 3.15pm

Finance and Performance

10.1 Report from Finance & Performance Committee

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Time

Agenda Item 11.

Attachment

Presented By

Acute & Community Commissioning

3.25pm 3.35pm

11.1 Report from Clinical Development Committee 11.2 Integrated Commissioning Executive Report 12. Primary Care Commissioning

Enclosed Enclosed

Dr S Mann Mr N Bucktin

3.45pm

12.1 Report from Primary Care Commissioning Committee

Enclosed

Mr D King

3.55pm

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 31 March (Extra-ordinary Board) 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 7 JANUARY 2016 AT 1.00 PM, STOURBRIDGE 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 Clinical Executive & 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 – Dudley CCG

Non-Voting Members Mrs L Broster Mr N Bucktin Mrs S Cartwright Ms J Emery Ms D Harkins Dr T Horsburgh Mr D King

Head of Communications and Public Insight – Dudley CCG Head of Commissioning – Dudley CCG Head of Organisational Development and Human Resources – Dudley CCG Chief Executive – Healthwatch Chief Officer of Health & Wellbeing (Director of Public Health) – Dudley MBC LMC Representative – Dudley LMC Head of Membership Development & Primary Care – Dudley CCG

In Attendance: Mrs H Codd Dr J Greenway Miss K Hodgson Ms S Johnson Dr D Pitches Mrs T Downton CCG001/2016

Community Engagement Manager – Dudley CCG Public Health Trainee – Dudley MBC Engagement Co-ordinator – Dudley CCG Deputy Chief Finance Officer – Dudley CCG Consultant in Public Health, Dudley MBC Minute Taker – Dudley CCG APOLOGIES

Apologies were received from: Dr J Darby Dr R Gee Mr T Oakman

Clinical Executive & GP Board Member – Dudley CCG GP Engagement Lead – Dudley CCG Strategic Director, People – Dudley MBC

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CCG002/2016

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. Mrs Jasper declared her standing interest as Chair of the Audit Committee, Sandwell and West Birmingham CCG. CCG003/2016

MINUTES FROM BOARD HELD ON 12 NOVEMBER 2015

The minutes of the meeting held on 12 November 2015 were accepted as a true and accurate record with the following amendments: Page 1 – Delete ‘Vice Chair’ from Dr Tapparo’s title Page 3 – Me Festival – change ‘formative’ to ‘informative’ event Resolved: 1) The Board accepted the minutes from the 12 November 2015 as a true and accurate record subject to the aforementioned amendments being made CCG004/20156

MATTERS OUTSTANDING

CCG121/2015 – Report from Chief Nurse Mr King advised that Practice Nurse Education was discussed at the Primary Care Operational Group and a Nursing Forum had been established which was in the process of developing a training and education programme for clinical and non-clinical staff for the new Long Term Conditions Framework in conjunction with Dr Willetts. CCG122/2015 – Report from Audit Committee Dr Mann advised that a new risk would be considered at the next Clinical Development Committee which related to the community domiciliary phlebotomy services. CCG129/2015 – Report from Health and Wellbeing Board Mr Bucktin advised that the governance and voting of the Health and Wellbeing Board had been discussed at its Development Group which both himself and Ms Harkins were members of. The Development Group considered the revised Terms of Reference for the Health and Wellbeing Board with a proposal for further consideration in the Local Authority for 1 member, 1 vote. PUBLIC VOICE CCG005/2016

QUESTIONS FROM THE PUBLIC

Mrs Jasper reported that three questions had been received from the public in advance of the Board. The first question was received by a member of the Castle Meadows PPG and asked ‘Is it possible to ask the Board how many DNR’s have been made in the last six months, whether a register of the subjects of such orders is kept and who should be notified when the orders are made? Dr Hegarty responded by saying the concept of DNR (Do Not Resuscitate) is an agreement on a number of basic presumptions between the patient and their GP. The CCG does not hold a register of DNR documentation as it is not legally entitled to have access to patient medical records. Dr Horsburgh added that the CCG supports an effective process of discussion with patients on how the decision is made and the CCG’s role is to ensure the clinician is taking the right course of action. This response would be relayed back to the Castle Meadows PPG. The second question was received by a member of The Ridgeway Surgery PPG and asked ‘Can we pursue this business of a dementia café in Sedgley. We discovered that there is a dementia suite in 2|Page

Ladies Walk Clinic standing empty – ideally suited for sessions. There is a lounge, kitchen and a ‘sensory’ room as well. Easy to get to, facilities for parking – community transport etc. and it really should be used. I know the building is ‘owned’ by someone not the CCG or NHS, but that should not complicate matters. I have been meaning to get on this case for ages and surely something can be done. I know from other sources that it is needed in the North of the Borough’. Mr Bucktin responded by saying the facility being referred to was the space previously occupied by Dudley and Walsall Mental Health Partnership Trust (DWMHPT) where an Older Adult Day Service was provided. As part of an estate rationalisation, the Trust had brought the two existing Older Adult Day Service provision together at Bushey Fields Hospital hence why the space was vacant. Further discussions would take place with DWMHPT to look at the potential for reusing the space however it was noted that a Dementia Gateway was serving the north of the Borough in Coseley. This response would be relayed back to The Ridgeway Surgery PPG. The third question was in two parts and had been raised by John Payne via the CCG Contact Inbox and referred to an article by Peter Roderick. The first part of the question asked ‘Can you explain the distinction between Commissioner Requested Services and other services?’ Mr Bucktin advised that Commissioner Requested Services are those identified by Commissioners, provided by a Foundation Trust, which would need to remain in a locality should a provider fail because there is no close alternative service. Removing them would increase health inequalities and make dependent services less viable. The second part of the question asked ‘The period of designation of services ends in April and Monitor has said that it expects “the number of services designated as CRS to decrease as a result”. What will be the consequences of this in Dudley?’ Mr Bucktin responded by saying in designing services from 1 April 2016, the CCG would wish to ensure that the three criteria identified for Commissioner Requested Services are still met to ensure there is no diminution of service for Dudley patients. Resolved: 1) The Board received questions from the Public Dr Gupta entered the meeting

CCG006/2016

FEET ON THE STREET: #ME FESTIVAL

Miss Hodgson spoke to this item and a presentation was made to Board members. The aim of the Festival was to work collaboratively with partners to provide a fun and interactive day for year 8 students within a safe environment. All Dudley schools were invited to attend to encourage better health and wellbeing for younger people and to increase their confidence. The Festival took place at Himley Hall where different agencies attended offering interactive activities, along with a number of interactive workshops, which included FastAid Black Country, Urban Strides, Kick Ash Dudley, Ucreate, What’s Up Doc, Loudmouth, Lets Get Active Tent, VIP Tent. Attendance at the Festival was well attended with over 120 students and 19 teaching staff from 11 schools and feedback received from students, teachers and facilitators was extremely positive. Moving forward, Miss Hodgson reported that a debrief meeting with partners would take place to evaluate whether it would be worthwhile holding the Festival again next year or if something different would be more beneficial. The meeting would also discuss the funding aspect. Miss Hodgson invited members for feedback on the presentation and any personal thoughts from those members who had attended on the day. Mrs Broster advised that the videos from the workshops would be shared through social media and the exercise to create a radio advertisement had been an enjoyable experience for students and helped them to work through some of the key messages from the Festival.

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Mrs Jasper asked whether students who had attended the Festival in 2014 had been involved in the Task and Finish Group. Miss Hodgson advised that feedback from 2014 had been fed into the group but the suggestion to involve students to plan for next year’s event would be considered. There was some disappointment shared that not all schools were able to attend but it was reported that this was due to staffing or transport issues. Dr Hegarty asked members what benefit they thought had been achieved by the Festival, whether it would be worth investing in it going forward, and the potential for the future. He suggested that next year the event should have a focus around childhood obesity and a joined up approach be agreed with different agencies to take this forward. Dr Horsburgh thought the festival had given the opportunity for young people to be involved in the commissioning process and he was encouraged by how interactive and positive the students were. In addition, some consideration should be given, moving forward, on how that interest could be used through the young health champions. Mrs Broster reported that time had been spent at Holly Hall School talking to students about health and careers. The feedback received from the Young Health Researchers indicated that the students that were best able to answer questions were those from Holly Hall which was reassuring. Ms Harkins informed the Board that a Children and Young People Alliance was being developed to identify key priorities for the quality of life for children and young people and suggested for next year those priorities are the ‘drive’ for the day. Ms Harkins requested that thanks were noted from Dudley MBC to the CCG for all the hard work that went into organising the Festival. Dr Hegarty summarised the discussion: • There was agreement that the event is extremely valuable and should continue; however it does come with a cost and there is a need to understand what the value is. • Consideration should be given as to how teachers and students could become more involved in the facilitation of such an event and to have a theme, such as childhood obesity. • One of the areas of feedback received from schools related to CPR and first aid as this is not provided at schools and whether that aspect can be provided through this event. • In addition, careers advice should also be available for students to understand opportunities available to them. • In planning for the next event, the spread of schools needs to be understood and how children from ethnic minorities are accessed and included. Dr Hegarty thanked Miss Hodgson for presenting to the Board and asked her to pass on the Board’s appreciation to the team. Resolved: 1) That the Board receive the presentation CCG007/2016

PUBLIC UPDATE

Mrs Broster spoke to this item and advised the Board on the following key areas: Antibiotic Awareness Work was being carried out in conjunction with Dr Shukla, GP and Minseh Parbat, Office of Public Health, to prepare for the next GP Education Event. The aim is to get as many GP champions as possible to attend. Listening Events A series of Listening Events were being planned with Healthwatch Dudley, which would commence on 25 January 2016. Community Forums to be held with partners will offer more formal consultations with members of the public on the new care models, what it means to them and what the future organisation model looks like.

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Quality Premium It was reported in July 2015 that there had been a decline of 0.2% in the rating of the overall experience at Dudley Group NHS Foundation Trust, resulting in a loss of £235,000 to Dudley CCG. However, NHS England had chosen to accept this small decline and it was announced that Dudley CCG will receive the quality premium. Ms Emery reported on the work being carried out by Healthwatch Dudley which included: Listening Events Healthwatch Dudley is working closely with Dudley CCG to plan for the community forum event on 25 January. Five focus groups in each locality were being organised during February and March with the intention of cascading into lesser heard voluntary organisations to gather thoughts. The information from the groups would be analysed and presented through the appropriate route and to a future Board meeting. Mental Health Services An event had been organised to capture patient experience, both good and bad, in relation to mental health services, which would feed into the CQC inspection which would take place on 1 February. Healthwatch Dudley would also meet with CQC inspectors and a report would be developed and shared following the visit. Dr Horsburgh acknowledged the youth health champion post and emphasised that the post should be a key member in the schools communication rolling programme. Mrs Jasper thanked Ms Emery and her team at Healthwatch for all the hard work that they do. Ms Emery acknowledged the support they get from their team of volunteers. Resolved: 1) The Board noted the report for assurance CHAIRMAN AND CHIEF EXECUTIVE OFFICER REPORT CCG008/2016

REPORT

Mr Maubach updated the Board on the following: Notices and Acknowledgements Dr Jaswant Rathore Regrettably, Dr Rathore had decided to step down from his role as GP Board Member for Sedgley, Coseley and Gornal Locality in order to devote his time to his practice. The Board passed on their sincere thanks for all the work he had done as a Board Member and Clinical Executive Member of the CCG. As a result, the CCG has two vacancies in the Sedgley, Coseley, Gornal Locality, and the CCG would be going out to advert to elect two new Board members. New Appointments Mrs Caroline Brunt was welcomed to her first meeting of the CCG Board in her new role as Chief Nursing and Quality Officer. Dudley Group NHS Foundation Trust had appointed a new Chair, Jenni Ord. Prior to restructuring the Clinical Executive roles, Dr Mann had agreed to take lead responsibility for the Multi-Specialty Community Provider (MCP) work. Recent and Upcoming Events Board Member Elections As previously reported, a process for elections would be held for the two vacant Board posts which would represent Sedgley, Coseley and Gornal Locality.

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Partnership Board Summit – 30 November 2015 All members of the Partnership Board had met to discuss progress on implementing the new care model. There was an agreement to complete the mapping process set out in the commissioning intentions, which described the full scope of the model and which services across the system need to be grouped together against shared outcome objectives. There was a recognition that each organisation would need to change and contribute to the benefit of the population and wider system, and there would need to be a change in the prioritisation and distribution of resources to match the priorities in the care model. There was not enough capacity in the system and therefore a request for additional project management and workforce development capacity would be included in the next value proposition to the new care models team. The first draft of the Value Proposition was submitted on 8 January with the final version due for completion by the end of January. The CCG would be notified by the end of the financial year whether the bid for approximately £10m had been successful. New Models of Care The involvement with the new care model team had been very productive and the CCG is taking a lead role in several national initiatives. In addition, the CCG is one of two organisations supporting the team on developing a new contract for a MCP and it was noted that recently, Dudley had agreed to participate in the governance work stream of the MCP programme. Dudley’s logic model is also being used as a national exemplar of good practice. 10 Downing Street Mr Maubach and Mrs Janet Beddows, Lead District Nurse, had visited 10 Downing Street to represent the work Dudley is doing and there was recognition of the positive steps being taken as a CCG and as a system. December Members Event The Members Event in December was to consider the Long Term Conditions Framework which was very positively received by members. The final proposal would be considered by the Primary Care Commissioning Committee at its next meeting. January Members Event Three Members meetings were being held in January. The Health Services Management Centre (HSMC) would be hosting a workshop on 13 January for practices to look at examples of how primary care is coming together elsewhere in the country. On the 15 January, a meeting would be held with the smaller practices to discuss how they could be supported to meet the proposed standards on access which are part of the Long Term Conditions Framework. On the 19 January, a further Members meeting would be held to share feedback with members on the information received from the individual practice visits and to discuss what this means in terms of preferred options for working together, with each other and the CCG. Visits to the CCG A number of organisations have requested a visit to Dudley CCG to find out about its work. The most interest is in how the MDTs have been established and how the CCG is enabling them to work better together. Future Proof Health Ltd A paper would be presented to the March Board in relation to Future Proof Health Ltd which sets out both the engagement to date and the CCG’s expectations about its potential role in the Dudley health and social care system. A due diligence process was being completed, hence why the paper was not available at the January Board. Winter Pressures It was noted that Dudley Group NHS Foundation Trust had been at Escalation Level 4 for several days however the preparation and planning for Christmas and New Year across agencies was put in place as much as possible and beds were made available to increase capacity. Since the New Year, the system pressures had increased and all agencies had been escalating work to stabilise the situation. It was noted that the system was still in a position where A&E performance targets were being met extremely well and there were no concerns in meeting the overall targets for the year. 6|Page

Board Development Session At the recent Board Development Session, members discussed progress to date as a CCG and looked at how the organisation could develop in future. There was recognition that the CCG had made significant progress however, there was also recognition that there was a need for very clear priorities to ensure the CCG functions effectively within its available resource. The development of the new model of care is central to what the CCG does and the heart of the model is primary care and associated community services. There was an agreement therefore that those services were the most critical to ensure ongoing sustainability of the healthcare system and it was essential that the CCG prioritise management time and resources in those areas. This would be addressed formally by the Board when next year’s corporate objectives were set. Dr Hegarty reiterated Mr Maubach’s thanks to Dr Rathore for his contribution to the CCG and for the population of Dudley. Dr Hegarty has written to Dr Rathore to this effect on behalf of the Board. A discussion took place with regards to the balance of primary and secondary care when establishing the scope of the MCP and that further work needs to take place to work out what the criteria for the model would be. Part of that discussion would be to get providers signed up to a vision of the MCP that all parties agree to however there was a recognition that there was a difference in organisations needing and having a willingness to change. It was felt important to find mutual areas between organisations to determine where changes can be made together, for example, nursing homes and End of Life/Palliative Care. Mr Maubach confirmed that the CCG were in the process of mapping every service within the system and this would be ready by the end of the financial year. In relation to recognition and willingness, it was noted that there had been willingness in some areas, MDTs for example, and the providers had changed the way they work however there is a resistance in some other areas. The point which made reference to mutual areas to work together was felt valid and it was noted that there was an opportunity to change the consensus within the system to take time working out what objectives we were trying to be achieve and how the contractual incentives could be changed, because until the incentives are changed, there would always be a resistance. Dr Hegarty spoke about winter pressures and hospital based performance and whether the Urgent Care Centre is working as expected and what the impact is. Dr Hegarty had been challenged at a meeting that the benefit from the Urgent Care Centre was limited and the performance improvement was from in-house changes at Dudley Group NHS FT. Mr Bucktin was asked to liaise with Mr Evans, Commissioning Manager for Urgent Care, to proceed with the evaluation of the Urgent Care Centre in order for the Board to understand the impact of the centre on performance and to understand where DGFT analysis is generating their perceived benefit. Dr Hegarty raised the point made regarding the areas of work that could be agreed upon across the economy which might achieve significant benefits. It was noted that at the last Primary and Secondary Care Clinical Forum a Surgical Consultant at Dudley Group NHS Foundation Trust had welcomed a future event and suggested the theme should be about care homes. It was agreed therefore to organise a quarterly themed event. Mr Wellings raised a point to the Board that approximately 12 months ago, the Board were presented with the DGFT Quality Report and were asked to provide comment at short notice. One of the comments made was that there was no recognition of partnership working within the document. Board members asked if a formal request could be made to the Trust to have early sight of this year’s Quality Report to enable the CCG to contribute and comment appropriately and to reflect on the credit they give to other organisations. Mrs Brunt agreed to take this action forward through the Quality and Safety Team. Resolved: 1) The Board noted the report for assurance 2) That a Primary and Secondary Care Clinical Forum be organised, focused on Care Homes 3) That DGFT be requested to send this year’s Quality Report to the CCG for early comment

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STRATEGY CCG009/2016

CORPORATE OBJECTIVES UPDATE

Mr Hartland spoke to this item and advised members that the CCG was achieving all of its corporate objectives which were set at the beginning of the year. Mr Hartland reported that one area not yet presented to Board was the revised Procurement Strategy. This was due to the work being undertaken on the National Contract and the European Procurement rules being changed in April. The intention was to reflect both and present a revised strategy to the Board in March. In addition, it was planned to present the revised corporate objectives for 2016/17 in March. It was noted that the Primary Care Business Plan action stated ‘removed’ and this understated the significant piece of work that had been done as part for the Primary Care Strategy. Mr Wellings requested that the reason for this be included. Resolved: 1) The Board noted the report for assurance 2) The Board noted that a further update would be presented in March CCG010/2016

HEALTH INEQUALITIES

Ms Harkins, Dr Pitches and Dr Greenway spoke to this item and made a presentation to the Board on Health Inequalities in Dudley. It was noted that an Intelligence Specialist had been appointed to focus and understand inequalities between different groups of populations, communities and between practices in Dudley. Ms Harkins suggested the development of a Task and Finish Group with the Office of Public Health and the CCG to discuss what the information would mean for commissioning priorities. Dr Pitches reported on the Marmot indicators where Dudley was significantly worse than elsewhere in England. These included: children failing to achieve a satisfactory level of development by the age of 5; number of pupils who are getting 5 good GCSEs by the time they reach 16; number of pupils eligible for free school meals achieving 5 or more GCSEs or equivalent of all children eligible for free school meals; high rates of people claiming Jobseekers Allowance; fuel poverty for high fuel cost households. The areas where Dudley was in the best performing fifth of CCGs, according to the NHS Atlas, included: patients having dialysis at home; admission rates for people with heart failure and diabetes compared to those without diabetes; people being admitted to acute stroke units within four hours of arrival at A&E; hospital admission for children with tooth decay; Tuberculosis rates; children’s immunisation rates and successful smoking quitting rates. According to the NHS Atlas, Dudley CCG was reported in the worst performing fifth of CCGs in the following areas: children and young people being admitted to hospital with mental health issues; emergency admissions through A&E; people who have had a kidney transplant and the kidney fails; ratio of reported to expected prevalence of dementia; low rates of breastfeeding; pupils in school reception with a healthy weight; very high obesity rates in adults; low rates of physical activity in adults; high rates of liver cirrhosis which correlates with high level of alcohol-related admissions. It was noted that some of the data presented referred to 2013 and more work would need to be completed in order to gain more accurate data. Ms Harkins provided an overview of where the Office of Public Health would focus on in order to narrow the gap. These included giving every child the best start in life by starting well; enabling healthy behaviour in adults by living well; and promoting healthy aging by aging well. Mrs Cartwright welcomed the information presented and offered to meet with Ms Harkins on how some of the initiatives could be progressed, particularly in relation to fuel poverty and keeping people in work. It was felt that the Task and Finish Group should gather further detail to understand the global figure around life expectancy and how the demographics were affecting it. Dr Horsburgh asked that the Task and Finish Group also develop the Marmot information further in order to carry out Horizon Scanning for planning and commissioning services for children and young people 8|Page

more effectively which would allow the CCG to have a greater impact. It was noted that Dudley CCG was the only CCG within the Birmingham and Black Country that supported the continuation of perinatal data collection – every other CCG across Birmingham and the Black Country refused to support it. Mr Wellings expressed his concern on the immunisation rates particularly as the CCG had fed back a detailed response to the national piloting of pharmacies when it was first introduced but this was not acted upon and should be addressed. In addition, Mr Wellings emphasised the importance of vocational training, particularly for younger people. This could be a piece of work carried out with the private sector, creating links and encouraging good practice. Mrs Jasper asked what the implications would be on the public health budget when reductions were being made across the Local Authority. Ms Harkins agreed to provide a summary of these in readiness for the next Board meeting but advised that the budget had been reduced but was ring-fenced within the Local Authority for Public Health. Mr Maubach requested details of the areas where the CCG needed to work jointly with the Office of Public Health. These areas could then be presented to the Health and Wellbeing Board to discuss joint priorities which could feed into the Strategic Plan update. Dr Hegarty thanked Ms Harkins for the presentation and recognised the request to establish a Task and Finish Group to understand the details presented more fully and make recommendations for commissioning priorities. Mr Bucktin agreed to liaise with Ms Harkins to take this forward. The issue with regards to sports and having an integrated approach was also recognised and how a programme could be developed which would help address childhood obesity. It was agreed that this would fall within the Multi-speciality Community Provider model that Dr Mann is leading on. Resolved: 1) The Board received the presentation for assurance 2) The Board agreed to delegate the work to a Task and Finish Group to report back to a future Board meeting with recommendations 3) The Board would receive a summary from Ms Harkins on the current public health budget at the March meeting CCG011/2016

DELIVERING THE FORWARD VIEW: NHS PLANNING GUIDANCE 2016/17 – 2020/21

Mr Bucktin made a presentation to support this item based on the planning guidance which had been released prior to Christmas. He reported that there was an expectation to produce two separate plans, a ‘Place Based’, five year, Sustainability and Transformation Plan (STP) and a CCG based Operational Plan for 2016/17 which is consistent with the STP. The deadline for the STP is June 2016 and this will cover the period October 2016 – March 2021 and should be place-based covering all NHS commissioned activity plus local authority, social care and prevention. The plan will be used to determine access to transformational change funding streams after 2016/17 and will secure early access to future funding. It was reported that there were a number of challenges to be addressed as part of the STP including: the health and wellbeing gap; the transformation process; finance and efficiency gap; financial sustainability plan and implementing new care models. Mr Bucktin informed the Board that for 2016/17, the guidance sets out nine ‘must dos’, which included: developing a STP; delivering financial balance; developing a local plan for sustainability and quality of general practice; meeting the A&E ambulance wait target; meeting the referral to treatment target; meeting the 62 day cancer wait target; achieving and maintaining new mental health standards; enhancing community provision and reducing inpatient capacity for learning disabilities; and finally, developing and implementing an affordable plan for improvements in quality. The key components of the operational plan include efficiency; reconciling finance and activity; delivering the nine ‘must dos’ and that it is seen as year one of a five year plan. The deadline for the first draft of the operational plan was the first week in February. 9|Page

It was reported that financial allocations were due on the 8 January 2016 but the average growth appeared to be approximately 3.5%, with growth from 2017/18 dependent on the agreement of the STP. Mr Hartland expanded on this point by advising the Board that in terms of growth, it is all pre-committed in terms of pension increases and some of the ‘must dos’ in the operational plan but further information would be available on the 8 January. In addition, Mr Hartland also advised that the bulk of the transformation fund would be to fund those Trusts around the country who are in deficit this year. Resolved: 1) The Board received the presentation for assurance CCG012/2016

PARTNERSHIP BOARD REPORT

Mrs Cartwright spoke to this item and updated the Board on matters discussed at the Partnership Board which had met in November. It was noted that since the report had been produced, a further meeting had taken place on 23 December. The meeting in December discussed the reflections from the Health Economy Summit and on the working relationships within the Partnership Board. A presentation was received from those individuals who had attended the national study visit to Alzera. The Value Proposition had also been discussed and this had been submitted on 8 January. Mrs Cartwright advised that the Partnership Board had agreed to open the attendance to West Midlands Ambulance Service and that was being taken forward. Partners at the meeting had responded with more assistance to the work streams, noting that an additional work stream had been added specifically for children. A workshop was being organised with partners for the end of January which would be to discuss what a multi-speciality community provider would look like. Mr Maubach reported that the latter point had been discussed at a Health and Wellbeing Board Development Session and when the workshop is organised, an invitation should be extended to the Health and Wellbeing Board. Dr Hegarty also advised that a clear conversation had taken place with regards to the work stream that defines what the final organisation that provides the MCP would look like. He stressed that individual providers should not be jeopardised by working closely with them if that would have an impact on the procurement process at a later date. Resolved: 1) The Board noted the report for assurance QUALITY AND SAFETY CCG013/2016

REPORT FROM QUALITY AND SAFETY COMMITTEE

Dr Edwards spoke to this item and confirmed that the report summarised the key issues raised at the Quality and Safety Committees held in November and December 2015. Healthwatch The Committee had received a report detailing findings of the Healthwatch Urgent Care Centre review which took place in July 2015. The report had included a number of recommendations regarding the provision and delivery of care to improve patient and visitor experience. Primary Care The Committee is now receiving an oversight of primary care which includes component parts of a governance framework to provide quality and safety assurances. Dr Edwards reported there were no contractual levers in place to support the reporting of incidents but it was planned to provide a reporting mechanism in order to encourage reporting of incidents.

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Electronic Discharge Letters A successful audit of 100 letters randomly selected was carried out in October 2015 and the findings provided evidence that 96% of letters were sent and received. Some procedural issues had been highlighted in primary care which were being addressed. Healthcare Associated Infections (HCAI) Both Dudley Group NHS Foundation Trust and Dudley CCG have breached the thresholds set and cross economy working is taking place to address this. Robust systems had been put in place to review each case and a more detailed report would be presented to the Board in March. Risk Register Two new risks had been added to the register: managing aggressive and violent behaviour directed towards staff in primary care; lack of provision in Perinatal Mental Health services. Resolved: 1) The Board noted the report for assurance 2) The Board would receive a detailed report in March with regards to Healthcare Associated Infections GOVERNANCE CCG014/2016

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 25 November 2016. Information Governance The current Information Governance toolkit score was 53% which was where the CCG were expected to be at this stage of the year, however mandatory training was only at 61% (target 95%). Policies and Decisions taken under Delegated Powers The Committee had received and approved policies under its delegated authority. These were the Gifts and Hospitality Policy; Standards for Business Conduct Policy; Policy Development Policy. Internal Audit The Committee had received three audit reports for 2015/16 for assurance which were Safeguarding Arrangements; Continuing Health Care and Personal Health Budgets; Provider Contract Management and Assurance. All gave significant assurance overall. Dr Mann noted that the Audit Committee had received details of the consultancy expenditure and asked if the values relating to the expenditure were available. It was agreed to incorporate the information into the Audit Committee report at the March Board meeting. Resolved: 1) The Board noted the report for assurance 2) The Board noted the decisions taken under delegated powers CCG015/2016

COMBINED BOARD ASSURANCE FRAMEWORK AND RISK REGISTER

Mrs Jasper spoke to this item and reported that the Audit Committee considered the overall Board Assurance Framework and Risk Register at its meeting held on 25 November 2015 and reported on the position as at 7 December 2015. The Board were advised of one adjustment to the risk register: Risk 43 – Failure to deliver significant QIPP targets in 15/16 puts the future financial stability of the CCG at risk. It was noted that the residual risk had been reduced from 20 to 12. One new risk had been included:

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Risk 84 – Failure to identify and deliver significant QIPP savings targets in 16/17 puts the future financial stability of the CCG at risk. There were no risks presented for closure. Resolved: 1) The Board noted the report for assurance CCG016/2016

REPORT FROM REMUNERATION COMMITTEE

Mr Wellings spoke to this item and confirmed that the report summarised the key issues discussed at the Remuneration Committee held on 3 and 10 December 2015. Board members declared an interest in the report due to the content on office holder contracts. HR/Workforce Metrics The level of sickness absence had risen and was above the 3% national guideline. This related to some long term absences which are being managed. The CCG was aiming to achieve 100% completeness for mandatory training requirements. Office Holder Contracts Feedback on the outcome of the consultation was given to the Remuneration Committee which resulted in new clinical leads expressing a desire to move to an employment contract whilst clinical leaders who have been in post longer, expressed an interest in continuing on the office holder contract. The following was agreed: • • • • •

Elected GPs will move to a revised Office Holder Contract Appointed GPs will move onto an employment contract Existing appointed GPs will move across to an employment contract once they have completed their term and if they are reappointed. New appointments will automatically commence on an employment contract Lay Members will move to a revised Office Holder Contract The Chair will move to a revised Office Holder Contract

All individuals would be written to outlining the decision that had been made. Staff Side Representation Mr J Cahill would be attending Remuneration Committee as staff side representative and was undertaking training from Unison. Resolved: 1) The Board noted the report for assurance FINANCE AND PERFORMANCE CCG017/2016

REPORT FROM FINANCE AND PERFORMANCE COMMITTEE

Mr Wellings spoke to this item and confirmed that the report summarised the key issues discussed at the Finance and Performance Committee held on 26 November 2015 and 17 December 2015. Statutory Financial Duties The CCG expected to meet all its financial duties in 2015/16 but noted that there was an anticipated overspend within that in the acute sector. Dr Heber raised the significant financial pressures and the contract over performance at Dudley Group NHS Foundation Trust (DGFT) and what the CCG could do to address this issue. Mr Hartland advised that the over performance had reduced from the beginning of the financial year and that the CCG was looking to change the contract form from 2017/18 by agreeing a block contract or having a contract with 12 | P a g e

a risk share agreement. The responsibility for the CCG would be to ensure that QIPP schemes were valid and met. Mr Maubach reported that half of the expenditure is on acute secondary care and questioned whether it was realistic to expect DGFT to be able to manage cost or if another strategy is needed where demand management is required outside the organisation. DGFT has been offered the opportunity to develop proposals on how pathways can be made more efficient and once the Trust reply it should be determined what the strategic direction should be. Mr Hartland added that a QIPP away day had taken place and it was highlighted that the key point was with regards to elective care and what action was needed to manage it. This would be discussed further at Clinical Development Committee. NHS Constitution Standards/CCG Assurance It was highlighted that the CCG continued to be rated as ‘outstanding’ by NHS England and is one of the few CCGs in the country to achieve the rating however, this could be at risk due to the Healthcare Associated Infections, referred to in the Quality and Safety Committee Report. Performance Exception Reporting It was noted that performance overall on major indicators was positive and the Board recognised that the hospital continued to meet it’s 95% target and were rated one of the best in the country. Lead Provider Framework – Commissioning Support Services Award Authorisation The Board were asked to endorse the action taken by the Committee under delegated authority to approve the award of the CSU contract for Commissioning Support Services. The Committee had approved the award of the contract for ‘End to End Services (excluding business intelligence and IT)’ to Arden and GEM CSU; ‘Business Intelligence’ to Midlands and Lancashire CSU; ‘Individual Funding Requests and Continuing Healthcare’ to Arden and GEM CSU. It was highlighted that the CSU procurement exercise across the Birmingham and Black Country was extensive and it was questioned as to whether it was value for money. The Board was asked to consider the value and appropriateness of such a procurement process in future or whether the CCG would take an independent route. The Board were also asked to approve the IT contract extension which provides IT support to Dudley CCG and the GP community. The CCG had given formal notice on the contract which is due to expire on 31 March 2016 and would carry out a tendering exercise for a service from 1 April 2016. The Committee agreed to an extension to the current contract for 12 months to March 2017 which would allow sufficient time to complete the tender exercise and transition to the chosen supplier. Resolved: 1) The Board noted the report for assurance 2) The Board endorsed the actions taken by the Committee under delegated authority to approve the award of CSU contracts ACUTE AND COMMUNITY COMMISSIONING CCG018/2016

PUBLIC INVOLVEMENT AND DUTY TO CONSULT

Mrs Broster spoke to this item and advised the Board that NHS England had recently issued new guidance regarding public consultation. The Dudley Communications and Engagement Strategy had been included in papers which had been approved by the Partnership Board in August 2015 which includes principles which were signed off by the Board in 2013 and follows the empowering approach to involve the people of Dudley. Mrs Broster informed the Board that she was looking for assurance and a decision which would allow the CCG to review the constitution and to check the principles are reflective of the latest legal guidance and also the NHS England guidance that had been published. The Strategy would be presented back to the Partnership Board for final sign off. Mr Wellings welcomed the paper and gave an example of public involvement when considering proposed branch closures. The current process which had been put in place by NHS England, and followed by the CCG, was felt to be as much involvement as consultation and stressed that when branch 13 | P a g e

closures are being considered, the public should be involved in the decision before it is made. Mr Wellings suggested the paper was considered at the next Primary Care Commissioning Committee to discuss what the implications are. Mrs Broster informed the Board that she had sought legal advice from Mills and Reeve and although she could provide assurance that the public are actively involved in the decisions which are being made, more work was required on the statutory consultation element. Mrs Broster further reported that Mills and Reeve would be attending the next Board Development Session in February to provide a dedicated session with regards to the legalities and to discuss this in more detail. It was noted that more resource and time would be needed to support this and it was questioned whether it would be deliverable. Resolved: 1) The Board noted the report for assurance 2) The Board noted the intention to discuss this further as part of a Board Development Session 3) The Board noted the intention to review the CCG’s published arrangements for public involvement, including in the constitution, a description of the arrangements that the CCG has made, and a statement of the principles which will be followed in implementing those arrangements CCG019/2016

REPORT FROM CLINICAL DEVELOPMENT COMMITTEE

Dr Mann spoke to this item and confirmed that the report summarised the key issues discussed at the Clinical Development Committees held on 18 November 2015 and 16 December 2015. Diabetes and Respiratory Services The Committee approved a proposal to continue redesigning services in relation to diabetes and respiratory services. Medicines Management The Committee expressed their concern at the potential cost pressure associated with the revised nutricia contract and agreed to explore alternative means of procuring the service. Non Emergency Patient Transport Service Concerns were raised by the Committee with regards to retendering for transport services and whether in future, if organisations withdrew from contracts half way through, would there be any redress from a CCG perspective with regards to retendering. Delayed Transfers of Care It was reported at the time of Board that there were 77 delayed discharges in Dudley Group NHS Foundation Trust, 51 of which were Dudley delays and this highlighted an issue with delayed transfers of care which the Board should be aware of. The Board agreed that the delayed discharges were unacceptable and discussed how the issue could be resolved and suggested consideration of what would be classed as an acceptable level of delay. Mr Bucktin explained that the issue is being caused primarily by social work assessments and there were no issues with funding packages of care and nursing home placements as these were dealt with on a ‘real time’ basis. It was agreed to ask Mr Oakman and Ms Norman for feedback through the Clinical Development Committee in the first instance. Mr Maubach made an observation that if the system had a higher rate of emergency admissions and a slower rate of discharge but not enough resource in the community to assess and manage patients, consideration has to be given to reducing the spend on high cost inpatient care and prioritising assessments in order to keep patient flow moving and keeping patients in their own home. Therefore, some thought should be given as to how the aforementioned services are ‘grouped’ and aligned to work to the same outcome objectives. It was agreed that this should be a key recommendation to the System Resilience Group and the outcome noted at the next Board meeting. Resolved: 1) The Board noted the report for assurance 14 | P a g e

2) The Board agreed for a key recommendation to be presented to the System Resilience Group and noted at the next Board meeting CCG020/2016

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 19 November 2015. As part of the planning process, Mr Bucktin advised that a Better Care Plan has to be produced for 2016/17 and guidance was awaited. Within the comprehensive spending review, there is a requirement to have a plan for integrating health and social care so the Better Care Fund would become a sub-set but further guidance was awaited. It was noted that based on data which had been analysed by the CSU across health and social care, some specific areas of work had been identified to work on as part of the plan for next year. Resolved: 1) The Board noted the report for assurance CCG021/2016

REPORT FROM HEALTH AND WELLBEING BOARD

Mr Bucktin spoke to this item and confirmed that the report summarised the key issues discussed by the Health and Wellbeing Board held on 2 December 2015. Children and Young People’s Alliance The Children and Young People’s Alliance Board would be adopting and identifying key health and wellbeing themes for children and young people. The Alliance would be developing a plan to engage with children and young people, as well as a delivery plan and outcomes framework to monitor agreed activities. Joint Strategic Assessment (JSA) A sub-group was being established to manage the JSA process with the intention that the JSA would produce various ‘products’ on particular issues that required addressing through the commissioning process. The Health and Wellbeing Board recognised it was important to ensure that all partners use this intelligence to inform their commissioning decisions. Resolved: 1) The Board noted the report for assurance PRIMARY CARE COMMISSIONING CCG022/2016

REPORT FROM PRIMARY CARE COMMISSIONING COMMITTEE

Mr Wellings spoke to this item and confirmed that the report summarised the key issues discussed by the Primary Care Commissioning Committees held on 20 November 2015 and 18 December 2015. Primary Care Contracting There were no significant performance issues or contractual breaches to be considered at Committee. The Committee approved the merger between St Thomas’s Medical Practice and Bean Road Medical Practice. It also accepted the retirement of a GP. New Contractual Framework The Committee received a progress report on the new contractual framework with the expectation that the final version would be signed off at Committee on 21 January 2016. Finance The budget had been increased by £1m to reflect the non-recurrent allocation to support winter pressures in primary care and those resources had been allocated. 15 | P a g e

Risk Register A new risk was added which was in relation to the Junior Doctors’ strike. Dr Hegarty recognised that the CCG were approaching the first year of Primary Care Commissioning in terms of delegated authority and noted the amount of work that had taken place and thanked Mr Wellings for his leadership and Mr King and the Primary Care Commissioning Team for their hard work. There was an agreement amongst Board Members that the Primary Care Commissioning Committee consider having a 12 month review by an external assessor as to the effectiveness of what has been achieved, including what has worked well, what has not worked so well and looking forward, lessons learnt. Mr Wellings advised that the Committee would produce an annual report which would include the points raised. Resolved: 1) The Board noted the report for assurance CCG023/2016

REFLECTION TIME

It was noted that although the presentations received were equally important and supported, it was felt that three at one meeting was quite a considerable amount to consider. 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 10 March 2016 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 MATTERS OUTSTANDING THURSDAY 10 MARCH 2016 – PUBLIC BOARD MEETING ITEM NO

AGENDA ITEM

ACTION TO BE TAKEN/UPDATE

ACTION FOR

DEADLINE

CCG008/2016

Chairman and Chief Executive Officer Report

A Primary and Secondary Care Clinical Forum be organised, focusing on Care Homes

Mr Maubach

March 2016

CCG008/2016

Chairman and Chief Executive Officer Report

Mrs Brunt to request that Dudley Group Foundation Trust send this year’s Quality Report to Dudley CCG at the earliest opportunity to provide comments

Mrs Brunt

March 2016

CCG010/2016 Health Inequalities

Ms Harkins to provide a summary of the financial implications in relation to the Public Health Budget to the March Board.

