Governing Body - NHS South Tees CCG

Transcription

A Meeting of the NHS South Tees Clinical Commissioning Group
Governing Body
will take place on
Wednesday, 25 November 2015 at 2.00pm-5.00pm
In the Boardroom at North Ormesby Health Village
AGENDA
Time
Item
No.
Item
14:00
14.02
14.05
1.1
1.2
1.3
14.10
1.4
Section 1
Apologies for Absence
Declarations of Interest
Draft Minutes of previous meeting held on
30th September 2015
Matters Arising & Action Log
14.15
1.5
Chair & Chief Officer’s Report
14.25
1.6
14.35
1.7
Clinical Council Reports:
 Middlesbrough
 Langbaurgh
 Eston
Patient Story
Attached
or Verbal
Presented by
Page No.
Verbal
Attached
Attached
Chair
Chair
Chair
N/A
1
3
Attached
Chair
18
Attached
Chair/
Amanda Hume
19
Attached
14.45
2.1
Attached/
Verbal
Section 2 – Items for Decision
Commissioning Intentions 2016/17
Attached
14.55
2.2
Life Store
Attached
15.05
2.3
Attached
15.10
2.4
Securing Quality in Health Services (SeQIHS)
Terms of Reference
Home Oxygen Service Contract Extension
15.20
15.30
2.5
2.6
15.35
15.50
16.00
3.1
3.2
3.3
16.05
16.00
16.10
3.4
3.5
3.6
16.20
16.25
4.1
4.2
Attached
Learning Disability Fast-Track Update
Attached
Appointment of Auditor Panels
Attached
Section 3 – Items for Discussion
Quality and Safeguarding Report
Attached
Finance Report
Attached
QPF Committee Update- 4th November 2015
Attached
Assurance Framework
Attached
Systems Resilience Update
Verbal
Delivering Our Strategic Aims 15/16- Progress Attached
Report
Section 4 – Items for Information
Update on 360 Survey action plan
Attached
Report from the Primary Care CoAttached
Dr Vaishali Nanda
Dr Ali Tahmassebi
Dr Janet Walker
Chair
23
N/A
Simon Gregory/
Alex Sinclair
Nigel
Rowell/Alastair
Dewar
Amanda Hume
26
Craig Blair/Dave
Welch
Jean Golightly
Simon Gregory
104
Jean Golightly
Simon Gregory
Simon
Gregory/John
Drury
Simon Gregory
Dr Mike Milner
Amanda
Hume/Alex
Sinclair
121
127
136
Simon Gregory
David Brunskill
158
162
38
92
107
113
142
NA/
150
16.35
4.3
16.45
5.1
Commissioning Committee
Urgent Care Update
Attached
Section 5 – Confirmed Minutes
Confirmed Minutes of:
5.1.1

5.1.2

6.2
Date of Next Meeting
The next Governing Body Meeting is scheduled to take place on Wednesday 27 January
2016 at 2.00pm in the Boardroom, North Ormesby Health Village.
Audit Committee – 27th May 2015
Attached
Julie Stevens
166
Peter Race
173
Attached David Brunskill
178
Governance & Risk Committee- 12th
August 2015
Questions from the Public – Members of the public may raise issues of general interest which relate to
the Agenda.
Section 6 – Other Information
16.50
6.1
Any Other Business
Verbal
16.57
“Representatives of the press and other members of the public be excluded from the remainder of the meeting having
regard to the confidential nature of the business to be transacted, publicity in which would be prejudicial to the public
interest (Section 1(2) of the Public Bodies Admissions to Meetings Act 1960)”
SOUTH TEES CLINICAL COMMISSIONING GROUP GOVERNING
BODY MEMBERS' REGISTER OF INTERESTS
NAME
TITLE
NAME OF
ORGANISATION AND
NATURE OF ITS
BUSINESS
as at 05.10.15
POSITION HELD / NATURE
OF INTEREST
PERSONAL INTEREST
DATE
DECLARED
DATE
UPDATED
GOVERNING BODY MEMBERS
Dr Janet Walker
Chair
Eston Locality Lead
Mr David Brunskill
Ms Karen Dales
Lay Member - PPI
Lay Member
Dr John Drury
Secondary Care Consultant Tees, Esk & Wear
Valley NHSTrust
Ms Jean Golightly
Executive Nurse
Mr Simon Gregory
Mrs Amanda Hume
Dr Rajesh K Khapra
Dr Mike Milner
Hartlepool College of
FE
Hartlepool & Stocktonon-Tees CCG
Partner : Dr Royal &
Partners Manor House
Surgery, Normanby
Nil
Assistant Principal
Governor (appointed by
CCG)
Executive Nurse (job share
South Tees and Hartlepool &
Stockton-on-Tees CCG's)
Chief Finance Officer
Chief Officer
Practice Representative,
Back Pain Lead
Urgent Care Lead,
Governing Body Member
Crossfell Medical
Practice
Northern Doctors, Out
of Hours GP Service
Huntcliff Surgery
Nil
06/12/2013
Nil
S Fallowfield (Internal
Audit) is Governor &
Chair of College's Audit
Committee
Wife undertakes
voluntary work on the
Oncology Unit at JCUH.
Nil
31/10/2013
23.09.15
06/12/2013
13.03.15
11.03.15
14.04.15
20/11/2013
25.02.15
22/11/2013
Nil
Partner
Partner works for Tees,
Esk and Wear Valley
NHS FT Finance Team
Nil
Nil
Partner, Out of hours GP
Nil
04/12/2013
GP
Nil
17/04/2014
11/11/2013
31/10/2013
25.03.15
26.02.15
15.04.15
24.02.15
1
Dr Vaishali Nanda
Mr Peter Race
Governing Body GP
Lay Member, Governance
The Discovery Practice GP at The Discovery
Practice
South Tees Trust
Tees, Esk & Wear
Valley Trust
Mr Nigel Rowell
Dr Ali Tahmassebi
Governor (appointed by
CCG)
Consultant
Husband owns Nanda
16/01/2014
Medical Services for
private orthopaedic work
Husband is a Consultant 02/04/2014
in orthopaedics at
NTHFT
Brother John D Race
04/11/2013
MBE JP is an elected
Governor with South
Tees Trust.
Neice is a Consultant
30.09.15
with TEWV.
Endeavour Practice Ltd Director
Nil
North of England Cardio Primary Care Lead
Vascular
Network
STAT JCUH
Heart
CPSI in Heart Failure
Failure Service
Servier Laboratories Ltd Live : Life Study Principal
Investigator
Living Longer Lives
AF Clinical Champion
Team
Bentley Medical
Partner
Practice
Park
Avenue Surgery
Partner
Slater's Bridge
Director
Nil
Nil
09.04.15
12.04.15
27/11/2013
25.03.15
Nil
25.03.15
Nil
Nil
05/11/2013
05/11/2013
18/03/2014
23.02.15
2
NHS Official
Minutes of the NHS South Tees Clinical Commissioning Group
Governing Body Meeting
Held on Wednesday, 30 September 2015 at 2.00pm
At Inspire2Learn, Normanby Road, Middlesbrough, TS6 9AE
Present:
Dr Janet Walker
Mrs Amanda Hume
Mr Simon Gregory
Ms Jean Golightly
Dr Rajesh Khapra
Dr Mike Milner
Dr Nigel Rowell
Dr Ali Tahmassebi
Dr John Drury
Mr Peter Race MBE
Mr David Brunskill
Mrs Karen Dales
In Attendance:
Mr Edward Kunonga
Ms Esther Mireku
Mrs Richenda Broad
Chair
Chief Officer
Executive Nurse
Governing Body GP Member
Secondary Care Doctor
Governing Body Lay Member
Mrs Liane Cotterill
Sandra Edwards
Director of Public Health – Middlesbrough Council
Senior Public Health Officer – Redcar & Cleveland Borough Council
Executive Director of Wellbeing, Care & Learning – Middlesbrough
Council
Associate Director – Commissioning, Delivery and Operations
Head of Programmes & Delivery
Governance Manager
Programme Director – SeQiHS – Item 70
Commissioning Manager – Service Planning & Reform, North of
England Commissioning Support (NECS) – Item 66
Senior Governance Manager – (NECS)
Governance Officer, (NECS) – Minute Taker
Members of the Public:
Vaughn Reeves
Alastair Haigh
Lisa Dawkins
Key Account Manager, Sandoz
Prometheus Director, Neonavitas
Healthcare Partnership, Abbvie
Mr Craig Blair
Mrs Alex Sinclair
Mrs Jacqui Keane
Jon Tomlinson
Ms Hannah Jeffrey
GB/52/15
Welcome and Apologies for Absence
52.1
The Chair welcomed everyone to the meeting, introducing Mrs Karen Dales the
new Governing Body Lay Member who would be involved in co-commissioning,
governance and audit; Esther Mireku on behalf of Paul Edmondson-Jones and
members of the public.
52.2
Apologies were received from Paul Edmondson-Jones (Director of Public Health,
Redcar & Cleveland Borough Council) and David Welch (Provider Management,
Commissioning Support Unit). It was noted that Ms Golightly, Executive Nurse,
would be joining the meeting for her item on the agenda.
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GB/53/15
53.1
Mr Race informed the meeting that his niece was a consultant with TEWV and
this should now be included on the Register of Interests.
53.2
Dr Tahmassebi advised that all the GP Members had a potential conflict of
interest on behalf of their practices regarding Commissioning Intentions.
However, it was noted that this item was for information only.
53.3
With the exception of Dr Khapra, all GPs had a conflict of interest in item 2.4
regarding their reappointment. The alternative quoracy arrangements provided
for in the Constitution would be adopted for this item.
GB/54/15
Draft Minutes of Previous Meeting – 29 July 2015
54.1
The Minutes of the meeting held on 29 July 2015 were AGREED and
ACCEPTED as a true and accurate record, subject to the following
amendments:
54.2
P10, 35.1 – it was confirmed that the Chair of the IFR Panel was a Lay Member
however the CCG Decision Maker was a GP.
54.3
P17, 43.6 – it was clarified that the Governing Body would receive updates on
the 360 Survey in November 2015.
GB/55/15
Matters Arising and Action Log
55.1
Matters Arising
There were no matters arising.
55.2
Action Log
55.2.1
GB/15/15 – Locality Reports – Rapid Response – Rapid response pathways
would be discussed at the next Integration Programme Board on 15 October and
reported to the next Governing Body meeting.
55.2.2
GB/16/15 – Quality & Safeguarding Report – CQC Timeframes - There is a
flexible period for STHFT (South Tees Hospitals NHS Foundation Trust) to
address actions before inviting CQC to return to validate they are in place.
STHFT were working towards a six-month timeframe. It was agreed this action
should now be closed.
55.2.3
GB/17/15 – Quality & Safeguarding Report – Mortality Reviews – Tony
Roberts (STHFT) was working with clinicians. STHFT to share lessons learned
from the reviews via CQRG. It was agreed this action should now be closed.
55.2.4
GB/18/15 – Quality & Safeguarding Report – Designated GP for Looked
After Children – Dr John Bye had recently been appointed. It was agreed this
action should now be closed.
55.2.5
GB/19/15 – 360̊ Stakeholder Survey – To be brought to November’s Governing
Body Meeting.
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GB/56/15
Chair & Chief Officer Report
To supplement the report, the Chief Officer highlighted the following:
56.1
Children and Young People’s Mental Health and Wellbeing Transformation
Plan
The CCG were working with other partners to develop the Plan, which would
provide a framework to improve the emotional wellbeing and mental health of all
children and young people across South Tees. The aim was to make it easier
for children, young people, parents and carers to access help and support when
needed. This topic was also a focus of the Middlesbrough Director of Public
Health’s report. Due to the constraints of the national timetable, the draft Plan
would be circulated to Governing Body members and would be ‘signed off’ by
the Governing Body’s executive lead for mental health (Simon Gregory, Chief
Finance Officer) prior to submission to NHS England.
56.2
Primary Care Strategy
The Governing Body noted that the Primary Care Co-Commissioning Committee
had approved the Primary Care Strategy, which identified three main priority
areas:
 To stabilise and strengthen General Practice, focussing on workforce
 To deliver integrated services between General Practices, community
services, hospital services and social care
 To work with Public Health to promote patient education and self-care.
It was noted that a meeting was scheduled with the Local Medical Committee to
discuss recruitment and retention issues.
56.3
Mental Health Crisis Care Concordat
In order to sustain the momentum of the work of the Concordat, all partners were
working together to secure some dedicated project support.
56.4
Welfare Rights
The CCG continued to work with partners on welfare rights. Mrs Hume
highlighted that the Executive Group had been considering implications and
possible options for support relating to the recent closure of the SSI Plant in
Redcar; an update would be provided to a future meeting of the Governing Body.
56.5
Annual General Meeting (AGM)
The second AGM was held on 9 September 2015 at The Heart, Redcar, which
was well attended by the public, partners and stakeholders who had also
enjoyed the Health and Wellbeing Fair which ran alongside the AGM.
56.6
Life Store
Two public engagement events had been held to supplement questionnaires
seeking feedback from the public, stakeholders and partners on the Life Store.
The results of these, together with work looking at other models of delivering
such services, would be used to inform how the services may be developed in
the future.
Recommendations for the service would be presented to the
November Governing Body meeting.
56.7
Patient and Public Advisory Group (PPAG)
Since its first meeting on 10 July, PPAG members had helped develop a publicfacing version of the Primary Care Strategy. The next meeting would be in
October and would focus on Urgent Care. PPAG was a key strand in the CCG’s
commitment to secure greater public involvement and also acted as the CCG’s
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‘critical friend’.
56.8
Key Appointments
Karen Dales had been appointed as a Governing Body Lay Member and would
primarily be involved in primary care co-commissioning, governance and audit.
Ms Dales had significant experience within the health and education sectors.
Dr John Bye had been appointed as the named GP for Safeguarding covering
both South Tees and Hartlepool & Stockton-on-Tees CCGs.
56.9
Office Relocation
The CCG would be moving offices within North Ormesby Health Village, being
fully operational on 5 October. This move would have significant advantages,
including enabling the CCG to remain in the heart of the community; encourage
greater engagement with the public because of improved facilities and cost
savings on travel and external accommodation.
56.10
Awards
The CCG had been shortlisted for the Health Service Journal Award for the
IMProVE programme (Integrated management and proactive care for the
vulnerable and elderly). The Award Ceremony would take place on 18
November.
56.11
Independent Funding Panel (IFR)
Following a request from Dave Walsh (local Councillor and Agent for Tom
Blenkinsop MP), the Chair and Mrs Hume had met with some families affected
by the current North East and Cumbria IFR policies related to funding of IVF
treatment, specifically the criterion relating to children from a previous
relationship.
The Governing Body were eager to ensure a consistency in
approach across the North East and that any review of this policy would be
undertaken on a North East level. It was noted that the policy does comply with
NICE Guidelines in funding 3 cycles.
56.12
Future working of General Practice
The Chair highlighted a meeting scheduled for 22 October to discuss the future
working of General Practice.
The Governing Body NOTED the Chair and Chief Officer’s Report.
GB/57/15
Locality Reports
57.1
Dr Tahmassebi advised that two meetings had been held in August (one each in
Middlesbrough and Redcar) to seek contributions and views on the development
of a strategy for urgent care and the case for change.
57.2
There was a lot of support from Practices across South Tees for a project aimed
at improving post-operative outcomes by patients working to increase or
maintain their fitness levels before an operation.
57.3
There was increasing involvement of Langbaurgh practices in the nationally
funded South Tees Access and Response (STAR) scheme to increase GP
access via extended hours together with support from other services.
This
would be rolled out to Middlesbrough Practices during October.
Dr Milner pointed out there were recruitment issues with the STAR Scheme and
highlighted a national report on the first wave of the Prime Ministers Challenge
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Fund Schemes which indicated that not all of the extended hours were needed;
the greater demand being for Saturday mornings.
The Chair advised that the STAR Scheme was not under CCG control but it was
important to continue to receive data for evaluation purposes to assess impact
on patient outcomes and to also consider it as part of the CCG’s urgent care
strategy development.
57.4
Other areas covered in the locality meetings included:


The importance of improving the take-up of annual health checks for
people with a learning disability was discussed.
improving the effectiveness of meetings for all 46 practices. This would
be discussed at the October Clinical Council of Members’ meeting.
The Governing Body NOTED the Locality Reports.
GB/58/15
Decision Making Framework for Individual Funding Requests (IFR)
58.1
In presenting this item, Mr Blair identified that in late 2014, IFR Decision Makers
granted delegated authority to approve refinements to the Value Based Clinical
Commissioning Policy via IFR Panel meetings on an ad-hoc basis. CCG’s had
agreed that this would only apply to changes in the wording of the policies in
order to clarify their meaning and to improve the Panel’s decision making. It
would not include making significant changes to, or the inclusion of new
treatments/criteria; this continued to require Governing Body approval.
58.2
In support of this, the Decision Making Framework (for use across the North
East) to support the IFR process had been amended to reflect this level of
delegated authority – the proposed change was at section 8.7 of the Framework.
58.3
Mr Blair explained that the change to the wording intended to clarify
‘exceptionality’.
58.4
In response to a question from Dr Tahmassebi, the Chair confirmed that there
was criterion for exceptionality. As the Chair of the IFR Panel, Mr Race advised
that exceptionality could be a difficult concept and this was frequently discussed.
However, it was recognised that as more cases were brought to the Panel
identifying the same issue to be considered as ‘exceptional’, then the less
exceptional it became. Mr Race assured the Governing Body that requests
were scrutinised in detail, with the process given an immense amount of
examination and interrogation before a decision was made to ensure a fair and
equitable process
58.5
It was agreed that a Governing Body Development Session would be held
around ‘exceptionality’.
The Governing Body ACCEPTED and RATIFIED the change to the wording
of the Decision Making Framework for Individual Funding Requests and
NOTED that a Development Session would be held on ‘Exceptionality’.
GB/59/15
Information Governance Strategy
59.1
Mrs Cotterill explained that, at its August 2015 meeting, the Governance and
Risk Committee had considered the Information Governance Strategy for 20157
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16 and recommended its approval by the Governing Body.
59.2
Mrs Cotterill highlighted the additions made to the Strategy:
 1.4 – the Information Governance Agenda now incorporated the Care Act
 2.2 – now included information sharing agreements
 6.1.4 and 6.1.5 were two new sections around reporting Information
Governance performance and a reference to the Information Governance
Toolkit being audited
59.3
Information Governance Toolkit (IGT) Action Plan
Mrs Cotterill explained the IGT Action Plan was a snapshot view of the CCG’s
current position within the Toolkit, and that Mrs Cotterill’s team and Mrs Keane
were having regular discussions around the detail. She clarified that the CCG
was required to achieve a minimum of Level 2 in all areas of the IGT, although
the CCG had been successful in achieving the higher Level 3 in some areas for
the 2014/15 and was working to further improve upon this during 2015/16.
59.4
The Governing Body recognised the progress made to-date against the IGT and
also noted that there was a work plan in place to deliver a positive year-end
position. Mrs Hume requested that the colour coding of the action plan be
amended to more positively identify where evidence had already been gathered.
Action GB/20/15 – Mrs Cotterill
59.5
In response to a question from Mrs Dales, Mrs Cotterill explained that the
shaded areas in the IGT indicated the Level 3 elements of the Toolkit; these
were not mandatory requirements for achievement.
The Governing Body APPROVED
Governance Strategy 2015-16.
and
RATIFIED
the
Information
GB/60/15
Contract Extension for Out-of-Hours and Walk-In Centres
60.1
Mr Blair explained the paper provided recommendations to extend the existing
contracts for the provision of the Resolution Health Centre, Eston Grange Health
Centre and Out of Hours GP Services via Northern Doctors Urgent Care (NDUC)
to 31 March 2017 from the previously agreed end-date of September 2016.
60.2
The proposed extension would ensure the CCG is able to ensure that the future
urgent care provision is in line with national direction and is cognisant of local
need determined through the current programme of public engagement.
60.3
The Governing Body recognised the importance of maintaining the immediate
stability of these services which provided care to c80,000 patients.
The
development of the urgent care strategy would take account of how these
services could be provided, taking account the views of patients, stakeholders
and partners.
60.4
Dr Milner asked whether the STAR Scheme had been taken into account,
however, Mr Blair reiterated that the CCG did not commission the STAR
Scheme.
The Governing Body APPROVED the Contract Extension for Out-of-Hours
and Walk-In Centres to 31 March 2017.
GB/61/15
Governing Body GP Membership Election Process
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61.1
In recognition of the conflict of interest of Drs Walker, Milner, Rowell, Nanda and
Tahmassebi, the alternative quoracy mechanism provided for in the Constitution
was adopted for this item, with Chairmanship being assumed by Mr Brunskill as
Vice-Chair.
61.2
Mrs Hume explained that the terms of office of Drs Walker, Milner, Rowell,
Nanda and Tahmassebi were due to expire in October 2015. All five continued
to meet the eligibility criteria for the post and had put themselves forward for reelection. For clarity, it was confirmed that, being the successor of a previous
Governing Body GP Member, Dr Khapra’s term of office was not yet due for
review.
61.3
On behalf of the CCG, Cleveland LMC had written to all 46 Practices, inviting
nominations and explaining that should no additional nominations be received
then these candidates would be elected uncontested. As no nominations were
received, these five GPs had been re-appointed.
To ensure transparency,
Practices were invited to express any concerns or objections to the process
undertaken; no such concerns had been raised.
61.4
The Governing Body, acting as the Nominations Panel, confirmed the
reappointment of Drs Milner, Nanda, Rowell, Tahmassebi and Walker to their
posts on the Governing Body.
61.5
Mr Race asked about the period of a Term of Office. The Chair confirmed it was
2-3 years subject to the annual appraisal process and a member could stand for
more than one term.
The Governing Body (excluding GPs) APPROVED the appointment of the
GPs to the Governing Body.
GB/62/15
To supplement the report, Ms Golightly highlighted the following key points:
62.1
Key Quality and Safeguarding Issues
 Following publication of the CQC planned inspection report for STHFT, the
Trust continued to work closely with partners on the improvement action plan.
 STHFT continued to exceed their C.Diff trajectory
 The Middlesbrough CQC Children Looked After and Safeguarding inspection
report (July 2015) had been published.
She went on to highlight key areas for the CCG’s main providers:
62.2
South Tees Hospitals Foundation Trust (STHFT)
 The Trust had undergone recent changes in its senior management team and
was continuing its increased level of collaborative working, particularly
around health care associated infections (HCAI) and mortality.
62.2.1
HCAI
 Ms Golightly was now a member of the Infection Protection Action Group
(IPAG).
 C.Diff numbers at 32/50 continued to be outside the annual trajectory and a
major cause for concern.
 The appointment of Antibiotic Medical Champions (consultants in specialist
areas) would be championing better prescribing.
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62.2.2
 The CCG and STHFT continued to work on an action plan, proposing a
composite approach.
Regulator Actions
 The CQC had published the report on STHFT findings with a ‘requires
improvement’ grading.
62.2.3
Safeguarding Children Mandatory Training
 The CCG continued to be concerned at the numbers of staff undertaking this
training and would be escalating this through the Contract Management
Board process.
62.3
62.3.1
North East Ambulance Service NHS Trust
Innovative Practice
 Following pilots held elsewhere it had been agreed to roll out a Cardiac
Arrest Unit using a car with a paramedic and consultant as part of the Rapid
Response Team.
 Ms Golightly explained that at the last Clinical Quality Review Group (CQRG)
a small out-of-area pilot scheme had been favourably evaluated and
discussions were in progress as to how this could be replicated over a wider
area. Depending upon how a South Tees pilot was evaluated the scheme
could become a Commissioning Intention.
62.4
62.4.1
Tees, Esk and Wear Valleys NHS Trust (TEWV)
Safeguarding Training
 The CCG continued to work with TEWV to achieve contractually mandated
compliance.
62.4.2
Safeguarding – Adult
 The Adult Safeguarding Team continued to work closely with partner Local
Authorities, the CQC and providers to monitor and support the quality of care
for patients in nursing homes in the South Tees area.
 There were challenges to nursing home capacity due to admission
restrictions in a number of Hartlepool general nursing homes and this had the
potential to increase demand in the South Tees area.
 Joint work was continuing with the CCG and NHS England on the
‘transforming care’ agenda for people with learning disabilities.
62.4.3
Safeguarding – Children
Discussions are underway with colleagues from Middlesbrough and Redcar &
Cleveland Local Authorities regarding a dedicated South Tees multi-agency
safeguarding hub (MASH).
62.4.4
Serious Case Review
The Serious Case Review for Stockton Local Safeguarding Children Board into
the care received by ‘child H’ had been published on 4 August 2015. The report
had made a number of recommendations involving South Tees Hospitals
Foundation Trust and the resulting action plan was being monitored by the
Stockton Learning and Improving Practice Sub-Group.
62.4.5
Safeguarding Children – key staff
As reported earlier, the CCG had appointed Dr John Bye as Named GP for
Safeguarding Children. Due to the appointment of a dedicated Designated
Children’s Safeguarding Nurse for Hartlepool and Stockton on Tees CCG, South
Tees’s Designated Nurse, Alison Ferguson, was now able to devote whole time
to South Tees.
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The Governing Body NOTED the Quality and Safeguarding Report.
GB/63/15
Finance Report
63.1
Mr Gregory highlighted that projections were similar to last year, with the CCG
being on target to achieve a surplus for the year. However, the main pressure
remained CHC costs which had been considered in depth by the QPF
Committee.
63.2
He explained that the reserves had been earmarked for investment relating to:
GP IT funding, enhanced tariff offer, Improving Access to Psychological
Therapies (IAPT) mental health related funding, neonatal services and, subject
to further information from NHS England, pneumonia.
63.3
Mr Gregory explained that this was, generally, a more strategic report than that
which was presented to QPF Committee, however, it had been expanded to
include more information on risks and their mitigations and non-ISFE reporting
(which related to the CCG’s assessment of risks where no provision had yet
been made).
63.4
Dr Tahmassebi said that although the report was very clear and highlighted
problem areas, it could be further improved by providing more detail for areas
where risks were apparent.
63.5
In response to a question from Dr Rowell relating to the risk regarding the GP IT
allocation, Mr Gregory advised that this had been a three year journey which
was heading towards a reduction from £7 to £3.50 per head to be in line with
national rates. Mr Gregory commended NECS in bringing down costs along with
Community of Interest Network (COIN). The CCG was awaiting the new national
GPIT offer.
63.6
Dr Tahmassebi noted that South Tees had the second highest prescribing costs
in the region; Mr Gregory advised that if the CCG’s prescribing costs were the
same as the average expenditure for the region, there would be potential
savings of c£1m.
The Governing Body NOTED the Finance Report.
GB/64/15
QPF Committee Headlines
64.1
Mr Gregory drew members’ attention to the issues highlighted in the report that
had been considered by the QPF Committee at its meeting on 26 August 2015.
64.2
In the course of discussing these areas, the following points were raised:
 The A&E 4 hour wait was improving
 Referral to treatment performance – new guidelines indicated that a ‘stop’
could not be applied when a patient wished to defer an appointment due to
holiday.
 Radiology – process issues continue which had resulted in delays
 Ambulance handovers were improving
 62 day waits were still problematic across area.
 IAPT – there were now two less providers but this was a relatively small
percentage of the market. The remaining providers were stepping up their
provision to ensure an improvement in the situation.
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64.3
Mr Blair pointed out the issue around the 62 day cancer treatment wait was often
due to complex pathways. There was additional pressure at James Cook
University Hospital (JCUH) because of its Cancer Centre status attracting
increased numbers of referrals. However, there had also been a substantial
number of delays which the Trust would be able to resolve and the CCG was
working with them through the Contract Management Board.
64.3.1
Mr Blair explained that the 62 days started when a patient was referred by a GP
but the original provider was sometimes referring to STHFT late in this time
period, resulting in STHFT admitting some patients after the 62 days. He
explained that in those cases this was seen as a shared breach with STHFT and
the original provider each receiving half a breach.
64.5
In response to a question from the Chair relating to the updating and issuing of
IAPT literature, Mr Blair confirmed that all web-based information could be
updated immediately and literature was being republished.
The Governing Body NOTED the QPF Committee Update.
GB/65/15
Assurance Framework
65.1
The Governing Body considered the risks identified in the Assurance Framework
and recognised that there had been detailed discussions with individual risk
owners and within the Executive Group.
65.2
Mr Gregory explained that Risk No 770 relating to the Named GP for
Safeguarding had been in place since the inception of the CCG. As reported
earlier in the meeting, a Named GP for Safeguarding had recently been
appointed and he, therefore, requested Governing Body approval to remove this
risk from the Register.
The Governing Body NOTED the Assurance Framework and AGREED to
remove Risk 770 as the Named GP for Safeguarding was now in place.
GB/66/15
Commissioning Intentions
66.1
Mr Blair and Ms Jeffrey outlined the process undertaken to develop the CCG’s
proposed commissioning intentions for 2016/17; drawing particular attention to
the CCG’s obligation for ensuring services continue to be commissioned on a
local basis with clear financial governance frameworks to support the delivery of
quality health services to the local population. The development of 3 high-level
commissioning intentions had been carried out within each of the CCG’s
workstreams and, therefore, covered the following areas:








66.2
Care closer to home
Health inequalities
Quality in primary care
Urgent care
Medicines optimisation
Mental health
Joint co-commissioning
Community based projects
They assured the Governing Body that the proposed intentions had been
informed by a number of key information sources, including: the CCG’s strategic
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vision, objectives and Clear and Credible Plan (CCP); Joint Strategic Needs
Assessments for Middlesbrough and Redcar & Cleveland; Commissioning for
Value Packs and health profiles for Middlesbrough and Redcar & Cleveland.
66.3
This was further informed through engagement events and on-line engagement
with public and partnership groups to seek views on the intent and to inform the
direction of travel. In addition there had been, and would continue to be,
engagement with the GP membership and Practice Managers via bespoke
meetings and the Clinical Council of Members meetings.
66.4
The Governing Body considered the recommendations of the Executive Group
for each of the commissioning intentions and raised the following:
66.4.1
Dr Drury pointed out that under Health Inequalities cardiovascular disease had
not been covered, however, at the July 2015 Governing Body meeting it had
been agreed that this should be a priority area for the CCG. Ms Jeffrey agreed
to address this.
Action GB/21/15 – Ms Jeffrey
66.4.2
Mr Kunonga stressed the importance of ensuring there was clarity re the next
steps of the STAR project relating to the diabetes pathway. Mr Blair would
ensure this was fed into the next workstream meeting to ensure this was moved
forward effectively.
66.4.3
In response to points raised by Dr Tahmassebi and Mr Gregory, Mr Blair
confirmed that the Commissioning Intentions report scheduled for the November
Governing Body would reflect work programmes, demographics and costs.
Action GB/22/15 – Mr Blair
66.4.4
Mr Kunonga and Mrs Broad asked if there was an opportunity to contribute to
future joint co-commissioning to further develop work underway relating to:
early years, lifestyle behaviour and vulnerable people and children in care. Mr
Gregory pointed out that CQUIN could also be used effectively towards joint cocommissioning. Mr Blair suggested joint co-commissioning for specialist
services in the area.
66.5
The Governing Body:
APPROVED the progression of the further development (or otherwise) of each
proposed commissioning intention as detailed in the paper;
APPROVED the continuation of public and partner engagement in the future
development of the intentions, and
AGREED to receive the final proposed commissioning intentions for 2016/17 at
the November Governing Body.
GB/67/15
Complaints Annual Report
67.1
Ms Golightly presented the Annual Complaints Report for the period 1 April 2014
– 31 March 2015 and affirmed the CCG’s commitment to working with
complainants to satisfactorily resolve their concerns and to ensure that the CCG
learned lessons from complaints. The North of England Commissioning Support
Unit (NECS) provides complaints handling support to the CCG, however, all
formal complaints were personally reviewed and overseen by Amanda Hume as
Chief Officer.
67.2
The following points were highlighted:
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
the North of England Commissioning Support Unit (NECS) Complaints
Team handled a total of 546 cases during the financial year 2014-15; 57
of which were from South Tees CCG residents, 37 of these cases were
referred to the care provider for investigation and response. Of the
remaining 20 cases that were the responsibility of the CCG, 8 were able
to be resolved as informal concerns or advice.

The most frequently raised complaints related to continuing health care
(particularly around the restitution process) and the individual funding
request process.

One complaint was to be investigated by the Parliamentary and Health
Service Ombudsman (PHSO). The outcome of the PHSO’s investigation
into this CHC restitution related complaint was awaited.