Ms Harkins

March 2016

Report from Clinical CCG019/2016 Development Committee

A key recommendation to be presented to the System Resilience Group on how services are grouped and aligned to work to the same outcome objectives

Mr Bucktin

March 2016

COMPLETED

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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 from the Activate workshops that Healthwatch Dudley and DCVS are hosting for the listening exercise. The focus is around what keeps people feeling well, healthy and cared for. They are also exploring what can help people to be healthy and what might be getting in the way.

Listening Exercise – Dudley’s biggest conversation ever about health and social care Late January saw the start of our listening exercise with attendance at the council Community Forums. A Doodle Ad (short animated clip) and foam boards were created for audiences to tell them about the New Care Model in Dudley. By the end of March some 40+ groups will have had the opportunity to learn more about the plans in Dudley and share their views on how health and social care works for them. Early conversations suggest that there is an appetite for information but there is some reticence that things will actually change and be different. A full report from the exercise will be presented to Partnership Board in April. Vanguard Engagement Group With the New Care Models work progressing rapidly in Dudley, it seemed the right time to invite people to be part of a group that could be focussed and involved specifically with the projects that fall under the New Care Model. We asked people to submit an Expression of Interest (EOI) if they wanted to be involved and were overwhelmed with 60+ responses. Around 25 of those turned up to our first 1

meeting in February and we worked together to look at how the group could work and feel valued and how best to continue. We are currently collecting information from everyone who submitted an EOI to build a picture and planning our next session for early April. We received some really positive feedback from the meeting and there was a real appetite to do something different and a passion to be involved in designing and co-producing patient pathways. We will be working with the Commissioning team to see how best we can support this. Staff Engagement We held a staff engagement session in January and co-hosted with a company called Spaghetti labs. The aim was to get a view on how staff understood the New Care Models work, how it affected them and to explore through active listening how they felt they could work better together. Feedback was honest and constructive. It was recognised that the pace of change was fast and that CCG staff wanted more opportunity to engage with the new care model development. We will look at further staff development sessions to build understanding and create further opportunities for involvement. Patient Opportunity Panel (POP) Meeting The POP group met in February with approximately 20 Patient Participation Group (PPG) members. Jason Evans, Commissioning Manager for Urgent Care, attended and gave an update on the Urgent Care Centre and on the considerations for a Single Patient Portal (SPP). The group agreed unanimously to endorse the hospital pharmacy prescribing green prescriptions. Other issues were around the amount of Do Not Attends (DNAs) at each practice and around the PPG Purse Funds. It was agreed that the PPG Purse Fund would be discussed at the next meeting to see whether the funds could be used in a participatory budgeting style. Dudley Borough Healthcare Forum The HCF this month focusses on the Operational Plan and the healthcare improvement priorities for the year ahead. The next HCF takes place 23rd June, 4.30pm until 6.30pm at Brierley Hill Civic Hall and is followed by the AGM and the staff awards. Kingswinford, Amblecote & Brierley Hill (KAB) POD (group of PPGS) The last KAB meeting took place in January. 7 PPGs were represented and updates were shared on the start of the listening exercises, the latest KAB MDT meeting (of which KAB POD members had attended) and the recent national team visit to the CCG where KAB POD members were present. The group agreed to retain a local focus but were keen to have regular updates on CCG business in general and New Care Models work. #Me Festival 2016 Planning has already started for this year’s Me Festival with Himley Hall being booked for 24th November. This year we are asking for partnership funding and commitment to ensure the event is a success and that as many Year 8 students as possible can attend. The theme this year will be around obesity and will draw on the 2016 Olympics and Paralympics in Rio de Janieiro– Making it Rio! 2

The Social Care Institute for Excellence (SCIE) The Partnership Board chose to focus on End of Life as the ‘wicked issue’ for SCIE to study. The issue selected should be related to the implementation of New Care Models and: • connected to many other issues; • difficult to define; • socially complex • require a whole system, multi-agency response; • have no clear or optimal solution; • have no immediate or ultimate test of ‘success’; • call for co-production with citizens. SCIE have been interviewing key stakeholders from the partnership organisations and we will share further information as available. Ultimately, Dudley will be used to inform future policy on how to have constructive conversations on the Wicked issues facing Health and Care.

During the quarter, we have been selected to present our vision for patient experience at the National Insight Conference taking place in March. This will be a fantastic opportunity to present all the work we have been doing over the last 12 months and will feature with other key note speakers from Ipsos MORI and NHS England. Rob Franklin will be representing the CCG on this and should be congratulated for all his work to promote Dudley on this national stage. Quarter 3 continued to see improvements in the number of patients leaving feedback through the patient experience app. There have been more pieces of feedback about Dudley Group NHS Foundation Trust in Q3 through the Mi Experience App than through NHS Choices and Patient Opinion combined. We hope that the progress we are making with the app will continue to be developed when the app is made available to all providers by April 2016. To encourage further openness and transparency we have begun the development of a website which will host patient stories posted directly through the app and website, it will also include the relevant responses from individual organisations. As discussed last quarter there are a number of practices who are not completing the Friends and Family Test (FFT). These practices have been highlighted in the most recent Quality & Safety paper and also shared with the Primary Care Membership Team. These practices will be contacted over the next few months by the membership to see what support they need in implementing the FFT.

Healthwatch Dudley is reporting quarterly updates in a new fresh way. A full report of outcomes and activities for October – December 2015 is now available to download at: www.healthwatchdudley.co.uk/reports.

Looking forward to 2016, Healthwatch Dudley is taking part in the biggest 3

conversation about health and care, through the All Together Better Partnership. In addition to supporting Dudley CCG listening events, we are hosting a series of bespoke listening events all around Dudley borough. These events identify what being healthy, well and cared for means and what helps or hinders people. The sessions go on to explore how this understanding can unlock creativity and potential for everyone to think and work in different ways. Bringing people together helps everyone to think about the active roles that everyone can play. Healthwatch Dudley will collate evidence and learning from all of the listening that takes place into a research report that will be circulated in the next quarter.

4

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 in both the nursing times and the Primary Care Today publication. We have also been reference by Sir Norman Lamb in a recent presentation that he gave on Mental Health New Care Models. This followed a briefing session which Paul Maubach was at. 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. • On 20 January 2016 we held a Teleconference with Thurrock CCG and 5 of their partner organisations to discuss our New Care Model. • Following the Teleconference with Thurrock CCG, South Essex Partnership Trust requested to hold 2 Teleconferences with us to discuss the New Care Model in more detail. These Teleconferences took place on 10 February 2016 and 1 March 2016 with around 10 attendees on each call. • On 20 January 2016 we held a Teleconference with Norfolk & Suffolk NHS Foundation Trust to how our mental health and voluntary services work. • On 4 February 2016, Staffordshire & Stoke on Trent Partnership Trust visited Dudley CCG to discuss our model and experience in order for them to implement MSCPs in their area. • Leicester, Leicestershire & Rutland CCG’s Urgent Care Lead contacted us to see how we work with our membership. • South West Yorkshire Partnership NHS Foundation Trust contacted us to find out more about our MCP model, the way in which it is intended to function in our area, how we may have used it to provide more integrated clinical care and the way it interacts with local providers. • West Norfolk CCG contacted us to find out more about how the New Care Model works for frail elderly and information about hub models. • Herts Valley CCG visited us on 9 February 2016 • Ian Dodge, National Director of Commissioning Strategy at NHS England visited on 17 February 2016 to see how Dudley is working differently. Ian Dodge met with staff from CCG and our partner organisations, Ian also visited an MDT meeting at Three Villages Medical Practice. • The NHS Confederation are visiting us on 26 April 2016 • Don Berwick will be with us on the 8th June 2016 Research & Benchmarking Project- Explain Market Research have been commissioned to deliver a research and benchmarking programme as part of the new models of care initiative. In January we developed a comprehensive brief outlining the objectives required for the research. The areas identified for the project are: • •

trust and confidence; Single Patient Portal & Data Sharing. 5

The two projects led themselves to two different types of methodologies. Trust and confidence requires a quantitative style questionnaire that can be repeated in order to measure the impact each year to track progress against set questions. The Single Patient Portal is a new service that plans to work for patients and all stakeholders, to do this in depth interviews, focus groups and an employee survey will be completed. With this in mind, the following programme of research activity has been agreed: Trust and Confidence •

Telephone interviews - 1,100 interviews

Single Patient Portal & Data Sharing • • •

Focus Groups – 6 profile groups to gain deeper insight into SPP and Data Sharing. Employee Online Survey – to engage with all employees across partnership. In Depth Stakeholder Interviews – in depth interviews with 15 key stakeholders.

We are currently in the process of working with Explain and partners to develop the telephone survey/questionnaire and detailed discussion guides for the above. Once agreed the public and stakeholder surveys will go live and focus groups will be scheduled for March 2016. The results and analysis of this research will be presented to the team in April 2016. Explain will facilitate a social marketing workshop to help translate the research outcomes and recommendations into an action plan. Commissioning Intentions 2016/17 – 2017/18 Consultation We launched a four week public consultation on the Commissioning Intentions 2016/17 – 2017/18 on Monday 1st February 2016, this closes on Tuesday 1st March 2016. This was published on the CCG news pages and via our social media accounts. There are a number of ways the public can give us their views, these are by completing an online survey, emailing the CCG contact inbox or by downloading a questionnaire. A batch of questionnaires was also printed and posted to all libraries in the borough with freepost envelopes for them to be posted back. The questions included in the survey are as follows: • • • • •

Do you feel we clearly explained our commissioning intentions for 2016- 2017? What are your views on our commissioning intentions? In your opinion, is the implementation of an integrated out of hospital system the best care solution for Dudley’s most vulnerable patients? Do you have any particular comments or concerns about our commissioning intentions that you haven't covered, and what are these? After considering our intentions for 2016- 2017, is there anything you would like to share about what this will mean for you personally?

No negative comments have been received in response to these. A full report of results will be produced at the end of the consultation.

Winter We continue to support the national ‘Stay Well’ winter campaign. 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 6

The table in appendix 1 gives a breakdown and hyperlinks to recent media activity for the CCG.

Patient Online We continue to work with all practices to ensure they are using and promoting Patient Online to patients. Practice Managers are happy with progress and the resources supplied so far. The CCG have now designed an application form in partnership with Practice Managers which has been produced and shared in a range of different languages for use in practice. Regular updates have been produced from NHS England and EMIS regarding resources, advice and assistance, Detailed Coded Record and webinars. All updates have been shared with our Practice Managers. We met with NHS England National Team and Barclays in January to discuss assistance from the Digital Eagles to promote Patient Online through Tea and Teach sessions in local branches and GP surgeries. Due to the low attendance of the December sessions, the manager of Barclays in Dudley confirmed they are happy to deploy Digital Eagles to each practice to work with staff and patients to teach them to use online services and possibly create ‘digital health heroes’. Further details will be confirmed by the National Team. We have not yet been able to arrange a Patient Online event for GPs, however the Patient Online Implementation Lead is attending the Dudley Practice Managers Meeting on the 9 March 2016. We are keeping a close eye on the data available to us for this. All practices should have this enabled by 31st March 2016. The latest position on this is 10/46 practices are switched on. A verbal update will be given at the Board meeting on the latest position. Branch Closures The Primary Care Commissioning Committee met on in public during January and February with agenda items for the closure of Market Street and Masefield Road branch surgeries. At the February Meeting we chose to move the committee to Lower Gornal so that local people could attend the meeting to hear the discussion on the Masefield Road closure. This meeting was well attended (35 members of the public). Both closure processes have highlighted the great work that the practices have done to engage their patients. Laura Broster Head of Communications & Public Insight

7

Appendix 1 Media Update- Jan/ Feb 2016

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

Summary

Release Date

Partnership working leads to numerous benefits for Dudley service users Partnership puts Dudley's mental health services top of the charts Area has shortest NHS waiting times in the country

Press Release (Joint DWMHT/CCG)

05.01.2016

Coverage of Press Release

07.01.2016

CCG supports Antibiotic Guardian Campaign Patient wait times are now best in UK

Press Release

Coverage (with links where available)

Release

Dudley & Stourbridge News Article


07.01.2016

Halesowen News Article

08.01.2016 Release


08.01.2016

Express & Star (Main) Article

Four-month wait for Coverage of Press psychological therapy Release

08.01.2016

Pulse Magazine Article

Removing the blocks

Media Story

08.01.2016

Frontline (Main) 9

Article

Health Chiefs remind residents to keep warm, keep well Antibiotics Are Not Always the Answer

Press Release

Merger improves health services


12.01.2016 Release

Press Release

12.01.2016 Release 13.01.2016

Dudley News Article

Public Invited to Dudley CCG’s Primary Care Commissioning Committee Meeting Dementia drug could help prevent falls in Parkinson’s disease patients GP Practice Merger/Closures

Press Release

Top tips to keeping warm and well in the winter weather


Mental health patients' waits shortest in country


GP: Antibiotics taken

Coverage of Press

13.01.2016 Release

Media Story

14.01.2016

Pharmaceutical Journal Article

Media Enquiry

15.01.2016 Response 16.01.2016

Dudley, Stourbridge & Halesowen News Article

16.01.2016

Walsall Chronicle Article

16.01.2016

Express & Star (Main) 10

too often

Release Article

Ashwood Nurseries raise #21.8k for Dudley Macmillan Cancer project Are you ready to join in Dudley’s ‘biggest ever conversation about Health and Social Care? Guarding antibiotics

Media Story

16.01.2016

Dudley, Stourbridge & Halesowen News Article

Press Release

20.01.2016 Release

Coverage of Media Enquiry

20.01.2016

Dudley News Article

Public meetings on future of surgeries


21.01.2016

Express and Star (Dudley) Article

Pedmore Road CQC Report 'Antibiotic guardians' to help combat resistance

Media Enquiry

21.01.2016

Response


21.01.2016

Stourbridge News

Target smashed at garden centre

Media Story

Article 21.01.2016

Stourbridge News Article

Surgery 'putting patients at risk' - No fire safety assessment since


22.01.2016

Express & Star Article 11

2006 and support staff not checked to see if they can work with children Doctors surgery to close by next month

Media Story (Following PCCC)

23.01.2016

Express & Star (Dudley) Article

Kingswinford GP surgery to close


23.01.2016

Express & Star West Midlands (Web) Article

Speak up as part of Dudley's biggest ever health care conversation It's best for patients if clinic closes - GP


23.01.2016

Dudley, Stourbridge News Article


28.01.2016

Express & Star (Main) Article

It's better for patients if clinic closes Dudley GP


Partnership leads to shorter wait for users


28.01.2016

Express & Star (Web) Article

28.01.2016


Views wanted on health care


28.01.2016

Dudley & Stourbridge News Article

Public Invited to Dudley CCG’s Primary Care

Press Release

29.01.2016 Release 12

Commissioning Committee Meeting Patients concerned over branch surgery closures


30.01.2016

Dudley & Stourbridge Chronicle Article

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

Summary

Release Date

Coverage (with links where available)

Patients concerned over branch surgery closures


01.02.2016

Dudley & Stourbridge Chronicle

GP practice rated 'inadequate' and put into special measures after inspection Closure of surgery to be debated by group Surgery fate facing debate Don’t be caught out by severe weather Medical practice branch closure to be considered at borough CCG meeting


Article 03.02.2016

Express & Star Article

Coverage of Press Release Coverage of Press Release Press Release

04.02.2016


05.02.2016

04.02.2016 05.02.2016

Express & Star Article Express & Star Article Release Bromsgrove Advertiser, Worcester News Malvern Gazette, Droitwich Spa Advertiser Dudley News, Redditch Advertiser Halesowen News, Evesham Journal Kidderminster Shuttle, Hereford Times Stourbridge News, Ledbury Reporter Cotswold Journal, Tewkesbury Admag 13

Ludlow Advertiser (WEB) Article It's best for patients if clinic closes GP


05.02.2016

Stourbridge Chronicle, Dudley Chronicle Article

Surgery's future is on agenda at meeting


11.02.2016

Dudley & Stourbridge Chronicle Article

Be Aware of Norovirus

Press Release

Norovirus Advice


16.02.2016 Release 17.02.2016

Express & Star (Final & All Main) Article

Take Part in Care Meeting


18.02.2016


Partnership working increases space utilisation

Media Story

Masefield Branch Closure

Media Enquiry

18.02.2016

Building Better Healthcare (Web) Article

22.02.2016

Nick Pullen – Dudley Chronicles Response

Vanguard spotlight: Dudley

Coverage of Interview

23.02.2016

Primary Care Today Article 14

The Role of the Medicines Management Dietitian How to use patient feedback more effectively Vanguard Spotlight: Finding a solution in Dudley

Media Story

Vanguard sites are testing the extent to which staff in different professions can do each other’s jobs Patients' fury at surgery closure


23.02.2016

CN Focus (Main) Article

Media Story

23.02.2016

Practice Business (Web) Article


24.02.2016

Primary Care Today (Web) Article

25.02.2016

Nursing Times Article


25.02.2016

Dudley News

15

DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 2016 Report: Communications and Engagement Strategy Agenda item No: 7.1 TITLE OF REPORT:

Dudley CCG Communications & Engagement Strategy

PURPOSE OF REPORT:

To seek the Boards approval to a refreshed Communications and Engagement Strategy

AUTHOR OF REPORT:

Mrs Laura Broster- Head of Communications and Public Insight

MANAGEMENT LEAD:

Mrs Laura Broster- Head of Communications and Public Insight

CLINICAL LEAD:

Dr David Hegarty – Chair, Dudley CCG • • •

KEY POINTS:

• • •

Public involvement goes far beyond the need to consult on specific proposals for major service redesign. We have a strong network for on-going engagement, which is key This strategy sets out the key principles which we will follow to engage the public in our decision making This strategy sets out the arrangements for CCG communications and engagement This strategy recognises that there is not a ‘one size fits all’ approach to Communicating and Engaging and supports the development of new arrangements to further enhance those set out in this strategy This strategy sets out how we will operationalise these principles through our commissioning cycle and business planning process.

That the Board: RECOMMENDATION:

FINANCIAL IMPLICATIONS:

WHAT ENGAGEMENT HAS TAKEN PLACE:

• •

Endorse the principles set out in this strategy Approve the strategy

•

The CCG has a statutory duty to involve. Failure to do so could result in costly judicial proceedings. Engaging people in service development will ensure that our decisions are as well-informed as possible. Involving those who currently use services, and those who may need them in the future, will help us to make better commissioning decisions.

•

A conversation on how we involve people in future service changes took place at the Healthcare Forum on the 5th December 2015. Through our on-going engagement we hear back, when we might not be getting things right and adjust our activity. We have asked for feedback on the principles set out in this strategy and will update verbally at Board on any we receive.

ACTION REQUIRED:

 Assurance  Decision

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From Public Relations to Patient Empowerment and Community Activation Communications, Engagement and Involvement Strategy 2016-2019

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Contents •

Introduction – Dr David Hegarty, CCG Chair

•

Context: o Our Vision and Values o Statutory Obligations o Policy Requirements o Constitutional Duties o Related Guidance

•

Principles o Our Objectives o Our Approach o Our Delivery

•

Operationalising this Strategy o Business Planning Process o Our Engagement Mechanisms

•

Monitoring, Evaluation, Reporting and Assurance o Check List o Evaluation

Appendix 1: •

Legal, regulatory and policy guidance which informs the CCG’s communications, engagement and involvement activity

Appendix 2: •

Our Pledge to Dudley People

Appendix 3: •

Brand positioning

Appendix 4: •

Engagement checklist

Appendix 5: •

Media management

Appendix 6: •

Stakeholder map

Appendix 7: •

Channels

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1.0 Introduction – Dr David Hegarty, CCG Chair The NHS and the services which work in partnership with us are going through a period of unprecedented challenge and change. New Models of Care and more joined up working across organisational boundaries are redefining the roles and responsibilities of health and care organisations and the people who work for them. At the same time there is a growing recognition that if we cannot help people understand why changes are necessary, it will be much harder to deliver change at the pace and scale which is required. We also know that we have a much better chance of seizing the opportunities that the future holds if we can secure the active participation of people in driving change and embracing those New Models of Care. What this means is that effective communication is more important across health and care than ever before. Effective communication and engagement networks can break down barriers, build alliances, encourage innovation, share good ideas and create an environment where all of us concerned with improving health and care across Dudley can work together to build a better future. Dudley CCG’s motto since we took over as the local leaders of the NHS has been ‘Think Differently.’ We are now starting to act differently as well – and turning visions into action requires a shift in our approach to communication and engagement. Dudley has been selected as one of the areas to test out new models of care. We are embracing this opportunity and in the rapidly evolving health and care system, there is no longer a ‘one size fits all’ model to communications. While the overall focus may be on sustainability, transformation and patient activation, these aims will be delivered in diverse ways, through a variety of programmes and projects bringing together different people from different organisations according to the change required. Each of these pieces of work may require a separate and unique communications strategy or plan to underpin its vision and support its delivery. This raises new challenges for the CCG in staying true to our principles, taking a consistent but flexible approach and being able to provide assurance to ourselves and our partners that we are not only fulfilling our statutory obligations regarding communications and engagement but going above and beyond them. Achieving this will require the active participation of everyone in our CCG – not just the communications and engagement professionals, but also our Governing Body, our members and our staff. This strategy provides an overarching set of principles which we will apply to any programme or project when developing, delivering, monitoring and evaluating any communications, involvement and engagement plan.

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Those principles should inform any conversation we have about the future of our health and care services – with Dudley people, partners, other system leaders or anyone with an interest in, or connection to, our NHS, including regulatory and oversight bodies. If we can live by these principles in our working lives, they can take us on a journey from ‘traditional’ public relations and communications to a new way of working which will engage our members, staff and Dudley people more meaningfully in delivering safe, high quality, sustainable health and care services which meet the needs of the communities we serve now and in the future

David Hegarty Chair, Dudley CCG

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2.0 Context 2.1 Our Vision and Values Running through this strategy and the plans which underpin it are our values of being patient centred and a listening organisation to realise our CCG vision, ‘to promote good health and ensure high quality health services for the people of Dudley’ This strategy is the vision for a future in which people and communities will contribute actively, collectively and inclusively to Health & Wellbeing outcomes. This strategy is also built on and supports our commitment to meeting, and exceeding where possible, a number of key statutory, policy or constitutional obligations. As a statutory organisation, we know that we need to: • • • • • • • • • •

Involve the public in the planning and development of services Involve the public on any changes that affect patient services, not just those with a “significant” impact Set out in our commissioning plans how we intend to involve people in our commissioning decisions Consult on our annual commissioning plans to ensure proper opportunities for public input; Report on involvement in our Annual Report; Have lay members on our Governing Body; Have due regard to the findings from the local HealthWatch Consult local authorities about substantial service change Have regard to the NHS Constitution in carrying out our functions Promote choice

They are set out in more detail in Appendix 1, but among the most significant are: 2.2 Statutory The NHS Act 2006 (as amended by the Health and Social Care Act 2012) – including the CCG’s legal duty to involve the public in the planning, development and delivery of their health care services set out at section 14Z2 Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013: Part 4: Health Scrutiny by Local Authorities including Regulation 23 which describes the CCG’s duty to consult with local authorities (through Overview and Scrutiny Committees or other forums as appropriate) on proposals for substantial variation in the provision of local services. 2.3 Policy The Five Year Forward View (October 2014) and supporting publications, including ‘The Five Year Forward View – Time to Deliver (June 2015), are key policy documents setting out the strategic direction of travel for the NHS in England up to, and beyond, 2020. At the heart of the Five Year Forward View (FYFV) is a recognition that the NHS needs to change if it is to meet the challenges posed by a growing, ageing population, more people living with long term conditions like diabetes, new technologies and treatments and an increasing funding gap.

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The FYFV supports innovation, radical change and locally-driven solutions (within defined limits). Dudley CCG was one of the organisations nationally to succeed in a bid for ‘Vanguard’ status, making Dudley one of the first health and care systems in the country to trial one of the new models of care proposed in the FYFV. Planning, Assuring and delivering service change for patients: (NHS England, November 2015) 1 Clinical Commissioning Groups are under a statutory duty to have regard to this guidance, which sets out the required assurance process commissioners follow when conducting service reconfiguration. Its purpose is to provide support and assurance to ensure reconfiguration can progress, with due consideration for the four tests of service change which the government mandate requires NHS England to test against. 2.4 Constitutional The NHS Constitution2 sets out a number of rights to which people and staff are entitled including the right for people to be involved, directly or through representatives, in the planning of healthcare services commissioned by NHS bodies, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services. The NHS Dudley CCG Constitution3 section 5.2 sets out in detail how we will make arrangements to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements. Those arrangements include “publishing and implementing a communication and engagement strategy.” These are summarised in our Constitution through the following statement, Dudley CCG complies with the following principles when engaging with the public: 1. i) that public involvement occurs at all stages of decision making: planning of the commissioning arrangements; development and consideration of proposals for changes in commissioning arrangements; and decisions affecting the operation of the commissioning arrangements. 2. ii) working collaboratively with our partners to ensure we engage the widest possible audience, using a variety of methods tailored to specific needs of different patient groups and communities, and actively seeking out the views of those groups most vulnerable to widening health inequalities. 3. iii) ensuring clarity about the purpose of engagement and focusing on engagement as a means of service improvement. 4. iv) valuing the feedback that the public give us and allowing adequate time and resource for this. 5. v) listening and taking account of all views - even those which may conflict with an organisationally favoured decision. 6. vi) ensuring that we truly understand our public feedback; accurately represent all views and act appropriately on the basis of feedback received. 1

https://www.england.nhs.uk/wp-content/uploads/2015/10/plan-ass-deliv-serv-chge.pdf

2

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/480482/NHS_Constitution_ WEB.pdf 3 http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/11/Dudley-CCG-Constitution.pdf 8|P a g e

7. vii) demonstrating responsible leadership by being transparent about our rationale. 8. viii) publishing information about health services. 9. ix) at all times seeking to build trust and reciprocity and to offer respect and empathy towards all stakeholders 2.5 Other related policies and information In drafting and delivering this strategy we will be mindful that we are communicating with a diverse range of audiences and we will use a variety of methods and messages to target key audiences to best effect. We know, for instance that 30% of adults in Dudley have no formal qualifications. We also know that one in every 25 households in our borough is home to at least one adult who does not have English as a first language. (2011 Census data) Finally, this strategy should not be read in isolation, it is a supporting document to our Operating Plan and Dudley’s Health & Wellbeing Strategy. These documents reflect the way health challenges nationally are reflected in Dudley – more people living longer, with more complex health issues sometimes of our own making. We know for instance that: • • • • • • •

1 in 5 people in Dudley have a limiting long term illness A quarter of early deaths (40 – 59 age band) are due to smoking, obesity, cardiovascular disease and lack of physical activity In two decades time there will be, 25,100 more people 65+ & 9,900 85+ 20% of single person households are in 60+ age group 30% of 16+ No Qualifications 4 96% of households with People Aged 16+ in Household regard English as their main Language 5 82% of Dudley people report using the Internet in the last month compared to a national average of 85% 6

4

Dudley Census 2011 Dudley Census 2011 6 Office for National statistics survey on internet usage 2014 5

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3.0 Principles 3.1 Our Objectives Our aim is to work with citizens and communities to create person centred care. We see a future in which people and communities will contribute actively, collectively and inclusively to health and wellbeing outcomes underpinned by effective collaborations with, and between, the CCG and its partners. To achieve this, we have set out six objectives which we think are key to us enabling and achieving that vision. • • • • • •

Understand what is important to people locally Connect what is happening with those that can bring about change and learning Inspire our local teams and partners to listen, take responsibility and make real changes to enable person centred care Build relationships and networks to have honest conversations Create an environment which supports people using health and care services to themselves drive change Develop and grow confidence and trust in local services in NHS Leadership

For each programme of work that the CCG undertakes we will ensure that there is a clear action plan detailing our actions in relation to these. 3.2 Our Approach We are committed to developing an organisational culture which supports an empowering and collaborative approach. Community Empowerment Dimensions By ‘confident’, we mean, working in a way which increases peoples skills, knowledge and confidence – and instills a belief that they can make a difference. By ‘inclusive’, we mean working in a way which recognises that discrimination exists, promotes equality of opportunity and good relations between groups and challenges inequality and exclusion. By ‘organised’, we mean working in a way which brings people together around common issues and concerns in organisations and groups that are open, democratic and accountable. By ‘cooperative’, we mean working a way which builds positive relationships across groups, identifies common messages, develops and maintains links to national bodies and promotes partnership working. By ‘influential’, we mean working in a way which encourages and equips communities to take part and influence decisions, services and activities.

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3.3 Our Delivery We will be true to the following principles in all our conversations. Open and transparent - Our communication will be as open and transparent as we can be, ensuring that when information cannot be given or is unavailable, the reasons are explained Consistent – There are no contradictions in the messages given to different stakeholder groups or individuals. The priority to those messages and the degree of detail may differ, but they should never conflict Two-way – There are opportunities for open and honest feedback and people have the chance to contribute their ideas and opinions about issues and decisions Clear – Communication should be jargon free, to the point, easy to understand and not open to interpretation Planned – Communications are planned and timely rather than ad-hoc and are regularly reviewed to ensure effectiveness Accessible – Our communications are available in a range of formats to meet the needs of the target audience

High quality – our communications are high quality with regard to structure, content and presentation at all times

Recognising our commitment to an empowering approach, we can make a series of pledges to Dudley people. These can be found in appendix 2.

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4.0 Operationalising this Strategy 4.1 Making our communications and engagement principles ‘business as usual’ Commissioning services is a continuous process of improving services, which deliver the best possible quality and outcomes for people, to meet the health needs of the whole community and reduce inequalities within the resources available. NHS Dudley CCG will ensure that we communicate appropriately with our key stakeholders at each stage of the commissioning cycle and engage with local people to include their views in the decision making process.

The CCG has a business case process which should be followed prior to decisions being taken to commission or decommission any services. A key part of the business case process is the requirement to evidence on-going involvement of people and communities and to detail any plans to formally consult (where necessary). The Communications and public Insight team will actively support the development of these business cases and create opportunities to involve people in any service changes. 12 | P a g e

The level of engagement will be proportionate and will include the Health Overview and Scrutiny Committee where applicable. Years one and two of this strategy will be delivered in a large part by the New Care Model Communications and Involvement Strategy which has been signoff by the CCG and the Partnership Board. 4.2 Mechanisms for communication and engagement As stated above the principles set out in this strategy will be used to inform bespoke communications plans to support a wide range of service developments and transformational work. However, there are a number of key communications channels supported by the CCG which have an important role to play in all these plans. The cornerstone of our public and patient involvement work is our network of Patient Participation Groups (PPGs) At the time of writing this strategy, all 46 of our member GP practices have an established PPG. We are committed to supporting these groups and their practices to give patients a voice. Through our innovative PPG Purse scheme, each PPG can receive up to £1,000 funding to invest in expanding their group, making it more diverse or delivering innovations that benefit people. Our PPGs are offered regular opportunities to come together through our Patient Opportunities Panel (POPs) which is chaired by our Lay Member for Public and Patient Involvement who reports directly to our Governing Body on issues raised. Our quarterly Healthcare Forum (HCF) brings together representatives of health related service user and community groups and the general public. Each meeting is chaired by one of our member GPs and discussions cover a wide range of health topics. Feedback is shared with our commissioners and leadership team. Although we recognise the limitations of digital communication, we are committed to seizing the opportunities which it offers to reach large numbers of people quickly and cost effectively. Ongoing development of our website, Facebook page and Twitter feed remain priorities for the CCG’s communications and engagement team as does the production of vox pop ‘Feet on the Street’ videos which offer local people a chance to share their views on a health topic and have those views broadcast to our Governing Body at their monthly meetings and with the wider community via our website. 4.3 Working with Corporate Stakeholders We need to work closely with our corporate stakeholders to achieve our ambitious engagement agenda. A full analysis of our stakeholders can be found in Appendix 6 and 7.

Dudley Health Overview and Scrutiny Committee (OSC)- We will maintain our positive working relationship with the OSC. We will continue to attend meetings on a regular basis to discuss service proposals and engagement activities, to brief members on our plans and

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activity and we will consult the OSC on any proposals for significant changes to local services. Dudley Health and Wellbeing Board- We are a committed partner on the Health and Wellbeing Board which allows health and local authority representatives to work much more closely together to address local health needs and inequalities, and improve health and social care services. We will continue to work closely with our partners on the Board and contribute to the overall Health and Wellbeing Strategy for Dudley Borough. Healthwatch Dudley- Healthwatch supports people across Dudley to: • • •

have a say in how health and social care services are provided find out about health and social care services make a formal complaint about NHS services

We will work with Healthwatch to support their work and drive engagement with members of the public. We will deepen our relationship with Healthwatch and work in partnership efficiently to engage with people and communities. We will ensure that the insight we receive about services we commission helps us to continually improve healthcare provision across Dudley. Local Authority- We will build on our firm relationships with Dudley Metropolitan Borough Council (including Public Health). Our local authority partners are a key corporate stakeholder and in line with our vision we will continue to strengthen relationships and partnership work between organisations within the health and social care community to improve the well-being of our residents. We will share intelligence wherever possible and where appropriate, we will work together to target specific communities and groups. This will help enable the involvement of particularly isolated and seldom heard groups, avoid duplication of effort and ensure that experiences and opinions expressed by local communities are incorporated into joint commissioning plans. Health Providers- we will work with our health service providers to continually review and act on the feedback from the public to improve services. We will work collaboratively with communication partners to ensure that we have campaigns which seek to encourage the right behaviour and reduce risk to individuals and the wider system of care. For example – winter plans. Local MPs- We will endeavour to meet with local MPs on a regular basis and will continue to proactively brief and involve MPs on developments in the area as well as receive feedback from their constituents about local health services. Voluntary Sector and community groups- We will extend our proactive engagement with voluntary and community partners, both as providers of services and as parties with an interest and influence in local health care. Other networks- Whenever we are engaging with people, we will endeavour to go to extra mile to engage as far and wide as possible. We will identify and seek guidance on which local self-help groups, condition-specific patient groups, carers groups, support groups, children’s trusts, advocacy groups, housing trusts, charities, parents and toddlers groups, community and residents’ groups can help us to reach people and make sure their voice is heard.

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5.0 Monitoring, Evaluation, Reporting and Assurance For any communications, engagement and involvement strategy or plan produced to support any programme or project, there should therefore be a common ‘check list’ of questions for the purposes of monitoring, evaluation, reporting and assurance: •

• • •

•

Does it fulfil the CCG’s legal obligations (including those imposed by the NHS Constitution)? and Is it consistent with other policy guidance? and Is it aligned with the CCG’s vision and values? and Does it actively support the delivery of one or more of the CCG’s aims and objectives? or Does it actively support the delivery of one or more of the aims and objectives in a programme or project in which the CCG is a partner?

Assurance would be in the form of positive answers to all these questions, supported by clear evidence and a robust audit trail. Ongoing evaluation of our engagement and communications activities will help us to: • • •

learn how well communication and engagement systems work and how they can be improved monitor if the systems are functioning to an acceptable standard hold ourselves up to scrutiny by internal and external stakeholders.

Dudley CCG has 10 values, 2 of which state: •

•

We will be a learning organisation (we will have a philosophy of accepting the past, forgiving and moving on. We will support individual learning. We will be outward looking. We will support and empower staff. We will actively listen and learn from others) We will work together as teams within the organisation and with partners (sharing good practice, improving integration, taking shared pride in work, winning hearts and minds to work collaboratively)

The CCG will develop a culture that is facilitative towards reflective practice and builds on a shared vision of empowering and collaborative communication and engagement. Evaluation will take place through a combination of quantitative and qualitative methods including: • • • • •

Ongoing media evaluation Patient surveys Website usage statistics Internal communications audits Patient, staff and stakeholder feedback, including compliments, comments and complaints.

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•

• •

Annually we will prepare a report on consultations carried out (duty to report), and on the influence that the results of the consultations have had on our commissioning decisions. Linking in closely with patient experience Strengthening relationships with our Overview and Scrutiny Committee & Healthwatch Dudley.

Activities relating to this strategy will be reported through relevant committees and to Board via the Public Update Paper.

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Appendix 1 Legal, regulatory and policy guidance which informs the CCG’s communications, engagement and involvement activity. Health and Social Care Act The statutory duties on NHS bodies are set out in the NHS Act 2006 (as amended by the Health and Social Care Act 2012) CCGs are governed by section 14Z2 of the 2006 Act, the most relevant parts of which state: (1) This section applies in relation to any health services which are, or are to be, provided pursuant to arrangements made by a clinical commissioning group in the exercise of its functions (“commissioning arrangements”). (2) The clinical commissioning group must make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information or in other ways): (a) in the planning of the commissioning arrangements by the group, (b) in the development and consideration of proposals by the group for changes in the commissioning arrangements, where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and (c) in decisions of the group affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact. Similar duties are imposed on NHS Trusts and Foundation Trusts by section 242 of the 2006 Act; and on NHS England by section 13Q of the 2006 Act. For Dudley CCG the core duty is for us to have made arrangements to ensure public involvement. The arrangements that we are required to put in place must secure the involvement of people who “may” use services as well as those who currently do. So, in terms of the section 14Z2 statutory duty, what matters is the “arrangements” that we have made. We are required (by section 14Z2(4))to have regard to guidance published by NHS England when discharging this duty. We are also required, by section 14Z2(3), to include in our constitution a description of the arrangements that we have made, and a statement of the principles we will follow in implementing those arrangements. Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013: Part 4: Health Scrutiny by Local Authorities including Regulation 23 which describes the CCG’s duty to consult with local authorities (through Overview and Scrutiny Committees or other forums as appropriate) on proposals for substantial variation in the provision of local services. Planning, Assuring and delivering service change for patients: (NHS England, November 2015) 7

7

https://www.england.nhs.uk/wp-content/uploads/2015/10/plan-ass-deliv-serv-chge.pdf

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Clinical Commissioning Groups are under a statutory duty to have regard to this guidance, which sets out the required assurance process commissioners follow when conducting service reconfiguration. Its purpose is to provide support and assurance to ensure reconfiguration can progress, with due consideration for the four tests of service change which the government mandate requires NHS England to test against. It also covers the agreed levels of assurance and decision making required for significant service change which the NHS England board ratified in May 2015; key themes of service reconfiguration; and the assurance process. Case Law – the ‘Gunning Principles’ These propositions were originally put forward in the case of R v.Brent London Borough Council, ex parte Gunning (1985) and were subsequently approved by the Court of Appeal in the case of R v. North and East Devon Health Authority, ex parte Coughlan [2001]. They summarise what makes a ‘fair’ consultation, namely that: • • • •

Consultation must take place when the proposal is still at a formative stage; Sufficient reasons must be put forward for the proposal to allow for intelligent consideration and response; Adequate time must be given for consideration and response; and The product of consultation must be conscientiously taken into account.