A number of learning points had been identified and implemented.
67.3
Mrs Hume welcomed the report and felt that the number of complaints received
by the CCG reflected the increasing levels of engagement with the public which
raised visibility of the CCG’s role. Each complaint provided important feedback
on services and gave an opportunity for learning.
67.4
Following a question from Dr Tahmassebi relating to satisfaction levels of
complainants at the end of the process, Ms Golightly and Mrs Keane explained
that the NECS Complaints Team initiated contact with complainants at the
beginning of the process to ensure there was clarity about what was to be
investigated and to understand the complainant’s desired outcome from the
complaint. It was recognised that not all complaints could be entirely resolved to
a complainant’s entire satisfaction, however, the aim was to always ensure that
a thorough investigation was undertaken and that the findings were clearly
provided to the complainant. Complainants were also advised that they had
recourse to the PHSO should they be dissatisfied with the CCG’s response.
67.5
The number of complaints relating to CHC restitution cases was discussed and it
was noted that these were often received via law firms on behalf of families
seeking a retrospective review of cases from a number of years ago prior to the
formation of CCGs.
The Governing Body NOTED the Complaints Annual Report.
GB/68/15
System Resilience Report
68.1
Dr Milner informed the Governing Body that partial assurance had been received
from NHS England in relation to the Systems Resilience Group Toolkit and that
an action plan was in place to gain higher assurance.
68.2
The SRG had expanded their membership with an undertaking from North East
Ambulance Service to have a representative at every meeting. The SRG hope
for a wider, more inclusive membership resulting in greater compliance with the
SRG Toolkit.
The Governing Body NOTED the System Resilience Report.
GB/69/15
CQC Report – Children Looked After and Safeguarding
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NHS Official
69.1
Ms Golightly advised that the Care Quality Commission’s (CQC) report of the
findings from their unannounced inspection of children’s health services in the
Middlesbrough was now available on the CQC website.
69.2
Ms Golightly reminded the Governing Body that the inspection had focussed on
early health for children, children in need and child protection and how all
services across the health spectrum worked together. As part of the inspection,
the CQC had found evidence of collaborative working between all health
partners and had rated the service as ‘good’. All parties had welcomed the
report and its recommendations and were reassured that there were no issues
raised that parties had been previously unaware of.
69.3
Ms Golightly concluded that the CCG would work to
recommendations were integrated across the South Tees area.
69.4
The Governing Body, Mrs Broad and Mr Kunonga expressed their thanks to Ms
Golightly and the Children’s Safeguarding Nurse, Alison Ferguson, for coordinating the visit and ensuring that all agencies were involved.
ensure
the
The Governing Body NOTED the CQC Report regarding Children Looked
After and Safeguarding.
GB/70/15
Securing Quality in Health Services (SeQiHS) Update
70.1
Mrs Hume introduced Jon Tomlinson, newly appointed Programme Director for
SeQiHS.
70.2
To set the context of the SeQiHS, Mr Tomlinson advised that the programme
was being led by NHS organisations in the Durham, Darlington and Tees area,
supported by NECS to explore and examine ways of ensuring acute care
services in the area can meet the increasing service demand.
70.3
The aim of the SeQiHS programme was to continually improve the acute care
services available to patients in the area as pressures continue to mount and
further challenge capacity. Some of the key challenges to address are:
-
-
-
The changing health needs of people, including an ageing population,
rising numbers of people with long term conditions and lifestyle risk
factors in young people as well as greater public expectations of NHS
provision.
The need to deliver consistently high quality clinical care, including
greater public expectations of improved clinical outcomes, introduction of
higher clinical standards, the impact of shortages in trained staff and the
introduction of seven-day services.
The need for acute care services to work seamlessly as one whole
system with local services that are provided out of hospital in primary
care and based in our communities.
Financial considerations, including the costs of new treatments, rising
patient numbers and finite budgets.
70.4
He stressed the importance of ensuring sustainable services for the next 10-15
years in order to have a stable health economy.
A co-ordinated and
collaborative approach was key to securing this and it was recognised that this
may lead to a reconfiguration of service provision and locations
70.5
As reported to previous meetings of the Governing Body, significant pieces of
15
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preparatory work that had been undertaken in the previous 3 years, which built
on the previous work of the Primary Care Trusts. This work included: developing
a set of agreed clinical standards; gaining advice from independent experts
relating to standards of care; discussions with partners, Health and Wellbeing
Boards and Overview and Scrutiny Groups; commissioning independent
research in order to hear the public’s views on a variety of issues and
discussions with clinical and medical staff about how to address the challenges.
70.6
Imminent workplans included significant levels of stakeholder engagement, via a
Stakeholder Forum, (commencing on 30 September 2015) to develop a
framework followed to secure involvement of the public as options are
developed. The aim was to undertake a full consultation by the summer of 2016
with a view to implementing any changes in 2017.
70.7
The Governing Body discussed the scope of the programme which focusses on:
acute medicine, acute surgery, accident and emergency, critical care, acute
paediatrics, maternity and neonatology and interventional radiology. It was
acknowledged that this reflected the original scope, and although it was likely to
impact on other areas the work undertaken to-date on clinical standards etc did
not currently extend to elective services.
70.8
Dr Rowell acknowledged the comprehensive report but felt improvements could
be made with more advanced technology. Mr Tomlinson advised that the group
would be looking at technology within the context of embracing all services.
The Governing Body NOTED the SeQiHS Update.
GB/71/15
Confirmed Minutes
Governance & Risk Committee – 13 May 2015
The confirmed Minutes of the Governance & Risk Committee held on 13 May
2015 were NOTED.
The Governing Body NOTED the Governance & Risk Committee Minutes.
GB/72/15
Any Other Business
On behalf of the Governing Body, the Chair thanked Sandra Edwards (Minute
Taker, NECS) for her help and support with corporate governance since
December 2014 as the CCG would now be taking this function in-house.
GB/73/15
Public Questions
The Chair asked whether any members of the public had questions for the
Governing Body.
There were no questions raised by members of the public.
GB/74/15
Date, Time and Venue of the Next Meeting
The next meeting of the Governing Body is scheduled for Wednesday 25
November 2015 at 2.00pm at North Ormesby Health Village.
16
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NHS Official
The meeting closed at 5.05 pm
Signed:
Dr Janet Walker
Chair of the Governing Body
Date:
17
GB – 30.09.15 – V1
South Tees CCG Governing Body Meeting Action Log
Action
Number
Date of
Meeting
Subject
Action
Responsible Officer
GB/19/15
29.07.15
360° Stakeholder Survey Survey Action Plan update to be presented in November.
Mrs Poole
GB/20/15
30.09.15
GB/21/15
30.09.15
GB/22/15
30.09.15
Information Governance At Mrs Hume's request, evidence on the IT Toolkit to be
Mrs Cotterill
Strategy - IG Toolkit
shown in green not red.
Commissioning Intentions Cardiovascular Disease (CVD ) to be included in the Health Ms Jeffrey
Inequalities section
Commissioning Intentions Health Inequalities priorities to be compared with those on Mr Blair
the Work Programme
Date Due
Comments
Date
Reviewed
Status
13.11.15
On agenda for November meeting.
13.11.15
Mrs Keane confirmed that this action is complete.
Done
13.11.15
CVD will be a focus of the work programme for Health
Inequlaities
The work programme for each of the workstreams will
be taken into consideration alongside the proposed
16/17 commissioning intentions. The Health
Inequalities Steering Group will have a work
programme which will utilise existing workstreams to
delevelop and deliver comissioning intentions
Done
13.11.15
Done
Done
18
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CLASSIFICATION – please
refer to Report Classification Guidance and
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NHS Confidential
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NHS South Tees Clinical Commissioning Group
Governing Body
Agenda Item: 1.5
Wednesday 25 November 2015
Purpose of Paper
Title
Responsible
Author of the Report
Recommendation(s)
Summary
Financial
Implications
Legal/Regulatory
Implications
Assurance
Framework/Risk
Register Implications
Details
of
relationship to the
NHS Constitution
For information
Report of the Chair and Chief Officer
Dr Janet Walker, CCG Chair and Mrs Amanda Hume, Chief
Officer
Mrs Jacqui Keane, Governance Manager
The Governing Body is asked to note the content and receive the
Report.
The report provides the Governing Body with a short summary of
business since the Governing Body meeting in September 2015.
There are no financial implications relating to this report.
There are no legal or regulatory implications relating directly to
this report.
There are no Risk Register or Assurance Framework implications
relating directly to this report.
A number of areas highlighted in the report reflect the CCG’s
compliance with the principles of the NHS Constitution, eg.
partnership working, engagement and continuing to work to
improve the quality of services.
Details of Patient and Although the content of this report was not subject to patient and
Public Involvement public involvement, it outlines some of the areas the CCG is
and/or Implications
pursuing to enhance involvement and engagement with patients,
stakeholders and member practices.
Has
an
Equality Not applicable to this report
Analysis
been
completed?
Attachments
Report of the Chair and Chief Officer – November 2015
Please detail any None.
Committees
or
Forums at which this
paper has previously
been tabled
19
Official
REPORT OF THE CHAIR AND CHIEF OFFICER
GOVERNING BODY MEETING – NOVEMBER 2015
1.
Introduction
This report provides a short summary of some of the business undertaken since the
Governing Body meeting in September 2015. The Governing Body is asked to
receive the report, note the update and consider the issues highlighted.
2.
Improving Health Together
The CCG’s overriding aim since its inception in 2012 has been to improve the health
of the population by working together with the public, patients and other
organisations. We have worked hard over this time to listen to the views of those
we serve and work with in order to develop our strategies to change services for the
better. We are proud of what we have achieved in this relatively short time, but do
recognise that there is still a lot to do.
The north east is recognised as an area with specific health and social care
challenges and high levels of health inequalities. The best way for us to tackle this
and work to improve our population’s health is by working, wherever we can, with
other agencies. The following gives a flavour of some of the areas we are pursuing:
a.
Urgent care services
In response to increasing pressure on the health care system, in 2013 the
Government announced a comprehensive review of the NHS urgent and
emergency care system in England.
The overall objective of the review was to consider how to improve services
for patients, right across the spectrum of urgent and emergency care, and to
identify potential solutions. In South Tees, we are doing exactly that and are
continuing to build upon the successful engagement events with the public
during July and August.
During October we invited clinicians and stakeholders (including local
Councillors) to a workshop to help us shape our urgent care strategy and
particularly focussed on how to ensure proposals were robust and transparent
in the way we will ultimately evaluate the options through defined appraisal
criteria. We also gained a patient focussed view of the appraisal criteria by
holding a session with our Patient and Public Advisory Group. All feedback
received will help to influence the development of our urgent care strategy;
with options being presented to an extraordinary meeting of the Governing
Body on 16 December 2015.
20
Official
b.
Working together with primary care
The South Tees Access and Response (STAR) scheme hosted a Federation
Working event that was attended by over 40 of our Practices to explore the
benefits to be gained by working more closely.
This provided a good
opportunity to learn from others; with a team from Bury attending to share
their experiences.
c.
Supporting our vulnerable population
The Chief Officer met with the Chief Fire Officer of Cleveland Fire Service to
explore ways of how to work together to support vulnerable individuals and
prevent avoidable hospital admissions. We agreed that there is clearly an
opportunity for the fire service to support our system resilience agenda as well
as the urgent care strategy and IMProVE and we will work together to ensure
mechanisms are in place for this to happen.
d.
Seven Day Working
Together with Tricia Hart, previous South Tees Hospitals Foundation Trust
Chief Executive, the Chief Officer opened an event for system-wide debate
around the provision of seven-day services and how we can appropriately
match capacity with demand and need.
3.
Striving for continual improvement
a.
Future Challenges
Dame Barbara Hakin attended a meeting of CCGs and the Cumbria and
North East Area Team at which CCGs were informed of the key central
messages to inform overriding planning and objectives over the coming years.
It was apparent that the financial environment would remain challenging and
there would be continued focus around key performance targets, particularly:
referral to treatment, A&E and cancer targets. There would be increasing
emphasis on the transformation of learning disability services and recovery
rates relating to improving access to psychological therapy. Looking beyond
next year there is likely to be a greater focus on integration, collaboration and
developing new models of care as well as devolution. The CCG is already
working well on all these areas, however, the leadership team are considering
how to further respond to this agenda and will also be working closely with our
key partners to develop our response.
b.
Governing Body Development Session
The Governing Body spent some dedicated time to look closely at the national
learning disability agenda and how the local health and social economy are
translating this into local action that will ensure improved outcomes for the
wider learning disability community
21
Official
c.
Preparing for winter
The national Vanguard team visited South Tees to understand the extent of
the work we are undertaking to ensure that we are able to respond to
pressures on the system during the winter period. The team were impressed
with our approach and they showed particular interest in our local approach to
reducing emergency admissions and the urgent care strategy development.
d.
Staff Awards Ceremony
In recognition of the immense dedication and talents of all the staff in the
CCG, we held our first internal awards ceremony to recognise staff’s
individual strengths and contributions. The CCG values all staff and this
event gave us the opportunity to show our appreciation to everyone who
works so hard to improve services for our population.
4.
Supporting our community
a.
SSI Plant Closure
The CCG, as part of the Redcar and Cleveland Health and Wellbeing Board
was involved in discussions around the SSI closure and the impact on the
health and wellbeing of affected families. Opportunities for supporting those
affected were discussed, including, for example, increased resilience support
via Improving Access to Psychological Therapy providers which has been put
in place. We have established a health task group to ensure we are able to
co-ordinate a health response across all health agencies. In addition, our staff
are doing their bit on an individual level by donating items for a collection coordinated by the Cabinet Member for Health and Housing.
b.
Charity Bike Ride
We have previously reported that a member of our staff, Hannah Boulton, had
undertaken to do a charity bike ride for the Women-v-Cancer charity which
covers Breast Cancer Care, Jo’s Cervical Cancer Trust and Ovarian Cancer
Action.
Hannah completed her mammoth challenge in October; cycling
400km across Tanzania and raised an incredible £3,164 - a fantastic
achievement!
Dr Janet Walker
CCG Chair
Amanda Hume
Chief Officer
22
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Governing Body
Agenda Item: 1.6
Wednesday 25th November 2015
Purpose of Paper
Title
For Information
Responsible
Locality Leads – Dr Vaishali Nanda, Dr Ali Tahmasebbi and Dr Janet
Walker
Julie Bailey, Partnership and Innovations Manager
Recommendation(s)
The Governing Body is asked to note the contents of the report
Summary
The report presents an overview of the October meeting of the Clinical
Council of Members and the November meetings of the Eston and
Middlesbrough Locality Clinical Councils. At the time of preparing this
report, the Langbaurgh Clinical Council has not met and a verbal
update will be presented at the Governing Body meeting.
None identified
Financial Implications
Clinical Council Reports
Legal/Regulatory
Implications
Assurance
Framework/Risk
Details of relationship
to the NHS
Constitution
Details of Patient and
Public Involvement
and/or Implications
Has an Equality
Analysis been
completed?
Attachments
None identified
Please detail any
Committees or Forums
at which this paper has
previously been tabled
None
None identified
None identified
None
Not applicable
23
Purpose of the report
To share with the Governing Body the discussions which have taken place within the
CCG’s three Locality Clinical Councils, and the Clinical Council of Members.
Background
NHS South Tees Clinical Commissioning Group (CCG) has three Locality Clinical
Councils; one in Eston, Langbaurgh and Middlesbrough. The councils are made up of a
clinical representative, a GP or a nurse, from each of the CCG’s member practices in the
area. Practice Managers also attend these meetings. The councils discuss matters
related to the commissioning of services for patients in their area.
Four times each year, the three Locality Clinical Councils meet together and become the
CCG’s Clinical Council of Members. This group holds the Governing Body to account for
the work it undertakes on behalf of the 46 GP practices which make up the CCG’s
membership.
Summary of matters discussed at Locality Clinical Councils
Since the last meeting of the Governing Body there has been a meeting of the Clinical
Council of Members in October and the three Locality Clinical Councils will have met in
November; however, at the time of writing the Langbaurgh Locality Clinical Council has
yet to meet.
Clinical Council of Members
The Clinical Council of Members met to discuss a range of matters relating to
commissioning.
Representatives from each of the GP practices were asked to consider whether they
would be in support of the CCG assuming additional commissioning responsibilities as
part of Primary Care Co-commissioning – this is known as delegated commissioning. At
present, the CCG works jointly with NHS England to contribute to the commissioning of
primary care services such as those delivered by local GPs. Nationally, NHS England
would like CCGs to take on more responsibility and have more of a say in how primary
care services are delivered and whether more services could be offered in the
community, near to where people live, rather than in hospital. Dr Neil O’Brien from
Durham, Dales, Easington and Sedgefield CCG talked to the Council about his
experience of delegated commissioning. Each representative was asked to discuss this
in their practice and provide the CCG with their view. After the meeting, the majority of
practices wanted to have more of an influence on primary care commissioning,
recognising that we will need to carefully manage conflicts of interest.
In addition, all of our member practices were given an overview and update on the
development of the CCG’s urgent care strategy and the latest supporting national
24
guidance on urgent care. This strategy will help the CCG shape and improve urgent care
services. As demand for urgent care services continues to increase, commissioning high
quality, accessible services is a high priority. The new strategy will ensure that the CCG
can continue to deliver high quality urgent care services in the future, adapting those
services to the changing needs of patients across the South Tees area.
Clinicians and Practice Managers were asked to work together in groups to discuss,
amend and refine a list of criteria which could be used to analyse and evaluate the
acceptability and merits of future models for urgent care that will be developed in the
coming months. These criteria will help the CCG identify and decide on the best way of
delivering urgent care services for local people.
Finally, the Clinical Council of Members discussed the future of the Locality Clinical
Council Meetings and the Clinical Council of Members. As the Clinical Council of
Members meets only four times each year, discussion took place as to whether it would
be useful for this important decision making group to meet more often, with less
meetings related to locality matters. Members agreed to discuss this with their practice
teams and report their views back to the CCG.
Locality Clinical Councils
Eston and Middlesbrough Locality Clinical Councils met in November to discuss a range
of matters relating to commissioning.
They discussed a recent event to explore how local GP practices may want to work
together collaboratively in a ‘federation’ to deliver benefits for patients as well as benefit
the practices through supporting one another. There were different views among
practices as to whether this was needed or would bring benefits; discussions will
continue across South Tees’ GP practices.
The councils also had some further discussions about whether to change the way the
Locality Clinical Councils and the Clinical Council of Members meet.
Finally, the councils discussed community nursing services. In Eston, GPs asked the
CCG to review the number of patients using the Rapid Response service that were later
admitted to hospital or referred back to the service. In Middlesbrough, GPs discussed
the new admission triage system that James Cook University Hospital had implemented.
This required a GP to speak with a Consultant at the hospital before admitting a patient.
GPs found the service easy to use but questioned whether this was a good use of the
Consultants' time as patients were often admitted as GPs had intended. A
representative from the hospital confirmed it was helping the hospital ensure patients
were directed to the most appropriate place and was helping to reduce avoidable
admissions.
Dr Janet Walker
Chair
Eston Locality Lead
13.11.15
Dr Ali Tahmassebi
Governing Body GP
Langbaurgh Locality Lead
Dr Vaishali Nanda
Governing Body GP
Middlesbrough Locality Lead
25
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Governing Body
Agenda Item: 2.1
Purpose of Paper
Title
Responsible
Recommendation(s)
Summary
Legal/Regulatory
Implications
Assurance
Framework/Risk
to the NHS
Constitution
Public Involvement
and/or Implications
Has an Equality
Analysis been
completed?
Attachments
Please detail any
For Decision
Alex Sinclair, Head of Programmes and Delivery
Carl Gowland, Business Delivery and Operations Manager
and
The Governing Body is asked to consider the recommendations of the
CCGs Executive Group as detailed within the table of proposed
commissioning intentions for progression in 2016/17. (Appendix A)
Throughout the current contract year the CCGs clinically lead work
streams have developed a range of proposed intentions for progression
in 2016/17.
In order to ensure that all proposed commissioning intentions are
supportive of delivering the CCGs Aims and Objectives the CCG has
undertaken a two stage review process overseen by the Executive
Group culminating in the attached process overview and
recommendations being provided to the Governing Body
Financial costs and savings estimates were provided to the Executive
group when prioritising the commissioning intentions for the Governing
body. All Commissioning intentions are still subject to a full business
case with a cost benefit analysis before any schemes are implemented.
These will be identified in the business case for each commissioning
intention.
These will be identified in the business case for each commissioning
intention.
The proposed intentions will help support the CCG in delivering its
responsibilities under the Constitution.
Public and patient engagement has been undertaken during the
development of the commissioning intentions.
Further detail, including summary feedback is contained within the
paper.( Appendix B)
No. This will form part of the full business case for each commissioning
intention.
Paper - South Tees Clinical Commissioning Group Commissioning
Intentions 2016/17
Appendix A - Recommendations from the Executive Group
Appendix B - Engagement feedback
Appendix C – Work-stream work programme
CCG Executive Group
26
27
South Tees Clinical Commissioning Group
1. Introduction
The purpose of this paper is to provide the Governing Body with further assurance
regarding the process implemented within the Clinical Commissioning Group (CCG)
to develop its commissioning intent for 2016/17 and to seek approval to progress this
intent via the 16/17 contracting round.
All commissioning intentions have been generated via the clinically led work streams
throughout the course of the current contract year. They have been developed in
order to support the CCG to deliver the strategic aims and corporate objectives and
to support the Clear and Credible Plan (2012- 2017).
A range of information sources have been used to evidence and develop the
proposed intentions including:







Joint Strategic Needs Assessments for Middlesbrough and Redcar &
Cleveland
Commissioning for Value Packs (November 2014 and February 2015)
CCG Aims & Objectives
Middlesbrough and Redcar & Cleveland Health Profiles (PHE)
Spend and Outcome tool (PHE)
NHS Outcomes Framework 2015/16
Prescribing data.
Commissioning intent for 16/17 continues to build on work undertaken throughout
the current contract year, and to this end a number of the intentions proposed by the
work streams build on the previous year’s intent.
CCGs are legally responsible for ensuring services continue to be commissioned on
a local basis. The CCG is required to retain a strong individual local focus with clear
financial governance frameworks to support the delivery of quality health services to
the local population. CCGs are required to work in partnership with key stakeholders
such as the Health and Wellbeing Boards, Local Authorities, Community and
Voluntary organisations and the third sector, in delivering this obligation.
2. Commissioning Intentions
All proposed intentions have been reviewed by the CCG Executive Group. The
review has been progressed as a two stage process. Stage 1 in September 2015
served as an initial review to ensure that resources, such as clinical time and
commissioning support capacity, were targeted at those intentions most
appropriately aligned to the CCGs strategic intent, whilst recognising any existing
operational pressures that required addressing.
Following approval by the Executive Group to further develop the supported
intentions, work streams undertook to provide all necessary information in
28
demonstrating the benefits and anticipated impact of the intentions, along with plans
for how they would be implemented. Stage 2 culminated in a second review by the
Executive Group whereby a recommendation and subsequent ranking of importance
was provided for the Governing Body as included in Appendix A.
It should be noted that any plans developed by the CCG at this stage are subject to
change following the release of the NHS Outcomes Framework for 2016-17
(NHSOF) and clarification of the Payment by Results (PbR) guidance for the same
period. The NHSOF is released by NHS England in December of each year in order
to ensure that any required plans or action can be reflected in contracts with
commissioned services/providers.
In developing the intentions, each work stream has completed a standardised
template detailing the rationale behind each proposal, the associated evidence base,
key actions required to progress the intention and the intended or expected
outcomes.
Furthermore each proposed intention presented to the Executive Group included
high level costings in relation to the anticipated costs and savings associated with
the implementation, for the CCG or broader health economy. However, until a full
analysis of demographic, demand and tariff implications has been undertaken and a
full business case presented, all intentions will be subject to further review.
A number of events have taken place during this process to engage and gather
feedback from members of the public and other organisations and to understand the
issues that matter most to our local communities and to share the work being
undertaken and planned by each work stream. These events helped to shape the
further development of the intentions and the key themes can be found in Appendix
B.
3. Work Programmes
The commissioning intentions for 2016/17 are presented to the Governing Body
alongside the work programme for each workstream. This work programme
(Appendix C) is included to highlight the ongoing activities being delivered within the
workstreams. It is recognised some of the activity is ongoing business as usual;
however a number of areas of work may develop into future commissioning
intentions following the completion of a service review.
4. Next Steps
The Governing Body is asked to review the attached table (Appendix A) of proposed
commissioning intentions for progression in 2016/17, alongside the work
programme, and provide approval for the intentions to be progressed into detailed
business cases to allow consideration by the CCG executive group alongside
funding allocations for 2016/17.
Subject to financial approval, a project initiation document (PID) will be completed for
each commissioning intention for 2016/17 to ensure the full scope and remit of the
29
projects can be defined and monitored. Once these PIDs are approved by the
Executive Group (via the Workstream Programme Board) they will be supported by
full project plans to allow effective reporting and monitoring by the CCG.
Carl Gowland
Business Delivery and Operations Manager
November 2015
30
Appendix A
South Tees CCG Commissioning Intentions 2016/17
Recommendations from Executive Group
Brief Overview
Executive Group
Recommendation
Care Closer to Home Targeted pathway reviews
Continue the rolling programme of specialty reviews, aimed at understanding specialty level pathways and
complexities so that patients are seen in the most suitable setting for their need.
This proposed Commissioning
Intention 2016/17 will form part of the
work programme
Continue to progress the transformation of community
Care Closer to Home
services
Evaluation of Community Assessment Unit pilot and implementation of recommendations (IMProVE), Step Up
model (IMProVE), Extend IV antibiotics in the community to other conditions, Implement outputs of the evaluation Intention 2016/17 will form part of the
of Community Nursing Services
work programme
Workstream
Commissioning Intention 2016/17
Work with partners to implement opportunities within
Care Closer to Home end of life to pursue better coordination and cooperation Implementation of outcomes identified in the review of specialist palliative care services.
across health and social care.
Gaining efficiencies and productivity in currently
Care Closer to Home commissioned pathways for Neuro Rehab, ensuring
patients are treated in the most appropriate setting.
Care Closer to
Home/ SRG
Commissioning Intention
2016/17 Priority
work programme
The aim of the review is to determine if there is a gap in current provision and that patients are being treated in the This proposed Commissioning
most appropriate setting. The review will concentrate on low level inpatient services for both Adults & Children
following discharge from either South Tees NHS Hospitals Foundation Trust or Walkergate Park.
work programme
Implementation of Diabetes pathway changes identified
The STAR tool will be applied to the diabetes care pathway during 2015/16, which will identify alternative
through the use of the STAR (Socio-Technical
scenarios with the aim of improving value of the care pathway through the re-allocation of resources.
Allocation of Resources) approach.
work programme
Work with partners to implement opportunities within
Implementation of ‘Achieving world-class cancer outcomes: a strategy for England 2015-2020’ with an initial focus
Care Closer to Home cancer to boost cancer survival rate and improve patient
Approved to progress
on Breast, Lower Gastrointestinal and Lung Cancer
experience.
High
Community
Innovation Fund
Low
Health Inequalities
Community Innovation Fund
To pump prime innovation projects and services with a view to assessing their value and development as a future
commissioning intention.
HeadStart Middlesbrough
Continued CCG engagement in the Middlesbrough Headstart Partnership programme, which centres around a bid
for Big Lottery Fund monies towards improving emotional wellbeing and resilience in children aged 10-16.
work programme
Joint Commissioning TCES – Tees Community Equipment Service
This project will be to consider the results of Community Equipment Project options paper which will be available
in November and to identify the gaps in service and any commissioning requirements, for both the Children’s and Approved to progress
Adult Health services.
Low
Joint Commissioning SEND Reforms – various
Foetal Alchol Syndrome Training, Extension of Personal Health Budgets to children not eligible for CCC but with
long term conditions eligible for EHC Plans, Preparation for SEND Reforms, NE12 Independent Non- Maintained
Residential Schools’ – Compliance Audits, NE12 - Support to Regional Procurement of a Framework agreement
for “Children’s Residential Homes”
Medium
Extending the number of carers on GP registers – with
Joint Commissioning assistance from the current carers service providers
and social care
Health will work with the Social care lead commissioners with them notifying the GP’s of a person’s status as a
carer under the new social care act duties. Any individual under the act in contact with Social care have to be
offered a carers assessments.
work programme
Medicines
Optimisation
The quality engagement scheme will build on the anticipated success of this year’s current scheme to ensure
prescribers continue to practice 'antibiotic stewardship' and only prescribe antibiotics in clinically appropriate
conditions and that resources to assist in this prudent use of antibiotics are fully utilised in practice.
Quality prescribing engagement scheme focusing on
inappropriate antibiotic prescribing
Medium
31
Appendix A
Recommendations from Executive Group
Workstream
Commissioning Intention 2016/17
Brief Overview
Medicines
Optimisation
A medicines optimisation service for care homes. Team to include, Pharmacist, Pharmacy Technician and
support staff. This description is in line with the proposed medicine management support work stream as part of
Better Care Fund - Medicines Optimisation workstream
the Better Care Fund Project, and will enable the expansion of the work the Medicines Optimisation team has
already undertaken in care homes across the CCG.
Executive Group
Recommendation
Commissioning Intention
2016/17 Priority
Medium
Learning Disability Healthcare Respite
The proposal is to deliver on the recommendations of the Review of Healthcare Respite, specifically to; stimulate This proposed Commissioning
local respite and short break options available to adults with learning disabilities and associated complex health
needs in partnership with Local Authorities
work programme
Mental Health/LD
Learning Disability Transformation- Delivery of Fast
Track
The North East and Cumbria has been identified as one of five national Fast Track areas. CCGS, in partnership
with LAs and NHSE Specialised Commissioning, will be a part of the Transforming Care programme which will
change how we deliver and commission services, so that more people with learning disabilities and/ or autism,
with behaviour that challenges – including those with a mental health condition – can live in the community, closer
to home. This will reduce the reliance on in-patient beds and close some facilities.
High
Mental Health/LD
Improving the journey for people living with dementia
and their carers
The overarching intention is improve patient outcomes and effectiveness of services across the whole spectrum
of dementia, from early diagnosis to end-of-life care via the Dementia collaborative approach.
Medium
Mental Health/LD
Improving Autism Services
In order to bring service provision in South Tees in line with NICE pathways, quality standards and clinical
guidance the following areas have been identified and need to be addressed: Speech & Language Therapy,
Medical Staffing, Occupational Therapy, Sensory Support, Post Diagnostic Parental Support
Medium
Implementation of Mental Health Strategies
To implement key priorities from the CCG’s Mental Health Strategy as well as nationally mandated service
enhancements.
work programme
Mental Health/LD
Neuropsychology Service
The STHFT Neuropsychology service is proposing to meet the specific needs of patients with Functional
Neurological Symptom Disorder in both Paediatric and Adult populations. This Adult and Paediatric FNS service
will be provided through the Clinical Neuropsychology service at South Tees Hospitals NHS Foundation Trust
(STHFT).
Low
Quality In Primary
Care
Primary Care Education
The outcome of the intention is to improve patient care in local practices using a structured clinical and nonclinical education programme supporting practices to improve quality and to reduce variation.
Medium
Urgent Care
To review, engage and investigate potential models of
care for Paediatric Urgent Care Services.
For the CCG to engage with all stakeholders to seek views on current paediatric urgent care services and
processes, identifying any gaps and discussing new models of care.
work programme
Urgent Care
To review existing services, engage with the community
For the CCG to engage with all stakeholders to seek views on current urgent care services and processes,
and investigate potential models of care for Urgent Care
identifying any gaps and discussing new models of care.
Services.
Mental Health/LD
Mental Health/LD
High
32
Appendix B
Engagement Feedback
Area of Focus
Medicines Optimisation
Key Themes
 Concern about waste of medicines
 More information/education for patients on
antibiotics
 Contacts within care homes seen as a good idea –
provide in-house training
 Importance of reducing medicines waste and
stockpiling of medicines
 Suggestion of an engagement scheme regarding
antibiotic prescribing – when not to expect
antibiotics – GP nurse prescriber training
Mental Health and
Learning Disabilities
 How can we get smaller agencies involved?
 More support needed for carers
 Ensure support for patients is available and
accessible within the community
 Dementia awareness is needed – stigma needs
tackling
 Better communication and more access to services
for people in crisis
 Healthcare respite for Learning Disabilities –
excellent idea
 More support for adult autism - smooth transition
from child to adult needed
 Keep services simple - too much choice – need to
be joined up
 Too many people seen to be in hospital settings
 Need for individual care packages
 Public awareness of services needed to reduce the
likelihood of a crisis situation
 Autism – the age of diagnosis determines the ability
to adapt. Schools and health staff need to be
trained to support
 Mental health seems to come second to public
health – needs addressing
33
Appendix B
Engagement Feedback
Urgent Care
Care Closer to Home /
Health Inequalities

A&E doctors should be available 24 hours

More use of Redcar Community Hospital

Better education for patients on the Urgent Care
system – too much choice

James Cook not consultant-led 24/7

Public need to know how to access services at
pharmacies and which are available – important
over Winter period

Public need educating on urgent care – too
much choice – other options than A&E

Good that services and care are being moved
out of hospitals to the community and patients’
homes

Pathways need to be improved and made very
clear

Evaluation of changes that have happened with
IMProVE project

Communication and education of patients and
professionals
34
Appendix C
South Tees CCG Workstream Work Programme
Workstream Alignment
Work Programme Name
Work Programme Detail
Exploration of cost growth anomalies
Reviewing prescribing pressures which are driving cost growth or areas where cost has reduced
Finance and QIPP progress
Discussing delivery against practice workplan
Monitoring antibiotic use
Reviewing the prescribing of antibiotics in CCG practices
Development of prescribing audits
Agreeing on the content of audits to look at specific areas of prescribing
Discussing RDTC reports
Discussing the CCG position in light of reports produced by the Regional Drug and Therapeutics Centre
Grading care home medication review interventions
Discussing interventions made by MO team during medication reviews in care homes to see if a hospital admission has been avoided as a result of the
intervention
Discussion options for Near patient CRP testing funding bid, and Straight to the Point Consensus
Discussing the options for near patient testing to help reduce unnecessary use of antibiotics
Report
SRG
Responsible for SRG assurance plans & delivery
SRG
Responsible for winter plan submissions & delivery
SRG
Responsible for capacity plan submissions & delivery
SRG
Responsible for high Impact Interventions submissions & delivery
SRG
Update and maintain Urgent Care Dashboard
SRG
Identify and update SRG winter schemes
SRG
SRG scenario testing
SRG
Participation in Vanguard programme
Development and implementation of a community assessment unit pilot service for the frail and elderly.
Evaluation of pilot.
Implementation of recommendations - to be confirmed following evaluation.
Pilot a district nursing weekend clinic in East Cleveland to assess potential demand for this service.
Interim evaluation of pilot following 6 months.
Final evaluation and decision re need for commissioned service.
Care Closer to Home
Community Assessment Unit
Care Closer to Home
Weekend District Nursing Clinic (East Cleveland) pilot
Care Closer to Home
Evaluation of ICCT / Rapid Response Nursing
Review and evaluation of current community nursing teams (Integrated Community Care Team and Rapid Response only).
Implementation of recommendations - to be confirmed following evaluation.
Care Closer to Home
GP Access to Diagnostics (urgent non-obstetric ultrasound scans)
Desk top review to be carried out to understand if there is an issue with current service.
Care Closer to Home
Heart Failure / Heart Function Clinic review
Improve the pathway for primary care access to heart failure diagnostic services.
Care Closer to Home
Intravenous / Subcutaneous therapy in a Community Setting
Implementation of IV antibiotics service in the community for non-CF bronchiecstasis.
Consider rollout to other condition areas.
Care Closer to Home
MSK Pathway
To implement an agreed streamlined referral pathway for all patients presenting with MSK conditions, to reduce the number of patients seen in
Orthopaedics that could have been assessed in the community.
35
Appendix C
Work Programme Name
Care Closer to Home
Step Up Model
Development and implementation of refreshed Step Up model of care.
Care Closer to Home
Step Down Policy
Development and implementation of Transfer Policy (Step Down) and review after 6 months.
Care Closer to Home
Home Oxygen Assessment Service Re-Procurement
Home Oxygen Assessment Service Re-Procurement (being led by Durham SPR with some input from workstream)
Quality in Primary Care
Practice Engagement Variation
Design and Implementation of new model of working. Themes/Areas of work for service redesign. Themes/Areas of work for Education Topics.
Incorporating work of Engagement and Variation to feature regularly within QIPC workstream meeting.
Deep End:
Evaluation and update on the work completed by the Deep End working group to be completed. Future ways of working to be considered, worked up and
potentailly implemented.
Better Care Fund - Support to Carehomes
Improve quality by providing regular planned clinical support to Care Homes for early identification and intervention of potential concerns to try and reduce
/ avoid emergency admissions.
Life Store: (Not QIPC. However project aligned to QIPC Commissioning Manager).
Review and evaluation of the Life Store Service and property lease. Facilitate South Tees wide engagement and feedback. Research and review alternate
service delivery options. Implement and project manage preferred option.
GP IT: (Not QIPC. However clinician aligned to QIPC Commissioning Manager).
Ongoing review of all GP IT . Next stage to be confirmed.
Mental Health/ LD
Transforming Care
The North-East has been designated a ‘fast track’ area to make quick reductions in Assessment and Treatment bed numbers for people with LD and move to
a new service model.
Mental Health/ LD
Stepping Forward
The Stepping Forward service provides outreach support to vulnerable adults with mental health difficulties and other complex needs who are at risk of
crisis. The service provides flexible support to individuals, tailored to their needs with the aim of brokering engagement with appropriate mainstream
services to reduce the likelihood of crisis and access to emergency care services.
Mental Health/LD
To develop a Middlesbrough Joint Implementation Plan of the National Mental Health Strategy
Development of an action plan, which would implement the national strategy – No Health without Mental Health
Mental Health/ LD
To develop a Redcar and Cleveland Joint Implementation Plan of the National Mental Health
Strategy
Development of an action plan, which would implement the national strategy – No Health without Mental Health
Mental Health/LD
Review of the Gateway Service
A review of TEWV out-patient service for adults with mild to moderate mental health issues has been undertaken and report to be presented to MH
workstream. This to be picked up by new MH manger in past 2/11/15
Mental health/ LD
South Tees Dementia Collaborative
Outputs to inform improvement priorities and the inform development of the South Tees Dementia Strategy. Task and finish group established for service
user/carer engagement and awareness raising.
Mental health/ LD
Refresh of adult autism strategy
Adult strategy refresh to commence in year (via autism strategy delivery group)
Mental health/LD
Lead Review of Complex Health Care Respite
Mental health/ LD
Lead the transformation of the Community CAMHS Service delivered by TEWV in Tees
Mental health/LD
Lead the Tees Autism Strategy group on behalf of Tees CCG's and associated action plan
Mental health/LD
Support local SEN reforms and development of notional Personal Health Budget
Mental health/LD
NE12 regional Procurement Children’s Independent Special Schools
Mental health/ LD
TCES Contract review as currently does not cover children’s equipment
Health Inequalities
CVD including diabetes
CVD and diabetes identified as one of two key priorities for the HI Steering Group. Steering Group have agreed to undertake a Deep Dive to understand the
sytem's approach to prevention, diagnosis, treatment and aftercare in relation to diabetes.
CCG partner in a Tees CCG and LA bid to become first wave of new national diabetes pilot
36
Appendix C
Work Programme Name
Health Inequalities
Welfare Rights
Increasing provision in R&C to bring in line with Mbro and to explore opportunities for joint comissioning.
Health Inequalities
Smoking cessation for inpatients
Exploring CCG duty re. commissioning smoking cessation serviecs for people admitted as inpatient
Health Inequalities
Health Needs of Care Leavers
CCG only CCG in NE to take part in national project to better understand and therefore meet the health needs of people in care and who have been in care
Health Inequalities
Cancer
Cancer has been identified as one of two key priorities for the HI Steering Group - other priority is CVD. Steering Group have agreed to undertake a Deep
Dive into lung cancer to understand the sytem's approach to prevention, diagnosis, treatment and aftercare in relation to Lung Cancer.
BCF
Single Point of Access
Exploration and Implementation of Single Point of Contact
BCF
Supporting Recovery & Independence
Recovery and Independence team - Rapid Response service - Residential Rehabilitation beds in the Middlesbrough Intermediate Care centre
This scheme will be enhanced by the Residential Reablement pilot scheme
BCF
Supporting Independence (reablement)
This scheme encompasses a number of different elements to maximise an individuals independence facilitating them to remain at home for as long as
possible.
BCF
Time to think Beds
Review of beds in non acute setting.
BCF
Residential rehabilitation and reablement-pilot
Plans for this service to be available to people on discharge from hospital or as a “step up option” from the community.
BCF
Rapid Response - Integration & overnight provision
This project aims to address a number of issues across South Tees in relation to Rapid Response
BCF
3 Consultants at A&E
BCF
AAU Therapies at Front of House (FOH)
BCF
JCUH AAU 7 day staffing/medical decision maker FOH
BCF
Support for Care Homes
To work proactively with Care Homes to improve health of residents, help prevent accidents and illness, manage emerging health problems in a timely way
and develop the overall resilience of the Care Home sector in managing health needs.
BCF
Carers
Carers Strategy Group have developed a Carers Strategy, R&C have a contract with Carers Together to deliver the services - Carers information service to be
procured.
BCF
Continuing Health Care
There will be a multi agency/stakeholder review of the NHS Continuing Health Care process in South Tees. It will cover application of NHS CHC eligibility
criteria, care planning, authorisation routes, care management and review.
Corporate
Social Prescribing
Corporate
Review of engagement schemes
3 services within JCUH A&E aimed to reduced avoidable admissions
A review of the existing engagement schemes including Practice Enhanced Treatment Scheme (PETS) and the Urgent Care scheme with a view to developing
an all-encompassing scheme, which includes primary care indicators (over and above QOF)
37
Official
NHS Confidential
NHS Protect
Public
Governing Body
Agenda Item: 2.2
Purpose of Paper
Title
Responsible
Recommendation(s)
For Decision
Life Store
Dr Nigel Rowel – Clinical Executive Sponsor
Alex Sinclair – Managerial Executive Sponsor
Deborah Ward - Commissioning Manager &
Alastair Dewar - Commissioning Manager
The South Tees CCG Executive Group recommended that the options
paper progress to the Governing Body along with the preferred option of
No.5 (Integration with new Public Health Hub models) for discussion
and a decision.
A decision is required in order to implement Phase 2 of the project.
Summary
The Governing Body is asked to confirm a decision on its preferred
option for the project which will be implemented in the coming period.
In March 2013, the PCT transferred the Life Store to NHS South Tees
CCG including the commissioning of the current provider Pioneering
Care Partnership (PCP) to deliver the service until June 2015. This
contract was then extended to run until March 2016.
There is a break clause in the lease for the premises for December
2015, whereby three months’ notice would be required to notify the
landlord of a decision to discontinue the lease. If this break clause is not
used the CCG would remain tied into the lease until 2020.
The Life Store costs in the region of £336k per year which includes the
cost of the commissioned service provider at approximately £87k and
£249k in rent charges.
The project was to be implemented in two phases;
Phase One; the initial decision by the CCG on 14th January 2015 was
to extend the current lease on the existing premises. By extending the
lease we could undertake a review of the options in relation to
commissioning and make an informed decision on future options. An
agreement was made with the landlord to move the break clause to
enable a release from the lease from 31st March 2016.
Therefore a decision is required from the CCG in order to confirm the
intention for the service from 1st April 2016 onwards.
Phase Two of the project will be developed around the outcome of the
options paper and any procurement or contract requirements.
There is a significant cost for the CCG should the contract for the
existing service be continued which will mean a further £1.34m is
needed over the next four years. This equates to £996k 38for
accommodation costs and a further £348k for the commissioned
service, based on current values.
Legal/Regulatory
Implications
Assurance
Framework/Risk
to the NHS
Constitution
Public Involvement
and/or Implications
Depending on the preferred option:
Employment Law: Advice to be sought regards staff implications
Legal implications: Property Services – Implementation and negotiation
of the Lease Break Clause with the landlord
Risks have been considered against each of the options; none of these
have been included on the Risk Register or Assurance Framework at
this stage. This will be reviewed once the preferred option has been
determined.
The NHS constitution requirements are intrinsic to delivery of the CCG
strategic priorities and are considered during development of all project
plans.
A clear and accessible approach to engagement included:
•
•
•
•
Street surveys
Online surveys
In-house surveys completed by members of the public within
Life Store
Public engagement events
Those engaged included:
•
•
•
•
Has an Equality
Analysis been
completed?
Patients / service users
Informal carers
Members of the public
Community and voluntary sector groups and organisations.
*Please see Appendix A for full engagement report.
An Equality Analysis has not been completed at this stage, however,
the CCG seeks to ensure that none of our functions, policies and
processes have an adverse impact on any people in any of the
protected groups. Due regard will be used as a tool to help us make
fair, sound and transparent decisions that are based on a robust
understanding of the needs and rights of the groups and individuals
who may be affected.
Engagement activity considered all client demographics and consisted
of quantitative and qualitative questions that were completed across two
versions of a survey. One version was completed within the Life Store
itself. The other surveys were completed on-street, online and at public
engagement events. A total of 701 people responded.
Phase 2 of this project will include a full Equality Analysis at an early
stage in the process.
Attachments
Please detail any
1.
2.
Life Store Options Paper
Appendix A - Life Store Engagement Report
The South Tees CCG Executive
The South Tees CCG Operational Management Team
39
Options Paper
Life Store Service
Paper prepared by: Deborah Ward and Alastair Dewar
Date prepared: October 2015
Version: 2.4
40
Contents Page
Page 1:
Front Cover
Page 2:
Contents Page
Page 3:
Current Situation & Rationale for Review
Page 4:
Current Service Model & Review Undertaken
Page 5:
Engagement Process
Page 6:
Options Appraisal Process
Page 7:
Key dates / Milestones
Pages 8-14:
CCG Commissioning Options
Page 15:
Additional Factors to be considered
Page 16:
Next Steps
Appendix:
A.
Life Store Engagement Report
41
Current situation:
The Life Store is located in Middlesbrough’s main shopping centre and provides advice to the public
regarding many aspects of health with an emphasis of providing a signposting service and health
interventions, for example, weight management. In March 2013, the PCT transferred the Life Store to
NHS South Tees CCG including the commissioning of the current provider Pioneering Care Partnership
(PCP) to deliver the service until June 2015, this contract was then extended until March 2016. There is
a break clause in the lease for the premises for December 2015, whereby three months’ notice would be
required to notifying the landlord of a decision to discontinue the lease. If this break clause is not used
the CCG would remain tied into the lease until 2020.
The Life Store costs in the region of £336k per year which includes the cost of the commissioned service
provider at approximately £87k and £249k in rent charges.
The project was to be implemented in two Phases; Phase One was in relation to the decision on the
options for the extension of the contract and to allow time to review the service and develop an options
paper. Phase Two of the project will be developed around the outcome of the options paper and any
procurement or contract requirements.
Phase One; the initial decision by the CCG on 14th January 2015 was to extend the current lease on the
existing premises. By extending the lease we could undertake a review of the options in relation to
commissioning and make an informed decision on future options. An agreement was made with the
landlord to move the break clause to enable a release from the lease from 31st March 2016.
Therefore a decision is required from the CCG in order to confirm the intention for the service from 1st
April 2016 onwards. There is a significant cost for the CCG should the contract for the existing service be
continued which will mean a further £1.34m is needed over the next four years. This equates to £996k
for accommodation costs and a further £348k for the commissioned service, based on current values.
On that basis a decision must be made by the CCG by 26/11/15 which would enable the break clause to
be exercised, should this be the preferred option. Arrangements will need to be made to reinstate the
premises as required in the contract.
Rationale for review:
There are a number of reasons for the current service review as listed below including:



Equity of Service – no similar service is commissioned in Redcar & Cleveland and the CCG is unable at
present to afford the cost of commissioning a similar service or provision. We have low numbers of
people from Redcar and Cleveland accessing the service therefore we need to understand the need
and potential to increase access and awareness in the locality.
Value for Money – the CCG needs to review all its financial commitments and be assured that we are
achieving value for money. If we do not take this opportunity to review the services and the
premises lease then we will remain tied into the lease until 2020 which will require a commitment
from the CCG of over £1.34m.
A review provides the CCG with the potential to develop local services in order to increase clinical
effectiveness and outcomes.
42
Current service model:
The Life Store has been located within Middlesbrough’s main shopping centre since January 2006. The
purpose when first established was to provide advice to members of the public regarding many aspects
of health, with an emphasis of providing a signposting service to a range of NHS, local authority (LA) and
community sector health related services. In addition to signposting, the Store offered support with
basic health checks such as weight measurement and healthy heart checks. Staff also offer a range of
sexual health information and support such as the provision of the C-Card service (free condom
scheme).
The space is currently largely open plan and offers a waiting area and “café-bar” reception area where
the public can speak to staff and access information. There are two small glass- panelled rooms for
private conversations. To the rear of the store is a small meeting / training room which contains a
demonstration kitchen. There is also a room suitable for small public meetings or training on the first
floor of the premises.
A range of services are provided by Voluntary Sector and commissioned services also access the space
in the Life Store to deliver the following services, but not limited to;
o
o
o
o
o
o
o
Smoking cessation
Carers support
Talking therapies (including hearing voices and relationship counselling)
Baby hearing clinic (JCUH service)
Stress management
Provision of chlamydia test kits
Hearing aid repair service and battery exchange
Review undertaken:
A review group was established in order to consider the current model and alternative options which
could address the issues of access, clinical benefit and value for money. This work included a review of
the levels of access and to try to identify possible outcomes for interventions.
The group undertook some work to scope options on how to increase access to information and
awareness of health and wellbeing and the potential health benefits for the wider CCG population. This
included identifying possible models and associated costs for new services.
In order to inform the development of any options, a robust patient and stakeholder engagement
process was developed. This sought to clarify who currently uses the services and how the service could
be improved to meet their needs. In addition, a workshop took place with the life store team to identify
strengths, gaps and opportunities within current service provision.
During the process of the review there were updates provided to the CCG Executive on a regular basis to
provide information and assurance on the review process. As part of our work with our LA partners
there was information shared with the Joint Health Overview and Scrutiny Committee and most recently
a presentation of the main themes of the engagement feedback.
43
Engagement Process:
As part of the review process and to consider potential options for the commissioning of other services
we developed an engagement process with the public and other stakeholders.





A survey was distributed to customers in store between July and September with 361 forms
completed and returned.
Details of an on-line survey (via Survey Monkey) were circulated to members of the public to access
those who are not aware of the service or who do not use the service. This yielded a total of 95
responses.
A public engagement event was held in each locality during August, whilst the turn-out was lower
than expected in each case we utilised the opportunity to seek clarity on why people used the
service and if there were any unmet needs which could be supported if the service was developed or
provided via other routes. Only 15 people attended these events combined.
The decision was made to commission an external company to conduct street surveys with members
of the public due to seek the particular views of Redcar & Cleveland residents. This exercise and the
public events resulted in a combined total of 245 survey responses.
Feedback on service benefits received from users of the store facilities (IAPT counsellors, Carers
Groups etc.) was also reviewed.
A full report of all the key themes from the engagement report is attached in Appendix A.
Key themes gathered from surveys completed in store
 86% of respondents use the Life Store because of the convenient location
 79% of respondents felt the Life Store had positively impacted their Health and Well being
 Respondents mainly used the Life Store for Audiology and hearing aid maintenance (41 of 48
responses), weight loss (225 of 379 responses) and smoking cessation (45 of 379 responses)
 38% of respondents would consider contacting their pharmacy for advice
 95% of respondents feel the best way to receive Health and Wellbeing advice is face to face
Key themes gathered from surveys completed by the general public, online and at the engagement
events
 70% of respondents had never used the Life Store and therefore could not comment on the service
 65% of respondents felt that they did not require any help managing their Health and Wellbeing
 166 respondents consider a GP surgery as the best place in the community to receive health
information
 24% of respondents felt they needed help to maintain a healthy weight
 89% of respondents feel the best way to receive Health and Wellbeing advice is face to face
 73% of respondents would consider a pharmacy for advice
Key themes gathered from discussion at the public engagement events
 The convenient town centre location is helpful though this is not replicated in Redcar and Cleveland.
It was suggested that the CCG provide transport to the Life Store
 Clients’ feel they have built rapport with staff due to a continuity which is not always possible in
other services.
 A community based service needs visibility, the ability to move and engage a wide section of the
population
44
Options appraisal process:
During the review process a number of potential service models were investigated and assessed which
included the information gained from initial feedback.
An analysis was undertaken on different health promotion models across the region and country. This
included both fixed and mobile service delivery models and also the benefit of contracted services and
the use of volunteers and community champions. Information and tools which proved to be informative
in the process and offered ideas considered as part of local options was the Due North Report of the
Inquiry on Health Equality in the North; Centre for Local Economic Strategies (Sept 2014). NHS Health
Inequalities National Support Team (online information). Health Inequalities Intervention Toolkit, Public
Health England (2010) and a literature review commissioned by NHS innovations North (2015).
Visits were made to a number of local community hubs and other schemes across the region to consider
the benefits of delivering health services via settings which will be closer to patients and within familiar
surroundings.
The Quality in Primary Care “Deep End” sub-group were also considering options for increasing
engagement, health promotion and screening rates during the same period and proposed that a mobile
‘Health-Bus’ model could support this. It could be purchased by the CCG or a service commissioned and
could be scheduled to set –up across the CCG area on agreed dates. The bus could be used to target
specific geographic areas during health campaigns which have the greatest need and also to share
information on the CCG’s priority conditions.
Both Public Health teams in each Local Authority have also been reviewing their own plans and services
for the delivery of health promotion and prevention services and have worked in partnership with the
CCG throughout this review. In particular Middlesbrough Council has secured external funding to
develop a public health hub hosting a holistic offer of health and wellbeing services within the town
centre. At present work is proposed to refurbish premises within the town centre.
Due to the conditions of the funding the hub will be opened during the current financial year and
additional services will continue to implement in phases in the future.
The CCG continues to work in partnership with Redcar and Cleveland colleagues as their plans develop.
45
Key dates / Milestones:


CCG Executive to confirm recommended option /decision:
CCG Governing Body to confirm recommended option/decision:
04/11/2015
25/11/2015
Dependent on decision and if required;