Policy •

•

•

The Five Year Forward View (October 2014) and supporting publications, including ‘The Five Year Forward View – Time to Deliver (June 2015), are key policy documents setting out the strategic direction of travel for the NHS in England up to, and beyond, 2020. At the heart of the Five Year Forward View (FYFV) is a recognition that the NHS needs to change if it is to meet the challenges posed by a growing, ageing population, more people living with long term conditions like diabetes, new technologies and treatments and an increasing funding gap. The FYFV supports innovation, radical change and locally-driven solutions (within defined limits). Dudley CCG was one of the organisations nationally to succeed in a bid for ‘Vanguard’ status, making Dudley one of the first health and care systems in the country to trial one of the new models of care proposed in the FYFV.

Vanguard – New Models of Care in Dudley Following our successful bid for Vanguard status we are now moving ahead at pace with our person centred, Multispecialty Community Provider (MCP) model. Through our conversations with the public and other key stakeholders, we have identified four key requirements: • better communication both to people and between staff; • improved access to consultation and diagnostics: • continuity of care in supporting the management of their long term condition(s); • effective coordination of care for the frail elderly and those with complex conditions.

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To respond to this the focus of our model of care builds on a joined up network of GP-led, community-based multi-disciplinary teams which enable staff from health, social care and the voluntary sector to work better together. The support for developing and implementing this model is also underpinning our work towards a complementary process of developing standardised best practice pathways of care. Through this we will ensure that all services provided outside of the MCP are commissioned in a way which incentivises optimum outcomes for the patient, maximises efficiency and enables effective communication back with the GP. In addition we continue to redesign urgent care services, building on a successful single point of entry to the service through the opening of the Urgent Care Centre in April 2015. This new way of working brings together Dudley CCG, General Practitioners (GPs), the local authority (Dudley Metropolitan Borough Council) and our main providers (Black Country Partnership NHS Foundation Trust, Dudley Group NHS Foundation Trust, Dudley and Walsall Mental Health Partnership NHS Trust) as well as Dudley Council for Voluntary Services (DCVS). The Vanguard is one example (although by no means the only one) of why a ‘one size fits all’ approach to communications, engagement and involvement is no longer feasible. Increasingly, communication strategies and plans will be developed to meet the needs of a particular programme or project – but the principles set out in this strategy will run through them all.

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Appendix 2 Our Pledge to Dudley People • • • • • • • •

By giving the right information, at the right time in the right way By listening to what you tell us and taking the time to hear what you are saying By making it easy for you to get in touch with us By working with partners to give you the skills, knowledge and confidence you need to participate By being transparent in our decision making processes By recognising and valuing your contributions By learning to appreciate and make better use of what we already have in our communities By feeding back to you – even if it is a difficult conversation

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Appendix 3 Dudley CCG Brand Positioning Dudley CCG needs to clearly identify its visions, aims, and identity, creating a platform that underpins all engagement and communications activity. The positioning helps us to outline the engagement vision and aims of the clinical commissioning group, as well as starting to identify the audiences and key engagement messages. It has been informed by the overall vision of the CCG (see organisational development plan) so there is consistency with the group’s overall aims. The CCG brand identity focuses on health service development led by clinicians and informed by Dudley people, and the relationship between clinicians in the health economy. This basic understanding of the CCG position is already helping to frame communications messages. The brand positioning has also enabled us to develop a visual identity and brand guidelines for the CCG. We will be producing a communications toolkit with templates for posters, newsletters and other materials to be shared with staff and with GP practices. Brand positioning What we do? Scope: What area of activity are we in? Working with you to promote good health and ensure high quality health services in Dudley. Status: What status do we want to achieve? Health service decisions led by Clinicians and informed by the people of Dudley Why we do it? Ambition: What is our heart-felt ambition? Healthier lives for the people of Dudley Ethos: What are the principles behind our actions? Passionate about your health Compassionate about your care Supportive of local services for local people How we do it? Style: How do we go about our business? Thinking differently/ giving things a new perspective Clinician to clinician supported by managers Reaching out to everyone Focused on you Simple and straight forward/ plain talking Response: What impression do we want to create? I’m heard, My views are represented to, I’m healthier, I’m cared for Focus: Our basis for making decisions The best results for people in Dudley

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Appendix 4- An engagement question checklist i.

Are you clear what the future will look like if the proposals are implemented? • Is there a clear rationale for doing this? • Is it clear who will be affected by the proposals – this the starting point for identifying who to engage with (eg a small group or wider implications for all people – see iv below) • What will the future look like from a patient’s perspective – put yourself in their shoes. Remember the IRP’s critical list especially the three issues most likely to excite local opinion – money, transport and emergency care. • Are you clearly distinguishing unavoidable drivers (eg financial imperatives) from the clinical evidence or considerations for enhanced patient experience and safety? • What does the data tell us and how robust is it – is it clear and unequivocal? How would we explain complex data/information to the general public?

ii.

What is positive about the change? • Is there a good news story to tell? • How can we assuage any fears or negativity about the change? • What reassurances can we offer?

iii.

Who needs to be involved? • Stakeholder analysis will help to identify who needs to be engaged and the mechanisms of engagement available. If a proposal affects a distinct group of people then the focus of engagement will be with them. If there are wider implications, then the engagement can include specific groups as well as representative forums (eg Healthcare Forum, LINk); or reference groups (eg: Service User Network; Registered users on Your NHS Dudley). • Are you clear what influence people can have on the proposals and any decisions to be made? ie what can and what can’t change?

iv.

Check the principles of engagement – does the intended engagement process cover all these adequately? • Especially be clear about if there are real choices on offer?

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Appendix 5- Media Management Dudley CCG is committed to being open and honest. One of the best ways to do this is via the media. We therefore have put a responsibility on ourselves to inform the media about health services, changes to services, the policies of the organisation and the way it works. All members are committed to promoting the work that we do internally and externally. The majority of the public hold opinions on the local and national NHS based largely on media reporting, so good relationships with the media are essential. Messages delivered through the media are seen as independent and more credible than advertising or corporate publications and they are a free resource. Whilst we have less control over the message or its timeliness it is a communications channel which is trusted and reaches a large population. The CCG will take a very proactive stance with media relations and is already successfully engaging with local journalists to promote positive health stories and to ensure correct, balanced and fair reporting of issues. A key part of our communications is therefore to ensure that any local health achievements are highlighted in the local press. Building on the enhanced relationship that our communication colleagues have with the local media is key. Their well developed relationships have resulted in most enquiries being centralised but in some instances where unfamiliar reporters are seeking information we recognise that reporters may come direct to a department or individual member of staff. In these cases advice and support is available from the Communications Team and media training is provided for staff. As the CCG is clinically led it is preferable for a clinician or other representative to front media stories, full media briefing will then be available prior to interview. We are actively building a bank of representatives who can talk on a range of subjects promoting the work of the CCG and the services which we commission.

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Appendix 6- Stakeholder map High

Involve

Partner

Professional media i.e. HSJ and Pulse NHS England National Media Local Media Practice Managers West Midlands ambulance Service Local Medical Committee Health and Wellbeing Board Health Overview & scrutiny Committee Membership of Provider organisations

Power

Local media Fellow members of Partnership Board GPs Service user representatives Healthwatch Dudley Health & Care Team leaders Public Health Dudley NHS England New Models Team

Inform Schools Community & voluntary groups

Consult Dudley public MPs Local Councillors

Local Pharmaceutical Committee Local Dental Committee Patient Members Local Ophthalmology Committee Care/Nursing Homes Staff Neighbouring CCGs Neighbouring providers Neighbouring Local authorities

Low

Low

Interest

High

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Appendix 7- Channels for key audiences Stakeholder Group Service users, carers, families

Risks / opportunities Risks of poor engagement • Complaints / concerns • Media activity • Disengage from services Opportunities • Feedback and contribution • Be ambassadors for the programme • Help shape our services

Children and Young People

Staff

Risks of poor engagement • Complaints / concerns • Disengage from services Opportunities • Feedback and contribution • Be ambassadors for the Trust • Help shape our services Risks of poor engagement • Demotivation • Feeling undervalued • Critial of the programme objectives to others • Focus on the wrong things • Poor productivity • Absenteeism Opportunities • Ambassadors for the new ways of working • Develop new ways of working / innovators • Promote the work of the MCP to others • Promote Dudley as a great place to work

GPs

Risks of poor engagement • GPs take leave the system because they feel the programme will not support them with increasing workforce challenges • Members feel like they don’t have the opportunities to get involved Opportunities • Ambassadors for new model • Attracting more GPs to work in Dudley

Current and future comms and engagement plans Current channels • Healthcare Forum • Mental Health Forum (quarterly) • One in 4 magazine (quarterly) • National and local surveys • Trust Information - Patient screens / Patient leaflets • Patient experience • Community events / national awareness days • Websites • Twitter feeds • Facebook Pages • Media/press coverage • Publications • Mobile Apps • Tea and chat • Envisage screens in GP practices Current channels - As above plus • •

Healthwatch youth workers #mefestival

Current channels • • • • • • • • • •

Staff survey / Staff FFT Board meetings AGM Website Media coverage Publications Twitter Mobile Apps Team meetings and briefings Intranet site

Current channels • • • • •

Membership meetings CCG news (weekly) Locality Meetings GP education events Practice visits

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• NHS England New Models Team

More co-ordinated and streamlined patient journey Risks of poor engagement • National team not aware of our progress towards new model • Dimissied support to delive our programme • Missed promotional oprtunities

• • • •

Involvement & participation in national work streams Participation in teleconferences Attendance at events Expo

Opportunities • Support • Funding • Sharing best practice

Press and media

Local Council, MPs and councillors

Risks of poor engagement • Negative media coverage • Limited understanding of new model of care • Information sourced from inaccurate sources • Story grows into wider issues Opportunities • Tell our story • Gather support for new model • Highlighting case studies • Recognition • Raising our profile wider Risks of poor engagement • PMQ's (Prime Minister’s questions) • Often asked to comment by the media • Can often cause delay to processes Opportunities • Ability to publicly support the programme • Political influence • Frequent contact with constituents and the media

Current channels • Media presence at public meetings • Pro-active press releases • Features/interviews/case studies • Photocalls and event invites • Reactive press statements • Publications • Twitter • facebook

Current channels • Overview and scrutiny committee • MP briefings with CEOs / Chairs • Invitation to events • Website • Press / Media coverage

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 2016 Report: Corporate Objectives Update Agenda item No: 7.2 TITLE OF REPORT:

Corporate Objectives Update

PURPOSE OF REPORT:

To update the Board on the achievement of the CCG’s corporate objectives.

AUTHOR OF REPORT:

Mr M Hartland, Chief Operating and Finance Officer

MANAGEMENT LEAD:

Mr P Maubach, Chief Executive Officer

CLINICAL LEAD:

Dr D Hegarty, Chair

KEY POINTS:

1. Update to Corporate Objectives agreed by Board in May 2015 2. The schedule is structured to map to the Corporate Objectives they are intended to deliver 3. Most updates relate to assurance provided to the Board via regular updates from Committees 4. NHS England no longer requiring a business plan to be produced for Primary Care

RECOMMENDATION:

1. To receive the report for assurance


None


None

ACTION REQUIRED:

Decision Approval  Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MARCH 2016 CORPORATE OBJECTIVES UPDATE

1.0

INTRODUCTION

1.1

At its meeting in May 2015 the Board approved the CCG’s Corporate Objectives for 2015/16 and was advised when it could expect to be asked to make strategic decisions and receive assurance throughout the year. Additionally the paper outlined the risk management approach to the delivery of these objectives.

1.2

The appendix listing the Corporate Objectives for 2015/16 now includes a summary update to provide assurance to the Board on the progress made to date.

1.3

The schedule has been structured to map to the ‘actions’ required by the Corporate Objectives they are intended to deliver, as described in the CCG’s 2015/16 Operational Plan, namely: 1. 2. 3. 4.

Reduce health inequalities Deliver the best quality outcomes Improve quality and safety Secure system effectiveness

1.4

The CCG is assessing contractual options in relation to the New Model of Care with Monitor and the New Models team. The outcome of this will influence 2016/17 contracting round (and beyond), the CCG’s procurement strategy and outcome objectives.

2.0

DECISIONS REFERRED TO THE BOARD

2.1

None

3.0

RECOMMENDATION

3.1

The Board is requested to: • •

Receive the report for assurance Note that a further update will be presented to the Board in March

APPENDICES Corporate Objectives 2015/16 – Update February 2016 Mr M Hartland Chief Operating and Finance Officer February 2016

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APPENDIX 1 Corporate Objectives 2015/16 – Update February 2016 Deliverable / Action Implementation of the CCG’s 2015/16 operational plan Implementation of the Vanguard programme and the new models of care Ensuring the public voice is integral to the decisions of the Board

Corporate Objectives*

Committee

Reporting to Board

All

Clinical Development (CDC)

Every Board

Included within Strategic Intent paper to September Board. Updates via CDC

All

Partnership Board

Every Board

Individual report to each Board from Partnership Board with progress.

1, 2 and 4

CCG Board

Every Board

Implementation of the Better Care Fund arrangements

1 and 2

Integrated Commissioning Executive (ICE)

Every Board

Implementation of the CCG’s primary care strategy

2

Primary Care Commissioning (PCC)

Every Board

Achievement of 2015/16 QIPP and service line budgetary control

2


Every Board

Achievement of 2015/16 budgetary control in Primary Care

4


Every Board

Finance and Performance (F&P)

2015/16 contracts: July

Ensuring appropriate contracts in place for all commissioned services

2 and 4

2016/17 contracts: Jan

Delivery of a robust financial plan and compliance with financial duties

2


Financial compliance: Every Board

Agenda Item 11.1

Summary Update

7.4

5.1-5.3

Regular ‘Public Update’ to each Board. Individual report to each Board. Implementation in line with expectations. Performance element underwriting agreed November Board subject to due diligence. Section 75 Agreement signed off. Board updated via report from PCC Committee. Board updated via report from Committee. QIPP forecast to achieve in total but 2 significant schemes not on target although position improved. Board updated via report from Committee. PCCC delegated budget forecast to breakeven. Report presented to July Board. All 15/16 contracts agreed & signed Plan for 2016/17: Draft contracts received Feb 16, final expected mid-late March. Finance schedule to be split MCP/non MCP subject to agreement of services in scope. Work continues on draft MCP contract with NCM team Board updated via report from Committee. 15/16 financial duties forecast to be achieved.

11.2

12.1 11.1

12.1

10.1

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Deliverable / Action

Ensuring provider adherence to contract terms and performance Ensuring provider adherence to appropriate quality and safety standards


4

3

Committee

Finance and Performance (F&P) Quality and Safety (Q&S)

Reporting to Board Refresh Longterm financial plan: February 2016/17 Budget plan: March Every Board

Every Board

Ensuring Primary Care provider adherence to contract terms, quality standards and performance

2, 3 and 4


Every Board

Ensuring provider delivery of high quality patient experience

2 and 3

Quality and Safety (Q&S)

Every Board

Ensuring the effectiveness of our workforce through our HR policies and procedures

Implementation of our IT strategy

Estate strategy for redesigning the estate and its use

2

Remuneration Committee

2 and 4

Finance and Performance (F&P) – link to Partnership Board

2 and 3

Finance and Performance (F&P) – link to Partnership Board

Every Board

Every Board

September

Agenda Item

Summary Update LTFM Feb 16: Allocations published January. LTFM updated February. To be presented to Board 31 March Budget book 31 Mar 16: in progress Board updated via report from Committee. Contract mechanisms adhered to and penalties applied. Board updated via report from Committee. Robust CQRM’s with providers and active management of issues as arise. Board updated via report from Committee. Committee receives assurance from Primary Care Operational Group - no significant performance issues or contractual breaches; new performance reporting tool developed. Board updated via report from Committee and ‘Public Voice’. Committee considers quarterly detailed reports. Board updated via report from Committee. All policies updated for 15/16 and compliance, metric performance and appropriate actions managed by Committee. Board updated via report from Committee. In progress to achieve objectives in 15/16, noting increasing IT agenda. Procurement process to commence for IT provider. Board updated via report from Committee. Health Infrastructure Strategy v1 presented to Board in September 2015. v2 presented to CHP December To present to Board 31 March.

10.1

8.1

12.1

5 & 8.1

9.4

10.1 & 7.4

10.1,& 7.4

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Deliverable / Action Performance framework for the BCF and new models of care

Plan for reinvestment of PMS resources Refresh future outcome objectives based on JSNA Refresh procurement strategy – approach to cooperation vs competition Produce proposals for piloting incentives for commissioning pathways of care

Corporate Committee Objectives* 1, 2 and 4 Finance and Performance (F&P) – link to Partnership Board & Integrated Commissioning Exec (ICE)

Reporting to Board

July

Summary Update Board updated via reports from Finance & Performance Committee, Partnership Board and Integrated Commissioning Executive. Framework in place and reporting to DMBC and CCG Committees. Detailed reporting at MDT level being trialled. Board updated via report from Committee. Incorporated into new Long Term Conditions Framework to be implemented wef April

12.1

7.3

1, 2 and 3


December

2


July

To be included in 16/17 Operational Plan

31 March

The CCG is assessing contractual options in relation to the New Model of Care with Monitor and the New Models team. The outcome of this will influence the 2016/17 contracting round, our procurement strategy and outcome objectives.

Proposals for consultation: September outstanding Sign off for implementation: January – outstanding

In progress – linking to LTC framework templates

November

Presented to November Board. Public Consultation 1 – 29 February 2016.

September

To be reported to a future Partnership Board.

N/A

No longer required by NHS England

Proposals for consultation:

Consultation commenced August 2015.

2

2 and 3

2016/17 Commissioning intentions

All

Medicines and Consumables whole system strategy

2 and 3

Primary Care Business plan

1 and 2

Develop new LTC framework / GP contract for 2016/17

1 and 2


Clinical Development (CDC) – link to Clinical Strategy Board

Clinical Development (CDC) Clinical Development (CDC) – link to Partnership Board Primary Care Commissioning (PCC) Primary Care Commissioning (PCC)

Agenda Item 10.1, 7.4 & 11.2

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Deliverable / Action

Workforce development strategy for a new competency-based workforce New 2-year operational plan and update to Strategy


Committee

Reporting to Board September

Summary Update

Sign off for implementation: January

Final sign off January for April 2016 commencement.

2

Quality and Safety (Q&S) – link to Partnership Board

November

In progress

All

CCG Board

January

Board 10 March 2016

Agenda Item

7.3

Corporate Objectives* 1) 2) 3) 4)

Reduce Health Inequalities Deliver the best quality outcomes Improve quality and safety Secure System Effectiveness

* Corporate Objectives Taken from Operational Plan 2015/16 approved by Board in March 2015 The CCG is assessing contractual options in relation to the New Model of Care with Monitor and the New Models team. The outcome of this will influence the 2016/17 contracting round, our procurement strategy and outcome objectives.

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 2016 Report: CCG Draft Operational Plan 2016/17 Agenda item No: 7.3 TITLE OF REPORT:

CCG Draft Operational Plan 2016/17

PURPOSE OF REPORT:

To approve the draft Operational Plan for 2016/17

AUTHOR OF REPORT:

Mr N Bucktin, Head of Commissioning

MANAGEMENT LEAD:


CLINICAL LEAD:

Dr S Mann, Clinical Executive Acute and Community Services 1. In accordance with the national planning guidance the CCG is required to submit its Operational Plan for 2016/17. 2. This plan will form year 1 of a 5 year “Sustainability and Transformation Plan” (STP) 3. The national planning guidance sets out a series of “must dos” which are reflected in the draft Operational Plan. 4. The prime focus is on developing and commissioning the CCG’s new model of care – the Multi-Speciality Community Provider (MCP). 5. The requirements of the planning guidance are reflected in contracts currently being negotiated with the CCG’s main providers. 6. The CCG is required to conclude its contract negotiations by the 31 March 2016 and a final version of the Plan must be submitted to NHS England by 11 April 2016.

KEY POINTS:

RECOMMENDATION:

That the draft Operational Plan for 2016/17 be approved


The financial implications of the plan are addressed in the CCG’s financial plan

WHAT ENGAGEMENT TAKEN PLACE: ACTION REQUIRED:

HAS Subject to the Board’s approval, a one month consultation process will take place Decision Approval  Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MARCH 2016 CCG DRAFT OPERATIONAL PLAN 2016/17

1.0

PURPOSE OF REPORT

1.1

To approve the draft Operational Plan for 2016/17.

2.0

BACKGROUND

2.1

The Board will recall that at its meeting in January 2016, it received a presentation on the key requirements of the national planning guidance.

2.2

This requires the production of a five year Sustainability and Transformation Plan (STP) and a one year Operational Plan. The Operational Plan is intended to inform year one of the STP.

2.3

Discussions have taken place with NHS England regarding the “footprint” for the STP and it was agreed that this will be at a Black Country level.

2.4

This report sets out the main issues addressed in the Operational Plan attached as Appendix 1.

3.0

EXISTING STRATEGY AND PLANS

3.1

The Board will recall that the CCG’s existing strategic vision “to promote good health and wellbeing and ensure high quality services for the people of Dudley” is based upon 3 objectives:• • •

3.2

reduce health inequalities deliver the best possible outcomes improve quality and safety

In addition, our agreed strategic intent describes 4 particular types of care which patients may require, all of which are designed to deliver the objectives above:• • • •

planned care urgent care reablement care preventative care

3.3

In addition, we commission for vulnerable groups – children, the elderly, people with mental health problems and people with learning disabilities.

3.4

Our existing plans are also informed by and consistent with the Joint Strategic Needs Assessment (JSNA) and the Joint Health and Wellbeing Strategy (JHWS). They reflect the JHW’s priorities of: • • • •

making our services healthy making our lifestyles healthy making our children healthy making our neighbourhoods healthy

3.5

Our approach to planning for 2016/17 is also based upon our commissioning intentions published in September 2015, which set out the basis upon which we intend to commission our new model of care with effect from the 1 April 2017.

3.6

The Operational Plan has been developed against the background of these existing plans and strategies as well as the national planning guidance.

4.0

COMPREHENSIVE SPENDING REVIEW

4.1

The Board will recall that as a result of the Comprehensive Spending Review (CSR) there is a requirement placed upon the NHS to : • • • •

implement the Five Year Forward View restore/ maintain financial balance deliver core access and quality standards close the “gaps” – health and wellbeing, care and quality, finance and efficiency.

4.2

This Operational Plan represents the CCG’s contribution to that process.

5.0

MUST DOS

5.1

The 9 must dos set out in the planning guidance and addressed in the Operational Plan are as follows: • • • • • • • • •

deliver the STP deliver financial balance provide a local plan for the sustainability and quality of general practice meet A&E and ambulance waiting/ access standards meet referral to treatment times standards meet 62 day cancer waits standard and improve 1 year cancer survival rate achieve and maintain new mental health standards for early intervention in psychosis and IAPT and the dementia diagnosis rate enhance community provision and reduce inpatient capacity for patients with learning disabilities develop and implement an affordable plan for improvements in quality

5.2

These 9 requirements are all addressed in the plan.

6.0

NEW CARE MODEL

6.1

The centre piece of the Operational Plan is the development and commissioning of our new care model – the Multi-Speciality Community Provider (MCP). Key features of the MCP include:• • • • • • •

integrating health and social care services at practice level developing and enhancing primary care commissioning services as an alternative to secondary care admission integrating physical and mental health care commissioning best care pathways for planned care and urgent care enhancing community and voluntary sector provision developing an effective relationship with citizens and service users

6.2

A number of features of the care model meet the requirements of the national planning guidance.

7.0

CLOSING THE “GAP”

7.1

The plan also identifies a number of initiatives designed to close the health and wellbeing care; quality and finance; and efficiency gaps.

7.2

In particular, the plan identifies a number of targets in relation to specific health and wellbeing issues identified in conjunction with public health. These cover alcohol, smoking and obesity. In addition, the Board will be aware of the contribution that we anticipate the new primary care contractual framework will make in these areas.

8.0

NEXT STEPS

8.1

Discussions are still taking place with our main NHS providers regarding the contractual arrangements we will enter into for 2016/17. The national deadline dictated that contracts must be

signed by 31 March 2016, however the contract will not be published by NHS England until 18 March at the earliest. 9.0

RECOMMENDATION

9.1

That the draft Operational Plan for 2016/17 be approved.

Mr N Bucktin, Head of Commissioning March 2016

Appendix 1

Developing and Commissioning a Sustainable Model of Care Operational Plan 2016/2017 Version

1

CCG Strategic Commissioning Plan

–

Initial

Draft

March

2016

1 |Pag e

0|Page

Contents Page

Item

3

Background

6

Dudley CCG Operational Plan

7

Vision, Objectives and Strategic Intent

8

Our 6 Key Principles

9

5 Year Vision

10

The Challenges

10

System Challenges

10

Financial Challenges

11

Performance Challenges

12

Health Status and Health Inequalities

14

Our Assets

14

JSNA – Key Messages and Actions

16

Prevention

25

Community Engagement

26

Clinician Engagement

26

Our Outcome Ambitions

26

Securing Additional years of Life for People with Treatable Conditions

27

Improving Quality of Life for 15m People Nationally with One or More Long Term Conditions

28

Reducing Time Spent Avoidably In Hospital Through More Integrated Community Care

28

Increasing Proportion of Older People Living Independently At Home After Discharge

29

Increasing People’s Positive Experience of Hospital Care

30

Increasing Number of People with Positive Experience of Care In General Practice and In Community 1|Page

30

Progress Towards Eliminating Avoidable Deaths In Hospital

30

Commissioning for Quality and Safety

31

Francis, Berwick and Winterbourne View

32

Staff Satisfaction

32

Patient Safety

34

Seven Day Services

34

Compassion in Practice and the 6 Cs

35

Provider Cost Improvement Programmes

38

Parity of Esteem for People with Mental Health Problems

42

Children’s Services

43

Our Key Priorities 2016/17

43

Impact on Providers

44

System Characteristics for Transformation

44

A new Model of Care

47

Citizen Participation and Empowerment

52

Wider Primary Care Provided at Scale

55

A Modern Model of Integrated Care

61

Our Better Care Fund Plan

62

Access to Highest Quality Urgent and Emergency Care

66

A Step Change in Productivity of Elective Care

70

Specialised Services Concentrated in Centres of Excellence

71

Innovation

73

Effective Information Management

73

Governance and Performance

75

Deliverability

77

Appendix 1

79

Glossary 2|Page

Dudley Clinical Commissioning Group Operational Plan 2016/17 Developing and Commissioning a Sustainable Model of Care Background In February 2014, the CCG approved its Operational Plan for 2014/15 – 2015/16. This was refreshed for a further year as part of the CCG’s original Strategic Plan. This Operational Plan now represents the first year of what will become our Sustainability and Transformation Plan (STP) both for Dudley and the wider Black Country footprint as agreed with NHS England. This plan is designed to:build on our achievements in implementing our plan for 2015/16; implement our plans heralded in our commissioning intentions for 2016/17 and 2017/18; fully implement our new Dudley model of care, establishing integrated health and social care services with primary care at its heart; reflect the work we are doing as the local leader of the NHS, in conjunction with our NHS providers, our local government partners and the voluntary/community sector; meet the expectations placed upon us through the national planning system; take us to the next step in our development as a clinically led commissioning organisation, responding to the significant clinical, service and financial challenges of the coming years. We have already engaged our stakeholders in the planning process through:• • •

•

discussing proposals with our GP membership on a regular basis; engaging with patients and the public through our Health Care Forum and Patient Participation Groups; sharing the key requirements of the planning guidance and our emergent plans with the Health and Wellbeing Board and the Overview and Scrutiny Committee; seeking the Health and Wellbeing Board’s support for key system changes including our plans for our new care model and the Better Care Fund;

3|Page

•

sharing our plan with our three NHS service providers, our local government partners and the voluntary sector, through our System Resilience Group.

This engagement lies at the heart of our value system and will continue as our plans are developed and implemented. In the sections below we have:• • •

•

reaffirmed and developed our objectives; identified the financial performance, and health challenges we face. explained how our commissioning priorities will position us to have a sustainable local health and care system, centred upon the delivery of a new model of care – a Multi-Specialty Community Provider (MCP) - and meeting our vision for population health and wellbeing; demonstrated how we will ensure we meet the highest standards of quality and patient safety.

We have demonstrated how we will:• • •

reduce the health and wellbeing gap reduce the care and quality gap reduce the funding and efficiency gap

We have described how we will deliver the 9 national “must dos”. 1. developing and agreeing a STP, with this plan being year 1 of the 5 year STP. 2. delivering aggregate financial balance. 3. ensuring the sustainability and quality of general practice. 4. achieve A and E and ambulance access standards. 5. improve and maintain the 18 week referral to treatment target. 6. deliver the cancer waiting standards and improve one year cancer survival rates through improved diagnosis. 7. achieve and maintain the first episode of psychosis and IAPT access standards, continue to meet a dementia diagnosis rate of two-thirds of the estimated number of people with dementia. 8. transform care for people with learning disabilities. 9. make improvements in quality. The main focus of our plan is to develop and commission the MCP in a manner that is consistent with the “5 principles” that support the delivery of the Five Year Forward View:• • • •

care and support is person-centred: personalised, coordinated and empowering; services are created in partnership with citizens and communities; there is a focus is on equality and narrowing health inequalities; carers are identified, supported and involved; 4|Page

• •

voluntary, community, social enterprise and housing sectors are key partners and enablers; volunteering and social action are key enablers.

5|Page

PLAN ON A PAGE TO BE UPDATED

6|Page

1. Vision and Objectives a) Our Vision Our vision is “to promote good health and wellbeing and ensure high quality health services for the people of Dudley” Our objectives which underpin this are to:• reduce health inequalities; • deliver the best quality outcomes; • improve quality and safety; • secure system effectiveness. b) Strategic Intent Our strategic intent is based around four particular types of care which patients may require, each of which displays separate characteristics but w h i c h u l t i m a t e l y contribute to the objectives above. These are:• •

• •

planned care – to deliver quick, reliable, value added interventions at a time and place of the patient’s choice; urgent care – to deliver value added interventions in a crisis, where the capacity available is appropriate to the presenting need and each part of the system has a clear, distinct and exclusive role; reablement care – to deliver an integrated system, where people regain independence in the least restrictive setting possible; preventative care – to empower people to take as much care of themselves as possible, in partnership with appropriate professionals, so that their level of clinical risk is reduced and their overall wellbeing enhanced.

In addition, we commission care for certain vulnerable groups – children, the elderly, people with mental health problems and people with learning difficulties. Their needs tend to be complex, variable over time, involve the input of social care, the third sector and other bodies. Such services have a focus on health and wellbeing. We will create specific programmes tailored to their needs. Our new service model will be designed to deliver these categories of care. This represents our strategic intent and is reflected in our plan.

7|Page

c) Our 6 key Principles Since inception, the following 6 key principles have informed the work of the CCG:i)

Patient and public involvement

The meaningful involvement of patients and public is of paramount importance. Throughout the NHS, the patient is usually the coordinator of their care. It is key that contact with healthcare professionals adds clinical value. We believe this contact must be re-aligned, from a hierarchical dialogue ‘expert to receptive patient’, to a horizontal dialogue ‘expert to expert’. Patients/families are most knowledgeable about their symptoms, bodies and psychological and social state. This self-expertise remains an under-tapped resource that if accessed will transform healthcare and well-being. Supporting autonomous living is of paramount importance. However when people do use healthcare we want them to have clearer information about the quality of services in order to inform their choices; and we want them to be better able to share whether services are working for them. ii)

Clinically Led

The public register with their GP and it is through the coordination that their GP provides, that they are able to best access the healthcare that they need. So our future health system will be organised around this key relationship between patient and their GP; providing a personalised service. Similarly, all population-based healthcare will be commissioned on a registered-population basis and will be organised in accordance with our GP and CCG structures (so around practices, localities and borough-wide) in order to enable a clear clinically-led approach to healthcare delivery.

iii)

Primary Care at our heart

The vast majority of care is either delivered by General Practice or is accessed through it. The success of primary care is therefore central to the future success of our health services locally. We have already developed a primary care strategy, in conjunction with the Health and Wellbeing Board and NHS England. There are significant recruitment and retention challenges for our primary care services so development of primary care infrastructure and workforce will be central components to our on-going work – we want Dudley to have a national reputation as the best place to work for GPs along with their extended primary care and community staff. We will continue to develop our shared commissioning of primary care with NHS England in order to ensure that this can be achieved. A sustainable primary care system lies at the heart of our new care model.

8|Page

iv)

Working with partners in our communities

Our locality-based approach to the Better Care Fund initiative recognises the need to network our GPs, patients and associated primary care/community services, social care and the voluntary sector in order to respond to the variable needs of different communities across our population. Health inequalities can only be addressed through a jointly targeted community-based approach. We will build our partnership relationships through the organisation of all of our services for all of our populations based on clinical need. v)

Focus on quality and continuous improvement

We will take a predominantly developmental approach to quality improvement that encourages transparency by all our service providers to reduce variations in care and outcomes; and to aim for best practice performance. We will expect every service to be able to demonstrate the value and quality that it provides to patients. We will utilise a continuous evaluation process that will ultimately ensure that we do not commission any service that cannot demonstrate value; and will actively promote those that can demonstrate best outcomes for patients.

vi)

Live within available resources

Dudley CCG will meet its financial responsibilities to address the reasonable needs of our population within available resources. This necessitates a drive for continuous efficiency and improvement given the economic constraints we face. Our emphasis will always be to maximise the effectiveness and availability of front-line services. d) 5 Year Vision In our o r i g i n a l 5 year strategic plan we applied these principles to establish a new vision for healthcare characterised by:•

•

• •

A Mutualist Culture – which recognises the mutual relationship between GP and patient and the associated rights and responsibilities in an organisation of member practices and registered patients. The Structure of The System – where we move away from traditional organisational boundaries and service categorisations to recognise the needs of individual patients in a modern world. Population Health and Wellbeing Services – commissioning proactive population based healthcare. Health and Wellbeing Centres for the 21st Century – providing the capacity to needed to deliver our vision of population health and wellbeing services.

•

Innovation and Learning – investing in research, technology and information systems as a basis for improving our organisational performance and the effectiveness of the system. 9|Page

These principles will be carried forward into our contribution to the Black Country STP and our local Dudley STP. We have agreed with our Black Country partners that the following areas will form the focus of the Black Country STP:• • • •

urgent and emergency care maternity services mental health developing the MCP

This CCG will take a lead for the MCP development element of the STP. The Dudley STP will be overseen by the Health and Social Care Leadership Group. This is led by the CCG and chaired by the CCG’s Chief Accountable Officer. It brings together:• • •

our local NHS partners; our local government partners – adult social care, children’s services and public health; our voluntary and community sector partners.

In conjunction with our adult social care partners, we intend to have in place plans to integrate health and social care by 1 April 2017 and this will be a key feature of our local STP 2. The Challenges a) System Challenges The key challenges facing the Dudley health and social care economy are:•

• • •

• • •

growing demand for healthcare from a population where, over the next two decades, the number of people over 65 will grow by 25,100 and the number over 85 by 9,900; the financial sustainability of our NHS partners; budgetary challenges facing Dudley MBC, in relation to public health, and adult social care and children’s services; the specific issue of budgetary pressures in adult social care and the potential impact on system equilibrium, affecting the ability to secure safe and timely discharges from hospital; need to secure effective transformation in leadership and cultural terms at a local level to ensure our new model of care is capable of delivery; need to secure full clinical engagement from clinicians across primary, community and secondary care; need for a system wide approach to system wide approach to information management and technology, including shared records and data sharing.

b) Financial Challenges The CCG’s financial plan for 2015/16 to 2020/21 has been constructed to deliver a 10 | P a g e

sustainable NHS in Dudley. The delivery of a financially sound health economy is, however, not without its challenges. The CCG will meet all of its statutory and local financial duties, delivering a planned surplus of £6.3m per annum. To achieve this, however, a QIPP programme has been developed that provides real, cash releasing savings as well as delivering improvements in productivity, outcomes and quality. The value of the internal QIPP programme (excluding provider tariff deflator) is £29.4m – MG TO CONFIRM over 5 years. The value for 2016/17 is £XXX. The main focus of initiatives in 2016/17 is a reduction in emergency/ED activity and the reducing the cost of elective care. This will be undertaken by 3 main initiatives: continuing the implementation a community rapid response service to reduce admissions to hospital through the Better Care Fund; the expansion of scope of the urgent care centre to triage patients arriving at ED by ambulance; and a number of initiatives to make elective care attendances at hospital more appropriate. There are also a number of separate qualitative schemes within the programme. A key task for the CCG and our providers, over the next 2 years is securing value for our patients whilst implementing our new model of care. Our commissioning intentions for 2014/2015 stated that we will only procure services from providers that actively demonstrate the value they provide for the patients they treat and this will continue for 2016/17. We will support providers in doing so and this is to ensure a continuous assessment of the efficiency of services used by GPs when making referral decisions. This will be done in a way, however, that does not detrimentally impact on any procurement required to implement the new model. In summary, the CCG is expected to meet its financial objectives over the planning period but will need to manage a number of key risks, the main ones being increasing financial instability in the provider sector nationally (and potential mandate from NHSE to utilise CCG reserves to support the sector); increasing demand; and not fully achieving a challenging efficiency programme, including the Better Care Fund. Mitigations have been identified to make sure the CCG meets its duties but the CCG intends to manage its finances to allow investment in the services outlined in our strategic plan over the next 5 years and to fully implement our new service model that will deliver long term financial sustainability in Dudley. c) Performance Challenges Our commissioning contracts with providers have been constructed to ensure that all NHS Constitution standards are met. There are specific performance challenges in relation to:• • • •

referral to treatment times for Urology, ENT, T and O; diagnostic waiting times for CT, MRI and non-obstetric ultrasound; waiting times for some community services including physiotherapy, phlebotomy and counselling; delayed transfers of care. 11 | P a g e

In order to address these, the following initiatives are being undertaken:• • • • •

we are working with Dudley Group NHS FT to review care pathways of ‘challenged specialties’ with the aim of improving the efficiency of the pathway to improve both 18 week performance and the patient experience; we are commissioning additional diagnostic capability; we are exploring the potential to shift to an ‘open-access’ model for physiotherapy and counselling services; we are actively working with all relevant bodies to improve the discharge of patients and this will be a key element of our Better Care Fund plan; we will continue to use all available mechanisms in contracts with providers to ensure they are held to account for their performance. This will be done with the aim of supporting providers to improve such performance to enable the delivery of high quality services to patients.

d) Health Status and Health Inequalities Dudley is characterised by significant health outcome differences between the most and least deprived parts of the Borough and bears the legacy of post industrialisation. Our JSNA sets out a number of key messages which have informed our plans and outcome ambitions as follows:• • • •

•

•

• • •

• •

nearly 20% of our population have a limiting long term illness or disability, this has increased since the 2001 census and is worse than the national average; the gap in life expectancy for the least and most deprived areas of Dudley has widened, mostly due to CHD, COPD and lung cancer in men; the mortality rate in the 60 -74 age band is significantly higher for males; female life expectancy is 82.7 years – similar to the national average, whilst male life expectance is 78.5 years – lower than the England average of 78.9; male life expectancy varies across Dudley. Halesowen South has the highest at 82.1 years, Netherton, Woodside and St. Andrews have the lowest at 73.9 years – a gap of 8.2 years; female life expectancy varies across Dudley. Belle Vale has the highest at 86.7 years, Castle and Priory has the lowest at 79 years – a gap of 7.7 years; nearly a quarter of deaths in the 40 – 59 age band are due to cardiovascular disease, smoking, obesity and lack of physical activity; mortality from respiratory disease is significantly higher than the national average. Lower respiratory tract infection is the major condition; mortality rates for alcohol related diseases are significantly higher than the national rate and the years of life lost in the under 75s from chronic liver disease, including cirrhosis, is significantly worse than the England average; emergency admissions for alcohol specific conditions increases from the 40-59 age group; 12.1 % of adults aged 16+ participate in sport for 30 minutes 3 or more times per week, showing a downward trend and below the national average of 17.4%; 12 | P a g e

• • • • •

• • • • • •

•

•

the percentage of people aged 16+ with a high BMI is is significantly worse than the England average; nearly two thirds of ED attendances are for people living in the 40% most deprived group in Dudley; the next two decades are forecast to see an additional 25,100 people over the age of 65 and an extra 9,900 over 85; uptake rates for both cervical and breast cancer screening are below the national target of 80%; disease prevalence rates as determined by primary care disease registers are low compared to modelled prevalence, however, these have improved – most markedly for COPD; the rate of delayed hospital discharge attributable to social care is higher than the national rate; the CCG is in the worst performing fifth of CCGs for the percentage of ED attendances that result in emergency admission; emergency admissions for gastroenteritis and lower respiratory disease are increasing for the 60 – 74 age band; emergency admissions for gastroenteritis in the 75+ age band are increasing; 20% of single person households are in the 60+ age group; with the ageing population there is an increasing number of older people who are carers of older people, or who are carers of adult children with learning or physical disabilities; the rate of deaths at home or in care homes has fallen from 53.05% to 51.9% but there is a higher percentage of terminal admissions that are emergencies than England; Marmot indicators show that Dudley has a higher rate for long term claimants of Job Seeker’s Allowance than the rest of England and a higher percentage of high fuel cost households in fuel poverty.

For our children and young people:• the infant mortality rate is 4.5 per 1,000 live births, compared to 4.3 for England and Wales; • male babies born in the most deprived areas of Dudley are up to 4 times more likely to die than those from the more affluent areas; • the percentage of pupils in school Reception and Year 6 with a healthy weight is significantly worse than the England average; • emergency hospital admissions for 0 – 4 year olds have risen. This is particularly prominent for lower respiratory tract infections in the most deprived areas; • the proportion of 9 and 11 year olds with a high self-esteem score has risen, though 25% of pupils reported bullying. The proportion of 13-15 year olds reporting being bullied has risen to nearly 20%; the CCG is in the worst performing fifth of CCGs for the rate of young people aged 0-18 with 3 or more mental health admissions per year; • the looked after children prevalence rate is significantly higher in Dudley and double the national rate; • smoking at delivery was 14.3% in Dudley, higher than both England and the West Midlands; 13 | P a g e

• Marmot indicators show that Dudley is significantly worse than the rest of England for children achieving a good level of development by age 5; the percentage of pupils achieving 5 or more GCSEs at grades A*-C; percentage of pupils eligible for free school meals achieving 5 or more GCSEs at grades A*- C; • breast feeding initiation rates at birth and at 6-8 weeks are lower than in England. These are also lower in the more deprived parts of Dudley and in younger mothers. “Commissioning for Prevention” suggests that in Dudley premature death is worse than average for:• cancer • heart disease • stroke • liver disease In addition, our review of the “Commissioning for Value Pack”, the “CSU QIPP Opportunities Pack”, “Commissioning for Prevention” and the CCG Outcome Indicators Framework, suggests that:• • • • • • • • • • •

gastroenteritis cancer and tumours CVD mental health problems musculoskeletal problems endocrine, nutritional and metabolic vaccine preventable conditions falls ambulatory care sensitive conditions frail elderly admissions via A and E with a primary mental health diagnosis

present opportunities for health status, service and cost improvement. e) Our Assets The JSNA identifies the way in which an asset based approach can help improve the resilience and lives of people at neighbourhood level, focusing on people, places, causes and influence. Mapping community assets through the JSNA process and building on these as a means of creating sustainable communities is an issue the CCG will pursue in its contribution to partnership working and addressing the wider determinants of health. This is a feature of our approach to the development of our new care model (see below). f) JSNA – Key Messages and Actions The key messages and actions arising from our assessment of the health status of our population are:14 | P a g e

•

• •

• • • •

• • • •

• • •

• •

• •

•

•

We have specific health inequalities for the male population both in terms of mortality rates in the 60 – 74 year age band and alcohol specific problems for the 40-59 year age band. This is contributing to a widening of life expectancy gap between the most and least deprived parts of our population. We need to ensure our locality based service delivery model provides an appropriate, differential intervention at neighbourhood level to respond to local health inequalities. Interventions in relation to cancer, heart disease, liver disease and stroke are required. We must ensure that our practices perform well in delivering smoking cessation services. Improved case finding, uptake of screening services and uptake of vaccination programmes are critical. Exploiting the potential of EMIS will assist this. The systematic management of patients with long term conditions in primary care and community health services will be a major contributor to our success, including the management of diabetes. Our new long term conditions framework, forming part of our primary medical services contract, will be designed to support this. Detection and prevention of alcohol related disease needs to be part of this. The care pathway for COPD requires attention to reduce unnecessary admissions. The local alcohol harm strategy needs to be fully implemented by all partners. The integration of maternity services with pre-conceptual, health visiting and school nursing services, together with primary care and the voluntary sector will improve outcomes across the life course. Child health inequalities can be reduced by promoting the uptake of breast feeding and the prevention of smoking. The commissioning of maternity services should be designed to prevent adult and childhood obesity. We have a growing frail elderly population, we need to improve the care pathway to prevent unnecessary admissions and create the conditions to enable people to be re-abled and retain their independence in their communities. The end of life pathway needs further review to increase the number of people who die at home and to reduce admission to hospital at the end of life. We require a continued focus on mental health and the relationship between mental health, physical health and the management of long term conditions. Keeping people in work should be an outcome of this. Our Multi-Disciplinary Teams need to identify those at risk of fuel poverty and refer to the winter warmth service. We need to ensure that our approach to prescribing and the input of our practice based pharmacists continues to improve our performance in relation to the use of drugs to reduce cholesterol, reduce blood pressure and manage atrial fibrillation. We need to ensure that our work on the systematic management of long term conditions, redesigning urgent and planned care pathways and integrating services in our localities is sensitive to the needs of our child population. As part of our approach to the Equality Delivery Scheme, we need to facilitate work with those groups protected by legislation where the difference in health outcome and need is greatest, as well as analyse the barriers to improved patient access and experience for these groups. This will be reflected in our Equality Objectives. 15 | P a g e

•

•

We will include undertake a programme of health equity audits, in conjunction with the Office of Public Health, to identify inequities in healthcare experienced by a number of excluded groups and those with protected characteristics, including people with mental health problems. Each equity audit will identify specific inequalities, the action necessary to reduce them and will set equity targets which will be monitored over time. We will use an asset based approach to our work with partners in addressing the wider determinants of health.

This is reflected in our plans.

3) Prevention – Reducing the Health and Wellbeing Gap Our approach to prevention will be based on implementing our new evidence based long term conditions framework. This will contribute to reducing existing prevalence gaps, reduce health inequalities and embed evidence based practice on a systematic basis. This has been developed jointly with the Office of Public Health, acting also as a critical friend for our proposals. Our programmes will involve delivery by primary care teams, practice based pharmacists, community pharmacy and primary mental health care. This will be linked to a robust monitoring framework. The National Audit Office report on health inequalities identified specific high impact interventions which have a direct impact on the life expectancy gap demonstrated in the JSNA. These were:•

•

•

•

increasing the prescribing of drugs to control blood pressure and cholesterol – there has been a 33% increase since 2008. We have set our local quality premium targets to address the evidence based treatment of hypertension and identification of patients ‘at risk’ of developing diabetes. In addition we will develop a systematic approach to the management of long term conditions in primary care and work with the Office of Public Health and GPs to improve the uptake of vascular checks; increasing anticoagulation treatment for atrial fibrillation – our standardised mortality rates for all circulatory diseases have decreased by 12.8 compared to the England and Wales average We will ensure we have a sustained approach to the prescribing of new oral anti-coagulants which will transition into primary care in the future; improving blood sugar control for diabetes – in 2014/15, 70% of patients had an HbA1C equal or less than 59 mmol/mol, 77.9 equal or less than 64 mmol/mol and or less and 87.4% The commissioning of our new model of care which includes more community based provision for diabetic patients will continue to address this issue; increasing smoking cessation services. We will work with the Office of Public Health to encourage improved performance from general practice in delivering these services. 16 | P a g e

We will develop a life course approach to joining up our plans with the Office of Public Health. This will be based upon:Giving every child the best start in life:• • •

joining up 0-5 year public health service with early years children’s services; developing early years settings, schools and colleges as healthy places; designing and commissioning an integrated young people’s wellbeing service.

Enable healthy behaviour in adults:• • •

embedding evidence based healthy working practice; design and deliver health and wellbeing enhancing places; develop and deliver an integrated adult wellness service.

Promote healthy aging:• •

raise awareness of the symptoms of long term conditions and cancer, promoting early presentation; develop and implement an integrated healthy aging programme.

We have agreed specific targets with the Office of Public Health, broken down by locality and practice for obesity, tobacco control and alcohol. These are shown below: a) Obesity i) Shared breastfeeding targets (baseline 2013-14)

Breastfeeding Prevalence at Initiation, Dudley CCG Registered Population, 2013-14, with Targets to 2018-19 80%

Breastfeeding Initiation

70% 60% 50% 40%

Target Actual

30% 20% 10% 0% 2013-14

2014-15

data source: NHS England produced by: Office of Public Health, Dudley MBC

2015-16

2016-17

2017-18

2018-19

Year

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Breastfeeding Prevalence at 6-8 Weeks, Dudley CCG Registered Population, 2013-14, with Targets to 2018-19 45%

Breastfeeding Prevalence

40% 35% 30% 25%

Target Actual

20% 15% 10% 5% 0% 2013-14

2014-15

2015-16

data source: NHS England produced by: Office of Public Health, Dudley MBC

2016-17

2017-18

2018-19

Year

ii) Shared adult excess weight targets (baseline 2013-14) Public Health Outcomes Framework (PHOF) Dudley Overweight & Obese Prevalence Targets (70.2%) 70.4%

70.2%

Overweight and Obese Prevalence

70.0%

69.8%

69.6%

69.4% PHOF Overweight & Obese Prevalence

69.2%

PHOF Overweight & Obese Targets

Produced by Public Health Intelligence, Office of Public Health, Dudley MBC Source: Public Health Outcomes Framework

69.0%

68.8% 2013/14

2014/15

2015/16

2016/17

2017/18

2018/19

Year

18 | P a g e

Percentage of Overweight and Obese Reception Year Children

iii) Shared child excess weight targets (baseline 2013-14) Dudley MBC Prevalence of Overweight and Obese Reception Year Children, Target to 2018/19 based on Mean results from 2006/07 2013/14

45% 40% 35% 30% 25% 20%

Historic data

Target

15% 10% 5% 0% 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

Produced by the Of f ice of Public Health, Dudley MBC

School Year

Source: NCMP data, Dudley MBC

Percentage of Overweight and Obese Year 6 Children

Dudley MBC Prevalence of Overweight and Obese Year 6 Children, Target to 2018/19 based on Mean results from 2006/07 - 2013/14 45% 40% 35% 30% 25%

Historic data

Target

20% 15% 10% 5% 0% 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

Produced by the Of f ice of Public Health, Dudley MBC

School Year

Source: NCMP data, Dudley MBC

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iv) Physical Activity Percentage of Adults (16+) Taking 150+ Minutes of Physical Activity Per Week (Baseline Active Peoples Survey 7 2014)

% 16+ Population Achieving 150 Minutes Physical Activity/Week (Baseline APS7) 53.0 52.2

52.0 51.4

51.0 %

50.7

50.0

49.9 49.2

49.0 48.4

48.0 47.0 46.0

2014-15

2014-16

2014-17

2014-18

2014-19

2014-20

Year

b) Tobacco control i) Smoking prevalence

Smoking Prevalence %

30

Dudley Smoking Prevalence Aged 18+ Projections (Based on Dudley Health Survey Prevalence 1992, 2004 and 2009*) DHS Smoking Prevalence

25 20 15

y = -0.3265x + 675.23 R² = 0.9663

10 5

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022

0

Year * Prevalence was assumed to have remained constant between 2009 and 2013. Based on ONS Integrated Household Survey data

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c) Alcohol i) Alcohol mortality targets

35

PHOF 4.06i - Under 75 mortality rate from liver disease (DSR per 100,000), Dudley, 3 year rates, 2001-03 to 2012-14, with targets to 2018-20

DSR per 100,000 population

30 25 20 15 10 Persons actual

Males actual

Females actual

Persons target

Males target

Females target

5 0

data source: Public Health Outcomes Framework produced by: Office of Public Health, Dudley MBC

DSR per 100,000 population

35

Year of Registration

PHOF 4.06ii - Under 75 mortality rate from liver disease considered preventable (DSR per 100,000), Dudley, 3 year rates, 2001-03 to 2012-14, with targets to 2018-20

30 25 20 15 10 5

Persons actual

Males actual

Females actual

Persons target

Males target

Females target

0

data source: Public Health Outcomes Framework produced by: Office of Public Health, Dudley MBC

Year of Registration

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ii) Alcohol related hospital admissions

Alcohol Related Hospital Admissions per 100,000 Persons, Narrow Indicator, Dudley, 2009/10 to 2014/15 with Projections to 2018/19 900

Rate per 100,000 Persons

800 700 600 500 400 300 200 Dudley Actual

Dudley No Change Projection

England Actual

England Projection

100 0 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

Year data source: Hospital Episode Statistics (HES) produced by: Office of Public Health, Dudley MBC

d) Health checks

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Practices have been classified according to whether they lie within one of the wards with the highest quintile of under-75 cardiovascular mortality. Targets for coverage (the proportion of the population who have a Health Check as a percentage of the eligible registered population) have been set separately, with the intention being to reach the Public Health England (PHE) “aspirational target” of 75% for people having a health check in 2016/7 in the highest risk areas and to reach the PHE “intermediate target” of 66% by 2017-8 for the other practices. The direction of travel over the period 2013-5 has diverged for the highest risk versus the rest; coverage in the highest risk is actually on course to be slightly lower in 2014/5 than in 2013/4 for the most at-risk populations, whereas the lower risk populations are receiving more health checks in 2014/5 than 2013/4. This has the potential to exacerbate health inequalities, hence the choice of a more stretching target for the highest risk practices. This is potentially achievable with additional targeted support to a small number of practices. We will implement our physical activity and sport action plan which includes:• • • •

providing grants to local community groups to increase levels of physical activity; Including referral rates to physical activity schemes on our practice scorecard; looking to incorporate the inclusion of gyms in future premises development; building on our workplace health scheme for CCG employees and holding our providers to account for ensuring their staff have access to similar schemes.

We will extend the model of healthy living pharmacies and opticians to general practice. In partnership with the Office of Public Health a delivery framework will be developed and piloted, working with public health and practice staff. For our practices, their local community’s health and wellbeing will be at the heart of everything the team does, consistent with our approach to population health and wellbeing. They will promote a healthy living ethos and deliver high quality public health services, such as smoking cessation, sexual health, NHS health checks and advice on alcohol and weight management. A number of services currently commissioned by the Office of Public Health will be incorporated into our new primary medical services contractual framework. The aim is to improve health and wellbeing and reduce health inequalities by using surgery staff to promote healthy living, provide well-being advice, signposting and services, and support people to self‐care and manage long‐term conditions. The teams will make every contact count to provide relevant health information. Surgeries would be awarded the Healthy Living Surgery quality mark following a robust accreditation process. The model will include:•

each surgery having a Healthy Living Champion (with a Royal Society of Public 23 | P a g e

Health qualification), who keeps up to date with community health services and spreads this knowledge throughout the team and a practice manager who has undertaken bespoke leadership training; •

a healthy living environment – a healthy living self-assessment and information area, promotion of lifestyle services and behaviour change campaigns.

The systematic management of patients with long term conditions will be part of this model. We have a significant group of patients identified by our risk stratification tool as being in the emergent risk cohort. At present, the approach to managing these patients is disparate and disjointed and the main commissioning vehicles for managing these patients in primary care are the Quality and Outcomes Framework (QOF) and enhanced services for diabetes and COPD. A more systematic approach is required to deliver better patient care, prevent risk escalation and find the 10% of patients that QOF alone fails to reach. As part of our new contractual framework for primary medical services, we will implement a new long term conditions framework making best use of the EMIS web system to support a systematised approach; case find; manage call and recall and extract data. The system will be implemented from 1 April 2016, replacing elements of the QOF and existing enhanced services. This will make a significant contribution to the early diagnosis of cancer and our one year survival rate; as well as the early diagnosis of other long term conditions. Our plan is to promote symptom recognition and case finding among those more likely to present later with cancer symptoms, through engagement with local communities about cancer signs and symptoms and by supporting general practice to address some of the perceived barriers that our communities face to presenting early. We wish to monitor the impact of this work by tracking cancer survival rates at practice level. We will work with our Council and Public Health England partners to secure cancer survival data at practice level and put in place the necessary data sharing arrangements to enable the local public health intelligence specialists to undertake the necessary analysis. Access to services is a major determinant of health status. We will enhance access to services in a number of ways:• more systematic case finding and call/recall systems using the EMIS • system; • identifying and responding to patients through risk stratification; • encouraging GP registration for non-registered patients attending the Urgent Care Centre; commissioning GP services at weekends and making better use of telephone appointments; • making primary mental health care available in non-stigmatising community venues; • commissioning a minor ailments scheme from community pharmacy. We have self-assessed against the “Better health outcomes” and “improved patient access and experience elements of the Equality Delivery System (EDS2). As well as the areas of action identified in this plan to deliver better outcomes and improved access and experience, we will, following a period of stakeholder engagement , review 24 | P a g e

an agreed range of services in relation to these EDS 2 goals. In addition we will:•

• •

• •

• • • • •

4.

implement the service specification for the redesigned Dudley Respiratory Assessment Service (DRAS), aligned to our 5 localities and providing a step down service from the Community Rapid Response Service; review the COPD pathway with a view to reducing emergency admissions; implement our diabetes model of care with a single point of access and triage for all referrals; the majority of care being provided in a primary care setting and the de-commissioning of routine type 2 diabetic reviews in secondary care; take part in the national Diabetes Prevention Programme; carry out further work on hypertension building on the outcome of the 2015/16 local quality premium scheme which has increased recording on primary care disease registers by 1%; implement a new pathway for anticoagulation services; commission IV antibiotics and IV diuretics in the community; implement the agreed familial hyperlipidaemia screening process; support a systematic approach to self-care programmes using appropriate technology, particularly in relation to COPD and heart failure; implement an integrated heart failure pathway across acute and community services, 7 days a week.

Community and Clinician Engagement

a) Community Engagement Our key plans have all been shaped by the views of patients and the public, through research, specific consultation exercises and through our Patient Participation Groups, our Patient Opportunities Panel and our Healthcare Forum. We have also been informed by the priorities contained in the Joint Health and Wellbeing Strategy and specific spotlight events run by the Health and Wellbeing Board in relation to their priorities. The Joint Health and Wellbeing Strategy’s priorities of:• • • • •

healthy services; healthy lifestyles; healthy minds; healthy children; healthy neighbourhoods;

are all reflected in our key service and outcome priorities. To develop a collective understanding of the context, scope and boundaries of our new model of care and the contents of the operational plan we have carried out a range of engagement activities. We have consulted on our commissioning intentions and we are currently conducting a further listening exercise which will be followed by a series of public consultations where required. 25 | P a g e

Through our conversations with the public and other key stakeholders, we have identified four key requirements:• • • •

better communication both to patients and between staff; improved access to consultation and diagnostics: continuity of care in supporting the management of their long term condition(s); effective coordination of care for the frail elderly and those with complex conditions.

We are committed to the ongoing involvement of people and communities as we develop our new model of care. A communications and engagement strategy has been developed for this work. b)

Clinician Engagement

As a clinically-led organisation, our member GPs play a key role in shaping our plans. GPs f o r m a majority of the voting members on our Board. More widely, issues are discussed at monthly locality meetings of GPs with major strategic plans and other issues taken from these locality meetings to bi-monthly borough-wide members’ meetings. Our key plans, including the development of our new care model have all been developed in partnership with our membership. 5. Our Outcome Ambitions – Reducing the Care and Quality Gap Our outcome ambitions reflect our assessment of local health need and key system effectiveness priorities. They have been drawn up with regard to the JSNA and in consultation with the Dudley Office of Public Health. Appendix 1 sets out our outcome ambitions, their relationship to the JSNA and our initiatives to respond to them:a) Securing additional years of life for people with treatable conditions:•

3.5% reduction in potential years of life lost (PYLL) per annum from 2087 per 100,000 in 2012/13 to 1943.5 per 100,000 in 2014/15 and 1685 per 100,000 in 2018/19; work with the Office of Public Health to improve the uptake of smoking cessation services in primary care;

•

Work with the Black Country Be Active Partnership and Dudley MBC to ensure that general practice contributes to initiatives designed to promote physical activity, as part of our physical activity and sport action plan.

26 | P a g e

Directly standardised rate per 100,000

PYLL from causes considered amenable to health care (directly standardised per 100,000) 2500 2000 1500 Actual

1000

Ambition

500 0 2009/10 2010/11 2011/12 Baseline 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2012/13

b) Improving quality of life for 15m plus people nationally with one or more long term conditions:• • • • •

• • •

70/100 people in 2012/13 reporting improved health status increasing to 71.6/100 in 2015/16 and 74/100 people in 2018/19; dementia diagnosis rate to increase from XX at 31st March 2015 to XXX by 31st March 2016; hypertension diagnosis rate to increase by 1% - current register 55,164 to 55,716 – an increase of 552 (local QP indicator); improve recording of disease in primary care registers, in particular for hypertension, heart failure and chronic kidney disease (recorded prevalence 18,838, modelled prevalence 31,398); work with the Office of Public Health and primary care to improve the uptake of vascular checks; work with the Office of Public Health on initiatives to reduce childhood obesity towards the England average; develop the use of personal health budgets.

27 | P a g e

Health related quality of life for people with long-term conditions (Crude rate per 100 people) EQ-5D 80

Crude rate per 100 people

70 60 50 40

Actual

30

Ambition

20 10 0 2009/10 2010/11 2011/12 Baseline 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2012/13

c) Reducing time spent community care:-

avoidably

in

hospital

through

more

integrated

• avoidable emergency admissions to be reduced from 2448 per 100,000 in 2012/13 to 2332 per 100,000 in 2015/16 and 2018/

d) Increasing proportion of older people living independently at home after discharge:•

people still at home 91 days after discharge to reablement will increase by 12 people in 2014/15, from 87.4% as at March 2013 to 88% by March 2015 and a further 11 in 2015/2016 to 89%. (BCF indicator).

28 | P a g e

Effectiveness of Re-ablement 90.0%

89.0%

89.0%

88.0%

88.0% 87.0%

87.40%

Actual

86.0%

Plan

85.0%

85.30%

84.0% 83.0% 2013/14

e) • • • • •

2014/15

2015/16

Increasing people's positive experience of hospital care:reducing the average number of negative responses per 100 patients from 159.2 in 2012/13 to 153.5 in 2015/16 and 145 in 2018/19; agree a plan with local providers to address issues identified in the 2013/14 Friends and Family Test results (QP indicator); reducing the number of pressure ulcers: - zero tolerance of grade 4s, no increase in grade 3s and a reduction in grade 2s.

29 | P a g e

f)

Increasing number of people with positive experience of care in general practice and in community:-

• reducing the average number of negative responses per 100 patients from 6.1 in 2012/13 to 5 in 2018/19.

g) Progress

towards eliminating avoidable deaths in hospital:-

•

medication incidents reported through the National Reporting and Learning System – quality of the reported learning to be shared;

•

development of a reporting system to support the investigation and remedy of medication related serious incidents for which the medicines management team have received root cause analysis training;

•

zero tolerance of MRSA.

•

Clostridium difficile reduction from XXX cases to XXX cases by March 2017. This is on target to be delivered.

6. Commissioning for Quality and Safety a) Holding providers to account We will develop quality initiatives and use the Commissioning for Quality and Innovation (CQUIN) process to reduce patient harm and improve patient outcomes. This continues and CQUINs have been refreshed for 2016/17. We will work with our providers to encourage the development of smart dashboards to illustrate the performance of their services and inform patient choice. We will look to work with providers who actively promote their own information to support this. Progress has been made in giving feedback to the public on quality metrics – e.g. 30 | P a g e

safer staffing levels. This will continue in 2016/17. We expect all providers to develop clear clinical quality standards for their services and measure their performance against these. In 2016/17 we will continue to focus on outcomes based quality standards for inclusion in contracts and will monitor providers against these mapped to the NHS Outcomes Framework. The CCG Board will use patient stories as a key mechanism for obtaining feedback from patients and build the lessons learned into the service design process. We have used the CQUIN process to incentivize this for some providers until firmly established. Mortality data and other variate intelligence continues to be used to triangulate an overall view of deaths. Where there are emergent patterns or themes, these are explored through a quality improvement approach. We require providers to have in place mortality tracking processes including case note review to provide assurance of safe care and reduce avoidable mortality. Mortality is tracked through the Clinical Quality Review Meeting (CQRM) process, mortality and morbidity meetings, the use of national metrics such as SHMI and other qualitative intelligence such as complaints and incidents. A collaborative approach will c o n t i n u e to identify where acts of omission might have contributed to an avoidable death. We will participate in specialty specific mortality reviews. In terms of meeting its responsibility for the commissioning of primary care, the CCG will put in place a comprehensive quality monitoring programme to ensure safe care. Our educational programmes for primary care practitioners and community services will be used to share best practice and lessons learnt. b) Francis, Berwick and Transforming Care The recommendations from the Francis report continue to steer service improvements and outcomes focused commissioning specifications. Previously, CQUINs were used to focus organisations on the Berwick report around organisational learning. The culture of learning climate will continue to be a feature of CQRMs supported by evidential matrices such as professional development, access to learning, learning and sharing from adverse incidents and feedback on what worked well. Organisational learning quality indicators will be included in contract specifications for 2016/17. Francis principles are now built into our business and contract management processes. We have developed, in conjunction with our social care partners, a Transforming Care Plan and achieved all actions on time as planned. Patients with a learning disability continue to be a high priority to ensure appropriate and timely placements based on individual assessed need. Working in conjunction with our Black Country commissioning partners we intend to commission:31 | P a g e

•

a community based assessment and treatment service for those patients who would have traditionally been admitted to an inpatient facility;

•

a community based “short breaks” service to prevent placement breakdown and admission.

Through our primary medical services contractual framework, we will be ensuring that the physical health needs of people with a learning disability are met. We will also look to support people with learning disabilities through the use of personal health budgets. c) Staff satisfaction We have used a CQUIN based on the American Association for Healthcare Research and Quality (AHRQ) report to inform and assist in the understanding of the patient safety culture as a means of influencing staff satisfaction. In 2016/17 we will continue to build on this work and use nationally reported staff surveys to focus efforts and engagement. d) Patient safety There are robust processes in place to oversee the quality agenda across provider services supported by the contractual Clinical Quality Review Meetings (CQRMs) between the CCG and each provider, and the CCG Quality & Safety Committee. All our commissioned providers are expected to be committed to the “Sign Up to Safety Campaign” and this is monitored through our CQRMs. The main thrust of the patient safety agenda is to:• • • • • • • • •

develop locally sensitive quality indicators and metrics to continually improve the quality outcomes of services; provide the governing body with a clear, comprehensive summary on the user view, effectiveness, safety and outcomes of services commissioned; monitor the performance of service providers against outcomes of agreed CQUINs and to support the development of future CQUINs; ensure nationally agreed CQUINs are fully implemented and complied with; support the implementation of improvement plans put in place by service providers in relation to breaches in quality and safety standards, using outcome measures and appropriate time lines; review and act upon any notification, advice or instruction issued by the National Regulators or NHS England; review and act upon any notification, advice or whistleblowing issued by other agencies or individuals; review reports from service providers on progress and outcomes against existing Quality Account work plans, and to review the outcomes of any new work plans; monitor and receive reports on incident data (Serious Incidents, Never Events, unexpected deaths); 32 | P a g e

• • •

quality exceptions reported (such as whistleblowing, serious case review, adverse media reports); review safeguarding issues; review a suite of key indicators including HCAI data; complaints; patient experience; safety thermometer; quality visits; reports on CQRMs that have taken place including any exceptions to be brought to the attention of the Quality and Safety Committee; and a quality dashboard.

The Quality and Safety Committee also receives reports based on themed reviews according to an agreed reporting matrix. This covers:• • • • • • • • • • • • • • • • • • • • • • • • •

children’s safeguarding adult safeguarding infection, prevention and control maternity services cancer outcomes mental health mortality, including unexpected death / suicide themes from incident reports, for example falls patient experience data, complaints and national surveys NHS Continuing Health Care nursing homes clinical visits quality in primary care commissioning for outcomes training and education (including Deanery visits) audit reports staff surveys workforce data medicines management / incidents information governance health & safety performance public health policies for ratification quality team work programme equality and diversity update

There are also ad hoc reports produced in response to events, such as national reports, public inquiries, and inspection reports from the Regulators e) Safe and effective prescribing Our prescribing policies and guidelines are overseen by the CCG’s Prescribing SubCommittee and the Area Clinical Effectiveness Sub-Committee, the latter including representatives of primary and secondary care. This oversight includes our guidelines on the prescribing of antibiotics.

Antibiotic prescribing rates remain a national public health concern. The national quality 33 | P a g e

premium includes objectives relating to the volume and nature of antibiotics prescribed in primary care. While excellent progress has been made in Dudley in previous years to reduce the volume of broad spectrum antibiotics, our biggest challenge for 2016/17 will be to achieve a further reduction in the overall number of antibiotic prescriptions issued. The CCG will be working with the Office of Public Health to support GPs and their patients, through awareness raising; education; use of technology such as our Antibiotic Guidelines app; implementation of our agreed guidelines for the prescribing of antibiotics in the community; and through our agreed Prescribing Incentive Scheme. We will work in partnership with Dudley Group of Hospitals NHS FT on guidelines and the clinical management of patients. f) Seven day services Our Service Development Improvement Plans with each of our main providers set out our plans for implementing seven day standards. We have requested each provider to carry out a further stock take in relation to all the standards by 1st June 2016. This will form the basis of a report to both the relevant contractual clinical quality review meeting and the Quality and Safety Committee. As a result of this, we will agree an action plan with each provider for meeting the appropriate standards by 1st August 2015. As well as assuring ourselves that our providers are putting in place appropriate arrangements for safe 7 day services, our integrated locality service model and our urgent care model operate on the basis of a 7 day service. This will be built into the relevant service specifications. We will continue to use the standards for community services, developed as a national 7 day working NHS IQ transformational pilot site, within our specifications for all the services within our new care model. These have been shared with NHS England. As part of the process for implementing our new contractual framework for primary medical services, we will be working with local practices to secure the most appropriate access to 7 day primary care services. g) Compassion in Practice (CIP) and the 6 Cs The nursing and allied health professional strategies of our main providers have been developed and assured against the expectations of “Compassion in Practice” and the 6Cs. Care Care is our core business and that of our providers. The care we deliver helps the individual person and improves the health of the whole community. Caring defines us and our work. People receiving care expect it to be right for them consistently throughout every stage of their life. Compassion Compassion is how care is given through relationships based on empathy, respect and 34 | P a g e

dignity. It can also be described as intelligent kindness and is central to how people perceive their care. Competence Competence means all those in caring roles must have the ability to understand an individual’s health and social needs. It is also about having the expertise, clinical and technical knowledge to deliver effective care and treatments based on research and evidence. Communication Communication is central to successful caring relationships and to effective team working. Listening is as important as what we say and do. It is essential for “no decision about me without me”. Communication is the key to a good workplace with benefits for those in our care and staff alike. Courage Courage enables us to do the right thing for the people we care for, to speak up when we have concerns. It means we have the personal strength and vision to innovate and to embrace new ways of working. Commitment A commitment to our patients and populations is a cornerstone of what we do. We need to build on our commitment to improve the care and experience of our patients. We need to take action to make this vision and strategy a reality for all and meet the health and social care challenges ahead. We will use our practice and community nurse fora to identify how the 6C principles are embedded and our education programmes will support this. h) Provider cost improvement programmes We continue to require providers to demonstrate a robust impact assessment process related to cost improvement programmes both in terms of qualitative impacts and operational impacts (such as reduced analytical or reporting capacity), and evidence of full reporting to their Boards. These will be considered by the CCG Quality and Safety Committee and appropriate assurance given to the Board. CIP meetings are held with providers regarding the clinical quality impact of cost improvement programmes and how this translates into workforce plans. Our CIP approach extends to our commissioning plans in relation to creating a modern system of integrated community services, capable of preventing unnecessary admission. i) Workforce Planning and the LETB 35 | P a g e

We will ensure staffing and workforce plans are safe affordable and meet our strategic requirements. The CCG is represented on the HEE LETC by one of its GP Board Members. The LETC Chair is a member of the West Midlands LETB and ensures that local issues are fed into the wider education commissioning agenda. A strategic system-wide workforce plan is being produced to support the delivery of our new care model. j) Ensuring Clinical Accountability Our new model of care aims to develop a team of integrated, GP- led health and social care multidisciplinary teams. This new clinically led care model will see teams working “without walls”, taking shared responsibility for delivering shared outcomes centred around the person. We are committed to a clinically-led system of care and will embed clinical accountability across the system:with GPs as the lead co-ordinators of population health and wellbeing:• • •

based on the registered patients with their practice; working in partnership with other consultants / physicians providing longterm care; supported by integrated population-based teams.

with consultants as the lead co-ordinators of pathways of care:• • • •

providing advice and guidance into population healthcare; working alongside GPs in co-ordinating frail elderly care; providing value-added treatments in line with best practice; supported by efficient communications with and from GPs.

k) Safeguarding children i) Section 11 audit

Section 11 of the Children Act 2004 places duties on a range of organisations and individuals to ensure their functions, and any services that they contract out to others, are discharged having regard for the need to safeguard and promote the welfare of children and young people. As members of Local Safeguarding Children Board, key partner agencies have agreed to ensure that their duty to safeguard and promote the welfare of children is carried out in such a way as to improve outcomes for children and young people in the borough. Wherever possible, evidence of impact on improving outcomes for children should be identified. For the Local Safeguarding Children Board to maintain oversight of the effectiveness of safeguarding children practice across the borough, and of the extent to which it is continuously improving, the key Section 11 agencies are expected to provide information 36 | P a g e

on the arrangements they have in place to protect and promote the welfare of children and young people. This includes Dudley CCG as a statutory member of the Safeguarding Children Board. The Designated Senior Nurse has completed the audit on behalf of Dudley CCG and its member practices for the period 2014/15. Overall the CCG is compliant with all of its statutory responsibilities. The CCG has worked hard to raise the profile of safeguarding children within the organisation and is working towards ensuring that safeguarding is fully embedded in all aspects of CCG business including all contracts and service specifications. The correct governance structures are in place and staff have undertaken appropriate safeguarding children training. Whilst the CCG has made excellent strides in listening to the voice of the child and determining wishes and feelings of local children and young people, they are not currently involved in service development and redesign. The CCG has plans to develop a cache of young health champions in an attempt to improve local children’s and young people’s health by: • • •

working with other young people to help to set up and support new health projects; becoming active and key partners working with health organisations to help develop health services for young people; Influencing young people to live healthier and active lives and providing peer support and a voice for young people around health issues.

With regards to safer recruitment processes, whilst all of the managers and HR staff within the CCG have undertaken recruitment training, this does not specifically include the safer element. The Designated Senior Nurse has undertaken safer recruitment training and the issue is currently being addressed in conjunction with the Head of Organisational Development & Human Resources. All appropriate staff undertake training, arranged via a Department for Education e-learning package or delivered face to face from a member of the Dudley Safeguarding Children Board.

l) Safeguarding adults i) Prevent agenda The Prevent strategy is a cross-Government policy that forms one of the four strands of the Government’s counter terrorism strategy. Prevent strategy was introduced as a specific requirement within the NHS Standard Contract for 2013/14 for provider organisations. The CCG Safeguarding Team has introduced new multi-disciplinary training workshops, training will continue to be offered at regular intervals in the future. Prevent training is offered to all CCG front-line practitioners, and is promoted via Members’ News, practice meetings, and other training events.

ii) Care Act and NHS Accountability framework 37 | P a g e

The NHS Accountability Safeguarding Framework has taken into consideration the Care Act in which adult safeguarding is, for the first time, spelt out in the law. Local authorities must make enquiries or ask others if they believe an adult is, or is at risk of being abused or neglected. The legal framework is to enable key organisations and individuals with responsibilities for adult safeguarding to agree on how they must work together and what roles they must play to keep adults at risk safe. The Safeguarding Adults Board will be a key requirement which includes key stakeholders such as health and the Police. This board will carry out safeguarding adult reviews when people die as a result of neglect or abuse and there is a concern that the local authority, or its partners, could have done more. M) The Mental Capacity Act 2006 (MCA) The CCG can demonstrate that consideration of mental capacity is part of the safeguarding adults process and where people lack capacity decisions are always made in their best interest. The CCG expects all providers to comply with the safeguarding standards within the CCG safeguarding policy and the policies and procedures of the Dudley Safeguarding Adults Board. Providers are required to demonstrate that they have all the appropriate arrangements in place to safeguard people. Safeguarding is integral within standards for all contracts. As a minimum contractual obligation, all providers are required to comply with local safeguarding policy and procedures (NHS Contract, Section E, Clause 24 ,Section C Part 7.2). Contracts specify compliance with CQC Essential Standards and related legislation, including the Mental Capacity Act; the Mental Health Act; Deprivation of Liberty Safeguards and the Safeguarding Vulnerable Groups Act.. Work is in hand to ensure that the recommendations from the MCA Scrutiny Panel’s recommendations on the Supreme Court’s judgement in the Cheshire West and Chester case are incorporated both operationally and contractually with service providers.