Deadline for break clause to be implemented by NHS property services:
26/11/2015
CCG Options:
The tables below (Pages 8-14) provide a summary of the identified options for the CCG in relation to
commissioning of a service. In each case there is a short summary of the end position and the benefits
and risks for the CCG in each case.
46
Commissioning Options
1) Decommission the service and offer no alternative
Notice will be given to the provider and the lease holder and the service will cease from 31st March 2016. There will therefore be no similar service
commissioned by the CCG from 1st April 2016 onwards. Please note that in the event that the current facilities are to be closed there will be costs to be met in
the current year in order to change the current facilities to their original state as per the lease agreement “dilapidation works” etc.
Benefits
Risks
No further financial commitment for the service and this would support a
CCG objective to achieve value for money and create a potential six figure
saving based on existing spend up to 2020
Option to utilise financial commitment elsewhere within the health
economy to increase additional benefit in other areas or services
Potential lack of identified location for health promotion and signposting
within Middlesbrough
One less contract to be managed
CCG to redeploy or arrange redundancy for any CCG employee currently
working within service.
Political impact due to loss of service and empty commercial space within
town the centre.
Reputational risk to CCG
47
2) Continue to commission the service – via current arrangements
Continue to commission the service from the existing location within Middlesbrough. Continue with services and try to extend the range of information
and signposting available. No commitment is made to commission any form of similar service for Redcar and Cleveland.
Benefits
Risks
Consistency of service provision
Significant long-term financial commitment required
Maintain positive relationships with partners and stakeholders
Impact on relationship with Redcar & Cleveland if partners seek a similar
commitment in that locality
Reputation of CCG not at risk in Middlesbrough
Impact of new Public Health Community Hub would create duplication of
service provision and could reduce footfall into service due to competition
for customers. Existing staff and knowledge might migrate to new Hub and
create a void for the existing service.
Maintain staff and consistency of service standards
Limited potential to offer clinical services or services with clinical benefit
from existing premises
Reputational risk of CCG in Redcar and Cleveland
48
3) Commission alternative service
3a. Service with central base within each locality
Continue to commission the service from the existing location within Middlesbrough. Continue with services and try to extend range of information
and signposting available. Commitment of additional funding will be required in order to commission a similar service for Redcar and Cleveland locality.
Benefits
Risks
Consistency of service provision and equity across both Middlesbrough and
Redcar & Cleveland
Significant financial commitment required to provide equity to commission
services in both localities and ensure that contract value reflected set –up
and for pop-up equipment and resources
Maintain positive relationships with partners and stakeholders
Impact of new Public Health Community Hub in Middlesbrough (and
potentially Redcar & Cleveland) would create duplication of service
provision and could reduce footfall into service due to competition for
customers. Existing staff and knowledge might migrate to new Hub’s and
create a void for the existing service.
Reputation of CCG not at risk in Middlesbrough or Redcar & Cleveland
from Middlesbrough premises
Maintain staff and consistency of service standards (initially)
49
3b. Service with central base and mobile / pop-up function
Continue to commission the service from the existing location within Middlesbrough. Continue with services and try to extend the range of information
and signposting available. A commitment of additional funding would be required in order to commission a similar service for the Redcar and Cleveland locality.
Will also require a commitment to ensure contract value reflects resource and materials for pop-up element of service.
Benefits
Risks
Equity of service for CCG patients in each locality
Additional financial commitment required to provide equity to commission
services in both localities. To ensure that contract value includes the set –
up, pop-up equipment and resource costs across both localities.
Could help facilitate the delivery of services in rural and geographic areas
to patients who do not use the existing premises in Middlesbrough
Impact of any potential future proposals for a Public Health Hub/ plan
(Redcar & Cleveland) as it would create duplication of provision and reduce
footfall into the service due to competition for customers.
Improve patient awareness and sign-posting to appropriate services
Impact of new Public Health Community Hub (Middlesbrough) plan as it
will create a duplication of provision and reduce footfall into service due to
competition for customers.
Increased awareness could improve earlier diagnosis or better selfmanagement
from existing Middlesbrough premises.
Potential to schedule and deliver pop-up service in specific areas or events
and increase health awareness and profile of CCG
Potential lack of engagement due to fear of lack of privacy or lack of
confidentiality with a pop-up service.
50
3c. Health Bus service
Notice to be served to current provider and lease holder. New service to be procured which will provide a Health Bus and would operate across the two
localities providing access to information and some clinical services. Please note that in the event that the current facilities are to be closed there will be costs to
be met in the current year in order to change the current facilities to their original state as per the lease agreement “dilapidation works” etc.
Benefits
Risks
Meets with the request for a new way of service delivery reaching areas of
high deprivation by the Deep-End project
Similar services have been commissioned previously and have been
discontinued (both NHS Tees and West Yorkshire).
Equity of service for CCG patients in each locality
Significant start up and annual costs (£414,540 - £487,040 for first year)
required from CCG for service provider and the maintenance of the vehicle
and equipment, driver, insurance, storage.
Able to deliver services in rural and geographic areas to patients who do
not use the existing premises in Middlesbrough
Risk of loss of access due to external factors such as vehicle out of use or
impact of bad weather. Therefore potential for reduced delivery.
Improve patient awareness and sign-posting to appropriate services.
Increased awareness could improve earlier diagnosis or better selfmanagement
Potential to schedule and deliver campaigns in specific areas or events and
increase health awareness and profile of CCG
from available space
Lack of engagement due fear of lack of privacy or lack of confidentiality.
51
4. Integration with existing LA Community Hub services
Notice will be given to the provider and the lease holder and the service will cease from 31st March 2016. A new project would be initiated to provide training to
existing paid and volunteer staff within the local community hubs who can provide health promotion advice and signposting to local services. Please note that in
the event that the current facilities are to be closed there will be costs to be met in the current year in order to change the current facilities to their original state
as per the lease agreement “dilapidation works” etc.
Benefits
Potential savings to be made on contract value (£87k PCP contract) and by
ending the commercial lease commitment
Risks
Zero or limited potential to offer clinical services or services with clinical
benefit from existing community hubs
CCG to redeploy or arrange redundancy for any CCG employees currently
working within existing service
Further improve relations and reputations with LA partners in each locality
by supporting existing service and working in partnership
Lack of engagement due to knowing local people delivering the service and
fear of lack of privacy or lack of confidentiality
Equity of service for CCG patients in each locality. Able to deliver services in
rural and geographic areas to patients who do not use the existing
premises in Middlesbrough
Potential to schedule and deliver campaigns in specific areas or events and
increase health awareness and profile of CCG
Variation in level and quality of service delivery due to differences in
available space and staff to deliver information
Impact of turnover of community hub volunteers could result in a variation
in the levels of knowledge and consistent delivery (issues with trying to
maintain staff and volunteer training plans/recruitment)
52
5. Integration with future Public Health models
The existing contract for the service and lease of the premises in Middlesbrough would cease from 31st March 2016. No separate service model would be
implemented in either locality. Work would progress with Public Health partners to identify potential services which might be delivered within their future
models of service delivery. There is the option for the CCG to contribute to the costs of their service and look to deliver more clinically beneficial services for the
CCG. Please note that in the event that the current facilities are to be closed there will be costs to be met in the current year in order to change the current
facilities to their original state as per the lease agreement “dilapidation works” etc.
Benefits
Risks
CCG will not need to commission current service within either locality as
alternative and enhanced services would be created
Financial commitment may be required if additional services are requested
by the CCG or extra space is required
Potential savings to be made on contract value and by ending the
commercial lease commitment
Political impact due to empty commercial space within town the centre and
potential staff implications for PCP
Further improve relations and reputations with LA partners in each locality
by supporting existing service and working in partnership and supporting
their projects
Potential for service users to benefit from the additional services that will
be offered which are not possible in the limited existing facilities
CCG to redeploy or arrange redundancy for any CCG employee currently
working within service.
53
Additional Factors to be considered:
Should the contract be extended until March 2020 then a further service review will be required during
2018/19 in order to identify options for the future delivery of a service and ensure that all procurement
plans can be initiated with sufficient time to avoid any break in service. The options for delivery are
likely to change due to changes within the local economy and local priorities.
In the event that the current facilities are to be closed then there will be costs to be met in the current
year in order to change the current facilities to original state as per the lease agreement “dilapidation
works” etc. This work must be completed by the end of March 2016 when the keys are handed back to
the landlord.
Therefore the premises might need to be closed from early to mid – March 2016 for the necessary
works to be completed by the 31st March. These costs will be dependent upon the works to be
completed and following a survey a detailed cost can be provided by NHS Property services once a
decision has been made to surrender the lease. Therefore, there will be a cost to the CCG in the current
financial year.
Next Steps:
A decision is required in order to implement Phase 2 of the project.
The CCG Governing Body is asked to confirm a decision on its preferred option for the project which will
be implemented in the coming period.
Once a decision has been made a further project plan and timeline will be presented to the Executive
which outlines Phase 2.
Appendix:
A. Life Store Engagement Report
54
Life Store Review Engagement Report
Life Store Review: Engagement Report
September 2015
1
55
The engagement activity described in this report
was analysed by the Communications and
Engagement Team of NHS North of England
Commissioning Support Unit on behalf of NHS
South Tees Clinical Commissioning Group.
The report was produced for NHS South Tees
Clinical Commissioning Group by NHS North of
England Commissioning Support Unit.
2
56
Contents
1
Introduction
4
2
Approaches to engagement
5
3
Who was engaged
6
4
Demographics of those engaged
6
5
Responses and analysis
12
6
Conclusions
35
3
57
1. Introduction
Life Store was established to provide an innovative concept in locally available
health advice and information, enabling people to take an active role in improving
their own health and lifestyle behaviours.
Based in the Cleveland Centre shopping mall in Middlesbrough, Life Store is
staffed by health trainers and health advisors. It focuses on promoting healthy
lifestyles and local and national health initiatives.
This includes areas such as:

BMI checks

Blood pressure checks

Healthy eating

Weight management

Smoking cessation
Life Store also provides information on a range of medical conditions and services
available locally, enabling people to become involved and informed regarding their
own health and lifestyle behaviours.
It provides signposting to, and hosts, a number of services delivered by both NHS
and independent providers. This includes:

Improving Access to Psychological Therapies (IAPT)

Stress management

Support for informal carers
The service also offers weight management support in Redcar and Cleveland as
part of its outreach work to the wider South Tees population.
4
58
NHS South Tees Clinical Commissioning Group (CCG) is currently reviewing the
service provided by the Life Store to determine how it can best continue to meet
the health needs of local people.
As part of this review, the CCG is engaging with members of the public to help it
think about how the service can be effectively delivered to extend its reach to the
wider population of South Tees.
This will include Redcar and Cleveland, as well as a greater number of
communities within the Middlesbrough area.
In order to effectively extend the service, the CCG is also thinking about how the
Life Store model of service may have to change or be further developed to
achieve this.
Engagement with the public was conducted over July and August 2015.
This report outlines the engagement activity that took place and the responses
and feedback from those engaged.
2. Approaches to engagement
NHS South Tees Clinical Commissioning Group used a combination of
approaches to engagement to ensure that a cross-section of local people with
different needs and backgrounds were given the opportunity to have their say.
A clear and accessible approach to engagement included:

Street surveys

Online surveys

In-house surveys completed by members of the public within Life Store

Public engagement events
5
59
3. Who was engaged?
A total of 701 people responded.

A combined total of 245 surveys were completed on the street and at
engagement events

361 surveys were completed by members of the public within Life Store

95 surveys were completed online

15 people attended the two public engagement events at the Life Store and
Tuned In in Redcar
4. Demographics of those engaged
South Tees CCG was able to produce demographic statistics (a summary of the
different statistics of people taking part, such as age, gender, and ethnicity) in
relation to responses submitted via the in-house Life Store surveys, the online
surveys and the street surveys.
The following charts illustrate the characteristics of people engaged.
4.1 In-House Life Store Surveys
Respondent postcode
TS1
40
TS10
8
TS17
11
TS18
4
TS19
4
TS20
4
TS3
51
TS4
40
TS5
86
TS6
TS7
TS8
27
22
19
6
60
Key to above postcodes
Postcode
Area Covered by Postcode
TS1
Middlesbrough Centre
TS10
Redcar
TS17
Thornaby
TS18
Stockton-on-Tees Centre
TS19
Stockton-on-Tees
TS20
Stockton-on-Tees
TS3
Middlesbrough – Riverside / Cargo Fleet Lane
TS4
Middlesbrough - Marton Road / James Cook University
Hospital
TS5
Middlesbrough - Acklam
TS6
Middlesbrough – South Bank / Grangetown / Eston /
Normanby
TS7
Middlesbrough – Marton / Nunthorpe
TS8
Middlesbrough – Stainton / Maltby / Thornton / Coulby
Newham / Newby
Gender of respondent
Male
26%
Female
74%
7
61
Ethnicity of respondent
Asian - Pakistani
4%
Asian - Bangladeshi
1%
Black African
1%
White - British
94%
Age of repondent
75 years or older
10.14%
Under 18 years
5.22%
19-24 years
8.99%
65-74 years
15.94%
25-34 years
10.72%
35-44 years
10.43%
55-64 years
19.13%
45-54 years
19.42%
8
62
Respondent with caring responsibilities
Yes
15%
No
85%
4.2 Street Surveys, Online Surveys and Surveys Completed at
Public Engagement Events
Respondent postcode
TS1
8
TS10
TS11
62
7
TS12
31
TS13
49
TS14
54
TS3
TS4
13
10
TS5
14
TS6
TS7
TS8
32
8
11
Key to above postcodes
Postcode
Area Covered by Postcode
TS1
Middlesbrough Centre
TS10
Redcar
9
63
TS11
Marske / Yearby / Upleatham
TS12
Saltburn / Skelton / Brotton / Moorsholm
TS13
Loftus / Ellerby / Scaling
TS14
Guisborough / Dunsdale / Pinchinthorpe
TS3
Middlesbrough – Riverside / Cargo Fleet Lane
TS4
Middlesbrough - Marton Road / James Cook University
Hospital
TS5
Middlesbrough - Acklam
TS6
Middlesbrough – South Bank / Grangetown / Eston /
Normanby
TS7
Middlesbrough – Marton / Nunthorpe
TS8
Middlesbrough – Stainton / Maltby / Thornton / Coulby
Newham / Newby
Gender of respondent
Male
38%
Female
62%
10
64
Age of respondent
75 years or older
3.36%
65-74 years
10.40%
Under 18 years
3.67%
18-24 years
7.95%
25-34 years
19.57%
55-64 years
15.60%
45-54 years
19.57%
35-44 years
19.88%
Ethnicity of respondent
Asian Indian
0.310%
Asian Bangladeshi
0.310%
Asian Pakistani
1.860%
Mixed white and Asian
2.170%
Asian other
0.620%
Black African
0.310%
Mixed white and black African
0.310%
White Irish
0.620%
White British
93.500%
11
65
Respondent with caring responsibilities
Yes
23%
No
77%
5. Responses and Analysis
The following provides an overview of questions asked and responses from all the
surveys. This is followed by analysis of responses to each question.
For the purposes of analysis, the surveys are coded “in-store survey” and “general
survey.”
General surveys include on-street, on-line and surveys completed at engagement
events.
Some questions in the in-house Life Store survey were different to the questions
asked in the street, online and public engagement event surveys.
Therefore separate analysis of the in-house Life Store surveys was required.
Responses and analysis are divided into in-store surveys and general surveys
below, to identify the origin of the data.
12
66
Where the same question was asked in both in-store and general surveys, there
is a sub-section for both in-store and general survey responses and analysis.
Where a question was asked in only one of the surveys, the summary response
and analysis for that question refers only to the survey from which the question
came.
5.1 How often have you used Life Store?
In-store Surveys
 146 (44%) of respondents use the service on a weekly basis
 85 (25%) or respondents use the service on a monthly basis
 26 respondents did not answer this question.
How often have you used the Life Store?
The main themes contained within the responses to this question are as follows
(please note these themes are interpreted from a large number of responses and
are intended to give a general overview):
Theme 1: Batteries for hearing aids
Out of the 20 responses received to this question, 4 (20%) mentioned batteries for
hearing aids.
Theme 2: First visit for C-card
Out of the 20 responses received to this question, 4 (20%) mentioned that it was
their first visit for a C-card.
13
67
Theme 3: Fortnightly visits
Out of the 20 responses received to this question, 4 (20%) mentioned that they
made fortnightly visits.
General Surveys
 241 (72%) of respondents have never used the service
 46 (14%) or respondents have used it once or twice
 5 respondents did not answer this question.
How often have you used the Life Store?
There were no common themes for this question.
5.2 What services have you used before?
In-store Surveys
 225 (76%) of respondents had used the weight loss/BMI service before
 47 (16%) had used the stop smoking service before
 In total, 379 responses were given for this answer.
14
68
What services have you used before?
Theme 1: Audiology/hearing
Out of the 48 responses received to this question, 21 (44%) mentioned
audiology/hearing.
Theme 2: hearing aid / repairs/ batteries
Out of the 48 responses received to this question, 20 (42%) mentioned hearing
aid, repairs or batteries.
5.3 What did you use the service for?