7. Parity of Esteem for People with Mental Health Problems “Healthy minds” is one of our Health and Wellbeing Board’s 5 priorities (see above). The Board has an ambition to create a “mental health friendly Dudley, where the social determinants of health and wellbeing are understood and action is taken to tackle inequalities with all partners and stakeholders”. The actions identified below are designed to reduce the inequalities gap for patients with a mental health problem. We will revise our joint mental health strategy to reflect the priorities and recommendations of the Mental Health Taskforce. To deliver parity of esteem we will increase our investment in mental health services by 3.2% in 2016/17.

a) Mental health at the heart of our integration model Our MCP service model (see below) is focused on both the integration of health and 38 | P a g e

social care services, as well as the integration of physical and mental health services. Mental health practitioners are key members of our locality teams, recognizing that physical and mental health problems are interrelated. Voluntary and community sector services also play a key role in the integration process. The links with local voluntary and community services and our focus on prevention and independence within asset rich communities is designed to reduce the harmful effects of social isolation. Access to locality link workers and a social prescribing scheme enhances this provision. As part of the continued development of our care model, we will develop, in each of our 5 localities, a specific mental health MDT and roll this out across all practices. In addition, we will explore how personal health budgets can be developed to support greater independence, choice and control for service users. We will work with our practices to improve the recording of patients with mental health problems in primary care disease registers and in turn ensure that these patients enjoy appropriate access to physical health services in primary care. As part of our primary care long term conditions framework, all patients with mental health problems will receive a comprehensive physical health assessment. Evidence has demonstrated that historically medications prescribed for mental illness and lifestyle have had extensive side effects on physical health and life expectancy. The lifestyle of an average person with a severe and enduring mental illness is one of poor self-care, poor diet, heavy smoking, sedentary behaviour all exacerbated by poor motivation, lack of insight and lack of capability to bring about the necessary changes. This creates a gap in life expectancy when compared to others without mental illness. There is also evidence that many people with mental illness develop diabetes, heart disease, respiratory disease and high blood pressure. We will continue to work with our partners to develop the “healthy neighbourhoods” envisaged in our Joint Health and Wellbeing Strategy, providing opportunities for guided walks, cookery and weight management classes. Our physical activity and sport action plan (see above) will contribute to this. We are working in conjunction with the national new care models team to examine how best to commission and contract for the new care model, including mental health. We envisage all mental health services to be delivered by the MCP and will agree an appropriate contracting and outcomes based payment model to be implemented from 1 April 2017. b) Access We will work with the Office of Public Health to tackle the issue of poor access by people with mental illness to public health interventions which can increase life expectancy e.g. smoking cessation, screening programmes and immunization. This will form part of our work on health equity audits referred to above. We will ensure that there is speedy access to primary mental health services and our CCG locality groups will be empowered to monitor, review and hold local services to account for performance. We will commission counseling services on the basis of direct access for patients. 39 | P a g e

We have taken steps, in conjunction with Dudley and Walsall Mental Health Partnership NHS Trust, to ensure that the new access standards can be met and commissioned the correct levels of activity to secure these. Our contracts, service specifications and information requirements reflect this. Effective mental health pathways are now a key component of our care mode and we are adopting the same approach to these and physical health pathways, commissioning on the basis of the optimum pathway and reducing unwarranted variation. This is described further at 9 c) below. In recent years we have focused relentlessly on avoiding the need for Dudley patients to be treated out of area, such that at the time of writing this plan, only 6 patients are accessing services out of area. In addition, clear expectations in relation to outcomes and recovery plans for these patients are set and their recovery to local services managed actively. c) A new mental health service model We will commission services which are “age appropriate”. The current age criteria do not reflect the differing ability of the brain to process cognitive information which is evidenced to be effective from 14 years of age, or to develop psychosocial maturity which enables processing of emotion and thinking evidenced to be effective from 21 to 25 years. These factors are vitally important in how people accessing services can effectively utilise and achieve optimal outcomes from the interventions provided. We intend to commission services for people aged 0 to 25 years and 25 years upwards, together with a specialist dementia service. We will eradicate the gap in provision for young people aged between 16 and 18 years created by the current criteria. This will also include appropriate out of hours provision for young people. As part of this model, we will commission a multi-agency hub as a single point of contact for children; young people; and their families experiencing social; emotional; developmental and/or safeguarding problems. This will include access to community based eating disorder services. Services will be developed as part of this model to enhance their ability to care for patients in primary care and community settings, reducing the reliance on inpatient beds. We will ensure that there is a primary care mental health service for people aged 0 to 25 years and 25 years upwards. Research demonstrates that 50% of first time experience of mental health problems will occur by age 14 years and 75% by age 25 years. The development of an appropriate workforce to support this model will be addressed in our system wide workforce plan designed to support the implementation of the MCP.

d) Pathway efficiency 40 | P a g e

We will look specifically at the pathway for early intervention in psychosis with a view to eliminating any unnecessary variation, enhancing pathway efficiency and meeting the new waiting time standards. We will apply the same approach to the IAPT pathway as we seek to meet the new waiting time standards for this service. Our contracts for 2016/17 have been constructed on the basis of meeting the national access targets. e) Crisis care As part of our commitment to the Crisis Care Concordat, we will review the operation of our mental health urgent care centre that has been in place over winter, incorporating our existing psychiatric liaison service with a view to making this a permanent, “all age” service. The street triage service, providing a combined ambulance service, mental health and police response to people experiencing mental health crises, has been a successful scheme this winter. It has:• • • •

prevented the unnecessary use of ED; prevented unnecessary use of our local place of safety; made better use of police and ambulance service resources; avoided the criminalisation of people with mental health problems.

We will now look to commission this service on a permanent basis. We will ensure that our new model of urgent care provides an appropriate and timely response to those presenting in crisis. f) Substance misuse We recognise the significance for the local system of alcohol related admissions and the associated dual diagnosis. We will work with the Office of Public Health on prevention initiatives associated with alcohol. Again, our integrated service delivery model and our approach to risk stratification will address the issues associated with substance misuse. g) Dementia Specific work on dementia is identified below. We are taking steps to improve the recording of patients diagnosed with dementia in primary care disease registers in order to meet the national target by:• • • •

sharing individual practice performance at our GP locality meetings; providing practices with details of recently diagnosed patients; identifying those practices with the greatest potential to improve recording; arranging for our 5 GP locality leads to provide specific input to these practices.

h) Perinatal Mental Health 41 | P a g e

We will commission a local service to complement specialist services already available for patients with perinatal mental health needs. i) Child and Adolescent Mental Health Service We will implement our CAMHS Transformation Plan, refreshing this as necessary in response to the findings of the recent review by the West Midlands Quality Review Service and a new needs assessment. Our investment plans will be updated to reflect additional allocations made available. The implementation of this plan and its associated outcomes will be overseen by the CAMHS Transformation Group, with representatives from the NHS, local government and voluntary sector partners. Specific immediate priorities in 2016/17 will include:• • • •

commissioning a camhs tier 3 plus service to prevent the inappropriate use of acute paediatric and mental health beds and prevent the need to access tier 4 services; working in collaboration with NHS England to prevent the unnecessary use of tier 4 services; commissioning a community based eating disorder service in line with the access and waiting time standard recommended model; the systematic engagement of children, young people and their families.

8. Children’s Services We will apply the principles of parity of esteem to children as well as adults. This will apply to all children who are or might become vulnerable. Although there is no one way of measuring vulnerability, in general it can be said that a vulnerable child is one who is unable to keep themselves safe from harm, or who is at risk of not reaching their potential and achieving appropriate outcomes. We will work with partners to commission services which ensure that this group of children have the necessary additional support to allow them to achieve and engage to the same level as other children and young people. Initiatives to support this include: • • • • •

• •

ensuring that the looked after children health assessment pathway meets demand and delivers outcomes; promoting breast feeding; preventing smoking by pregnant women; ensuring that the commissioning of maternity services is designed to give children the best start in life work in partnership with the Office of Public Health on initiatives to reduce childhood obesity, including a review of the existing maternity services pathway; providing support to carers through a revised carers strategy; fulfilling our statutory duty to contribute to education, health and social care plans for children with special educational needs; 42 | P a g e

• • • • • •

offering personal health budgets where appropriate; reviewing existing services designed to meet our statutory duties for safeguarding; reviewing the end of life pathway and improving Advanced Care Planning; implementing an integrated children’s community health service; expanding our paediatric triage service; introducing “Health Champions” for young people.

9. Our Key Priorities – 2016/17 In responding to the challenges we face there are 4 key priorities which need to be delivered in 2016/17:• urgent care – ensuring our local urgent care system meets the requirements of the urgent and emergency care review. Reviewing urgent care pathways to ensure proper integration across physical health and mental health services, securing better ambulance turnround times and commissioning new services from primary care to avoid unnecessary admission from care homes; • planned care – implementing best practice elective pathways to deliver service efficiencies, meet NHS Constitution targets and eliminate unwarranted variation in our pathways for ENT, diabetes, cardiology, ophthalmology, urology and orthopaedics; • integrated care – implementing our MCP care model through practice based multi-disciplinary teams, transforming the nature of joint working across health and social care and providing out of hospital services as a real alternative to hospital admission; • primary care transformation – commissioning a modern system of primary care capable of managing patients systematically supported by skilled staff, appropriate IT, modern premises and at the heart of our MCP care model. These are all brought together in our plans to develop and commission the MCP. a) Impact on Providers The achievement of these priorities will be dependent on the appetite, ability and speed of providers to react to the change in our commissioned service model. If providers react in the way we have indicated, then we foresee a reduction in the acute and mental health bed base within Dudley and an increase in the provision of community/primary care services. This will be done in a planned and managed way with our providers to ensure that the cost base within providers reduces in line with potential income reductions. If providers do not work with us in delivering our service model, then there is a significant risk of financial sustainability for providers, as the CCG will have no choice but to test the market for services. The financial environment for our local NHS providers is already very challenging, so we wish to work collaboratively to ensure that the health economy is financially viable for the foreseeable future. 43 | P a g e

We will not, however, work with providers that do not share our values or vision. b) System Characteristics for Transformation In December 3013, NHS England identified six key characteristics which sustainable health and care systems need to demonstrate by 2017/18. Our plan maintains this direction of travel, in the context of moving into a new phase of transformation during year 1 of the STP. Our initiatives in relation to these key characteristics are set out below. Fundamental to the CCG’s transformation programme is the commissioning our new model of care c) A new model of care We are implementing a sustainable and replicable whole-system change, designed around the person, communities and clinically-led delivery, which enables both mutual-networked care and best practice pathways of care – the Multi-Specialty Community Provider (MCP). This model is broader than just health and care. It is designed to support and sustain our communities, in partnership with the community and voluntary sector, and enable people to play a fulfilling role within their community. It is consistent with the “six principles” to support the delivery of the NHS Forward View. • • • • • •

care and support is person-centred: personalised, coordinated and empowering; services are created in partnership with citizens and communities; there is a focus is on equality and narrowing health inequalities; carers are identified, supported and involved; voluntary, community, social enterprise and housing sectors are key partners and enablers; volunteering and social action are key enablers.

Measured against these principles, our care model:• • • • • •

•

understands the position, needs and motivation of people and communities; works with people and communities to hear their voices; engages with people and communities to build relationships and offer genuine opportunities for influence; embraces the assets of people and communities to create opportunities for co-production, building collaborative relationships that recognise that different roles and perspectives are a constructive force for change; empowers staff to lead service changes to benefit people; enables people and communities to put themselves at the centre of their care - so that they can make informed decisions about their health - be supported to manage their conditions and stay as independent and in control as possible; creates an environment to support people using health and social care to drive change themselves. 44 | P a g e

Taken together, these approaches will improve health outcomes and allocate resources more efficiently to areas of need and want – especially for those with long term conditions and complex care needs. We have already made significant progress to implement the main components and key enablers of this care model in 2015/16. Work on this will continue in 2016/17 as we develop the contractual mechanisms and service specifications for all elements of the model. There are three elements to the model based upon the fundamental principle of supporting population-based health and wellbeing. This starts with the patient registered with their GP – the main co-ordinator of their care. This is delivered through a mutual network of care, best exemplified by the work of the practice based multi-disciplinary team, linked to a series of other community based services. This, in effect, is the MCP, based on the principles of shared ownership, shared responsibility and shared benefits. The first element of the model is the mutual network of care, to be delivered by the MCP, commissioned around the following themes and outcomes:• • • •

better communication with patients and between staff; improved access to different types of consultation and diagnostics in the community; continuity of care in supporting the management of peoples’ long term conditions; effective co-ordination of care for the frail elderly, those with the most complex conditions and at the end of life.

Through the second element of the model, we will support people to remain at home wherever possible by developing evidence based best practice pathways of care. We will reduce variation, so that all services are commissioned and delivered in a way that incentivises optimum outcomes for the patient, shares risk, makes the best use of the resources we have available; and enables effective communication between all stakeholders. To deliver these pathways for both planned and urgent care, we plan to move away from PbR tariffs to a payment that reflects best practice. The final element is a re-commissioned system of primary medical services. This will be commissioned through a refreshed outcomes based contractual framework, reflecting the themes of access, continuity and co-ordination. i) Clinical development The core concepts of the clinical model are that care should first be person-centred, integrating population-based health and wellbeing services around the person:• • •

to maximise people’s independence from care through self care and personalisation; based upon the registered patient with the practice. delivering best practice pathways of care: 45 | P a g e

• •

to achieve best possible outcomes from treatment; to provide efficient care offering the best possible experience.

Secondly, that care should be designed around our clinical delivery, with GPs as the lead coordinators of population health and wellbeing:• •

providing care-coordination of mutual-networked care; taking shared responsibility for achieving shared outcomes for patients.

With consultants as the lead co-ordinators of pathways of care-providing valueadded treatments in line with best practice. ii) Stage one – teams without walls The first stage, already substantially in place, of delivering this mutual-networked care is to establish across Dudley a joined up network of GP-led, community-based multi-disciplinary teams which enable health, social care and the voluntary sector to work together in “teams without walls” for shared benefits and outcomes, coordinating the care planning for individual patients. These teams transcend organisational boundaries and interests, and focus collectively on delivering integrated patient centred care aimed particularly at that cohort of patients identified as being most at risk of emergency hospital admission. This concept begins at practice level with Multi-Disciplinary Teams (MDTs) including the GP, District Nurse, Assertive Case Manager, Mental Health Worker, Social Worker and Voluntary Sector Link Worker. iii) Stage two – aligning specialist services This involves expanding the mutual network of care to fully incorporate all specialist community services and some aspects of urgent care, better aligning health and social care services into a single approach – such as single access to CAMHs services and the integration of telecare and telehealth. This includes the establishment of a community rapid response service, designed to intervene in a crisis in the patient’s home – both avoiding the need to go to ED and connecting the person back into their local network of care. This also includes using our primary-care led urgent care centre as a point of triage for all patients attending hospital. This reduces the need for ED services and connects people back to their local primary care service. iv) Stage three – community care led retrieval This extends the model to include current consultant-led services which operate to support population health and wellbeing. This next stage has already been agreed by our clinical strategy board, which includes consultants and GP leadership from across the CCG and our main provider. This will include specialties which support the management of long-term conditions such as diabetes medicine and respiratory medicine. Consultants will 46 | P a g e

work in partnership with GPs to the same outcome objectives for improving population health and wellbeing. This will include collaborating to deliver improved services to the frail elderly. Our ambition is to remove all delayed transfers of care from the system. We will achieve this by shifting the locus of control from hospital to community. The integrated MDT, with support from consultant physicians, will become responsible for the whole pathway of care for the frail elderly: from community, into hospital and back into the community – so that there are no longer any transfers of care. Patients will be retrieved back into the community rather than transferred from one team, or one organisation, to another. v) In parallel – whole pathway care We will be piloting a new approach to planned care to develop best practice pathways of care – based upon the whole pathway of care followed by the patient. Our aim will be to streamline and standardise the actual pathways that patients follow, so that they are fully patient-centred, efficient and deliver best practice outcomes. We are looking at the whole pathway, not just the stages from referral to treatment. This will include both physical and mental health d) Citizen Participation and Empowerment We recognise that if we cannot persuade patients and the public of the need for change, it will be much harder to deliver change at the pace and scale which is required. We also know that we have a much better chance of seizing the opportunities that the future holds if we can secure the active participation of patients and carers in driving change and embracing those new models of care. This means that effective communication is more important across health and care than ever before. Effective communication, involvement and engagement networks can break down barriers, build alliances, encourage innovation, share good ideas and create an environment where all of us concerned with improving health and care across Dudley can work together to build a better future. Our CCG Communications and Engagement Strategy provides an overarching set of principles which we will apply to any programme or project when developing, delivering, monitoring and evaluating any communications, involvement and engagement plan. Those principles will inform any conversation we have about the future of our health and care services – with patients, carers, the public, partners, other system leaders or anyone with an interest in, or connection to, our NHS, including regulatory and oversight bodies. Living by these principles in our working lives, should take us on a journey from ‘traditional’ public relations and communications to a new way of working which 47 | P a g e

will engage our members, staff, partners, patients and the public more meaningfully in delivering safe, high quality, sustainable health and care services which meet the needs of the communities we serve now and in the future. Our aim is to work with citizens and communities to create person centered care. We see a future in which patients (including patients with caring responsibilities), public and communities will contribute actively, collectively and inclusively to health and wellbeing outcomes underpinned by effective collaborations with, and between, the CCG and its partners. To achieve this, we have set out six Communications and Engagement objectives which we think are key to us enabling and achieving that vision and supporting the six principles set out earlier in this plan:• • • • • •

understand what is important to people locally; connect what is happening with those that can bring about change and learning; inspire our local teams and partners to listen, take responsibility and make real changes to enable person centred care; build relationships and networks to have honest conversations; create an environment which supports people using health and care services to themselves drive change; develop and grow confidence and trust in local services and NHS leadership.

The cornerstone of our public and patient involvement work is our network of Patient Participation Groups (PPGs). At the time of writing this plan, all of our 46 member GP practices had an established PPG. We are committed to supporting these groups and their practices to give patients a voice. Through our innovative PPG Purse scheme, each PPG can receive up to £1,000 funding to invest in expanding their group, making it more diverse or delivering innovations that benefit patients. Our PPGs are offered regular opportunities to come together through our Patient Opportunities Panel (POPs) which is chaired by our Lay Member for Public and Patient Involvement who reports directly to our Governing Body on issues raised. Our quarterly Healthcare Forum (HCF) brings together representatives of a health related service user and community groups. Each meeting is chaired by one of our member GPs and discussions cover a wide range of health topics. Feedback is shared with our commissioners and leadership team. Although we recognise the limitations of digital communication, we are committed to seizing the opportunities which it offers to reach large numbers of people quickly and cost effectively. Ongoing development of our website, Facebook page and Twitter feed remain priorities, as does the production of vox pop ‘Feet on the Street’ videos which offer local people a chance to share their views on a health topic and have 48 | P a g e

those views broadcast to our Governing Body at their monthly meetings and with the wider community via our website. Key developments for 2016/17 are to:• • •

•

•

•

• •

• • • • •

continue to support and develop our network of practice based Patient Participation Groups (PPGs). Maintaining one in each practice and developing a strong link to our models locality focus; build on the success of our #mefestival for young people, with a further event for young people in 2016/17 organised collaboratively with Health & Wellbeing Partners; actively promote arrangements for online access to repeat prescriptions; appointment booking and coded record information. Working with practices to ensure that these services are available, that patients are supported when their access is enabled and developing programmes of engagement with Barclays Digital eagles to encourage more online access; to create a citizen contact database which not only details those people who want to be informed of health service developments but match those individuals to areas of interest. This information can then be used to match people to clinicians and managers at the formative stage of service redesign. This greater insight should encourage co-design of services; work in partnership across health and care to use all available communication channels to extend our reach to local citizens. This will be led by a strategic Communications and Engagement group which will sit under the Health & Wellbeing Board and will be complimented by the Communications & Involvement work stream in the New Care Model Programme; grow a group of patient and public representatives to support the New Care Model development and link into each work stream. We will encourage those representatives and the wider organisation to work in partnership with Clinical, Management and Public leadership for each work stream; act on the feedback from our young people to develop a network of young health champions and strive to make our information more accessible to young people through the internet and social media; ensure that we respond to the health needs of new migrants by developing a better understanding of our local communities, working with our partners and building on the JSNA; improving data recording in primary care so that we can more effectively target health interventions; identify how we can ensure our engagement approaches are sensitive to the needs of new migrants; promote the new Dudley Community Information Directory for Dudley citizens; support practice staff to become Accredited Dudley Information Champions; procure new accessible websites for the All Together Better Partnership and the CCG; actively support our member practices and their PPGs to adopt social media presence; 49 | P a g e

•

•

•

•

I.

seek opportunities to adopt participatory budgeting – allowing people to take the power to make the decisions. This supports co-production in allowing communities to decide what is important to them and allowing them to make the decisions which can affect their health and wellbeing; promote staff engagement – staff are our greatest ambassadors and our greatest assets. They are integral to the success of the new care model. We recognise that staff working across the partnership need to be supported to maximise their potential, feel valued and understand how they can contribute to the delivery of a new care model. A series of design jam sessions and workshops based on human centred design will help unlock ambition, bring fears into the open and harness the energy of our staff to create a future that supports health and wellbeing for staff and the new models of care; co-produce care pathways - we believe that services created in partnership with Dudley people and communities are best. A patient’s experience of care can varying significantly by intervention, however research carried out by Deloitte showed significant variation in a number of pathways in Dudley. To support more effective and patient centred commissioning we would like to identify what issues and barriers exist in the system and explore how we can work in partnership with clinicians, patients and healthcare professionals, to co-produce improved pathways of care. We aim to use this resource to work with an academic institute to facilitate this co-design; support the use of personal health budgets for children and young people, and people with learning disabilities, mental health problems and long term conditions. Measurement – what ‘counts’ for people rather than ‘counting people’ As we develop new ways of working and we place a much greater emphasis on the person, we must find new ways of measuring the value of those services to that person. This is an area which has traditionally been under explored or invested in. We will focus on the following areas.

II.

Integrated reporting system As new services develop, a powerful tool to shape health and care delivery will be feedback from individual patients, carers, families and patient groups on their experience of care. Evaluation will be able to draw on Dudley’s Integrated Patient Experience Reporting System, which is being expanded into community and primary care to include all our 46 GP practices and our main providers.The system, which was developed in partnership with our main acute provider, Dudley Group NHS Foundation Trust, is being used to track experiences across their services. This will provide us with an excellent means of examining the vital outcome of improved patient experience. We will further develop a web portal to display and encourage feedback.

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We will roll out the integrated reporting system to all our healthcare providers. We will ensure that our reporting systems are robust so that the right people are aware of the information and can take appropriate action. III.

Mi Experience of Care Application The drive for the NHS to become more digital is supported in Dudley, our ambition is for Wi-Fi to be available in all our GP practices, it is now available throughout the hospital and as a result we want new ways to connect with people in these settings. We have recently launched a feedback app, which captures a person’s experience of care by provider. In 2016/17 we expect this option to be available to patients using all our services.

IV.

Patient reported outcomes This is an area where we have done some innovative work to date with our locally developed PSIAMS system. This system which we have developed with the voluntary sector, enables individuals to both track their progress as well as demonstrate the social value impact of the services they receive. This work will be further supported through research to develop measures which can be used to measure how engaged the patient is in managing their own health. We will use the PSIAMS system of personal and social impact action measurement to understand the impact of our commissioning interventions as part of our approach to commission for value. We will develop the PSIAMs tool to empower individuals to assess the impact of commissioning interventions on them.

V.

The lived experience of people and staff Understanding the lived experiences of people/staff that have been in contact with MCP services are vital to its evaluation. In order to achieve this we will work with a research provider over a 2 year period to evaluate the change for people and staff. This evaluation will involve detailed interviews with patients and staff and will be overseen by an academic research organisation to provide independent authentication of our findings. We also want to be sure that the changes we are making are not negatively impacting on the provider and confidence that people have in health and care services in Dudley. To do this we want to conduct some 360 degree surveys to understand, set a baseline and track opinion over time. We are actively working to share the benefits of this work this. We have been selected by the Social Care Institute for Excellence (SCIE) to be a site in their Changing Together Work. This programme aims to influence a 51 | P a g e

policy document to be published in June 2016 which will examine how best to have constructive conversations on the ‘wicked issues’ of New Care Models. e) Wider Primary Care, Provided at Scale i) In 2015/16 • • • • • •

•

• •

• •

•

We have fully exercised our delegated functions for the commissioning of primary care since 1st April 2015. All of our Primary Care Commissioning Committee meetings have been held in public session, on a monthly basis from 1st April 2015. Our commissioning and governance arrangements for have been audited and assured in our first year of delegation, by NHS England, the Good Governance Institute and internal audit. We have developed a new contractual framework with our GPs that has reformed the QOF locally, and consolidated DESs, LISs and public health commissioned services. We suspended the current QOF in 2015-16 to prepare for the introduction of the new contractual framework in 2016-17. The outcome measures in the new contractual framework have attracted positive and supportive National attention from Dr Martin McShane, National Clinical Director for Long Term Conditions and Ian Dodge, National Director for Commissioning Strategy, NHS England. We have developed and implemented a Primary Care Development Programme – a quality improvement programme that has improved practice efficiency; improved knowledge and skills for clinical and non-clinical 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. We will be extending 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. We have supported all practices moving to EMIS is to maximise efficiency, this has included developing standard protocols and searches across member practices and enhancing our use of risk stratification tools to identify and manage the frail elderly; reducing unplanned admissions, and co-ordinating physical, mental and social care in the community. We have developed, in house, an EMIS template to support the introduction of the new contractual framework. This has been piloted in our member GP practices We have developed and commissioned winter pressure schemes 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. We have increased the use of technologies within our member practices, such as telecare, online prescriptions and appointment booking. All of our member practices have online services enabled. 52 | P a g e

•

• •

• •

We have invested in development and training for 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. We have continued to invest in mentorship support for our GPs, practice nurses and practice managers. We have worked with our 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. We have developed a new primary care quality performance tool – and have been publishing practice level data on performance throughout 2015-16. Our approach and investment in GP engagement remains critically important – in 2015-16 the membership engagement team has visited every GP principle in Dudley to discuss and understand the challenges faced by practices including:-

• • •

workforce challenges – planned retirements workload challenges – sustainability income – personal and practice change appetite – level of interest in co-operation, federation or merger

Our commissioning intentions for primary care, and our value proposition submitted for the implementation of the Dudley MCP set out how we will respond to the challenges identified by our GP engagement activities. We have hosted several events for our 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. We continue to meet with our members on a monthly basis through our locality meetings, and quarterly of the wider membership. We achieve excellent levels of engagement – Dr Robert Varnam commented that he had not seen the same level of GP engagement anywhere else in England.

In 2016/17 Sustainability of General Practice The sustainability and quality of general practice is dependent on the implementation of the Dudley MCP new model of care. The key work areas are summarised below, and are set out in more detail in the document “Dudley New Care Model, Developing a Multispecialty Community Provider – Value Proposition” submitted to the NHS England New Care Models Team in February 2016 and our Commissioning Intentions document. New Contractual Framework The changes in the nature of demand for care have not been matched by changes in capacity. In particular, we need to change the way we care for people with long term conditions, including mental health conditions. To achieve this - and in consultation with our membership - we have designed a new contractual framework to replace QoF, DESs and LISs. This contract will reflect the three themes of access, continuity and coordination. We will use this programme to roll out the framework, with training, 53 | P a g e

templates and support. This will be evaluated (and published) to maximise learning; it will also be used to establish appropriate shared outcome measures that could be used to align incentives between MCP services and secondary care. Access • • • • • • •

enabling resilience in primary care is critical through the CCG’s primary care strategy and primary care development programme; we will support practices to work in partnership together where appropriate (for to provide evening and weekend access and same day access for the over 75s; working with practices to meet the requirements to enable full access to records for all patients across the system; creating a new “back office” function and eliminating unnecessary transaction costs to support efficiency improvement in primary care; standardising referral protocols, triage and discharge information to improve the efficiency of communication (both ways) between primary and secondary care; ensuring all practices can utilise the full range of options for providing access to their patients (e.g.: online, telephone appointments); implementation of our estate strategy to support enhanced primary and community care capacity and capability.

Continuity Through the new contractual framework we will be commissioning:• • • • • • •

a holistic assessment on at least an annual basis of all patients with long term conditions; a named care co-ordinator; joint development of care plans with the patient; support for access to self-management programmes; condition specific outcome targets - many shared with secondary care; enhanced management of patients with diabetes and COPD; the development, and use of one template through the EMIS system to support the delivery of this.

Coordination Through the new contractual framework we will be commissioning:• • • • • • • •

an annual enhanced assessment of the frail elderly; monthly MDT meetings carried out to a consistent format; consistent risk stratification process across all practices; providing professional advice and guidance to the MDTs; unplanned admissions – replication of the existing Directed Enhanced Service; support for patients with dementia and palliative/ end of life needs; systematic management of patients in care homes; systematic management of repeat prescribing.

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Primary Care at Scale We have made significant progress in primary care: all practices are on the same IT system (EMIS); our 46 practices come together into five localities (each with ~60,000 population) to exchange information / best practice; we have developed, piloted and evaluated a General Practice Development Programme (showing potential efficiencies of ~30% in administrative functions). This needs to be expanded and accelerated. We will therefore scale up and enhance the programme to cover all practices. This will address five topics:• • • • •

education on the new long term conditions framework; support for collaborative, cross-practice, working; developing options on premises; recruitment support and career development; back office savings.

Fundamentally, this will aid the formation of larger-scale operations that will provide resilience, sustainability and quality across General Practice. f) A Modern Model of Integrated Care • Emergency admissions will be reduced from XXXX to XXXX. • Avoidable admissions will reduce from XXXX per 100,000 in XXXXX to XXXX per 100,000 in XXXX. • Delayed days in hospital will reduce by XXX days in XXXX and by a further XXXdays in XXXX. • People still at home 91 days after discharge to reablement will increase by XX people in XXXXX and a further XX in XXXXX. • The number of new admissions to nursing homes will reduce by XXX In XXXXXXX and by a further XX in XXXXXX. • We expect the specialties of general medicine, geriatric medicine, respiratory medicine and endocrinology to be most affected by the reduction in emergency admissions.

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Non-Elective Admissions

30,000

59,101

56,656

54,363

40,000

52,157

50,000

39,355

Activity

60,000

61,584

70,000

Activity Forecast Plan

20,000 15/16

16/17

17/18

18/19

19/20

20/21

Year

The graph above shows the planned reductions in Emergency Admissions against the backdrop of predicted activity growth due to changes in demography.

The graph above demonstrates the interventions and the respective impact required to achieve the planned reductions in Emergency Admissions. i) Our model of integrated care Our new model of care – the MCP is described above. This model is designed to ensure that: • every Dudley person has a high quality experience of health and care throughout their life journey; • the health and care system promotes independence; • prevention and wellbeing are integrated and privileged; • every unplanned hospital admission is treated as a system failure; 56 | P a g e

• risk stratification and other tools enable an intelligent approach to service intervention. Our approach is based upon integrating primary, community, mental health, social care and public health activities to support older people. In addition, our model supports integration with voluntary and community sector services at a neighbourhood level. Integration will take place at three levels – practice level, locality level within our 5 CCG localities and at borough wide level. Teams will integrate services from practice to borough wide level and connect local services more effectively with their local communities. These services will provide:• proactive, preventative support to a common population using risk stratification and other data tools; • an enhanced community based urgent care service as a real alternative to ED/hospital admission; • step down for supported discharges from secondary care; • a consistent response 7 days per week to agreed clinical standards. Specific initiatives which underpin this model are set out below. ii) Practice based multi-disciplinary teams (MDTs) - building on the work of our early implementer sites, we have now rolled out our MDT model across all practices, supported by a comprehensive organizational development programme. General practitioners act as the lead clinicians for these community teams. A set of agreed performance metrics will be monitored by our GP locality groups where teams will account for their performance. Service delivery will be enabled by a single IT solution. Success will be measured by:• • • • • •

an enhanced service experience for patients and users; reduced clinical risk measured by the risk stratification tool; reduced levels of dependency; reduced social isolation; reduced ED attendances and unnecessary admissions; better quality of life for patients with long term conditions through efficient management.

iii) Community nursing service – this is intrinsic to the functioning of the MDTs and will incorporate both district nursing and the virtual ward case managers. This will provide a generic community nursing skill base, support timely and safe discharge from acute care settings; through a co-ordinated ‘pull function’ as part of the MDT. iv) Intelligent service response – MDTs are using our risk stratification tool to support their work and reviewing all admissions for over 65s in their practices. We are reviewing the use of the existing tool in the light of others available. 57 | P a g e

v) GP locality leadership – 5 GPs have been appointed. They implementation of our integrated model in each locality.

lead the

vi) Locality link workers – 5 workers have been commissioned from the Council for Voluntary Service, working with the MDTs and ensuring patients are connected to voluntary services in their communities. This will be extended across all MDTs vii) Social prescribing scheme – commissioned from Age UK as an alternative means of supporting people in their communities. This and the locality link workers will use the PSIAMSs tool (see above). viii) Community Rapid Response Team (CRRT) - the Advanced Nurse Practitioners in the Community Rapid Response Team have commenced working from the WMAS control centre to access the Computer Aided Dispatch System. This enables the nurses to identify appropriate patients for assessment and prevent admissions to hospital. The team will be up to full capacity by summer 2016 providing a 7 day and out of hours service.

ix) Dementia support - the diagnosis rate has increased to 57.87% as at December 2015 and on target to meet the England national benchmark of 67% by the end of 2016/17. A comprehensive programme is in place to achieve the national target. The majority of practices are participating in the National Enhanced Dementia Identification service and are undertaking dementia harmonisation coding.

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In addition:• • • • • •

a refreshed Dudley Dementia Strategy will be the subject of consultation in June 2016; a home treatment and crisis resolution service, as an alternative to hospital admission, will be commissioned; patients with dementia will be offered the opportunity to have an advanced care plan. MDTs will be trained on caring and managing people affected by dementia; minimum waiting time standards from referral to psychiatric assessment will be in place for patients on acute hospital wards; we will contribute to the Dudley Dementia Action Alliance and the creation of a Dementia Friendly Community in Dudley.

x) Elderly care A new elderly care pathway will be commissioned based upon the notion of “retrieval” of patients from hospital into the community. This will include the development of the role of the geriatrician in the community and contribute to MDT meetings on management issues in relation to complex frail elderly patients. An Older People and Frailty System Wide Group has been established and to develop a Dudley Frailty Strategy. This includes the following workstreams:• • • • • • • • •

workforce and education in care homes medicines management in care homes effective transition in and out of hospital nutrition and hydration palliative care falls the role of the voluntary sector in hospital discharge prevention social isolation and loneliness

A new falls strategy will be developed with adult social care and public health. A particular focus will be given to primary prevention to reduce the numbers of older people falling and particularly those requiring assessment in ED or admission to hospital.

xi) Dudley Care Home Programme We will commission a bespoke palliative care and end of life care programme for care home staff. This will focus on the five priorities of care from the Leadership Alliance for the Care of the Dying - recognise, communicate, involve, support, plan and do.

We will build on the success of our pilot reactive care home out of hours service and commission an urgent care clinical response team for care homes. All nursing and 59 | P a g e

residential homes will have a dedicated out of hours service to contact for clinical triage and home visiting. This will be designed to reduce inappropriate admissions to hospital. The Care Home Nurse Practitioners and Mental Health Nurse for Care Homes will provide 7 day support to care homes. Services that support care homes will be co-ordinated in an integrated approach including the care home nurse practitioners; older people’s pharmacist; specialist diabetes nurse for care homes; continence nurses; dieticians and Macmillan nurses for care homes. Objectives will include reducing admissions to hospital and attendances at ED; increasing utilisation of advance palliative care plans; improved discharges from hospital; consultant out-reach from hospitals; improved knowledge and management of non-life threatening conditions such as urinary tract infections. xii) Seven day services - the provision of services on a 7 day basis has commenced for the virtual ward and community rapid response team. The community heart failure team, palliative care team and care home nurse practitioners will form part of the next phase. Seven day service standards have been developed for community services as part of our work with NHS IQ and shared with NHS England. These will now feature in our service specifications xiii) Palliative and end of life care Recent initiatives include:•

•

• •

completion of the Midhurst Project - the Dudley Macmillan Specialist Care at Home Team. The service has now amalgamated the hospital team, the community Macmillan team and Mary Stevens Hospice and is accessed via one single point of access with a central specialist triage team; a Local Improvement Scheme (LIS) for primary care for ‘end fo life and palliative care’ he objectives/outcomes are to enhance the quality of care provided to people requiring palliative care and end of life care with a particular focus on increasing support to the non-cancer conditions; reducing admissions to hospital by increased support in the community; and ensuring advance care plans are in place that include the patients preferred place of care at end of life, with the desired outcome of reducing deaths in hospital; launched a new standardised advanced care plan and DNACPR (Do not attempt co-pulmonary resuscitation) form across secondary, community and primary care; the specialist community palliative care team now has a palliative care consultant and Macmillan nurse aligned to each of the five localities and attending practice MDTs to discuss and support the care management of end of life and palliative care patients.

Further initiatives to include:•

the focus in 2016-17 will be on ensuring every resident in a nursing home is offered (and supported) an advance care plan that includes a directive on ‘preferred place of care’ and medical treatment towards end of life. This initiative 60 | P a g e

• • •

will also extend to residents in residential care homes that have had an urgent care admission during the last year; to commission electronic patient care records system for end of life/palliative care that includes the utilisation by WMAS; to extend the palliative care service to a 7 day service; the specialist community palliative care team is now providing further community capacity to intervene early, prevent unnecessary admissions and facilitate preferred place of care for patients.

xiv) Extra care housing – we have commenced a pilot project with a community nurse to support practices with patients in extra care housing schemes. This was in response to residents requiring health services and increased admissions from extra care housing to hospital. xv) Community respiratory service – a community based service is now in place. Each locality has a named community respiratory nurse linked to the MDTs and palliative care nurses. Palliative care MDTs for patients with advanced respiratory disease and on the palliative care register forms part of this model. xvi) Community back pain service - a community back pain clinic will be commissioned. This will comprise of triage and access to a multi-disciplinary team (GP, consultant, physiotherapist and psychologist) xvii) Neurology - the community neurology team are now linking into practice MDTs to support the management of patients with complex neurological conditions. Further work has taken place in relation to Acquired Brain Injury; muscular dystrophy, palliative care needs and advanced dementia. xviii) Community IV antibiotics – this service has commenced for primary care initiation. GPs can diagnose and refer patients to avoid a hospital admission. xix) Our Better Care Fund Plan This is consistent with the development of our MCP service model, designed to reduce emergency admissions as part of our overall approach to resilience planning through:• developing integrated practice and locality based teams led by GPs; • investing in a locality based rapid response team as the referral point of choice for patients in crisis; • reducing admissions to hospital and residential/nursing home care as a result of this; • creating strong links to local community and voluntary services, reducing social isolation and supporting people to be as independent as possible in their local communities. The key elements of our BCF Plan for 2016/17 will be schemes relating to: • • •

delayed transfers of care and an integrated discharge pathway; services to support car homes; falls; 61 | P a g e

•

support to carers.

In terms of the key performance metrics:• • • • • •

service efficiencies will provide the recurrent investment for the rapid response service and the GP leadership role for the over 75s; emergency admissions to reduce by 15% in financial terms by 2018/19; Avoidable admissions will reduce by 129 from 8,142 (2,596/100,000 population) in 2012/13 to 8,278 (2,530/100,000 population) in 2014/15; delayed days in hospital will reduce by 600 days in 2014/15 and by a further 636 days in 2015/16; people still at home 91 days after discharge to reablement will increase by 12 people in 2014/15 and a further 11 in 2015/16; the number of new admissions to nursing homes will reduce by 32 in 2014/15 and by a further 36 in 2014/15 and 2015/16.

Our agreed contract with Dudley Group NHS Foundation Trust for 2016/17 is constructed on the basis of the required reduction in emergency activity from the BCF. g) Access to Highest Quality Urgent and Emergency Care • a reduction in ED attendances by 2016/17 resulting from a redesigned urgent care system and the rapid response team. • delivery of the Urgent Care Centre (UCC). Co-located within ED, the UCC streams all presenting ambulatory patients to ED or the UCC for primary care assessment and treatment. • a reduction in emergency admissions of 100 cases from the new GP respite pathway.

15/16

95,311

92,507

89,509

86,780

84,217

110,000 100,000 90,000 80,000 70,000 60,000 50,000 40,000 30,000

74,068

Activity

Accident & Emergency

Forecast Activity Plan

16/17

17/18

18/19

19/20

20/21

Year

The graph above shows the planned reduction of A&E attendances against the back drop of predicted activity growth due to changes in demography.

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A&E Activity - Reductions by Intervention 16/17 0 -500 -1,000 -1,500 -2,000 -2,500 -3,000 -3,500 -4,000 -4,500

-4,180 Urgent Care Centre

The graph above demonstrates the interventions and the respective impact required to achieve the planned reductions in ED Activity. i) A new urgent care model The new urgent care system for Dudley is now in place, following extensive patient and public engagement and successful mobilisation on 1 April 2015. Dudley urgent care system currently meets all national recommendations and performance measures for urgent and emergency care. Furthermore, whilst there has been some recent deterioration in performance, Dudley Group NHS Foundation Trust is now one of England’s strongest performers against the ED four hour wait standard. Performance in terms of ambulance handovers improved during the latter part of 2015/16 following an intensive piece of work led by the Urgent Care Working Group. This did deteriorate during January when the system was under a high level of pressure. Focus on this performance will be maintained in 2016/17.

Ambulance Handovers: Last 12 months

190

200 156

138

150

87

100 50 0

68

54 4

5

2

1

36 1

Feb-15 Mar-15 Apr-15 May-15 Jun-15

35 0

Jul-15

1

21

1

9 0

6 0

18

2

14

Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16

Ambulance Handover between 30mins…

The new service model was informed and developed following extensive patient and stakeholder engagement and is in line with the outcome of the national urgent and 63 | P a g e

emergency care review. Key features of this engagement and as a result core aspects of the current urgent care system in Dudley are:• • •

improved access to primary care – patients preferred to see their own GP; a simplified approach to access without confusing multiple entry points; patients being able to access urgent care 24 hours a day 7 days a week, 365 days a year.

Particular priorities for 2016/17 include:• • • • •

addressing issues in relation to delayed transfers of care; ensuring “see and treat” and “ hear and treat” are reflected in our ambulance service specifications; remodeling the UCC and ED estate to facilitate the more effective management of patients as they present, including those with mental health needs; continuing to address ambulance handover performance; commissioning a 24 hour access and assessment service for patinets with mental health problems.

We will continue to work with local partners to enhance and strengthen the pathways of care available within the UCC for presenting patients. The CCG will also work with neighboring health economies and NHS England to implement emerging and future proposals for urgent and emergency care system reconfiguration across the Black Country. We will continue to work with our partner CCGs across the West Midlands to reconfigure hyper acute stroke services. Until such time as this work is concluded, our planning assumption is that there will be no change to local service provision.

ii) System resilience Our Urgent Care Working Group, reporting to the System Resilience Group and in turn the Health and W ellbeing Board, has oversight of the urgent care system.

Health and Wellbeing Board

System Resilience Group

Better Care Fund Section 75 Agreement Integrated Commissioning Executive

Urgent Care Working Group

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The Urgent Care Working Group (UCWG) co-ordinates performance improvement, system redesign and surge and escalation planning for the urgent care system. Throughout 2015/16 the UCWG oversaw the commissioning a number of schemes to increase capacity within the system and ensure Winter resilience. These included:-

refining the community rapid response service as part of our integrated services model to reduce the number of patients going to ED; implementing a discharge to assess model to improve discharges from secondary care; enhancing the level of support available to patients with mental health problems at times of crisis; and using an agreed model to manage the number of supported and unsupported discharges destined for health or social care, together with an integrated community bed management system.

Alongside these system changes a number of schemes that have been developed to manage demand and facilitate discharge during 2015/16 will be considered for further funding in 2016/17. These schemes are currently under review by the UCWG and a recommendation for further funding will be made to the System Resilience Group in April 2016. The SRG will invest recurrently in those initiatives which are demonstrably effective. This investment will be contained within the SRG recurrent allocation for 2016/17 of £2,015,000.

SRG Schemes 2015/16 Frail Elderly Assessment Unit Care Home Select Red Cross PTS Weekend Discharge 7 Day Streaming is SAU SRG Scheme Social Care Urgent Response Service Falls First Response Service SRG Scheme Mental Health Car SRG Scheme Mental Health Urgent Care Centre Psychiatric Liaison Service Total

Provider DGH DGH DGH DGH DGH Provider DMBC DMBC Provider WMAS Provider DWMH DWMH

£ £259,600 £150,000 £240,000 £216,000 £31,200 £280,000 £262,000 £53,690 £334,049 £212,050 £2,038,589

Our expectation is that by continuing to implement the schemes which pass the 2015/16 year-end confirm and challenge process, the current emergency four hour wait performance target will continue to be met. In addition in 2016/17 we will:65 | P a g e

•

•

review the pathways and charging arrangements for the various admission avoidance and assessment units currently linked to the Acute Trust unplanned care pathway; re-commission the NHS 111 service by July 2016.

h) A Step Change in Productivity of Elective Care • • • •

•

To be met by a 20% reduction over 5 years, whilst countering a potential £100,000 cost increase, due to demographic change, per year. Outpatient follow up attendances to reduce by 8929 by 2017/18. Advice and Guidance and Triage to be introduced across all appropriate specialties at the point of referral. The introduction of Advice and Guidance and Triage will begin to significantly reduce the need for Outpatient Appointments. As a result, patients who do require such appointments will be seen more quickly. Referrals which no longer require an outpatient appointment will be returned to General Practice with a management plan to support management in primary care.

1st Outpatient Appointments

98,909

94,362

90,102

60,000

86,109

80,000

87,129

Activity

100,000

103,548

120,000

Forecast Activity

40,000

Plan

20,000 15/16

16/17

17/18

18/19

19/20

20/21

Year

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1st Outpatient Appointments -16/17 Reductions by Intervention 0 -2000 -4000 -6000 -8000 -8970 Pathways

-10000

Outpatient Follow Ups 320,000

17/18

290,521

16/17

266,016

220,000

254,651

240,000

243,998

260,000

278,146

280,000 258,108

Activity

300,000

Forecast Activity Plan

200,000 15/16

18/19

19/20

20/21

Year

The graph above shows the planned reduction of Elective Activity against the backdrop of predicted activity growth due to changes in demography.

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The graph above demonstrates the interventions and the respective impact required to achieve the planned reductions. Reductions in Musculo-Skeletal activity are predicated on the ‘Commissioning for Value insight pack’ which demonstrates that Dudley CCG could realise significant activity and cost reductions by moving from 2nd highest CCG in England for activity and expenditure on Musculo-skeletal Elective and day cases to the average of Dudley’s ONS Cluster Group (most similar CCGs).

700,000 473,184

492,256

506,544

528,663

300,000

576,739

485,897

400,000

554,438

466,481

500,000

532,319

458,660

600,000

511,672

550,964

Activity Reductions Overall

15/16

16/17

17/18

18/19

19/20

Activity Forecast Plan

200,000 100,000 20/21

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Activity Overall - Reductions by Intervention 16/17 -350

-491

-5,000

-375

-

Rapid Response Team MDTs Elderley Frail

-10,000 Falls Prevention -15,000 -20,000

Long-Term Conditions Framework

Planned care represents our largest area of spend. However, there is a significant variation both between services and between providers in the number of steps that a person may go through in the course of treatment. W e will expect each provider to determine how they will improve the efficiency of the services they provide. During 2014/15, referral to treatment (RTT) times have improved at Dudley Group NHS FT. In December 2014, 93.5% of patients received treatment within 18 weeks. The number of patients waiting over 18 weeks has significantly reduced. Challenges remain for the specialties of trauma and orthopaedics; ophthalmology; urology and oral surgery. i) Pathway efficiency Planned care represents our largest area of spend. However, there is a significant variation both between services and between providers in the number of steps that a person may go through in the course of treatment. We will expect each provider to determine how they will improve the efficiency of the services they provide. During 2014/15, referral to treatment (RTT) times have improved at Dudley Group NHS FT. In December 2014, 93.5% of patients received treatment within 18 weeks. The number of patients waiting over 18 weeks has significantly reduced. Challenges remain for the specialties of trauma and orthopaedics; ophthalmology; urology and oral surgery. We will invite all providers to demonstrate the effectiveness of the services they provide. Services which demonstrate effective outcomes will be positively promoted. Services where the outcome value cannot be demonstrated will be decommissioned.

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In particular, we will:• • • •

extend access to “advice and guidance” services for GPs across all elective pathways to reduce outpatient attendances; work with Dudley Group Foundation Trust to deliver a robust triage service to ensure that outpatient appointments are provided to those that need them; ensure that 100% of referrals take place using the NHS e-Referral service; establish redesigned services across four key specialties:

ENT •

a more efficiently managed ear pathway for patients and to increase nurse-led follow ups

MSK • • • •

reduce the number of inappropriate referrals to secondary care through use of the Orthopaedic Assessment Service permit direct referral by the service to other specialties; provide non-specialist management of Fibromyalgia in primary care; take the methotrexate and blood monitoring services out into primary care, where the majority of such patients already receive their treatment in primary care.

Ophthalmology • •

introduce Consultant-led Triage of all new Ophthalmology introduce Optometrist sessions for low-complexity

referrals

into

Urology •

introduce an Advice and Guidance service to reduce outpatient appointments and free up consultant time for more complex patients and those on the RTT waiting lists.

i) Specialised Services Concentrated in Centres of Excellence Specialised services are those services that are provided in relatively few hospitals to a catchment population of more than one million people. The number of patients accessing these rarer services is small and a critical mass of patients is needed in each centre in order to deliver the best outcomes. In addition a concentration of skills and expertise by the clinical team undertaking the treatment also benefits the standard of care delivered. These services are commissioned directly by NHS England. 70 | P a g e

It is important for the CCG to align its local strategy to the direction of travel nationally for specialised services over the next five years as:• the focus on planning across the entire patient pathway is vital i.e. any changes to a patient’s pathway considered by the CCG/Local Authority for a service such as Child and Adolescent Mental Health Services (CAMHS) will impact on the specialised element of the inpatient care given to children as part of the directly commissioned tier 4 service (or vice versa); • historically specialised services account for £12.2 billion per annum of the NHS allocation. Historically, the growth in cost exceeds other parts of healthcare by as much as 4% per annum. Planning to look at how we work together with NHS England to review and achieve better value for money and improved quality is a key priority. Specialised services will be developing a robust QIPP challenge of its own and the CCG will need to work with NHS England to understand the QIPP agenda on the local health economy; • the national strategy for specialised services is in the early stages of its development but it is clear the direction of travel is towards fewer centres concentrated in centres of excellence (around 15 to 30 centres). The CCG will need to work closely with NHS England to understand the implications of the strategy and work together on how to implement the transformational change required; • there will be joint opportunities for maximising research teaching opportunities to encourage innovation and change.

and

The CCG will therefore be ensuring that local operational plans involve:• identification of opportunities for joint planning and development of care across the whole patient pathway within local plans. Supporting the need for change within an agreed case for change; • close contract management arrangements with specialised commissioners for providers; • supporting the development of the local service priorities and/or reconfigurations currently being considered by the Area Team which include camhs tier 4, cancer services, cardiology, paediatric intensive care and high dependency services and neuro-rehabilitation services. 10. Innovation The CCG is strongly committed to supporting and championing innovation at all levels within the organisation. The Chair and Chief Accountable Officer take personal responsibility for ensuring that this process is reflected in our commissioning plans. A GP Board Member has specific responsibility for innovation 71 | P a g e

and research and in addition the CCG has a designated management lead for research and innovation along with an appointed Clinical Lead for Research. Therefore a strong disseminated leadership promotes innovation throughout the membership of the CCG. This disseminated innovation has supported:• • • • • •

the development of our community rapid response service; measuring individual consultant performance and pathway variance; having one IT system for all 46 GP practices; using the PSIAMS system to understand the holistic commissioning impact from the patient perspective; the development of a new integrated performance and analytics platform the development of new and user friendly methods for patient feedback on services and interventions.

However, the CCG also recognises the importance of innovation horizon scanning and connectivity with the broader network of research and innovation. Dudley CCG is linked to areas of best practice and research based interventions through membership of the NHS Benchmarking network, health literature research via academic portals and working in conjunction with Birmingham University’s Health Service Management Centre on continuing development and evaluation. The CCG embraces the acceleration of innovation described in ‘The Forward view into action: Planning for 2015/16’ and mirrors the principles of this acceleration in the development of robust and integrated outcomes measures for all services commissioned, facilitating more responsive and impactful decision-making within the commissioning cycle. The CCG is committed to utilise and promote the principle that commissioning health services, delivering services and individual patient care are based on best evidence, underpinned by high quality evidence based research. Professionals within the CCG are expected to hold differing levels of evidence, knowledge and information (dependable on role) to translate and disseminate research and innovation in to practice. Accessing and facilitating appraisal of evidence to support and inform commissioning decisions will be a crucial element. A systematic method of promoting a culture where commissioning decisions are based on evidence will involve the engagement with NICE, PHO, Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) and use of approved research databases. Links with local Higher Educational Institutions (HEIs) , Royal Colleges and other relevant bodies, for example the Academic Health Science Network (ASHN) will be strengthened to support knowledge transfer, the translation of research into practice and rapid implementation of evidence based improvement. Local clinical networks will also be utilised to provide local insights and nurture a 72 | P a g e

culture of being more research aware to support the use of evidence for clinical improvement and to inform commissioning plans. The CCG is committed to promoting research, service evaluation and innovation when addressing the healthcare priorities of the population in Dudley to ensure commissioning decisions are based on best available evidence. The CCG recognises that maximising the quality and effectiveness of patient care is best realised through a strategic approach in taking part, attracting and funding research studies that best match the population characteristics in Dudley as well as working towards attracting more high quality commercial studies into this area. Maximising the benefits of research through innovation, income, knowledge improvement are key to improving patient/public outcomes. 11. Effective Information Management We will continue to make the best use of information Technology to support the delivery of better care and to influence clinician and patient behavior. This will include:• • • • • • • • • • • • •

enhancements to better enable integrated working within MDTs; continuing the creation and implementation of a single view of patient records; greater use of existing and introduction of new Enterprise working capabilities within EMIS Web; expansion of mobile technology, particularly for our integrated MDTs and GPs to enable remote access to clinical records; remote monitoring systems – for heart failure and COPD; risk stratification – evaluating the use of other tools including SAS; development of applications and infrastructure to support the Single Patient Portal to include primary care, MCP services,111, telehealth and telecare; implementation of Wifi in GP practices; continued investment in technology refresh in GP practices to maximise performance and service delivery; continued development and implementation of EMIS templates, pathways and concepts to maximise consistency and enhance data quality; to commission electronic patient care records system for end of life/palliative care that includes the utilisation by WMAS; co-ordinate the creation of a digital roadmap to deliver a service that is paper free at the point of care across the Dudley care economy; promote the use of Patient online services.

12. Governance and Performance Our commissioning intentions were approved by our Board and shared with our partners in Autumn 2015. Outline planning requirements were shared with the CCG Board and the Health and Wellbeing Board in January 2015. 73 | P a g e

Key issues already identified in our commissioning intentions will be addressed in our contracts with our main providers. Our draft plan will be considered by the CCG Board on 10 March 2016. Our final plan will be considered by the CCG Board on 31 March 2016. Our system of governance involves the oversight of our main initiatives by 4 key committees:• • • •

quality and safety – CQUIN performance, assurance from our clinical quality review meetings, safeguarding matters, implementation of Francis and Winterbourne View recommendations and our quality strategy; primary care commissioning – implementation of our primary care development strategy and commissioning intentions; clinical development – our key system initiatives, including service integration, urgent care, planned care productivity, as well as health outcome metrics, quality premium indicators and our QIPP initiatives; finance and performance – our financial and QIPP plan and key performance metrics.

We have developed a comprehensive set of performance metrics, linked to a logic model to support the implementation of our new care model. This is overseen by our Partnership Board. We have a separate but related set of metrics that support the Better Care Fund, reflected in our Section 75 Agreement and overseen by the Integrated Commissioning Executive. We have described the key functions of the CCG as:• • • • • •

setting the vision for our local health system; holding our system to account; facilitating service improvements; engaging with patients and the public; supporting quality improvements; ensuring good governance and working with our partners.

Our internal governance processes are geared to discharging these functions and ensuring appropriate reporting and accountability arrangements to our Board through our quality and safety, clinical development, primary care commissioning, and finance and performance committees. We recognise our statutory duty to reduce health inequalities and the Director of Public Health is a member of the CCG Board. Our relationship with the Office of Public Health is reflected in an annually agreed memorandum of understanding. As described above we also have a number of mechanisms in place to engage with and hold ourselves accountable to our local community outside our traditional governance processes. Our plans will continue to be developed with and our 74 | P a g e

performance reported to our stakeholders through:• our Health Care Forum, Patient Participation Groups and Patient Opportunity Panel; • our GP Membership meetings and the development of our mutuality model; • our GP locality meetings – particularly in relation to the delivery of our integrated care model; • Health watch – who we will encourage to act as a “critical friend” in the development of future plans; Our NHS, local government and voluntary and community sector partners through the System Resilience Group; • the Health Overview and Scrutiny Committee; • the Health and Wellbeing Board, not least as the oversight body for the BCF. At the heart of our system vision is the development of a new model of care. As described above this will be characterised by locality teams led by GPs, acting as the main mechanism for providing responsive services, capable of enabling people to live independently in strong communities, providing a real alternative to hospital admission. These teams will operate on the basis of distributed leadership, where accountability will be at its strongest within the team itself and performance reported regularly to our GP locality meetings. 13. Deliverability The proposed changes to service models included in this strategy cannot be delivered by the current infrastructure. A system wide organisational development programme, delivered at pace and scale, will be a key enabler for the implementation of the new service model which lies at the heart of our plan. This work has already begun and encompasses community nurses, CPNs, GPs and social workers and is aimed at creating a distributed leadership model which places an onus on responsive, integrated service delivery. The development of our primary care system, through the implementation of our delegated commissioning responsibilities, will create the capacity and capability to support and complement our urgent and planned care systems. This will include the systematic management of patients with long term conditions to meet our outcome ambitions and respond to our assessment of local health need. We will continue to develop our single IT platform for primary care, capable of developing the capacity to intervene systematically to manage a practice population and link with other systems as part of the integrated response process. We will refresh our programme management functions to deliver this plan, our STP and our new care model to plan and on-budget. 75 | P a g e

In addition, we will ensure we get the highest quality and best value from our corporate support structures. We will review the range of services we commission from our CSU and ensure we have a management infrastructure that is fit for purpose. This may bring new corporate support providers into Dudley in addition to the external support we currently commission, including support on organisational development, governance, patient experience and primary care. We believe this is the most appropriate model to deliver our aim to continue to innovate and support the delivery of the best services possible to the population of Dudley. We will continue to invest in and develop our workforce. We undertake regular staff surveys and have reviewed all our employment policies. This has resulted in: − more flexible working opportunities; − more support for staff with carer responsibilities; − implementation of a staff health and wellbeing programme We have an extensive organisational development programme from Board level downwards, together with a focus on individual development opportunities for all staff. We are committed to being a “healthy board”. We have concluded a comprehensive review of our governance processes and behaviours by the Good Governance Institute and will implement our action plan to refresh our governance arrangements. We are in the process of reassessing the organisation against the goals and outcomes of EDS2. We believe we are on track to being compliant in terms of having a “representative and supported workforce” and “inclusive leadership”. The review of our employment policies described above has contributed to this. We will review the composition of the CCG Board in the context of the community we serve and the NHS workforce race equality standard. This will inform the succession planning process.

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Appendix 1 JSNA Gap in life expectancy for the least and most deprived areas of Dudley has widened mostly due to chd, copd and lung cancer in men.

Nearly one fifth of 40-59 year olds are living with a long term limiting illness

The rate of delayed discharges attributable to social care is higher than the national rate

Outcome Ambition Initiative Securing additional years • Systematic management of life of long term conditions • Prescribing for heart 3.5% reduction in disease potential years of life lost • Prescribing for cholesterol per annum from • Smoking cessation 2087/100,000 in 2012/13 • Weight management to 1875.4/100,000 in • Sport and physical activity 2015/16 action plan • Diabetes LES and diabetes control Improving the quality of • Responsive IAPT services life for people with long • Diagnosing and term conditions. responding to dementia • Diagnosing hypertension Average EQ-5D score for • Vascular checks people with one or more • Improved recording in long term condition to disease registers for heart increase by 1.6% from failure, hypertension and 70/100 people in 2012/13 kidney disease to 71.6/100 in 2015/16. • Community based respiratory service • Community based pain service • COPD LES review • Revised diabetes LES • Community diabetes team Reducing time spent in • Rapid Response Team hospital through more • Redesigned virtual ward integrated care • Care home CPN • 7 day services Avoidable emergency • Community respiratory, admissions to reduce diabetes and antifrom 8,142 coagulation services (2,596/100,000 • Enhanced telehealth and population) in 2012/13 to telecare 8,013 (2,530/100,000) in • Community pain, 2015/16 dermatology and ophthalmology services

20% of single person Increasing the proportion • households are in the of people living 60+ age range independently at home • • People still at home 91 • days after discharge to increase by 4% from 86%

Integrated locality services Rapid Response Team Social prescribing scheme Locality link workers

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at March 2013 to 90% at March 2016 Musculoskeletal services Increasing people’s • present an opportunity to positive experience of • improve the patient hospital care pathway, secure value • for money and deliver Reducing the average • better outcomes number of negative responses from 159.2 per • 100 patients in 2012/13 to 153.5 per 100 patients in 2015/16. A reduction of 3.58% Systematic management Increasing the proportion • of long term conditions is of people with a positive • required in primary care experience of GP care • and in the community • Reducing the average • number of negative response from 6.1 per • 100 patients in 2012/13 to 5.66 in 2015/16. A • reduction of 7.2%. Emergency admissions Eliminating avoidable • for gastroenteritis and deaths in hospital • lower respiratory disease are increasing for the 60 • – 74 age group •

Clear clinical standards Efficient planned care pathways Patient safety CQUIN Organisational learning CQUIN Medication error reporting

Better access 7 day services Active patient participation groups Reducing variation Transfer of services to primary care Managing long term conditions Single IT system for all practices MRSA zero tolerance Grade four pressure ulcer zero tolerance Reducing infection rates including Cdiff Reducing medication errors

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GLOSSARY ADVANCED CARE A process of discussion between an individual and a care practitioner to PLANNING make clear a person’s wishes in the event of their health deteriorating. ANP

Advanced Nurse Practitioner – a nurse working at an advanced level of practice, encompassing aspects of education, research and management but grounded in direct care provision.

AHRQ

Agency for Healthcare Research and Quality – an agency of the US Government responsible for improving quality, safety, efficiency and effectiveness.

AQP

Any Qualified Provider – a mechanism for procuring services where there are multiple providers working to a common quality standard and price.

ANP

Advanced Nurse Practitioner.

BERWICK REPORT BCF

A report into patient safety.

6 CS

Care, Compassion, Competence, Communication, Courage and Commitment – the Chief Nursing Officer’s ‘culture of compassionate care’

CAB

Citizen’s Advice Bureau – a charity providing advice on legal, financial and other matters.

CDIFF

Clostridium Difficile – a bacteria best known for causing diarrhoea.

CEN

Community Engagement Network – Dudley Council’s network for public consultation.

CHD

Coronary Heart Disease.

CPN

Community Psychiatric Nurse.

COPD

Chronic, Obstructive, Pulmonary Disease – a type of lung disease characterised by poor airflow.

CIP

Compassion in Practice – see 6Cs.

CQUIN

Commissioning for Quality and Innovation – a system of payment designed for commissioners to reward excellence.

CSU

Commissioning Support Unit – an organisation providing services to support the CCG’s functions.

CALL TO ACTION

A programme of engagement with the public about the future of the NHS.

Better Care Fund – a pooled budget with the Local Authority designed to support service integration and reduce admissions to hospital, nursing and residential care.

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CONTINUING HEALTHCARE

A situation where responsibility for meeting the costs of a patient’s health need continues to rest with the NHS.

ECIST

Emergency Care intensive Support Team – A Department of Health sponsored team which assists health and social care systems to improve emergency care.`

ED

Emergency Department.

EDS

Equality and Diversity Scheme – a mechanism used to deliver the CCG’s duties under the Equality Act.

EMIS

A computer system for general practice.

ENT

Ear, Nose and Throat

FRANCIS REPORT

A report of an enquiry conducted by Robert Francis, QC into events at Stafford Hospital.

FRIENDS AND A test of patient satisfaction based on asking ‘how likely are you to FAMILY TEST recommend our services to your friends or family if they needed treatment.’ GSF

Gold Standards Framework – A means of managing end of life patients to agreed standards in primary care.

HED

Health Education Data – a system drawing upon multiple data sources to benchmark performance.

HSMR

Hospital Standardised Mortality Ratio – a method of comparing mortality levels in different years.

HSW

Health and Wellbeing Board – a statutory committee of the council responsible for producing the JSNA (see below) and the JHWS (see below). The Board consists of representatives from a number of bodies with a responsibility for health and wellbeing.

HEALTHCARE FORUM

Dudley CCG’s forum for consultation with patients and the public.

HEALTHWATCH

The voice of the consumer in healthcare.

IAPT

Improving Access to Psychological Therapies – an initiative to enable patients to access psychological ‘talking’ therapies.

JSNA

Joint Strategic Needs Assessment – a joint assessment carried out by the CCG and the Council on the main needs affecting the residents of Dudley.

JHWS

Joint Health and Wellbeing Strategy – a Strategy developed by the Health and Wellbeing Board in response to the JSNA.

LA

Local Authority – an elected local government body, eg Dudley 80 | P a g e

LES

Metropolitan Borough Council. Local Enhanced Service – a service commissioned from primary care beyond the scope of their usual contract.

MIND

A national charity supporting people with mental health needs.

MRSA

Methicillin Resistant Staphylococcus Aureusis – a bacterial infection resistant to a number of antibiotics.

POP

Patient Opportunities Panel – a group consisting of representatives from PPGs (see below) with whom the CCG consults.

PPG

Patient Participation Group – a group established to enable engagement with practices at GP practice level.

PRIMARY CARE An organisation set up to support the development of best practice FOUNDATION within primary care and urgent care. PSIAMS

Personal and Social Action Measurement System – a mechanism for measuring the impact of an intervention on an individual.

QIPP

Quality Innovation, Productivity and Prevention – a programme designed to deliver improvements in quality and productivity.

QOF

Quality and Outcomes Framework – Part of the GP contract which links remuneration to the improvement of quality and outcomes.

QP

Quality Premium – a series of nationally and locally agreed indicators against which the CCG’s performance is assessed and for which a performance payment is received.

RMN

Registered Mental Nurse.

RTT

Referral to Treatment – The target waiting time for elective care.

SAU

Surgical Assessment Unit

SHIMI

Summary Hospital Level Mortality Indicator – an indicator of mortality at Trust level.

SHO

Senior House Officer.

SRG

System Resilience Group – Multi-agency body, reporting to the Health and Wellbeing Board, responsible for system wide management and resilience.

WINTERBOURNE VIEW

A former facility for patients with learning disabilities where patients were mistreated.

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 2016 Report: Partnership Board Agenda item No: 7.4 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, Head of Organisational Development and Human Resources

MANAGEMENT LEAD:

Mrs Stephanie Cartwright, Head of Organisational Development and Human Resources

CLINICAL LEAD:

Dr David Hegarty, Chair • •

KEY POINTS: • •

Since the last report the Partnership Board has met on 23rd December, 26 January and 24 February. Since the last report to the Board, staff from the partnership have participated in two study tours as part of the new care models programme. 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.

RECOMMENDATION:

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


None


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 is currently undertaking an extensive piece of work undertaking listening exercises out in the community.

ACTION REQUIRED:


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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MARCH 2016 PARTNERSHIP BOARD

INTRODUCTION 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

REPORT 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 three times since the last report to the Board which was in January 2016. The December meeting of the Partnership Board included a detailed presentation on the study tour to Spain to visit the Alzira model. The study tour included Matthew Gamage from Dudley CCG, Matthew Bowsher from the Local Authority and Paul Bytheway from Dudley Group Foundation NHS Trust. The presentation included particular reference to their fifteen year contract, the mobilisation of their model and their contracting and payment mechanisms. The meeting also included a detailed discussion on the process surrounding submission of the value proposition including submission deadlines and input required from partners. The Board also discussed the concepts behind the single patient portal and the project plan aligned to this initiative and also received a detailed briefing from the communications workstream on the three month listening exercise that was commencing in January. The January meeting of the Partnership Board’s main agenda item was the Value Proposition. With a final submission of 8th February 2016, the Partnership Board discussed in detail the level of investment requested and provided recommendations on priorities. The Board also discussed potential backfill arrangements for front line staff to further enhance the roll out of the model (particularly in relation to teams without walls). This principle was agreed by the Board and would be arranged on an organisation by organisation basis. The Programme Plan for the new care models was discussed and Partnership Board made recommendations for improvements to the information shared, risk mitigation and the escalation process to Partnership Board for areas of concern. In February, Partnership Board discussed the Value Proposition which was submitted on 8th February and the approval process. It is anticipated that we will know the outcome of our submission by 16th March, although it may not be the full outcome, it may be an indication with request for further clarification. It was shared that indicative feedback is that our Value Proposition was a strong submission and all members were thanked for their contributions. The Partnership Board also received a presentation from the second study tour that our partnership has participated in. Janet Beddows, District Nurse Team Leader and Taps Mtemachani visited the Buurtzorg Model in the Netherlands. The Buurtzorg model is a nurse led organisation that employs 15,000 nurses. The main learning points from the visit were self-managed teams, caseload management and the input of voluntary sector and communities into their model of care. The Board also received a verbal update on the IT workstream and challenges that this workstream is working hard to overcome and an interesting update on governance which included learning from the Manchester model. The learning from this model will be taken forward by the governance workstream and will also feed into the development of the future organisational model. 2|P a g e

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

Stephanie Cartwright Head of Organisational Development and Human Resources Vanguard Management Lead February 2016

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 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 on 19 January 2016 and 16 February 2016. This report contains key updates on issues discussed by the Committee to include:

KEY POINTS:

• • • • • • • • • • •

Infection Prevention and Control Ofsted visit to the Local Authority teams in Dudley Recommendations from the Southern Health Independent review Coppice Lodge final inspection West Midlands Quality Review Service - Dementia Review Dudley Group Maternity Services Primary Care Quality issues Proposal to establish a Clinical Quality Review Meeting for the Urgent Care Centre NSL Nursing & Midwifery Council – Revalidation of Nurses 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.


None


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 – 10 MARCH 2016 QUALITY & SAFETY COMMITTEE REPORT TO GOVERNING BODY 1.

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 January and February 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.

KEY ISSUES DISCUSSED

2.1

Infection Prevention and Control

2.1.1

Healthcare Associated Infection Report is submitted as Appendix 1.

2.1.2

Dudley Antimicrobial Stewardship (AMS) Programme annual update is submitted as Appendix 2.

2.1.3

An update was provided to the Committee around the discovery of legionella in the water system at Bushey Fields Hospital. As part of D&WMHT’s Water Safety Plan, water samples were taken on 27 October 2015. Results identified that legionella was present in 11 of 64 samples. The DWMHT Estates department will continue to complete and carry out tests to achieve agreed targets. There have been no concerns regarding patient safety throughout this period.

2.2

Safeguarding

2.2.1

Local Authority OFSTED report

2.2.2

An inspection of services for children commenced in Dudley on 11 January 2016.

2.2.3

The inspection was completed on 4 February 2016. Initial verbal feedback has been given to the Director and Chair of the DSCB (Dudley Safeguarding Children Board) The official feedback and rating will be announced on 29 March 2016.

2.2.4

Serious and Local Safeguarding Case Reviews (SCR)

2.2.5

The CCG Designated Nurse currently chairs the DSCB SCR sub group. The SCR sub group has been involved in a number of local and formalised case reviews since September 2015. These include:

2.2.6

• • •

2.2.7

All of the cases have been referred to the national panel for their agreement. OFSTED inspectors reported that referral into the group and review methods were robust.

2.2.8

Multi Agency Safeguarding Hub (MASH)

2.2.9

The Dudley MASH is due to go live in April 2016. Currently there is one health post out to advert which has been funded by Public Health. A further post will be required along with

one Thematic Serious Incident Learning Process (SILP) one single case SILP five Local (tabletop) Case Reviews

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administration support to ensure resilience. 2.3

Independent Review of deaths of people with a Learning Disability or Mental Health Problem in contact with Southern Health NHS Foundation Trust - April 2011 to March 2015

2.3.1

The Committee received a resume of the recommendations published in December 2015 which highlighted a range of findings and patient associated learning’s related to Mental Health and Learning Disability Service Users deaths. The Quality & Safety team is requesting that all providers review the recommendations.

2.3.2

Reports have been received from BCPFT and DWMHT which provide evidence that providers are sighted on the contents of the report with particular focus on the comprehensive list of recommendations being made. The Quality & Safety team is reviewing the responses from all providers to gain assurance that rigorous processes are in place to confirm compliance. A report is expected from DGFT in April 2016

2.3.3

The report contained recommendations for commissioners which have been discussed at the Quality and Safety Committee and will be actioned.

2.4

Coppice Lodge

2.4.1

Coppice Lodge is a six bedded purpose built Learning Disability respite facility for children with complex needs and provides families with short breaks. The facility is part of the Caretech organisation and has been open since February 2015.

2.4.2

The CCG has worked in partnership with a number of external colleagues to support this organisation following the reporting of serious incidents relating to medication management.

2.4.3

A visit was planned to follow up on the contents of the action plan submitted in August 2015. The visiting team were satisfied that the home has implemented all recommendations and responded positively to the findings of the investigation. Managers provided assurance that lessons had been learnt from past incidents.

2.5

West Midlands Quality Review Service (WMQRS) Dementia Review

2.5.1

The Committee received a report from the lead commissioner for integrated services which provided details of the formative review of dementia services in Dudley health and social care economy. The review took place on 29 & 30 September 2015. The purpose of the visit was to help the health and social care economy to improve clinical outcomes for service users and carers.

2.5.2

The report commended the progress that had been made whilst identifying areas for improvement. Three areas of concern were: diagnostic & assessment pathway, data collection (activity and performance monitoring) and coordination of services.

2.5.3

The report has been discussed at Committee level, and we agreed areas for ongoing improvements which will be monitored by the lead commissioner. The document is to be published on the WMQRS website on 29 February 2016.

2.6

Maternity Services at DGFT

2.6.1

NHS England West Midlands, during a benchmarking exercise, identified governance issues in respect of Dudley Group maternity services. A detailed CCG assessment of the issues are ongoing with Dudley Group maternity and governance staff, NHS England staff and external reviewers. A verbal update will be given at Board and a full report will be provided to Board

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as soon as it is available. 2.7

Primary Care Quality

2.7.1

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

2.7.2

CQC have carried out a number of inspections and the outcomes of these are contained in appendix 3. A verbal update will be given at Board regarding the inadequate rating at Bath Street Surgery. Themes following inspections focus on the lack of DBS checks, fridge temperatures and infection control. The Quality and Safety team are working with practices to ensure remedial actions are taken.

2.7.3

The Quality and Safety team are actively involved in monitoring serious incidents reported by primary care practices.

2.8

Urgent Care Centre

2.8.1

The Committee was updated on the progress being made by the Quality and Safety team to gain greater assurance of quality and safety matters. Discussions have taken place with the manager of Malling Health who has agreed in principle to establishing Clinical Quality Review Meetings. Dates and terms of reference will be agreed at a meeting planned for March 2016

2.8.2

A review of prescribing practices has taken place at the urgent care centre and a report was presented to the Committee which outlined a number of emerging themes. A review of the current prescribing pathways has been recommended.

2.9

NSL Update

2.9.1

NSL has been advised to develop a more widespread and robust process for collecting feedback on the patient experience

2.9.2

Concern has been expressed at CRM regarding the timeliness and content of NSL’s Quality Report. A letter has been sent to NSL (on 11 January 2016) drawing their attention to what is confirmed as a breach of contract and asking for a formal response which should aim to provide ongoing assurance.

2.9.3

Dudley CCG is working with commissioners in Wolverhampton CCG to achieve prompt and complete performance data to support the remedial action plan which remains in place.

2.10

Nurse and Midwifery Council Revalidation

2.10.1

The Committee was provided with an update on the actions being taken by all providers to support the revalidation of nurses during 2016. All providers have advised that plans are in place for the scheme starting in April 2016. Details have been received outlining the proactive stance being taken to support the workforce and mitigate future risks to resources.

2.10.2

Dudley CCG is working closely with the HeART (Healthcare e-Portfolio for Appraisal, Revalidation & Training) learning appraisal framework, an RCN accredited organisation who have developed a tool to monitor and support revalidation of all nurses in the primary care setting and Dudley CCG. Further sessions have been planned to include training on how to use the tool. A record is being established to identify the status of all nurses to include dates for revalidation.