34 (44%) of respondents used the service for weight loss/BMI

22 (29%) brought someone else to the Life Store

95 responses were received to this question, with respondents able to
choose more than one response.
15
69
What did you use the service for?
Theme 1: Blood pressure check
Out of the 13 responses received to this question, 2 (15%) mentioned blood
pressure check.
Theme 2: Collect literature
Out of the 13 responses received to this question, 2 (15%) mentioned collect
literature.
5.4 Some of the services offered by the Life Store are also available locally.
Why did you choose the Life Store?
In-store Surveys

289 (86%) of respondents suggested that they chose to visit the Life Store
due to its convenient location

563 responses were received to this question, with respondents choosing
more than one option.
16
70
Some of the services offered by the Life Store are also available locally. Why did
you choose the Life Store?
Theme 1: Friend recommended or brought them
Out of the 7 responses received to this question, 2 (29%) mentioned their friend
recommended the service or brought them.
Theme 2: Referred by Doctor
Out of the 7 responses received to this question 2, (29%) mentioned they were
referred by a doctor.
Theme 3: Discreet service
Out of the 7 responses received to this question 2, (29%) mentioned that Life
Store offered a discreet service.
5.5 What was the reason for your visit today?
In-store Surveys
 162 (56%) of respondents suggested they visited today for a BMI check
17
71
 128 (45%) visited for weight loss
 394 responses were received to this question, with respondents able to
choose more than one option.
What was the reason for your visit today?
Theme 1: hearing aids/batteries/repairs
Out of the 39 responses received to this question, 22 (56%) mentioned hearing
aids batteries and or repairs.
Theme 2: Audiology / hearing test
Out of the 39 responses received to this question 14, (36%) mentioned hearing
audiology.
5.6 How did you get here today?

123 (36%) of respondents arrived at the Life Store by car

112 (32%) of arrived by bus

346 responses were received to this question

15 respondents did not answer this question.
18
72
How did you get here today?
5.7 If the Life Store was not open today, would you have used another
service?
In-store Surveys
261, (75%) of respondents would have waited for the Life Store to re-open if it
wasn’t open today

50, (14%) would not have used any other service

In total 347 respondents completed this question

14 respondents did not answer the question.
If the Life Store was not open today, would you have used another service?
19
73
5.8 If yes, which service would you have used?
In-store Surveys

41, (72%) of respondents would have visited their GP Surgery if the Life
Store was closed today

31, (54%) would have visited their pharmacy / chemist

84 respondents completed this question

48 more respondents completed this question than said they would use
another service.
If yes, which service would you have used?
Theme 1: Audiology Department
Out of the 13 responses received to this question, 5 (38%) mentioned the
audiology department.
Theme 2: Hospital
Out of the 13 responses received to this question, 4 (31%) mentioned the
hospital.
5.9 Has the Life Store made a difference to your health and wellbeing?
In-store Surveys
20
74

267 (79%) of respondents stated that the Life Store had made a difference
to their health and wellbeing

41 (12%) said they were not sure


24 respondents did not answer this question.
Has the Life Store made a difference to your health and wellbeing?
5.10 If yes, please tell us in what way.
In-store Surveys
 39 people responded to this question
Theme 1: Weight
Out of the 39 responses received to this question, 25 (64%) mentioned weight.
Theme 2: Stop smoking
Out of the 39 responses received to this question, 11 (28%) mentioned stop
smoking.
Theme 3: C-card
Out of the 39 responses received to this question, 3 (8%) mentioned C-card.
21
75
5.11 Do you think the Life Store service could be improved?
In-store Surveys

302 (88%) of respondents do not think that the Life Store service can be
improved

30 (9%) of respondents think that the Life Store service could be improved


18 respondents did not answer the question.
Do you think the Life Store service could be improved?
General Surveys

232 (70%) of respondents never use the Life Store so could not say if the
service could be improved

68 (20%) of respondents did not think that the Life Store service could be
improved

Do you think the Life Store service could be improved?
5.12 If yes, please tell us how you think it could be improved e.g. what
services would you like to see, location, opening times etc.
22
76
In-store Surveys
No general themes were showing for this question.
General Surveys
Theme 1: More services available
Out of the 12 responses received to this question, 2 (17%) mentioned more
services should be available, with one suggesting a drop in service where people
could make comments or complaints.
Theme 2: Always room for improvement
Out of the 12 responses received to this question, 2 (17%) mentioned that there is
always room for improvement.
Theme 3: More information available
Out of the 12 responses received to this question, 2 (17%) mentioned that there
should be more information available.
5.13 Are there any aspects of your own health you would like some help
with?
In-store Surveys
23
77

157 (47%) of respondents suggested that they would like help to be a
healthy weight

140 (42%) of respondents suggested they did not need help

407 responses were received, with respondents choosing more than one
option.
Are there any aspects of your own health you would like some help with?
No general themes were available for this question.
General Surveys

209 (65%) of respondents suggested that they did not require help with
their own health

79 (24%) of respondents suggested they required help to be a healthy
weight

400 responses were received, with respondents choosing more than one
option.
24
78
Are there any aspects of your own health you would like some help with?
Theme 1: Get help from my GP
get help from their GP.
5.14 What do you think are some of the biggest health issues facing local
people where you live?
In-store Surveys
 263 (77%) of respondents think that the biggest health issue facing local
people is drinking too much alcohol
 254 (75%) of respondents think that being a healthy weight is a big health
issue
 1290 responses were received, with respondents choosing more than one
option.
25
79
What do you think are some of the biggest health issues facing local people
where you live?
Theme 1: Don’t know
didn’t know.
General Surveys
 187 (65%) of respondents think that the biggest health issues facing local
people is drinking too much alcohol
 173 (60%) of respondents think that being a healthy weight is another big
health issue
 903 responses were received, with respondents choosing more than one
option.
26
80
What do you think are some of the biggest health issues facing local people
where you live?
Theme 1: Don’t know / not sure
didn’t know or weren’t sure.
5.15 What do you think is the best way to offer help and advice to people
about their health?
In-store Surveys
 339 (95%) of respondents believe the best way to offer help and advice to
people about their health is face to face
 113 (32%) of respondents believe that the best way to offer help and advice
to people about their health is through information leaflets
 576 responses were received to this question, with respondents choosing
27
81
What do you think is the best way to offer help and advice to people about their
health?
No general themes were available for this question.
General Surveys
 299 (89%) of respondents think the best way to offer help and advice to
people about their health is face to face
 187 (56%) of respondents think the best way to offer help and advice to
people about their health is through information leaflets
What do you think is the best way to offer help and advice to people about their
health?
28
82
Theme 1: Depends on the person / people learn differently
Out of the 12 responses received to this question, 3 (25%) mentioned that it
depends on the person or people learn differently.
Theme 2: all of the above
Out of the 12 responses received to this question, 2 (17%) mentioned all of the
above.
5.16 Where would you consider accessing services that help you look after
your health?
In-store Surveys
 236 (75%) of respondents would consider accessing the GP surgery to help
them look after their health
 121 (38%) of respondents would consider accessing a pharmacy to help
Where would you consider accessing services that help you look after your
health?
29
83
Theme 1: Life Store
Out of the 20 responses received to this question, 12 (60%) mentioned the Life
Store.
Theme 2: Internet
Out of the 20 responses received to this question, 3 (15%) mentioned the Internet.
Theme 3: Hub
Out of the 20 responses received to this question, 2 (10%) mentioned a hub.
General Surveys
 270 (89%) of respondents would consider accessing the GP surgery to help
 220 (73%) of respondents would consider accessing a pharmacy to help
Where would you consider accessing services that help you look after your
health?
30
84
Theme 1: Walk-in centres
Out of the 29 responses received to this question, 14 (48%) mentioned a walk-in
centre.
Theme 2: Anywhere
Out of the 29 responses received to this question, 7 (24%) mentioned anywhere.
Theme 3: Don’t know
Out of the 29 responses received to this question, 4 (14%) mentioned anywhere.
5.17 Where do you think would be the best place in the community to
receive information about your health and to receive health services?
In-store Surveys

121 people responded to this question.
Theme 1: Life Store
Out of the 121 responses received to this question, 56 (46%) mentioned the Life
Store.
Theme 2: Town Centre
Out of the 121 responses received to this question, 36 (30%) mentioned the Town
Centre.
Theme 3: GP surgery
31
85
Out of the 121 responses received to this question, 31 (26%) mentioned GP
surgery.
General Surveys

196 people responded to this question.
Theme 1: GP surgery
Out of the 196 responses received to this question, 166 (85%) mentioned a GP
surgery.
Theme 2: Pharmacy
Out of the 196 responses received to this question, 8 (4%) mentioned pharmacy.
5.18 Which of the following have you visited to ask for health advice or
treatment in the last 12 months?
In-store Surveys

263 (77%) of respondents had visited a GP for health advice or
treatment in the last 12 months

247 (72%) of respondents had visited Life Store for health advice or
treatment in the last 12 months

833 responses were received to this question, with respondents
choosing more than one option.
32
86
Which of the following have you visited to ask for health advice or treatment in the
last 12 months?
General Surveys
 236 (72%) of respondents have visited a GP for health advice or treatment in
the last 12 months
 110 (33%) of respondents had visited a pharmacy / chemist for health advice
or treatment in the last 12 months
Which of the following have you visited to ask for health advice or treatment in the
last 12 months?
33
87
6. Conclusions
Engagement activity consisted of quantitative and qualitative questions that were
completed across two versions of a survey. One version was completed within
Life Store itself. The other surveys were completed on-street, online and at public
engagement events.
In-store and general surveys were analysed separately, as they were different
questionnaires. It can be seen within the analysis of main themes for each
element of activity that there are quite distinct responses to each.
Out of the people who completed the questionnaire at the Life Store, it proves to
be a popular venue with 44% of people visiting on a weekly basis. However,
when looking at the other surveys that were not completed at Life Store, 72% said
they had never visited. It can therefore be concluded that a small proportion of
residents in South Tees use Life Store regularly.
When visiting Life Store, weight loss/BMI was the service people used most
amongst both surveys, (In-store: 76%, General: 44%). People also visit Life Store
regularly for audiology services, often to get their hearing aid repaired or new
batteries fitted.
When looking at respondents who completed the survey within Life Store, the
majority attend due to the convenient location (86%).
The most popular reasons for attendance on the day of completing the survey
were:

Weight loss

BMI check

Audiology.
If Life Store was not open on the day they visited, the majority of respondents said
they would wait until it re-opened, (75%).
34
88
Out of the minority of people who did say they would visit elsewhere, GP practices
proved to be the most popular service, with 72% of people stating they would visit
their GP surgery.
79% of people completing the survey within Life Store said the service has made
a difference to them.
The majority of people who completed the in-store survey do not think that Life
Store can be improved (77%).
The majority of people (70%) who completed the general survey had never used
Life Store, and felt unable to say whether or not it could be improved.
Overall, respondents said that they would like help to maintain a healthy weight,
(In-store: 47%, general: 42%). The biggest health issues facing local people were
perceived as:

Drinking too much alcohol, (In-store: 77%, General: 65%)

Maintaining a healthy weight, (In-store: 75%, General: 60%)

Smoking, (In-store: 64%, General: 59%).
Some respondents felt that the best way to offer help and advice in relation to
health is to talk to people face to face (In-store: 95%, General: 89%).
The next most popular method would be via an information leaflet, (In-store: 32%,
General: 56%).
Services that people would consider accessing to help them look after their health
included GP practice, (In-store: 75%, General: 89%) and local pharmacy, (Instore: 38%, General: 73%).
When respondents were asked where they thought would be the best place in the
local community to receive information about their health and to receive health
services, the prevalent theme showing amongst both surveys was also GP
35
89
practice. Amongst the surveys completed within the Life Store, a popular
response was the Life Store.
Over the last 12 months the majority of respondents have visited their GP
practice, (In-store: 77%, General: 72%) for health advice or treatment.
Life Store, (In-store: 72%) was popular amongst the surveys completed within the
store, with pharmacy, (General: 33%) and walk-in centre, (General: 23%) being
popular amongst the general surveys.
36
90
37
91
NHS Confidential
NHS Protect
Public
Governing Body
Agenda Item: 2.3
Purpose of Paper
Title
Responsible
Recommendation(s)
Summary
Legal/Regulatory
Implications
Assurance
Framework/Risk
to the NHS
Constitution
Public Involvement
and/or Implications
Has an Equality
Analysis been
completed?
Attachments
Please detail any
For Decision
Securing Quality in Health Services – Terms of reference and
governance arrangements
Amanda Hume, Chief Officer
Jon Tomlinson, SeQIHS Programme Director
The Governing Body are asked to:
a. consider the proposed amendments to the Constitution and
recommend their approval by the Clinical Council of Members in order
that the CCG can enter into a joint committee.
b. consider and approve the proposed Terms of Reference for the joint
committee, recognising that some issues as detailed in the paper need
to be confirmed by all Chief Officers.
The Securing Quality in Health Services (SeQIHS) programme involves
health leaders across Durham, Darlington and Tees who have
collectively committed to change the way certain elements of health
care is provided to the local population to deliver the highest quality of
care possible within available resources. The work of the SeQIHS
programme is designed to deliver key clinical standards consistently
across the population so that all people receive the highest possible
care and best outcomes with more care provided out of hospital.
The programme is now at a stage requiring robust and formal
governance arrangements across each organisation in order to further
progress the project and appropriate and transparent decisions are
made.
This paper does not have any financial implications.
The proposed changes to the Constitution and adoption of the Terms of
Reference are required in order to enter into a Joint Committee.
Not specifically to this report, however, any risks associated with the
overall SeQIHS project will be considered and managed appropriately.
The aim of the programme is to ensure that all elements of the NHS
Constitution are met in a consistent way in relation to the project.
Not specifically for this report, however, full engagement and
consultation will be undertaken as appropriate in relation to the SeQIHS
programme of work.
Not for this report.
SeQIHS – CCG Joint Committee proposal
SeQIHS – Joint Committee Terms of Reference
None within the CCG.
92
SeQIHS: CCG Joint Committee
1.
Introduction
Discussions have been taking place for some time on how best to secure timely decision making
as the SeQIHS programme starts the next phase towards public consultation. In essence we need
to be able to make decisions and agree documentation in a timely manner in line with the existing
CCG governance arrangements. The form used in other health systems and more recently for cocommissioning is the mechanism of a “Joint Committee of CCGs”
Rosemary Granger has been working with Capsticks to produce a scheme of delegation which
meets legal and governance requirements and is seen by all CCGs as meeting their needs.
Proposed membership of the Joint Committee:
 NHS North Durham CCG
 NHS Durham Dales, Easington and Sedgefield CCG
 NHS Darlington CCG
 NHS Hartlepool and Stockton-on-Tees CCG
 NHS South Tees CCG.
2.
Actions required to establish the Joint Committee
CCGs will need to amend the CCG’s Constitution to include the Joint Committee within the
governance arrangements for the CCG. This would be in line with amendments that have already
been made to allow for the establishment of joint committees with NHS England for the
commissioning of primary care.
Draft wording to be added to CCG Constitutions is set out below. The existing Constitution has
already referenced a Joint Committee for primary care commissioning. The SeQIHS Joint
Committee is a separate committee and should be inserted in the Constitution as the next section
as follows:
“Joint Commissioning Committee with other CCGs – Securing Quality in Health
Services (SeQIHS) Joint Committee
The Joint Committee is a joint committee of NHS North Durham CCG, NHS Durham, Dales,
Easington and Sedgefield CCG, NHS Darlington CCG, NHS Hartlepool and Stockton-onTees CCG and NHS South Tees CCG. The primary purpose of the Joint Committee is to
arrange the formal consultation and undertake the decisions on the issues which are the
subject of the consultation in relation to the SeQIHS programme.
The Joint Committee will operate in line with the joint arrangements set out in section [..]
and the Terms of Reference for the Joint Committee can be found at the following link to
the CCG website […].
The main activities of the Joint Committee include the following:
 Determine the options appraisal process, including agreeing the evaluation criteria and
weighting of the criteria.
 Determine the method and scope of the consultation process.
 Act as the formal body in relation to the public consultation with the Joint Overview and
Scrutiny Committees established for it by the relevant Local Authorities.
 Make any necessary decisions arising from a Pre-Consultation Business Case (and the
decision to run a formal consultation process).
 Approve the Consultation Plan.
 Approve the text and issues on which the public’s views are sought in the Consultation
Document.
93