2.11

Risk Register

2.11.1

The Committee reviewed the risk register in depth during January 2016 Committee. Two new

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risks were added to include Looked After Children (LAC) health assessments and staffing resources within the Infection Prevention and Control team. 3.

RECOMMENDATIONS

3.1

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.

Ruth Edwards Clinical Executive Lead for Quality 2 March 2016

Appendix 1 - Healthcare Associated Infection Report Appendix 2 - The Dudley Antimicrobial Stewardship (AMS) programme annual update Appendix 3 - Primary Care update – CQC inspections status

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 2016 Report: Healthcare Associated Infection Report (Appendix 1) Agenda item No: 8.1 TITLE OF REPORT:

Healthcare Associated Infection Report – Appendix 1

PURPOSE OF REPORT:

To provide on-going assurance, and highlight areas for action and improvement

AUTHOR(S) OF REPORT:

Barry Jones, Caroline Brunt, Ruth Edward

MANAGEMENT LEAD:

Mrs Caroline Brunt, Chief Nurse

CLINICAL LEAD:

Dr Ruth Edwards, Clinical Executive Lead for Quality

KEY POINTS: The Board is asked to: • • RECOMMENDATION: • •

Accept this report as evidence of on-going assurance around work being undertaken to identify and minimise the risk of infection. Provide support those actions and initiatives aimed at minimising the risk of infection highlighted in this and reports to the Quality and Safety Committee. Consider the current resources available for infection prevention and control in Dudley CCG and Public Health and how these can be best utilised. Agree to support the development of a Board Approved HCAI Assurance Framework.


None


Engagement across the health economy to address this Public Health priority

ACTION REQUIRED:

 Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MARCH 2016 HEALTHCARE ASSOCIATED INFECTION REPORT

1.

INTRODUCTION

1.1

The reduction of Healthcare Associated Infection (HCAI) remains a key patient safety objective of the NHS and Dudley CCG. This report provides an update of infection prevention and control issues in Dudley relating to the two key objectives Clostridium difficile and MRSA. This builds on information provided quarterly to the Quality & Safety Committee.

1.2

This report will look at the key issues around the epidemiology of each organism, processes in place in the community to reduce infection rates and issues identified so far this year. It will also make recommendations moving forward to improve Dudley’s resilience and reduce the rate of infection.

2.

KEY ISSUES

2.1

Clostridium difficile

2.1.1 Clostridium difficile infection (CDI) is the most important cause of hospital-acquired diarrhoea. C. difficile is an anaerobic bacterium that is present in the gut of up to 3% of healthy adults and 66% of infants. The people most at risk of C. difficile infection are those that have been treated with broad spectrum antibiotics, people with serious underlying illnesses and the elderly. Careful use of antibiotics, excellent infection prevention practice and high standards of environmental and healthcare equipment cleanliness are essential to control this organism which has historically contributed to, or caused death, in vulnerable groups. 2.1.2 CDI remains a key objective of Dudley CCG with a national objective for 2015/16 of no more than 76 cases in its responsible population. Figure 1 clearly shows that this objective has not been achieved with a projection that the number of cases will be approximately 120. Fig 1: Cumulative counts of Clostridium difficile Cases within Dudley CCG responsible population vs Objective April 2015 - March 2016 Cumulative No. Cases

2015/16 Objective

Linear Trajectory

Cumulative number of cases

140

120

120

100

76

80

60

40

20

0

0

Source: HPA HCAI Data Capture System *Provisional data only

Week Ending

Produced by Public Health Intelligence

2.1.3 The rate of C. difficile in the twelve month period as a whole (January 2015 - December 2015) in Dudley CCG’s population was 39.3 cases per 100,000. 2.1.4 This is the 6th highest (Fig 2) when compared to the neighbouring and most similar CCGs, and is above the current England rate of 29.3 cases per 100,000. Whilst historically Dudley has regularly held a similar position, there has been a 51.2% increase in all cases, compared to the previous twelve month period (January 2014 - December 2014). The number of acute trust

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cases in Dudley CCG's population increased 37.5% compared to the previous twelve month period. 2.1.5 Nationally, whilst there have been increases in reported Clostridium difficle cases, primarily with an increasing trend in the number of none acute cases, the increase in Dudley is greater. Fig 2: Clostridium difficile by CCG - West Midlands and 10 Most Similar CCGs to Dudley January 2015 - December 2015 Rate per 100,000 resident population

Rate per 100,000 resident population Rate per 100,000 resident population

NHS DUDLEY CCG

England

70 60 50 40 30 20 10 0

CCG Source: Of f ice of National Statistics, Final Mid-Year CCG Population Estimates 2014 and PHE HCAI Data capture system, NHS Englands 10 Most similar CCGs to Dudley CCG, Rank of Similarity in brackets, most similar being (1)


2.2

Meticillin Sensitive Staphylococcus aureus (MRSA)

2.2.1

Staphylococcus aureus is a bacterium that is often carried on the skin and on the inside of nostrils and throat without causing any problems. However it can also cause disease if the bacteria enter the body, for example through broken skin or during medical procedures. Most strains are sensitive to commonly used antibiotics and can therefore be effectively treated, however some are more resistant. Those resistant to the antibiotic Meticillin are known as Meticillin-resistant Staphylococcus aureus (MRSA) and often require different types of antibiotic to treat them. All cases of MRSA positive blood cultures caused case is subjected to two distinct classification processes: the automatic

2.2.2

The NHS continues with a zero tolerance approach to MRSA bacteraemia cases. All cases occurring in the population are reported nationally and subject to a Post Infection Review (PIR).

2.2.3

Figure 3 below, highlights the Dudley position over time. As can be seen so far during this financial year there have been 3 MRSA bacteraemia cases in Dudley CCG’s responsible population. Two cases were identified as apportioned to an acute trust, which in this case was Dudley Group of Hospitals NHS Foundation Trust. An acute trust is apportioned the case when the sample was taken from the patient on or after the third day of an admission to an acute Trust (where the day of admission is Day 1). Non-acute trust cases are all other situations, for example those in Accident and Emergency. Whilst some issues remain with the level of cooperation and the standard of investigations, important lessons have been identified from the PIR process, including insertion/care of central and peripheral lines, improved communication and care of intravenous drug users.

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Fig 3: MRSA bacteraemia Apportionment of Cases (all ages) in Dudley CCG responsible Population Quarterly Count, Apr - Jun 2009 to Oct - Dec 2015 Apportioned to non-acute trust Apportioned to acute trust 4

Number of Cases

3

2

2009/10

2010/11

2011/12

2013/14

2014/15

Jul - Sep

Oct - Dec

Apr - Jun

Jan - Mar

Jul - Sep

Oct - Dec

Apr - Jun

Jan - Mar

Jul - Sep

Oct - Dec

Apr - Jun

Jan - Mar

Jul - Sep

Oct - Dec

2012/13

Quarter

Source: HCAI DCS, PHE

2.2.5

Apr - Jun

Jan - Mar

Jul - Sep

Oct - Dec

Apr - Jun

Jan - Mar

Jul - Sep

Oct - Dec

Apr - Jun

Jan - Mar

Jul - Sep

Oct - Dec

0

Apr - Jun

1

2015/16


For the 12 month period January 2015 to December 2015, the rate of MRSA in Dudley CCG’s population was 1.1 cases per 100,000. This is the 4th lowest rate when compared to Dudley CCG’s neighbouring and ten most similar CCGs (Figure 4). Fig 4: MRSA bacteraemia - West Midlands and 10 Most Similar CCGs to Dudley January 2015 - December 2015 Rate per 100,000 resident population Rate per 100,000 resident population

Rate per 100,000 resident population

NHS DUDLEY CCG

England

10 9 8 7 6 5 4 3 2 1 0

CCG Source: Of f ice of National Statistics, Final Mid-Year CCG Population Estimates 2014 and PHE HCAI Data capture system, NHS Englands 10 Most similar CCGs to Dudley CCG, Rank of Similarity in brackets, most similar being (1)

2.3


Action taken by the Public Health Infection Prevention Team (IPCT)

2.3.1 The team with colleagues in public health support Dudley CCG under a Memorandum of Understanding, which sets out what will be provided. Whilst this document is prescriptive in nature, the team have increased the amount of support provided to the CCG providing additional assurance and challenge to providers around infection control. This has been undertaken with a reduced resource within the team. 2.3.2 Within Public Health a series of surveillance measures are undertaken to monitor for incidents and outbreaks of infection. Where cases are linked to time and place the team investigate. There is a long running system to monitor for incidents of CDI in care homes in Dudley. Two incidents were identified in Dudley homes so far this financial year, both linked to recent discharges from an acute trust. In addition there have been 6 periods of increased incidents (PII) at DGFT.

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2.3.3 The team undertake a programme of infection control audits in Dudley residential care settings, with 31 visits taking place by the end of this financial year. These audits look at standards throughout the home and require the home to make any improvements recommended. These audits are shared the Commissioners and the Care Quality Commission (CQC). 2.3.4 In addition, the number of GP audits undertaken this year has doubled to 16. Whilst these audits again provide assurance to the CCG, identifying areas for improvement, they also aim to assist the practice achieve the requirements of CQC registration, offering advice and support to the practice. 2.3.5 Free Education programmes exist for both care home and GP staff. This year a programme of support to domiciliary care providers has also commenced, with the aim of reducing avoidable harm in all community care settings. 2.3.6 Scrutiny and challenge of providers at commissioning, incident, Root Cause Analysis and other meetings, as well as reviewing all Incident reports relating to infection control. 2.3.7 Advice and support to all providers on the management of infections in the community and standard of infection control in the built environment. 2.3.8 An Infection Prevention and Control Link Worker Programme, for care home staff, with the aim of increasing the skills and knowledge of the workforce. 2.3.9 Ensuring that all cases of CDI in the community are rapidly reported to providers, advising on management of cases. All of these cases are investigated further using the Significant Evident Analysis (SEA) process. 2.4

Clostridium difficile Significant Evident Analysis (SEA) process

2.4.1 As part of the learning process to continually reduce the risk to patients, The IPC team developed the SEA process. Dudley CCG requests that a GP practice completes a Significant Event Analysis (SEA) tool following a case of CDI. The SEA tool is a retrospective investigation that allows the involved parties to identify how and why an infection may have occurred and whether it has been dealt with in line with best practice guidance. 2.4.2 The first SEA form was sent on the 2nd December 2013 and, as at 08/02/2016, there have been 121 SEAs requested from GP practices in Dudley. Of these 104 SEA forms which have been returned by GP practices and the stakeholder reviews have been completed. However, 13 SEA reviews were never completed by GP practices despite follow up from Public Health and the CCG. 2.4.3 The purpose of the process is to gain greater understanding of our community cases to see what actions we can take as a health and social care economy. Figure 5 below looks at themes in our patients and known risk factors. It also identifies that many of the questions remain unanswered. To improve compliance with the tool and the programme, the system has been revised which shortens and simplifies processes for practices.

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Fig 5:

Percentage of cases with Clostridium difficile risk factors (n=104), Dudley CCG, December 2013 - December 2015 Yes

Left blank

100% 90%

85%

% of cases

80%

72%

70%

70% 60% 50% 40% 30%

20%

25%

17%

20% 10%

38%

35% 29%

25% 13% 2%

2%

11%

9% 0%

5%

1%

6%

8% 2%

5%

5%

1%

Taking a PPI

On anti diarrhoeal medicine

On chemotherapy

Had Clinical Intervention

Prescribed Antibiotics

Visited/Been visited by GP

Seen by Community Services

Received Social Care

Resident in Care Home

Been in hospital

Undergoing enteral feeding

Previously had C. difficile

0%

Within last 3 months


Source: SEA database, Office of Public Health, Dudley MBC

2.4.4

Analysis of 104 community cases and their risk factors in the three months prior to diagnosis, identifies multiple risk factors within the information which should be used to drive improvements and target resources. Two the most common risk factors known to contribute to the acquisition of CDI are hospital admission and antibiotic therapy. Both of these are clearly visible in the sample, with 85% of community cases having a hospital admission and 70% receiving an antibiotic. Another interesting risk identified, are that these patients either visit/or are visited by the GP prior to diagnosis (72%). Whilst all these factors may be due to the demographic of the patient, contact with a GP highlights the importance of good infection control standards in primary care, as Clostridium difficile is easily transmitted and will also contaminate the environment, where it can lay dormant for months, if not longer.

2.4.5

The SEA process also asks for detail of what antibiotics were prescribed for each patient. Figure 6, provides details of the antibiotic prescribed for these patients. 119 courses of antibiotics were excluded due to the indication being either for CDI or no indication being given. A further 56 items were excluded from the analysis as they were not antibiotics. A total of 171 courses of antibiotics were included in the analysis.

Fig 6: Antibiotic IV Piperacillin/Tazobactam

Number 24

Percentage of Antibiotic Courses 14%

Flucloxacillin

19

11%

Metronidazole

19

11%

Nitrofurantoin

18

11%

Doxycycline

14

8%

Co-Amoxiclav

14

8%

Amoxicillin

12

7%

Trimethoprim

11

6%

Clarithromycin

7

4%

Penicillin V

5

3%

Whilst any interpretation of the data must take into account those antibiotics excluded, the surprising finding from the analysis, is that the most common antibiotic prescribed to those patients in the community identified that an intravenous antibiotic, used to treat commonly to treat sepsis in secondary care is the most common antibiotic given to community cases in the

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three months prior to diagnosis. Again this information provides the platform from which to target resources and effort. 2.5

Gaps in Scrutiny

2.5.1

Commissioning organisations should be assured that all services about to be, or currently commissioned by them, or on their behalf, are compliant with a range of guidance, policy and regulations in relation to Infection prevention and control. Furthermore, with the changing and expanding role of the CCG, the expectations placed upon it for this scrutiny is increasing. However, with diminished resources within Public Health the ability to meet this demand is challenging.

2.5.2

Antimicrobial Stewardship programme – A significant piece of work has been conducted by the Office of Public Health Pharmaceutical team – see appendix 2 for details.

2.5.3

The CCG must lead on influencing the strategy in provider organisations for infection control, with multi-lateral decisions being made which support improvements across all service users. Plans are in place to re-launch a cross economy infection prevention group, however to invigorate and maintain this will require dedicated resource.

2.5.4

Various methods of scrutiny and assurance are provided to the CCG, including through information in this report. However, there is no HCAI assurance framework in place in Dudley CCG. The aim of a framework would be to provide assurance to the public, patients and regulators, that the HCAI safety agenda is seen as a priority, being well managed and national guidance is being implemented locally. Besides assurance to the organisation, a framework would enable commissioned providers to have a clear understanding of the standards expected of them.

3.

RECOMMENDATIONS Board is asked to:

3.1

Accept this report as evidence of on-going assurance around work being undertaken to identify and minimise the risk of infection.

3.2

Support those actions and initiatives aimed at minimising the risk of infection highlighted in this and reports to the Quality and Safety Committee.

3.3

Agree to support the development of a Board Approved HCAI Assurance Framework.

Caroline Brunt Chief Nurse March 2016

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 2016 Report: Dudley Antimicrobial Stewardship (AMS) Programme Annual Update Agenda item No: 8.1 (Appendix 2) TITLE OF REPORT:

The Dudley Antimicrobial Stewardship (AMS) Programme Annual Update – Appendix 2

PURPOSE OF REPORT:

Programme update

AUTHOR OF REPORT:

Minesh Parbat, Prescribing Advisor, Pharmaceutical Public Health Team

MANAGEMENT LEAD:

Dr Duncan Jenkins

CLINICAL LEAD:

Dr Ruth Edwards

KEY POINTS:

For the Board to be sighted on the outcomes of the Antimicrobial Stewardship Programme within Dudley.

RECOMMENDATION:

The Board is asked to accept this report for assurance for evidence of ongoing assurance around work being undertaken to support the Dudley Antimicrobial Stewardship Programme.


Time required for practices’ clinicians to engage with their review. IMPACT campaign total cost was £7050 – Funded by OPH


Demonstrated patient questionnaire, social media, and road show at Tesco, Dudley

ACTION REQUIRED:

 Assurance

1|Page

1.0

OUTCOMES

1.1

The Dudley Antimicrobial Stewardship (AMS) Programme has achieved the following outcomes to date:

1.2

All practices have completed an audit of patients prescribed antibiotics to measure formulary adherence to drug, dose and duration (quantity) prescribed: • • •

At baseline antibiotic formulary adherence was 53% ,at re-audit this increased to 60% The audit demonstrated an improvement in formulary adherence- 10% reduction in amoxicillin prescribed for bronchitis/sore throat Formulary adherence increased by 7 % from baseline

2.0

ACHIEVED INDICATORS

2.1

As of November 2015, the Quality Premium target is met for the following indicators:

2.2

Reduction in the number of antibiotics prescribed in primary care by 1% (or greater) from each CCG’s 2013/14 value.

2.3

The number of co-amoxiclav, cephalosporins and quinolones as a percentage of the total number of selected antibiotics prescribed in primary care to be reduced by 10% from each CCG’s 2013/14 value, or to be below the 2013/14 median proportion for English CCGs (11.3%), whichever represents the smallest reduction for the CCG in question.

2.4

To implement a social media strategy to engage wider public. Social media plan implemented and Twitter account utilised to raise awareness. Currently 66 followers @Dudleymedicines.

2.5

To implement a plan of action to engage the public and raise awareness of AMS: • •

Attendance at POP meeting to raise awareness of AMS TARGET posters on GP waiting room screens and Youtube video from Dr Steve Mann talking about antimicrobial resistance • Road show at Tesco’s Dudley to raise awareness of AMS • Questionnaire identified the following: o 36% of the public did not know what antibiotics are? o 36% of the public thought that antibiotics are used to treat virus infections o 27% of the public questioned did not know about antibiotic resistance

2.6

To implement a plan of action to engage both clinical/non-clinical staff in AMS: • • • •

A GP educational session was held to raise the awareness of antibiotics resistance in Dudley which was attended by over 100 GPs IMPACT Educational campaign delivered to 11 high priority GP practices, completed January 2016 47 AMS packs sent out to all GP practices that contained ‘TARGET leaflet’ pads (400 sent out), posters and leaflet. This pack contained a letter signed off by Dr R Edwards and Dr P.D Gupta TARGET leaflet EMIS protocol in implemented in majority of practices

3.0

FUTURE ACTIONS

3.1

Produce patient information which provides a simplified overview of AMS. (Locality focus on campaigns taking into account demographics and local issues e.g. raising awareness in the BME community). 2|P a g e

3.2

AMS rolling programme – 5 year plan.

3.3

Utilisation of a local medicines Facebook page to aid the social media campaign.

3.4

CCG endorsed educational programme for non medical and GP prescribers delivered annually specifically on AMS.

3.5

Regular antimicrobial feature in the bimonthly TABLET newsletter.

3.6

CCG endorsed strategy for the use of delayed prescriptions.

4.0

RECOMMENDATION

4.1

Accept this report as evidence of ongoing assurance and the continued focus to raise awareness of antibiotic resistance within Dudley.

Caroline Brunt Chief Nurse March 2016

3|P a g e

APPENDIX 3 : Overview of Status of CQC inspections (as of 23/02/16) Domain Rating

09/12/2015

Status awaited

15/12/2015 17/12/2015 13/01/2016 19/01/16 02/12/16 10/02/16 16/02/16 Not announced

28/01/16 04/02/16

11/02/16 Report gone to regional review 11/02/16

Well Led

Good Requires Improvement Inadequate

11/06/2015 11/06/2015 27/08/2015 31/03/2015 11/06/2015 16/07/2015 16/04/2015 27/08/2015 06/08/2015 03/09/2015 01/10/2015 08/10/2015 15/10/2015 29/10/2015 03/12/2015 17/12/2015 14/01/2016 17/12/15. 07/01/15.

Responsive

Key:

06/01/2015 13/01/2015 14/01/2015 14/01/2015 20/01/2015 27/01/2015 27/01/2015 28/01/2015 05/05/2015 07/07/2015 21/07/2015 04/08/2015 18/08/2015 01/09/2015 30/09/2015 14/10/2015 22/10/2015 28/10/2015 12/11/2015 24/11/2015 & 26/11/2015 08/12/2015

Overall rating

Caring

Woodsetton Medical Practice Bilston Street Surgery - follow-up inspection Lapal Medical Centre The Waterfront Surgery The Limes Medical Centre Moss Grove Surgery Central Clinic - follow up inspection Dudley Partnerships for Health Stourside Medical Practice Quincy Rise Surgery Lower Gornal Medical Practice Eve Hill Medical Practice AW Surgeries

Report Published

Effective

Keelinge House Netherton Health Centre Central Clinic Lion Health Chapel Street Surgery Bilston Street Surgery St James Medical Practice Meadowbrook Surgery Alexandra Medical Practice Bean Road Surgery Castle Meadows Surgery Norton Medical Practice Crestfield Surgery High Oak Surgery Summerhill Surgery Thorns Road Surgery Pedmore Road Surgery Steppingstones Surgery Rangeways Road Surgery Bath Street Surgery

Visit Date

Safe

Practice Name

DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 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 meeting on 4 February 2016

AUTHOR OF REPORT:


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 Update received with IG Toolkit at a score of 57%. IG Handbook and Subject Access Request Operating Procedure approved. Combined BAF & Risk Register as at 7 January reviewed. Risk 15 approved for closure. Head of Commissioning provided assurance about the management of risks by the Clinical Development Committee. Internal Audit Progress report and one audit report with significant assurance received External Audit Progress report received Anti-Fraud progress update for 2015/16 received Expenditure on Consultants for the period 1 April-31 December 2015 received. Confirmation Internal Audit contract extended to 31 March 2017 Update on Annual Report and Accounts 2015/16 received; Accounting policies approved; AGM to be held on 23 June 2016. Other matters considered-FOI Report; update on Business Continuity Plan; EMIS Web Governance policy; Monitoring compliance with Prime Financial Policies

The Board is asked to: RECOMMENDATION:

• •


None


None

ACTION REQUIRED:


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

1|P a g e

DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MARCH 2016 AUDIT COMMITTEE REPORT 1.0

INTRODUCTION The report summarises the key issues discussed at the Audit Committee meeting on 4 February 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 2014/15

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. To be reviewed following outcome of governance review No issues Governance action plan revised into themes and considered October Audit Committee. Report due to March Audit Committee. Annual Report & Accounts approved and submitted by national deadline. AGM held. NHSE Workshop attended. Further workshops by HFMA and External Audit attended by finance and communications staff. Good Progress Annual Report 2014/15 approved; 2015/16 Plan approved; revised Counter Fraud, Bribery and Corruption Policy approved; Updates received. BAF & Risk Register updated monthly and actively managed. Risk appetite being considered following GGI review. Procurement Strategy & reporting being updated to reflect new managing conflicts of interest guidance Interim audit 2015/16 completed. Internal Audit Plan approved by March Committee. Audits progressing with significant assurance overall. 3 revised policies approved November 2015 Business Continuity Strategy & Plan to go to March Audit Committee & 31 March Board for approval. IG Support Officer – some capacity issues with less on-site presence. Meeting informally as work on information asset register progresses Work progressing with Toolkit, score at 57%. IG mandatory training at 80% Additional IAAs identified. Training in small groups completed. Populating asset register progressing. Overarching IG Policy updated and approved. All responded to within required timescale

RAG

2|P a g e

3.0

ITEMS DISCUSSED – 4 FEBRUARY 2016

3.1

Information Governance (IG) The Committee received a bi-monthly IG Report providing an overview of progress against the IG Toolkit including the IG improvement plan; policies and procedures; mandatory IG training; information risk management plan; IG incidents; IG spot checks; privacy impact assessments; Caldicott issues and data protection (subject access) requests. The Committee was informed that the current IG toolkit score was at 57% which was lower than where the CCG was expected to be at this stage of the year, with a final score of 89% required to achieve compliance with the Toolkit. However mandatory training was now at 80% (target 95%) with all face to face training completed. The remaining staff were being followed up to ensure they complete their training on line. The Committee was also updated on the continued lack of progress in the logging of assets on the CCG’s Information Asset Register. It was noted that a number of Information Asset Owners and Administrators were having technical difficulties in accessing the U-Assure system. It was agreed that the IAOs and IAAs would be provided with a spreadsheet solution and that evidence from both the system and spreadsheets would be used to populate the toolkit. IG spot checks had highlighted a number of areas for improvement such as storing removable data and sensitive documents securely when not at a desk. The Committee approved the updated IG Handbook although it was agreed that the social media section would be checked for consistency with the Social Media policy that had been approved by the Remuneration Committee. The Committee also approved an updated Subject Access Request Operating Procedure. The Committee received a report on FOI requests for the period 01/11/15 – 31/12/15 and noted that all 46 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 January 2016 for assurance. The Committee noted the following changes since it last met and considered the BAF & Risk Register as at 6 November 2015: • reduction in the residual score for risk 43 • addition of 3 new risks – 84,85 and 86 • risks closed following Board approval – 14, 16, 41 and 65 • risks closed following Audit Committee approval – 72 and 78 The Committee also approved the closure of risk 15 under its delegated authority following a recommendation from the Clinical Development Committee. This risk was in relation to the failure to embrace or implement the CCG’s IT strategy and health care technology. The Head of Commissioning attended the Committee to provide assurance in respect of the processes within the Clinical Development Committee for managing the risks it was accountable for. In addition he agreed to ensure any relevant risks from the Partnership Board and Integrated Clinical Executive were integrated into the CCG’s BAF & Risk Register. He was not aware of any at this stage. A separate report to the Board based on the Board Assurance Framework (i.e. risks 16 and over) as at 5 February 2016 reflects these changes and provides a further update.

3.3

External Audit The Committee was introduced to Mr John Gregory, who was now the appointed Engagement Lead for Dudley CCG. The Committee received a report that set out progress in the delivery of the external audit responsibilities. It also highlighted emerging national issues and developments and suggested a number of associated challenge questions that the Committee might wish to consider. 3|P a g e

3.4

Internal Audit The Committee received a report on progress against the internal plan and the position on the recommendation tracker. Currently there were only 8 recommendations not fully implemented, none of which were high risk. Based on the work carried out to date, internal audit was predicting “significant assurance” overall for the Head of Internal Audit Opinion. No significant concerns or issues had been raised by the auditors. The Committee received the final 2015/16 audit report on Financial Systems which gave significant assurance overall.

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. It was noted that there had been one referral since the last Committee meeting and this related to attempted prescription fraud.

3.6

Evaluation of Consultant Contracts The Committee considered the expenditure for the period 1 April 2015 - 31 December 2015. It was agreed that the Committee members would review the document and raise any specific queries with the officers. At the last Board meeting the Audit Committee Chair agreed that the Committee would share the details of the consultancy spend it received with the Board. At its meeting in February the Committee received expenditure for the period 1 April 2015 – 31 December 2015 and any consultancy above £10,000 is detailed in the table below: CONSULTANT/ INTERIM Alscient Ltd.

CATEGORY OF PROFESSIONAL SERVICE Interim Manager Management Consultancy-IT Management Consultancy-IT

Management Consultancy-IT Trisha Curran Consulting Ltd. GGI Ltd. Neljet Consultancy Ltd. Impact Change Solutions

3.7

Interim Manager Management ConsultancyOrganisation & Change Management Specialist Contractor Management ConsultancyProgramme & Project Management

NATURE OF WORK Programme & Project Management IT Procurement Vanguard work – mobile device roll-out; architecture principles; futuristic design; Bluesky workshop; governance Service management contract – maintenance, development & improvement of Members Database, Primary Care

SPEND 01/04/15 – 31/12/15 £58,950 £44,325 £41,085

£5,460

Chief Nurse role

£108,220

Governance Review

£30,606

IT Project Support

£48,305

Dudley MCP-Partnership Office

£40,500

CCG and Audit Committee Policies The Committee received an updated EMIS Web Governance policy. The approval of the policy was deferred until the next meeting to allow for assurance to be provided around the impact of the changes for the CCG and also intellectual property rights for the templates the CCG had developed. The Committee also received a verbal update on the progress in the development of the CCG’s Business Continuity Strategy and Plan and was assured that additional resources had been put into place to meet the 31 March 2016 deadline.

3.8

Annual Report and Accounts 2015/16 The Committee received a report on Annual Report Planning for 2015/16 for assurance. The report was also seeking approval for the style and approach being taken. The Committee approved the contents subject to any further guidance from external audit. It also noted the date of the Annual General Meeting as 23 June 2016. 4|P a g e

The Committee also received an update on preparation for the delivery of the Annual Accounts and approved the draft Accounting Policies under its delegated powers. 3.9

Internal Auditor Tender The Committee confirmed that at the last meeting it had agreed to extend the contract with CW Audit Services under its delegated powers until 31 March 2017, not 31 March 2016 as previously reported.

3.10

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

Inaugural Auditor Panel would be meeting straight after the Audit Committee. This panel would be responsible for the appointment of external auditors from 2017/18 onwards. The Board will receive a separate report on this. Monitoring compliance with Prime Financial Policies.

4.0

DECISIONS TAKEN UNDER DELEGATED POWERS Approval of: • Information Governance Handbook • Subject Access Requests Operating Procedure • Closure of Risk 15 in the BAF & Risk Register • Contents of and approach to the Annual Report 2015/16 • Accounting Policies

5.0

DECISIONS REFERRED TO THE BOARD • None

6.0

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 March 2015

5|P a g e

DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 2016 Report: Combined Board Assurance Framework and Risk Register Agenda item No: 9.2 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 5 February 2016

AUTHOR OF REPORT:


MANAGEMENT LEAD:


CLINICAL LEAD:

Dr D Hegarty, Chair

KEY POINTS:

• • • •

Update on combined BAF & Risk Register Summary of risks as at 5 February 2016 presented Details provided of changes made since 7 December 2015 Risk 13 presented for consideration by the Board

• •

The Board is asked to receive the report for assurance The Board is asked to decide if risk 13 should be routinely included in this report 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


None

ACTION REQUIRED:

 Decision Approval  Assurance

1|P a g e

DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MARCH 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 5 February 2016. The Audit Committee considered the overall combined BAF and Risk Register as at 7 January at its meeting on 4 February 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. 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

16

12

Clinical Development

16

12


16

8


16

6

Primary Care Commissioning

16

16

25

12

Clinical Development Finance & Performance

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

20

15


20

12

Quality & Safety

16

12

Quality & Safety

Risks 16 or higher as at 7 February 2016 6.

10.

17.

19.

34.

36. 43.

2|P a g e

Risks 16 or higher as at 7 February 2016 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. 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. NEW RISK

3.0

Initial Risk

Residual Risk


16

12

Quality & Safety

16

9


16

16

Quality & Safety

20

15

Quality & Safety

25

20


16

16


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 7 December at its meeting on 7 January 2016: Review & Updates – Updates were received from the leads for the Finance & Performance and Quality & Safety Committees. The leads for the Clinical Development; Primary Care Commissioning and Remuneration Committees reported no changes. The Management Lead for those risks under the accountability of the Quality & Safety has been amended from Trisha Curran to Caroline Brunt. An additional column has been added to the BAF & Risk Register at the request of the Audit Committee. This is to distinguish between when a Committee last considered the BAF & Risk Register and when an update had been provided.

3|P a g e

3.1

Risk Description, related controls, assurances, actions and comments 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 Committee agreed that this risk no longer remains and would shortly be considered for closure. Risk 71: The timescale for action against this risk has been amended to March 2016. It was further noted that the Chief Nurse attends the CLT meeting and has oversight of the key issues which affect quality & safety. Risk 75: The timescale for actions against this risk has been amended to June 2016. Risk 83: This risk in respect of the non-emergency patient transport KPIs has transferred from the Quality & Safety Committee to the Clinical Development Committee to reflect that a reprocurement exercise is now being undertaken. Risk 84: An additional internal assurance has been added in that a QIPP away day on the 5th January had scoped a savings programme for 2016/17. It was noted that PIDs were under development to be produced by 15th February following a revised QIPP target and assumptions around the Value Proposition being agreed.

3.2

Changes to the Residual Risk Scores There were no changes to the residual risk scores.

3.3

New Risks Risk 90: Although the CCG has been notified of its Resource Allocation for the period 2016/17 for planning purposes, there are a number of new policy commitments and assumptions within the guidance. The impact of these are currently being worked through in the CCG’s five year financial plans and there is a risk that there may be future financial pressures. The CCG is seeking clarification in some areas and also challenging some of the assumptions with NHS England. The local NHS England team is assuring local processes.

3.4

Risks Proposed for Closure There were no risks proposed for closure that had an initial score of 16 or over.

3.5

Risk 13 – Governing Body Accountability The Committee noted that 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” where the Governing Body is the accountable committee has not been reviewed or updated since September 2013. As a risk with an initial score of 12, this does not appear with the risks in the table above. It is proposed that in future this risk is routinely included in this report for review by the Board. The risk currently gives key controls as the Organisational Development plan and Governing Body development events, with gaps in control of the Clinical leadership structure being reviewed and gaps in assurance being that the OD plan delivery is not being reported upon yet. The actions to improve control, ensure delivery of principal objectives and gain assurance are to implement the OD plan delivery reporting to Remuneration Committee The Board is asked to consider the key controls, gaps in control and assurance, and the actions and agree an update.

4|P a g e

4.0

RECOMMENDATIONS

4.1 4.2 4.3

The Board is asked to receive the report for assurance. The Board is asked to decide if risk 13 should be routinely included in this report The Board is asked to consider the key controls, gaps in control and assurance, and the actions and agree an update.

5.0

APPENDICES Appendix 1 – Combined BAF & Risk Register as at 5 February 2016 (risks 16 and over)

M Hartland Chief Operating and Finance Officer March 2016

5|P a g e

Dudley CCG Combined Board Assurance Framework and Corporate Risk Register 2015/16 05-Feb-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

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

Last Review (Committee Date)

17/01/2016

Last Update (Risk Amended)

28/05/2015

LINK TO CORPORATE OBJECTIVE (SEE KEY ABOVE)

ID

2

Risk Description

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)


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

Gaps in Assurance (R) P (R) I Residual Where are we failing to gain Risk Score evidence that our controls/ (PxI) systems, on which we place Score reliance, are effective. Such as following 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

=

01/05/2013

20/01/2016

22/04/2015

2

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.

CDC

Dr Steve Mann / To be updated

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

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

19

01/05/2013

20/01/2016

20/01/2016

22/04/2015

22/04/2015

2

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

CDC

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.

2

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

PCC

Steve Wellings

Dan King

4

4

16

CDC

Neill Bucktin

Neill Bucktin

4

4

16

34

22/04/2013

22/01/2016

05/10/2015

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

36

16/05/2013

20/01/2016

22/04/2015

3

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

CDC

Dr Steve Mann

Neill Bucktin/Laura Broster

4

4

GP Contracts / Appraisals Peer Review Audit Training and Education GMC Registration GP under performance referred to the NHS England Professional & Practice Information Gathering Group (PIGG)

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)

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

Reporting on proper engagement through the business case process

Review of health economy financial position

4

3

12

=

reports to CDC

=

Establish revised business case process. Ensure clear exposition of engagement Report to process is followed Health Watch, Overview Commissioning before Development Committee & Scrutiny Committee recommendations through business cases, to Board through the Minutes of OSC, assurance that revised business newspaper coverage from engagement is taking case process input meetings place to Comms & into governance Engagement Committee. review to check committee responsibility for engagement taking place.

8

None identified.

None identified

2

3

6

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

None

4

4

16

=

=

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

Increased uncertainty on DGFT financial position.

Incentivise Quality

=

4

COMMENTS

Committee has confirmed the risk continues to exist and is discussed at each F&P On-going committee.

Financial Modelling of vanguard programme

12

2

Timescales Date action will be completed

Ensure contracts are compliant with PbR

3

Commissioning intentions, Change Meetings with providers

01/05/2013

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

4

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

17

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.

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

1.Develop and implement service improvement development plans with JHWS External peer plans with all providers.. 2. Health and Social Care Leadership Internal and external audit Group to be QIPP reporting to CDC responsible for reviews and governing body. major system change: Report to Board on CCG Review of Performance - 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.

10

Internal Assurances External Assurances Board Reports, Internal and External Minutes of meetings Audit Reports, CQC Reports

Significant innovation programme in Operational Plan.

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

Quality Premia achievement reporting to None CDC and governing body

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.

On-going Partnership Board established.

On-going

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

On-going

Original risk no longer remains, Nov-15 however, risk renewed in respect of current year's performance

43

48

Original Date

05/12/2013

05/06/2014


17/01/2016

17/01/2016


07/12/2015

28/05/2015


ID

2

2

Risk Description

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.


F&P

F&P


Dr Jonathan Darby

Dr Jonathan Darby

Management Lead

Matt Hartland

Matt Hartland

P

5

4

I

5

5


25

20


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 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.



Risk Trend


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.

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

None identified

Not determined at this stage.

3

3

4

5

12

15

=

=



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

58

71

75

07/10/2014

14/07/2015

14/07/2015

15/01/2016

15/01/2016

15/01/2016

15/12/2015

15/12/2015

06/11/2015

3

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.

3

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.

3

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

Q&S

Q&S

Dr Ruth Edwards

Dr Ruth Edwards

Dr Ruth Edwards

Caroline Brunt

Caroline Brunt

Caroline Brunt

4

4

4

5

4

4

20

16

16

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

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.

4

4

4

3

3

3

12

12

12

1. Review of this risk in QSC, agreed that the risk no longer remains, Medicines management agreement to team continues to monitor recommence high risk medicines; electronic letters. DGH FT have placed on JAC has been their Risk Register and switched on and risk monitored through audit achieved Board. satisfactory target. Manual sign-off remains In May 2016 JAC in place. 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 Jan-16 further assurance - this should be completed by December 2015. Action Completed and agreement reached to discontinue the use of paper copies. Audit results confirm 96% accuracy

=

Escalated to trust risk register

=

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

Mar-16

=

Support for all staff going through the revalidation process. Revalidation briefings and Board reports regular updates Q&SC reports provided by the PCCC reports Updates at professional CCG Chief Nurse. nurses forum Explore the use and Revalidation sessions for deployment of an Reports to national board CCG nurses and electronic tool to at NHSE and NMC Practice Nurses have support portfolio been facilitated by the management for CCG Chief Nurse. practice nurses Preparation materials CCG nurses can have been shared with use ESR. all nurses. Ensure practice nurses are included in the workforce planning workstream to support future resilience.

Jun-16

Quality oversight is through the monthly CQRM and which concerns are flagged in addition to the monthly Collaborative 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



77

22/07/2015

20/01/2016

22/07/2015


ID

1, 2, 3, 4

82

05/10/2015

15/01/2016

15/12/2015

3

83

06/11/2015

20/01/2016

16/12/2015

3

84

90

07/12/2015

17/01/2016

17/01/2016

17/01/2016

17/01/2016

17/01/2016

3

4

Risk Description

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

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


CDC


Management Lead

P

I


Dr Steve Mann

Neil Bucktin

4

4

16



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

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

To be updated

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 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

None

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.


Confirmation of external performance management arrangements

3

3

9

Risk Trend

=

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

4

4

16

=

None

5

3

15

=

None identified

4

5

20

=


Reports to Board

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 processes with from registered to other LA's to ensure resident situation i.e. Board reports transfer of children in the paper records for Q&SC reports care of a HV from being those transferring in PCCC reports are received. It with a GP to their home CQRM meetings cannot be address. established at this This risk is also on the LA stage how long it will take to be risk register. 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 CQRM meetings with the complaints received from provider at which Reviewing finance all sources. complaints received and activity Discussions with Cofrom all sources. elements 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.


COMMENTS

Dec-15

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 Nov-15 borough, particularly the transfer of their records. This is also 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.

Feb-16

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

Jun-16

PID's are still under development and are to be prodced by 15th February following the revised QIPP target and the assumptions assumed within the Value Proposition

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

NEW

CCG Financial plans for 2016-2021 are currently Financial plans will be presented to NHS E for being constructed and 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, nd

th

2 Mar and 11 Apr

DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 2016 Report: Establishment of CCG Auditor Panel Agenda item No: 9.3 TITLE OF REPORT:

Establishment of Auditor Panel

PURPOSE OF REPORT:

To seek Board approval for the Establishment of the CCG’s Auditor Panel and the Panel’s Terms of Reference

AUTHOR OF REPORT:


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: • • •

From 2017/18 onwards all CCGs must have an ‘auditor panel’ to advise on the appointment of their external auditors. As the 2017/18 appointment must be made by the end of the preceding year (i.e. by 31st December 2016), auditor panels need to be in place early in 2016. The shadow Auditor Panel met for the first time on 4th February 2016. The draft Terms of Reference (see Appendix) have been prepared in line with Department of Health and Healthcare Financial Management Association (HFMA) Guidance. All members of the Panel would be expected to declare any acquaintances they had with any partners or members of an external audit firm. A collaborative procurement process was being considered at Chief Finance Officer level within the Birmingham, Black Country & Solihull CCGs in order to obtain economies of scale. The Panel identified 2 risks for its risk register which will be fed into the next iteration of the CCG’s overall risk register.

The Board is asked to:

RECOMMENDATION:

• • • • •

Approve the establishment of the CCG’s Auditor Panel Adopt the Auditor Panel Terms of Reference as presented Approve the appointment of Mrs Julie Jasper as the Chair and Mr Steve Wellings as the Vice-Chair of the Panel Note the timeline for the procurement process Agree a collaborative approach for the procurement


None


None

ACTION REQUIRED:

Decision  Approval  Assurance 1|P a g e

AUDITOR PANEL TERMS OF REFERENCE 1.0

CONSTITUTION

1.1

The Board hereby resolve to nominate its Audit Committee to act as its Auditor Panel in line with schedule 4, paragraph 1 of the 2014 Act. The Auditor Panel is a non-executive committee of the Board and has no executive powers other than those specifically delegated in these terms of reference.

2.0

MEMBERSHIP

2.1

The Auditor Panel shall comprise all Lay Members of the Audit Committee with no additional appointees. The Chief Operating and Finance Officer, Deputy Chief Finance Officer and the Audit Committee Clinical Lead representative will be in attendance. This means that all members of the auditor panel are independent, non-executives, as follows:• • • •

Chair of the Audit Committee, who will be Chair of the Auditor Panel (voting) Lay Member for Governance, who will be Vice-Chair of the Auditor Panel (voting) Lay Member for Quality and Safety (voting) Secondary Care Doctor/Lay Member (voting)

In attendance • Chief Operating and Finance Officer (non-voting) • Deputy Chief Finance Officer (non-voting) • Audit Committee Clinical Lead representative (non-voting) This satisfies the requirement that an auditor panel must have at least three members with a majority who are independent and non-executive members of the Board. In line with the requirement of the Local Audit (Health Services Bodies Auditor Panel and Independence) Regulations 2015 (regulation 6) each member’s independence must be reviewed against the criteria laid down in the regulations. 3.0

CHAIRPERSON

3.1

Either the Audit Committee chairperson will be appointed by the Board to chair the auditor panel or one of the auditor panel’s members shall be appointed chairperson of the auditor panel by the Board.

4.0

REMOVAL/RESIGNATION

4.1

The Auditor Panel chairperson and/or members of the panel can be removed in line with rules agreed by the Board, outlined with the CCG Constitution.

5.0

QUORUM

5.1

To be quorate there must be at least two Lay Members present one of whom is the Chair or Vice-Chair.

6.0

ATTENDANCE AT MEETINGS

6.1

The Auditor Panel’s chairperson may invite executive directors and others to attend depending on the requirements of each meeting’s agendas. These invites are not members of the Auditor Panel.

2|P a g e

7.0

FREQUENCY OF MEETINGS

7.1

The Auditor Panel shall consider the frequency and timing of meetings needed to allow it to discharge its responsibilities, but as a general rule will meet on the same day as the Audit Committee.

7.2

Auditor Panel business will be identified clearly and separately on the agenda and audit committee members shall deal with these matters as Auditor Panel members not as audit committee members.

7.3

The Auditor Panel’s chairperson shall formally state at the start of each meeting that the auditor panel is meeting in that capacity and not as the audit committee.

8.0

CONFLICTS OF INTEREST

8.1

Conflicts of interest must be declared and recorded at the start of each meeting of the Auditor Panel.

8.2

A register of Auditor Panel members’ interests must be maintained by the panel chairperson and submitted to the Board in accordance with the organisation’s existing conflicts of interest policy.

8.3

If a conflict of interest arises, the chairperson may require the affected Auditor Panel member to withdraw at the relevant discussion or voting point.

9.0

AUTHORITY

9.1

The Auditor Panel is authorised by the Board to carry out the functions specified below and can seek any information it requires from any employees/relevant third parties. All employees are directed to cooperate with the request made by the auditor panel.

9.2

The Auditor Panel is authorised by the Board to obtain outside legal or other independent professional advice (for example, from procurement specialists) and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary. Any such ‘outside advice’ must be obtained in line with the organisation’s existing rules.

10.0

FUNCTIONS

10.1

The Auditor Panel’s functions are to:•

• • • •

Advise the Board on the selection and appointment of the external auditor. This includes o agreeing and overseeing a robust process for selecting the external auditors in line with the organisation’s normal procurement rules o making a recommendation to the Board as to who should be appointed o ensuring that any conflicts of interest are dealt with effectively advise the organisation’s Board on the maintenance of an independent relationship with the appointed external auditor advise (if asked) the organisation’s Board on whether or not any proposal from the external auditor to enter into a liability limitation agreement as part of the procurement process if fair and reasonable advice on (and approve) the contents of the organisation’s policy on the purchase of non-audit services from the appointed external auditor advise the organisation’s Board on any decision about the removal or resignation of the external auditor.

11.0

REPORTING

11.1

The chairperson of the Auditor Panel must report to the Board on how the Auditor Panel discharges its responsibilities. The chairperson of the Auditor Panel must draw to the attention of the Board any issues that require disclosure to the full Board or require executive action.

11.2

The minutes of the panel’s meetings must be formally recorded.

3|P a g e

12.0

REMUNERATION

12.1

Payments to Auditor Panel members shall be in line with the organisation’s existing approach to remuneration and allowances.

13.0

ADMINISTRATIVE SUPPORT

13.1

The organisation’s secretary or (governance lead) shall be responsible for organising effective administrative support to the Auditor Panel. The duties of the person appointed to fulfil this role shall include: • • • • • • • • • •

agreement of agendas with the chairperson preparation, collation and circulation of papers in good time ensuring that those invited to each meeting attend taking the minutes and helping the chairperson to prepare reports to the Governing Body keeping a record of matters arising and issues to be carried forward arranging meetings for the chairperson maintain records of members’ appointments and renewal dates, etc advising the auditor panel on pertinent issues/areas of interest/policy developments ensuring that panel members receive the development and training they need providing appropriate support to the chairperson and panel members.

February 2016

4|P a g e

DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 2016 Report: Remuneration Committee Report Agenda item No: 9.4 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 3 February 2016

AUTHOR OF REPORT:

Mrs S Cartwright, Head of Organisational Development and Human Resources

MANAGEMENT LEAD:

Mrs S Cartwright, Head of Organisational Development and Human Resources

CLINICAL LEAD/LAY MEMBER:

Mr S Wellings, Lay Member for Governance • • •

KEY POINTS:

• • • •

Terms of Reference were approved with minor amendments. Workforce Dashboard was received with a request for mandatory training and PDR information to be investigated. Occupational Health and Staff Support were discussed with a recommendation to review the provider to enable a local service to be commissioned. TUPE Transfer of Pharmacy Services was approved. Staff survey was discussed and a recommendation for review by Staff Forum and Board. Social Media Policy was discussed and deferred to the next meeting following consolidation with other HR policies. Remuneration for Lay Members was discussed and a recommendation made for approval by Board.

The Board to note the report for assurance. RECOMMENDATION:

The Board is asked to ratify the decision to increase the remuneration for lay members.


Within financial plan


n/a

ACTION REQUIRED:


1|P a g e

DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MARCH 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 3 February 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 has risen again and continues to be above the 3% national guideline. Reasons for this level of absence are five members of staff who are currently on long term sick leave. 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; however we strive for 100% completeness and this is managed through line managers. Compliance with Personal Development Review compliance is lower than expected however this is due to recording issues on our ESR system, not that the Personal Development Reviews have not taken place. The recording issue is being addressed by the HR and senior management team. The Committee agreed that bespoke training will be arranged for line managers on how to manage employment related issues.

2.2

Terms of Reference The terms of reference for the Committee were reviewed and the following amendments have been made: • • • • • •

2.3

Change of name from Remuneration and Human Resources Committee to Remuneration Committee. 2 elected GP members will the Chair of the CCG and the Clinical Executive for Finance, Performance and Business Intelligence The Head 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 Remove the section under “relationship with the governing body” that states minutes will be presented to the governing body for information.

Occupational Health and Staff Support The Committee agreed to review 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. 2|P a g e

The Committee also agreed that the organisation is committed to promoting health and wellbeing for its staff. The CCG Staff Forum will be asked to review a number of health and wellbeing initiatives and provide recommendations for Remuneration Committee to consider. 2.4

TUPE Transfer in (Pharmacy Services) The Committee received a report to approve the transfer of staff and services from the Medicines Management Function from the Local Authority and Dudley Group NHS Foundation Trust to the CCG from 1st April 2016. This request was approved with a request to review all job descriptions and engage the staff in a discussion on transfer to the CCG contract following transfer. The Committee requested a summary of pay scales for all staff for presentation to the next Committee meeting.

2.5

Staff Survey The HR Team have recently received the results of the staff survey. These results will be considered by the management team and the Staff Forum with a report to the CCG Board in March 2016.

2.6

Social Media Policy The committee received the Social Media Policy and agreed that sections of the policy needed to be aligned with other HR policies. This item was therefore deferred to the next Remuneration Committee.

2.7

Remuneration for Lay Members The Lay Members stepped out of Committee, and the Committee considered a report regarding the remuneration of lay members. The national position is that lay member roles should be appointed on a basis of approximately 3-5 days per month. An audit has been undertaken on the amount of time that Dudley CCG lay members are currently spending in their roles that has revealed the following: • • •

Lay Member for Governance (average of 8 days per month) Lay Member for Patient and Public Engagement (average of 6 days per month) Lay Member for Quality and Safety (average of 6 days per month)

At the time of the Remuneration Committee meeting the discussion with the Secondary Care Clinician had not taken place, however it is envisaged to be similar to the Lay Members for Quality and Safety/Patient and Public Engagement. The Committee agreed with the recommendation to increase the remuneration of these posts as follows: Lay Member for Governance: Recommendation this is increased to an average 8 days per month Lay Members for Patient & Public Involvement and Quality & Safety: Recommendation this is increased to an average of 6 days per month Secondary Care Clinician: To be confirmed following audit meeting but in line with the above if similar. This recommendation is presented to Board for approval.

3|P a g e

3.0

RECOMMENDATION The Board to note the report for assurance. The Board is asked to approve the recommendation to increase the remuneration for lay members as stated above.

Mrs S Cartwright Head of Organisational Development and Human Resources February 2016

4|P a g e

DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 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 28 January 2016 and 25 February 2016.

AUTHOR OF REPORT:


MANAGEMENT LEAD:


CLINICAL LEAD:

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

KEY POINTS:

• •

The CCG expects to meet all financial duties in 2015/16 The CCG is reporting a year to date underspend of £5,909,000 and expects to achieve its year end control total of £6,337,000 as agreed with the NHS England All NHS England financial assurance indicators are being achieved to date All NHS Constitution aggregate standards are being achieved with the exception of 6 weeks Diagnostics (98.84% against target of 99%), Mixed Sex accommodation, MRSA and C.Diff The committee endorsed the recommendation of the IT procurement Group to proceed to full OJEU tender for Dudley IT Services from 1 April 2017.

RECOMMENDATION:

The Board is asked to receive the report for assurance


As outlined in report and key points above

WHAT ENGAGEMENT TAKEN PLACE:

None

ACTION REQUIRED:

HAS


1|P a g e

DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MARCH 2016 FINANCE AND PERFORMANCE COMMITTEE REPORT 1.0

INTRODUCTION The report summarises the key issues discussed by the Finance and Performance Committee at its meetings on 28 January 2016 and 25 February 2015. This report has been revised to provide an overall assurance position for all finance and performance key performance indicators. The report to the Board presents the new financial governance framework where responsibility and accountability has been delegated to Committees, commissioners and budget holders for their portfolios of work. In line with the framework, the report identifies the Committees responsible for finance and performance metrics. The overall financial position and QIPP are also reported in this format. Responsible Committees will report on any material variances in relevance to their portfolios and individual reports to Board.

2.0

KEY INDICATOR SUMMARY The table below identifies the CCG’s performance against key financial and performance indicators for 2015/16 to date. This represents November performance. 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.

2|P a g e

3.0

STATUTORY FINANCIAL DUTIES The Committee heard that the CCG had an annual budget at January 2016 of £447,132,000. This reflected the notified allocation from NHS England and CCG anticipated allocations. At this point in time, the CCG is underspent by £5,909,000 and is forecast to achieve a surplus on its Revenue Resource Limit of £6,337,000 in line with our financial plan. Capital budgets, and the CCG’s programme and administration expenditure targets are expected to breakeven, and the cash limit is expected to be 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 (Clinical Development Committee), running/staffing costs and reserves (Finance and Performance Committee) and primary care commissioning/membership development (Primary Care Commissioning Committee). The table below identifies the financial position to date by Committee:

Clinical Development Committee Finance & Performance Committee Primary Care Commissioning Committee Surplus Total

Annual Budget

YTD variance £

Forecast variance £

380.3m 20.5m 40.0m £6.3m 447.1m

1.2m (1.1m) (0.1m) (5.9m) (5.9m)

1.5m (1.4m) (0.1m) (6.3m) (6.3m)

Whilst the Finance and Performance Committee will retain oversight of the financial position of the organisation and advise the Board regarding any mitigating actions that may need to be taken, the clinical and management leads of appropriate Committees will be responsible and accountable for financial performance of their delegated portfolio.

3|P a g e

The most significant financial pressures facing the CCG at this point in time are in relation to contract over-performance. The Dudley Group Foundation Trust (DGFT) acute contract is reporting a year to date over-performance of £1.24m consisting of over-performance against maternity, day cases and elective admissions. Ramsay Healthcare is reporting a year to date over-performance of £0.65m 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 is meeting all NHS Constitution standards at January 2016 with the exception of diagnostics and mixed sex accommodation. 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 April 2016 based on 2015/16 performance, but may be at risk due to HCAI breaches described later in the report.

5.0

PERFORMANCE EXCEPTION REPORTING

5.1

Diagnostics Although DGFT have had difficulty in meeting the headline target for diagnostics in quarters 2 and 3, the target was met in January 2016. Remedial Action Plans have been enacted through contract management throughout the period and the January achievement appears sustainable.

5.2

Referral to Treatment (RTT) DGFT have consistently met the headline level for the Referral to treatment standard.

5.3

Mixed Sex Accommodation There have been two cases of mixed sex accommodation breaches at DGFT both of these were in the intensive treatment unit (ITU). However, this was due to clinical necessity and could not be resolved within the 4 hour threshold.

6.0

NHS ENGLAND INDICATORS

6.1

A&E A&E performance remains strong, with DGFT’s four hour percentage being amongst the highest nationally. DGFT are on track to meet the standard for Quarter 4 and year total achievement.

6.2

Cancer DGFT performance against the 62 day cancer wait standard failed Quarter 2 but achieved the target in Quarter 3. Performance is monitored closely through the performance monitoring and management mechanisms within the contract.

6.3

Ambulance Handovers There has been a significant improvement in performance for Ambulance Handovers throughout the year. However, numbers of 30 minute and 60 minute breaches did increase in January. This continues to be monitored and appropriate actions taken.

4|P a g e

6.4

MRSA Three MRSA cases were confirmed in September, 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.

6.5

C.Difficile There are 2 C.Difficile measures for the CCG; Secondary Care and CCG attributable. The nationally set threshold for Dudley CCG attributable cases is 76 and as of 31st January 2016 there have been 94 confirmed cases. For Secondary Care there have been 38 cases for the same period. However, although there is a Secondary Care threshold of 29 for the year for DGFT, only ‘avoidable’ cases are counted. DGFT have had 12 avoidable C.Difficile cases during the period. A separate paper to Board provides further information on this issue.

7.0

QIPP 2015/16 AND 2016/17 The CCG is forecasting to over-achieve the 2015/16 QIPP target of £7,190,000 by £7,000 giving total savings of £7,197,000. The Clinical Development Committee is reporting an underachievement of £1,022,000 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 will enable 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

YTD variance £

Forecast outturn £

7.190m 0

0.865m (0.676m)

1.022m (1.029m)

The CCG is currently reviewing QIPP requirements for 2016/17, and further information will be presented to Board in the Financial Plan at 31 March 2016. It is likely that a more aggressive target will be required due to the NHS new business rules to be adopted for next year. 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 4 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 Committee heard that the GP balanced scorecard metrics are split over four domains. At CCG level, all measures are being achieved except emergency admissions and A&E attendances from the secondary care domain.

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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 financial position in 2016/17 and longer term financial modelling following release of CGG allocations.

9.2

CCG Allocations 2016/17 to 2020/21 The Committee received a report on notified CCG allocations for the next 5 years and the potential impact on the CCG’s financial plan. In summary, nationally next year funding would rise by £3.8 billion, of which £1.8 billon would be directed by Monitor and the TDA to the provider sector. The CCG’s total ‘place-based’ allocation for 2016/17 is £531,011,000: £411,750,000 core CCG funding; £39,863,000 Primary care (resulting in a total start point allocation of £451,613,000); £79,398,000 for specialised services. The CCG’s ‘Distance from target’ increases from 2.9% below to 3.2% below due to the formula change. One significant change to the business rules was that the 1% non-recurrent reserve must remain uncommitted. This principle had historically been applied to the contingency reserve. The CCG would develop plans to spend the non-recurrent reserve with the expectation we can utilise such funds locally. We are awaiting further clarification from NHS England on aspects of the allocation, and the CCG’s Budget Book for 2016/17 will be presented to Board on 31 March 2016.

9.3

Draft Value Proposition (VP) The committee received an update on progress with the drafting and financial modelling associated with the Value Proposition to NHS England with regard to the implementation of the New Model of Care.

9.5

Transitional Support to Dudley Group FT Following a request from Board members, the Committee received a paper confirming the process that had been followed to date with regard to DGFT transition and a request to confirm conditions to be applied to the non-recurrent payment. The Committee reviewed the process followed and confirmed that whilst Dudley Group did not 100% comply with the original conditions set by the CCG (9 out of 73 posts made redundant were community staff), a number of points should be considered: • the Trust had originally requested £2m to support redundancies but the CCG was supporting only £1m; • the payment is a contribution to the total cost of redundancies and not funding on a ‘post-bypost’ basis • the redundancies were reducing the overall cost of the NHS locally • the payment is in line with NHS England approval for use of the funds. The Committee therefore reconfirmed the decision to fund £1m subject to Dudley Group FT agreeing to the conditions quoted in the paper which were viewed to be robust, stretching, reduce CCG costs and enable quicker delivery of the new model of care. One additional condition was requested by Committee. Dudley Group FT have since agreed to all conditions set.

9.4

IT Procurement Update A report was presented to committee of the options for the procurement of IT services for the CCG and GPs. The recommendation from the IT Procurement Project Group was to follow a full OJEU tender. DWMHPT had decided to join the tender exercise and would give both organisations a more tailored solution over going through a framework agreement. The committee endorsed the 6|P a g e

recommendation of the IT procurement Group to proceed to full OJEU tender for Dudley IT Services from 1 April 2017. The contract with Dudley IT services had been extended for a further 12 months to 31 March 2017 during the procurement process which allows for sufficient time for mobilisation if the incumbent supplier was unsuccessful. 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 that there had been an improvement in responses since the meeting on 19 January between CCG and EMIS representatives. A single point of contact had been identified in EMIS/Egton for the CCG, which was proving beneficial. Further regular meetings had been scheduled.

10.2

Estates Strategy/Operational Group The report on the issues discussed by the Estates Operational and Estates Strategy Groups was presented. In particular, the Committee noted that a process would be put in place shortly to obtain expressions of interest from practices in the Primary Care Transformation Fund and progress towards the development of the Health Infrastructure Strategy which would be presented to the 31 March Board. The Committee noted the useful and positive discussions that the Chief Operating and Finance Officer had had via the DH Strategic Estates Planning Group with Community Health Partnerships, NHS Property Services and also to the New Care Models lead, all of whom would be prepared to use Dudley as a test case for asset ownership by CCGs.

11.0

DECISIONS TAKEN UNDER DELEGATED POWERS The committee endorsed the recommendation of the IT procurement Group to proceed to full OJEU tender for Dudley IT Services from 1 April 2017.

12.0

RECOMMENDATION The Board is asked to receive the report for assurance.

Mr M Hartland Chief Operating and Finance Officer December 2015

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 2016 Report: Clinical Development Committee Report Agenda item No: 11.1 TITLE OF REPORT:

Report of the Clinical Development Committee

PURPOSE OF REPORT:

This report sets out the main issues considered by the Clinical Development Committee at its meetings on 20 January and 17 February 2016.

AUTHOR OF REPORT:


MANAGEMENT LEAD:


CLINICAL LEAD:

Dr S Mann, Clinical Executive

1. Over performance noted in relation to emergency admissions at Dudley Group NHS Foundation Trust and CAMHS at Dudley and Walsall Mental Health Partnership NHS Trust. Improved performance in relation to Cancer 62 day standard at Dudley Group NHS Foundation Trust 2. Local Improvement Schemes (LISs) for diabetes, COPD, care homes and palliative care suspended for 2016/17 to enable the implementation of the new contractual framework for primary care. LISs still to be offered to those practices not participating in the new KEY POINTS: contractual framework 3. Contract variation approved to enable Seisdon Peninsula practices from the South East Staffordshire and Seisdon Peninsula CCG, to be part of the out of hours contract with Malling Health from 1 April 2016. 4. Proposed community imaging hub for MRI and CT scanning approved in principle 5. Evaluation carried out of WHAT? Centre 6. Update received on pathway efficiencies work 7. Arrangements agreed for the continued delivery of the extended practice based pharmacist scheme That the matters considered by the Clinical Development Committee be RECOMMENDATION: noted 1. Implications in relation to financial performance and the QIPP Programme are identified in the Finance and Performance Committee’s report FINANCIAL IMPLICATIONS: 2. Projected underspend of £275,000 in relation to the GP Prescribing Budget 3. Extension of practice based pharmacist scheme for 6 months £100,000 Some engagement carried out in relation to the preference of patients WHAT ENGAGEMENT HAS from the Seisdon Peninsula regarding the preferred location of their out TAKEN PLACE: of hours provider, demonstrating a preference for Dudley rather than Wolverhampton Decision ACTION REQUIRED:  Approval Assurance 1|P a g e

DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MARCH 2016 REPORT OF THE CLINICAL DEVELOPMENT COMMITTEE

1.0

PURPOSE OF REPORT

1.1

This report sets out the main issues considered by the Clinical Development Committee at its meetings on 20 January and 17 February 2016.

2.0

BACKGROUND

2.1

The Clinical Development Committee met on 20 January and 17 February 2016. The main items considered are set out below.

3.0

FINANCE AND PERFORMANCE

3.1

The Committee have noted a forecast overspend of £1.16m for the period to January 2016. This includes the effect of increased emergency admissions at Dudley Group NHS Foundation Trust (DGNHSFT) and increased CAMHS referrals at Dudley and Walsall Mental Health Partnership NHS Trust (DWMHPT).

3.2

The referral to treatment time standard is being met by DGNHSFT but a recovery plan is in place in relation to urology designed to meet the standard by April 2016.

3.3

The 62 day cancer wait standard has been met by DGNHSFT for 3 consecutive months.

3.4

Further reports to be considered in March 2016 in relation to the Community Rapid Response Team and the out of hours service for care homes.

4.0

LOCAL IMPROVEMENT SCHEMES (LISs)

4.1

The Committee has 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. Practices not opting to participate in the new framework will still be offered the LISs, subject to all practices working to the same specification and outcome objectives.

5.0

PROPOSED COMMUNITY IMAGING HUB FOR MRI AND CT SCANNING

5.1

The Committee has approved in principle a proposal to develop a community based hub for MRI and CT scanning.

5.2

A further report will now be considered on the specification for such a service and how it might be delivered through a collaborative approach involving a number of providers.

6.0

WHAT? CENTRE

6.1

Following its decision to increase investment in the tier 2 CAMHS service provided by the WHAT? Centre, the Committee has received an evaluation of its current performance.

6.2

This has shown the level and source of increased activity and demonstrated the need for such a service to manage this demand.

6.3

A further review of the totality of CAMHS provision will now take place led by the CAMHS Transformation Group.

7.0

PATHWAYS EFFICIENCIES

7.1

The Committee has received an update on work in relation to the MSK, ENT, Ophthalmology and Urology pathways. More detailed proposals will now be considered by the Committee. 2|P a g e

8.0

MEDICINES MANAGEMENT

8.1

The Committee has approved a variation to the terms of reference of the Nutrition Sub Group of the Area Clinical Effectiveness Committee, in order to give it responsibility for hydration.

8.2

The Committee has approved the proposed work programme for the Pharmaceutical Public Health and Practice Based Pharmacist Team. This will be reviewed further as part of the QIPP challenge process.

8.3

The Committee has noted that 9 additional Practice Based Pharmacists were commissioned until March 2016 to support practices taking part in the Enhanced Primary Care Development Programme. Further resources have now been sought as part of the Vanguard Programme “Value Proposition” submission to NHS England to provide support to all practices at a cost of £573,844 on an invest to save basis.

8.4

The outcome of the bid to NHS England and an evaluation of the original scheme by Aston University will not be known until at least the end of March 2016. Therefore, to maintain the existing service and avoid the diminution of a valued team, the Committee has agreed to maintain the existing 9 pharmacists at a cost of £100,000 for a further 6 months.

9.0

RECOMMENDATION

9.1

That matters considered by the Clinical Development Committee be noted

9.2

That the terms of reference for the Nutrition Sub-Group of the Area Clinical Effectiveness SubCommittee be approved in order to give it responsibility for hydration.

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 2016 Report: BCF Integrated Commissioning Executive Agenda item No: 11.2 TITLE OF REPORT:

Report of the BCF Integrated Commissioning Executive

PURPOSE OF REPORT:

This report sets out the main issues considered by the BCF Integrated Commissioning Executive at its meeting on 21 January 2016

AUTHOR OF REPORT:


MANAGEMENT LEAD:


CLINICAL LEAD:

Dr S Mann, Clinical Executive 1. Performance position noted. Financial value of reduction in emergency admissions identified as approximately £400,000. 2. Better Care Fund policy framework for 2016/17 considered. Main features of 2016/17 Better Care Fund Plan agreed as: • delayed transfers of care • integrated discharge pathway • services for care homes • falls • carers

KEY POINTS:

RECOMMENDATION:

That the matters considered by the Integrated Commissioning Executive be noted.


The financial implications of the Better Care Fund are dealt with in the report of the Finance and Performance Committee.

WHAT ENGAGEMENT TAKEN PLACE:

No direct engagement

ACTION REQUIRED:

HAS


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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MARCH 2016 REPORT OF THE INTEGRATED COMMISSIONING EXECUTIVE

1.0

PURPOSE OF REPORT

1.1

To consider the main issues considered by the Integrated Commissioning Executive at its meeting on 21 January 2016.

2.0

BACKGROUND

2.1

The Integrated Commissioning Executive was established in order to oversee the management of the Better Care Fund (BCF). The main items considered at its meeting on 21 January 2016 are set out below.

3.0

PERFORMANCE REPORT

3.1

The Executive has noted, in particular, current performance in relation to emergency admissions.

3.2

The Board will recall that at its meeting in November 2015, it agreed to underwrite the “pay for performance element” of the BCF, to be paid to Dudley MBC, in the sum of £1.6million. Current performance in relation to emergency admissions equates to a potential saving of £400,000. Therefore, this leaves a shortfall of £1.2million.

3.3

The Executive has also received an update in relation to the current status of the operation of the Community Rapid Response Team. The team has now reached a position where it is able to respond more effectively to calls received by the ambulance service. Further discussions are taking place with both West Midlands Ambulance Service and Dudley Group NHS Foundation Trust about how the service can continue to be developed.

3.4

The Executive has also noted the impact of the pilot service commissioned to support care homes. This will be the subject of a separate report to the Clinical Development Committee in March 2016.

4.0

BCF PLAN 2016/17

4.1

Guidance has now been received on how BCF plans are to be prepared for 2016/17, following the publication of a policy framework in early 2016.

4.2

The most significant change to the guidance is that there is no “pay for performance” element of the fund in 2016/17. Instead, local health and care economies are expected to develop an effective action plan for reducing delayed transfers of care.

4.3

The Executive has agreed an outline of the main areas it wishes to focus upon in terms of developing the BCF Plan for 2016/17. These are as follows: • • • • •

delayed transfers of care integrated discharge pathway support for care homes falls carers

4.4

In addition, with the development of the MCP, the integration of health and social care will accelerate during 2016/17. In effect 2016/17 will form the last year of the BCF.

5.0

RECOMMENDATION

5.1

That the matters considered by the Integrated Commissioning Executive be noted.

Mr N Bucktin, Head of Commissioning March 2016 2|P a g e

DUDLEY CLINICAL COMMISSIONING GROUP BOARD Date of Board: 10 March 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 22 January and 19 February 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:

Primary Care Strategy Implementation • Two events held in January to feedback to member GPs – first event with National Lead for GP Development on different organisational models, second event extraordinary membership event to feedback findings and discuss support required by member practices. • The Committee received the evaluation of the Enhanced Primary Care Development Programme – and approved the development of the next iteration of the programme to focus on transformational change, and business management skills Primary Care Contracting • The Committee approved the application to close Market Street surgery, a branch surgery of Wordsley Green Medical Practice. The branch surgery will close on 14 March 2016 • The Committee approved the application to close Masefield Road surgery, a branch surgery of Lower Gornal Medical Practice. The branch surgery will close on 1 April 2016. • Other contractual changes considered and approved as set out in report • Committee Chair has attended and updated the Health Overview Scrutiny Committee on the activities of the Committee. New Contractual Framework • The Committee approved the new ‘Dudley Outcomes for Health’ framework that consolidates the Quality and Outcomes Framework, Directed and Local Enhanced Services into one framework to be commissioned on a pilot basis from 1 April 2016. • The detailed recommendations considered by the Committee are set out in the report. Quality • The Committee received an overview of CQC inspections complete as at 26 January 2016. • A summary of the CQC inspection reports is set out in the Quality and Safety report. 1|P a g e

Finance • The Committee supported the proposal to roll out WiFi to all practices and delegate responsibility to IT Strategy Group to develop the scheme Risk Register • The Committee noted and approved comprehensive updates to the register that are set out in the report. RECOMMENDATIONS:

•

The Board is asked to note for assurance the issues discussed, and decisions taken by the Primary Care Commissioning Committee

•

The budgets reported to Committee are showing a year to date underspend of £54,000 and an under spend of £75,000 is forecast at year end

•

Significant consultation undertaken in respect of branch surgery closure applications – in line with NHS England policy for branch closure for primary medical services.

FINANCIAL IMPLICATIONS: WHAT ENGAGEMENT HAS TAKEN PLACE: ACTION REQUIRED:

 Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MARCH 2016 REPORT FROM THE PRIMARY CARE COMMISSIONING COMMITTEE

1.0

INTRODUCTION This report summarises the key issues discussed at the Primary Care Commissioning Committee on 22 January and 19 February 2016.

2.0

ITEMS DISCUSSED

2.1

PRIMARY CARE STRATEGY

2.2

On 13 January 2016, representatives from 38 GP practices, CCG representatives and expert speakers - came together to consider the future of primary care in Dudley. The theme of the event was primary care ‘at scale’ and its aim was exploratory. The sessions were designed to stimulate thought and discussion: to understand problems, outline possible solutions and consider practical implications. Professor Judith Smith from the Health Services Management Centre presented evidence from national and international research, David Goldberg – an International Associate of the Good Governance Institute – hosted a discussion on the sustainability of General Practice, and Dr Robert Varnman a GP in inner city Manchester and Head of General Practice Development at NHS England hosted a discussion on the model of care defining the organisational structure for primary care to operate at scale. The event was well attended and well received.

2.2

On the 19 January 2016, representatives from 42 GP practices and CCG representatives came together to consider the outcome of the practice visits conducted over three months by the membership team. The intention of the event was understand what support the CCG can provide to member practices moving towards operating at scale. The event was well attended, and subsequent to the meeting the CCG has written to all practices setting out how the CCG will be offering support to practices in relation to the issues that were discussed at the event.

2.3

The Committee received an evaluation of the Enhanced Primary Care Development Programme. The programme has been developed and commissioned within Dudley, in partnership with the Strategy Unit of the Midlands and Lancashire CSU. The programme has been running in 6 practices over the past 6 months. The evaluation demonstrated improvements in practice efficiency, clinical leadership, communication and staff experience. The Committee supported the continuation of the programme, with a project group to develop the next iteration of the programme that will focus on performing as a team, transformational change and management and business skills.

3.0

PRIMARY CARE CONTRACTING

3.1

The Committee received assurance from the Primary Care Operational Group (the Group)

3.2

There were no significant performance issues or contractual breaches in any Dudley practice holding a contract for General Medical Services.

3.3

The Committee accepted recommendations from the Group and approved a number of contractual changes: o Two 24 hour retirements o Three additions to partnerships o Three removals from partnerships

3.4

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.

3.5

The Committee approved an application to close Market Street surgery, a branch surgery of Wordsley Green Medical Practice. The branch surgery will close on 14 March 2016. The practice presented to the Committee at its meeting on 22 January 2016. The CCG and the practice had fully complied with 3|P a g e

the NHS England policy for branch surgery closures. The practice had undertaken a full and comprehensive public consultation and provided assurance to the Committee that it engaged and responded to the public on the issues related to the closure. 3.6

The Committee approved an application to close Masefield Road surgery, a branch surgery of Lower Gornal Medical Practice. The branch surgery will close on 1 April 2016. The practice presented to the Committee at its meeting on 19 February 2016. The meeting was held in Gornal and was attended by 35 members of the public. The CCG and the practice had fully complied with the NHS England policy for branch surgery closures. The practice had undertaken a full and comprehensive public consultation and provided assurance to the Committee that it engaged and responded to the public on the issues related to the closure.

3.7

The Committee approved the quarter 3 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.

3.8

The Committee supported the implementation of e-referrals and EMIS templates developed for aesthetic surgery and procedures of limited clinical value subject to further promotion via locality and practice manager meetings.

3.9

The Committee noted for assurance that the CCG is fulfilling the requirements of the draft framework for public and patient participation prepared by NHS England for comment.

4.0

NEW CONTRACTUAL FRAMEWORK

4.1

The Committee received an update on the development of the new indicators and approved that the scheme be offered as a pilot in 2016/17 with a view to commissioning the scheme from 2017/18.

4.2

The Committee approved the following o

o o

o

o o o o

Approved the suspension of QoF for 2016/17 to offer a New Contractual Framework (Dudley Outcomes for Health) to be piloted in 2016/17. The CCG has received legal advice confirming that the CCG are able to suspend the QoF and Directed Enhanced Services (DES). Approved the recommendation to use a single EMIS Web template for the duration of the pilot of the New Contractual Framework. Approved the recommendation that for the duration of the pilot in 2016/17 that the practices are paid on a monthly basis in accordance with the current QoF payment mechanism, subject to any national changes that may come through 2016/17. Approved the four headings under which indicators will be assessed, that further work be undertaken to develop the detailed criteria for assessment, and that an assessment against these criteria be undertaken as part of the pilot process. Approved the recommendation that the project group develops a contract variation agreement seeking legal advice from Mills & Reeve on its content. Approved the recommendation that the project group develop an evaluation framework in partnership with an academic institute. Approved the recommendation that the project group develop a business rules document in collaboration with the practice managers steering group. Referred a decision to the Clinical Development Committee so that they consider if a practice does not wish to participate in the new contractual framework whether the LIS schemes included within the framework will still be offered to practices in 2016/17.

4.3

The Committee will receive a paper in March 2016 setting out the contract variation and conditions to be offered to practices to participate in the pilot new contractual framework from 1st April 2016.

5.0

QUALITY

5.1

The Committee noted that there are no quality issues that are resulting in practices breaching their contracts. 4|P a g e

5.2

The Quality and Safety report to the Board will set out in more detail those areas and issues pertinent to primary care.

6.0

FINANCE

6.1

The budgets reported to Committee are showing a year to date underspend of £54,000 and an under spend of £75,000 is forecast at year end.

6.2

A review of the investments approved by the Committee in December 2015 has highlighted a number of expected underspends against plans, to a value of £435,000.

6.3

The Committee approved utilising the underspend by supporting the roll out of WiFi to all General Practices to make better use of IT infrastructure and also act as an enabler for a number of key strategic aims of the CCG.

7.0

RISK REGISTER

7.1

The Committee approved significant updates to the risk register as summarised below: o o o o o o o o

Risk 34: the residual risk score has reduced from 6 to 2 based on the key controls and mitigation in place Risk 50: the residual risk score has increased from 9 to 16 based on the outcome of recent CQC inspections. Risk 59: the residual risk score has increased from 9 to 20 based on the outcome of practice visits and workforce data collection. Risk 68: the recommendation is to remove this risk as delegated functions from NHS England are now in place. Risk 69: the residual risk has increased from 3 to 16 based on the outcome of practice visits and practice branch surgery applications. Risk 70: the medicines management team have been asked to review the risk that will be reported to the March Committee Risk 76: no change to the risk score, minor amendments to narrative and timescale. Risk 81: the residual risk score has increased from 4 to 12 based on the outcomes of recent CQC inspections

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 22 January and 19 February 2016

Mr D King Head of Membership Development and Primary Care March 2016

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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

dudley clinical commissioning group board - Dudley CCG

dudley clinical commissioning group board - Dudley CCG

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