Take or arrange for all necessary steps to be taken to enable the CCGs to comply with
their public sector equality duties.
Approve the formal report on the outcome of the consultation that incorporates all of the
representations received in response to the consultation document in order to reach a
decision.
Make decisions about future service configuration and service change, taking into
account all of the information collated and representations received in relation to the
consultation process. This should include consideration of any recommendations made
by the Programme Board or views expressed by the Joint Health Overview and Scrutiny
Committee or any other relevant organisations.
The Governing Body of the CCG shall require, in all joint commissioning arrangements,
that the lead clinician and lead manager of the CCG, make a quarterly written report to the
Governing Body and hold at least annual engagement events to review aims, objectives,
strategy and progress and publish an annual report on progress made against objectives.”
Furthermore, CCGs will need to amend the scheme of delegation to describe the functions that will
be delegated to the Joint Committee.
Draft amendment to the schedule of delegation in relation to the Joint Committee:
Policy Area Decision
Commission
ing
for
Clinical
Services
Determine
the method
and scope of
the Option
Appraisal
Reserved to Reserved
Membership to
Governing
Body
Delegated Accountable
to
a Officer
Committee
Chief
Finance
Officer
SeQIHS
CCG Joint
Committee
Approval of
Consultation
Plan
Approval of
Outcome
from
Consultation
Approve the
decisions
about
the
future
service
configuration
and service
change
In addition:
 the CCG needs to check its current scheme of delegation to ensure that any elements that
need to be removed to avoid double delegation, are removed
 the CCG needs to remove any references that the Governing Body would need to ratify
decisions of the Joint Committee, since this would negate the purpose of the Joint
Committee.
94
3.
Recommendation
1. To accept the draft Terms of Reference for the Joint Committee - latest version attached and
outstanding issues, with recommendations, discussed in section 4 below.
2. Finalise the terms of Reference for the Joint Committee subject to the Governing Body’s
consideration of the issues and related recommendations in section 4. The recommendations
are reflected in the draft Terms of Reference submitted to the Governing Body.
4.
Proposals re outstanding issues
In order to finalise the draft terms of reference there are a few issues that remain to be resolved by
the CCG COs. Legal advice (Gerard Hanratty, Capsticks) has been obtained to shape the current
draft which are set out below:
a. Joint Committee revenue budget
Establish a budget to enable the joint committee to carry out its work (this is already enabled for
joint committees in CCG Constitutions). However, this is viewed as unnecessary since the budget
for running the consultation is already included in the NECS agreement and the proposal therefore
is not to include reference to a budget for the committee.
Recommendation – this is unnecessary and it is covered by the CCG/NECS SLA
b. Joint Committee commissioning budget
Transfer affected commissioning budgets to the Joint Committee. This could include the acute care
commissioning budget for all the CCGs. This would be a significant step for the CCGs and
arguably unnecessary as decisions made by the Joint Committee will determine the shape and
configuration of the services commissioned by the CCGs in the future. The Joint Committee will not
be carrying out the commissioning of those services and therefore the acute care commissioning
budget should not be part of the Joint Committee Terms of Reference.
Recommendation – this is unnecessary as the Joint Committee is not managing
commissioning
c. Voting and thresholds
To-date CCG Chief Officers have favoured unanimous decision making, to avoid a situation where
one or more CCG votes against the proposed service changes which could be a difficult situation
to handle with the media, opponents to the changes, Local Authorities etc. Gerard Hanratty argues
that this is not a realistic approach because it might be extremely difficult politically for one or more
CCGs to support a decision that could be perceived as being detrimental to their local population.
They could take the view that their only option is to withdraw from the Joint Committee and the
ramifications of this would be very serious for the Programme as a whole. His view is that the
CCGs should consider a majority decision (i.e. 80%).
Recommendation: decisions should be unanimous
d. Membership of the Joint Committee
In discussions to-date there had been a suggestion that it would be beneficial to appoint an
independent chair to the Joint Committee. However, no suggestions have been forthcoming on
how to progress this and it is probably timely to reconsider this approach and think about the pros
and cons of appointing a chair and vice chair from the membership of the committee.
95
Recommendation: that the Joint Committee selects a chair and vice-chair from their
number. The chair and vice-chair must be from different CCGs.
Non-voting members - including non-voting members in the membership such as Local Authority
representatives and Healthwatch representatives risks duplication with the membership of the
Programme Board and consideration should be given as to whether non-voting members should
be included in the Joint Committee membership.
Recommendation: membership to include voting CCG members only with the Joint
Committee having the power to invite organisations or individuals to attend in a non-voting
capacity
5. Ensuring the terms of reference are consistent with CCG Constitutions
Most CCGs have used the wording that is included in the model wording for amendments to CCG
Constitutions in relation to setting up joint committees and this states that the agreement setting
out the arrangements for joint working, in this case the terms of reference, will include the following
areas:
 How the parties will work together to carry out their commissioning functions
 The duties and responsibilities of the parties
 How risk will be managed and apportioned between the parties
 Financial arrangements, including, if applicable, payments towards a pooled fund and
management of that fund
 Contributions from the parties, including details around assets, employees and equipment
to be used under the joint working arrangements
The first two are covered in the current draft terms of reference, and finance and contributions are
discussed at 4a and 4b above.
In relation to risk it is proposed that reference should be made to the fact that decisions should be
made taking into consideration the implications of those decisions on potential risk to the
sustainability and viability of Foundation Trusts.
6.
Summary and final recommendation:
The Governing Body are asked to:
a.
consider and approve the proposed amendments to the Constitution and Scheme of
Delegation.
b.
consider and approve the proposed Terms of Reference for the Joint Committee,
recognising that those issues detailed at (4) above need to be confirmed by Chief
Officers.
Jon Tomlinson
SeQIHS Programme Director
30 October 2015
96
Securing Quality in Health Services (SeQIHS) CCG Joint Committee
Draft Terms of Reference
1. Introduction
1.1
The NHS Act 2006 (as amended) (“the NHS Act”) was amended in 2014 to allow
Clinical Commissioning Groups (CCGs) to form joint committees. This means that
two or more CCGs exercising commissioning functions jointly may form a joint
committee. The Legislative Reform Order (“LRO”), which amended section 14Z3
(CCGs working together) of the NHS Act, was passed by Parliament and the reforms
took effect from 1 October 2014. The reforms mean that CCGs will no longer find it
necessary to operate work-around arrangements such as committees in common,
encouraging integration and co-working.
Joint committees are a statutory mechanism which gives CCGs an additional option
for undertaking collective strategic decision making.
In addition, the NHS Act provides, at section 13Z, that some of NHS England’s
functions may be exercised jointly with a CCG, and that functions exercised jointly in
accordance with that section may be exercised by a joint committee of NHS England
and the CCG. Section 13Z of the NHS Act further provides that arrangements made
under that section may be on such terms and conditions as may be agreed between
NHS England and the CCG.
Although the Securing Quality in Health Services (SeQIHS) Programme will affect
services commissioned by the Specialised Commissioning function of NHS England
it is not possible for that function to be shared with CCGs. Instead a collaborative
commissioning arrangement will be put in place with NHS England’s Specialised
Commissioning North East and Cumbria group.
Individual CCGs will still remain accountable for meeting their statutory duties. The
aim of the LRO is to encourage the development of strong collaborative and
integrated relationships and decision making between partners.
1.2
The SeQIHS CCG Joint Committee (hereafter referred to as the Joint Committee) is
a joint committee of NHS North Durham CCG, NHS Durham Dales, Easington and
Sedgefield CCG, NHS Darlington CCG, NHS Hartlepool and Stockton-on-Tees CCG
and NHS South Tees CCG with the primary purpose of arranging formal public
consultation and then making decisions on the issues which are the subject of the
consultation in relation to the SeQIHS Programme.
In addition, the Joint Committee will meet collaboratively with those exercising the
Specialised Commissioning function of NHS England (NHS England committee or
nominated individual) to ensure that integrated decisions are made in respect of the
commissioning of Specialised Services and connected health services commissioned
by CCGs.
1.3
The SeQIHS Programme - Health leaders across Durham, Darlington and Tees
have collectively committed to change the way certain elements of health care is
97
provided to the local population to deliver the highest quality of care possible within
the resources available. The work of the SeQIHS programme is designed to deliver
key clinical standards consistently across the patch so that all people receive the
highest possible care and best outcomes with more care provided out of hospital.
Currently for those people who do need in hospital treatment care can be variable in
terms of outcomes because not all hospitals or services can achieve the agreed
clinical quality standards. Hospitals are providing the same services in a health
system that is constrained by both finance and capacity, particularly certain elements
of the workforce, to deliver services at the levels required. From the work carried out
to date it is clear that this is not sustainable with the need for some acute and
specialist services to be carried out in fewer locations with other services provided in
more locations.
1.4 Guiding principles:






1.5
The needs of people in Darlington, Durham and Tees will have priority over
organisational interests.
NHS and Local Authority Commissioners and providers will work collaboratively and
urgently on system reform and transformation.
Costs will be reduced by better co-ordinated proactive care which keeps people well
enough to need less acute, long term and institutional care.
Waste will be reduced, duplication avoided and activities stopped which have limited
value. Patients who are no longer acutely unwell will be discharged promptly from
hospital and cared for in their own home or a local care facility.
Our health and social care system is made up of many independent and interdependent parts which can positively or adversely affect each other. We will develop
strong working relationships with clear aims and a shared vision putting the needs of
the people we serve first.
There will be partnership with the people of Darlington, Durham and Tees the
workforce, voluntary, community and faith based organisations, NHS and Local
Authorities
The SeQIHS Programme established a Programme Board in 2012 which has
overseen the development of agreed clinical quality standards, a feasibility analysis
looking at the implications of implementing these standards, a clinical case for
change, a financial case for change and a model of care. The Programme Board will
continue to oversee the continued work of the programme.
2. Statutory Framework
The NHS Act which has been amended by Legislative Reform Order 2014/2436, provides
at section 14Z3 that where two or more Clinical Commissioning Groups are exercising
their commissioning functions jointly, those functions may be exercised by a joint
committee of the groups.
The CCGs named in paragraph 1.2 above have delegated the functions set out in
schedule 1 to the SeQIHS Joint Committee.
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3. Role of the SeQIHS Joint Committee
The role of the SeQIHS Joint Committee shall be to carry out the functions relating to
undertaking formal public consultation and making decisions on the issues which are the
subject of the consultation in relation to the SeQIHS Programme.
This includes the following key responsibilities:









Determine the options appraisal process, including agreeing the evaluation criteria
and weighting of the criteria.
Determine the method and scope of the consultation process.
Act as the formal body in relation to the public consultation with the Joint Overview
and Scrutiny Committees established for it by the relevant Local Authorities.
Make any necessary decisions arising from a Pre-Consultation Business Case (and
the decision to run a formal consultation process).
Approve the Consultation Plan.
Approve the text and issues on which the public’s views are sought in the
Consultation Document.
Take or arrange for all necessary steps to be taken to enable the CCGs to comply
with their public sector equality duties.
Approve the formal report on the outcome of the consultation that incorporates all of
the representations received in response to the consultation document in order to
reach a decision.
Make decisions about future service configuration and service change, taking into
account all of the information collated and representations received in relation to the
consultation process. This should include consideration of any recommendations
made by the Programme Board or views expressed by the Joint Health Overview and
Scrutiny Committee or any other relevant organisations. It should also include
consideration of the implications of the decisions in relation to potential risk to the
sustainability and viability of the Foundation Trusts included in the remit of the
Programme.
4. Geographical coverage
The Joint Committee will comprise





NHS North Durham CCG
NHS Durham Dales, Easington and Sedgefield CCG
NHS Darlington CCG
NHS Hartlepool and Stockton on Tees CCG
NHS South Tees CCG
NHS England Specialised Commissioning North East and Cumbria will also be involved
through a collaborative commissioning arrangement.
The Joint Committee will have the primary purpose of arranging and undertaking the
formal public consultation and then making decisions on the issues which are the subject
of the consultation in relation to the SeQIHS Programme.
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5. Membership



Two senior Governing Body decision makers from each of the member CCGs,
including the accountable officer, depending on the management arrangements for
each CCG.
Chair and Vice Chair – elected by the members. The Chair and Vice Chair must come
from the member CCGs, but both roles cannot be undertaken by members of the
same CCG.
The SeQIHS Programme Director will act as Secretary to the Committee to ensure
the day to day work of the Joint Committee is proceeding satisfactorily.
6. Meetings and Voting
6.1 The Joint Committee shall adopt the standing orders of Darlington CCG insofar as they
relate to the:





notice of meetings
handling of meetings
agendas
circulation of papers
conflicts of interest (together with complying with the statutory guidance issued by
NHS England)
6.2 Voting - All decisions of the joint committee must be unanimous.
6.3 Quorum - at least one full voting member from each CCG must be present for the
meeting to be quorate.
6.4 Frequency of meetings – at least quarterly.
6.5 Meetings of the SeQIHS Joint Committee:
Meetings of the Joint Committee shall be held in public unless the Joint Committee
considers that it would not be in the public interest to permit members of the public to attend
a meeting or part of a meeting. Therefore, the Joint Committee may resolve to exclude the
public from a meeting that is open to the public (whether during the whole or part of the
proceedings) whenever publicity would be prejudicial to the public interest by reason of the
confidential nature of the business to be transacted or for other special reasons stated in the
resolution and arising from the nature of that business or of the proceedings or for any other
reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or
succeeded from time to time.
6.6 Members of the Joint Committee have a collective responsibility for the operation of the
Joint Committee, They will participate in discussion, review evidence and provide objective
expert input to the best of the knowledge and ability, and endeavour to reach a collective
view.
6.7 The Joint Committee may call additional experts to attend meetings on an ad hoc basis
to inform discussions.
6.8 The Joint Committee has the power to establish sub groups and working groups and any
such groups will be accountable to the Joint Committee.
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6.9 Members of the Joint Committee shall respect confidentiality requirements as set out in
the Standing Orders referred to above unless separate confidentiality requirements are set
out for the joint committee in which event these shall be observed
6.10
Secretariat to be provided by NECS Programme Management Office
The secretariat to the Joint Committee will:


circulate the minutes and action notes of the committee within three working days of
the meeting to all members
Present the minutes and action notes to the governing bodies of the CCGs set out in
4 above
7. Reporting to CCGs and NHS England
The Joint Committee will make a quarterly written report to the member Governing Bodies
and NHS England and hold at least annual engagement events to review aims, objectives,
strategy and progress and publish an annual report on progress made against objectives.
8. Withdrawal from the Joint Committee
Should this joint commissioning arrangement prove to be unsatisfactory, the Governing Body
of any of the member CCGs can decide to withdraw from the arrangement. This withdrawal
to be on such terms as are agreed between the other CCG members of the Joint Committee
and the withdrawing CCG member.
9. Decisions
9.1 The Joint Committee will make decisions within the bounds of its remit
9.2 The decisions of the Joint Committee shall be binding on all member CCGs
9.3 Decisions will be published by NHS North Durham CCG, NHS Durham Dales, Easington
and Sedgefield CCG, NHS Darlington CCG, NHS Hartlepool and Stockton on Tees CCG
and NHS South Tees CCG
10. Review of Terms of Reference
These terms of reference will be formally reviewed by the CCGs named in 4 above in April of
each year, following the year in which the Joint Committee is created and may be amended
by mutual agreement between the CCGs at any time to reflect changes in circumstances as
they may arise.
10. Signatures:
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Schedule 1 - Delegation by CCGs to Joint Committee
A.
The following CCG functions will be delegated to the SeQIHS Joint
Committee by the member CCGs in accordance with their statutory powers under
s.14Z3 of the NHS Act 2006 (as amended). S.14Z3 allows CCGs to make
arrangements in respect of the exercise of their functions and includes the ability for
two or more CCGs to create a joint committee to exercise functions. The delegated
functions relate to the acute hospital services provided to the five CCG members of
the Joint CCG Committee by the three NHS Foundation Trusts, namely:



South Tees NHS Foundation Trust
North Tees and Hartlepool NHS Foundation Trust
County Durham and Darlington NHS Foundation Trust
The SeQIHS Programme focuses on achieving clinical quality standards in the
services listed below provided by the NHS Foundation Trusts named above. As part
of this work it is necessary to consider interdependencies between these services
and any other services that are affected.

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


Acute surgery
Acute medicine
Critical care
Maternity, Paediatrics & Neonatology
Accident & Emergency
Interventional radiology
B.
Each member CCG shall also delegate the following functions to the Joint
CCG Committee so that it can achieve the purpose set out in (A) above:
1. Acting with a view to securing continuous improvement to the quality of
commissioned services in so far as these services are included within the scope of
the SeQIHS Programme. This will include outcomes for patients with regard to
clinical effectiveness, safety and patient experience to contribute to improved patient
outcomes across the NHS Outcomes Framework
2. Promoting innovation in so far as this affects the services included within the
scope of the SeQIHS Programme, seeking out and adopting best practice, by
supporting research and adopting and diffusing transformative, innovative ideas,
products, services and clinical practice within its commissioned services, which add
value in relation to quality and productivity.
3. The requirement to comply with various statutory obligations, including to make
arrangements for public involvement and consultation throughout the process. That
includes any determination on the viability of models of care pre-consultation and
during formal consultation processes, as set out in s.13Q, s.14Z2 and s.242 of the
NHS Act 2006 (as amended) (‘the Act’)
4. The requirement to ensure process and decisions comply with the four key tests
for service change introduced by the last Secretary of State for Health, which are:
 support from GP commissioners
 strengthened public and patient engagement
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
clarity on the clinical evidence base
consistency with current and prospective patient choice.
5. The requirement to comply with the statutory duty under s.149 of the Equality Act
2010 i.e. the public sector equality duty.
6. The requirement to have regard to the other statutory obligations set out in the
new sections 13 and 14 of the Act. The following are relevant but this is not an
exhaustive list:
 14O - management of conflicts of interest
 14P – Duty to promote NHS Constitution
 14Q – Duty to exercise functions effectively, efficiently and economically
 14R – Duty as to improvement in quality of services
 14T – Duty as to reducing inequalities
 14V – Duty as to patient choice
 14X - Duty to promote innovation
 14Z1 – Duty as to promoting integration
 14Z2 – Public involvement and consultation by CCGs (see above)
7. The expectation is that CCGs will ensure that clear governance arrangements are
put in place so that they can assure themselves that the exercise by the Joint CCG
Committee of their functions is compliant with statute.
8. The requirement to comply with the obligation to consult the relevant local
authorities under s.244 of the Act and the associated Regulations.
9. To continue to work in partnership with key partners e.g. the local authority and
other commissioners and providers to take forward plans so that pathways of care
are seamless and integrated within and across organisations
10. The joint committee will be delegated the capacity to propose, consult on and
agree future service configurations that will shape the medium and long terms
financial plans of the constituent organisations. The joint committee will have no
contract negotiation powers meaning that it will not be the body for formal annual
contract negotiation between commissioners and providers. These processes will
continue to be the responsibility of Clinical Commissioning Groups and NHS England
under national guidance, tariffs and contracts during the pre-consultation and
consultation periods.
Schedule 2 - List of members





NHS Durham Dales, Easington and Sedgefield CCG
NHS Darlington CCG
NHS Hartlepool and Stockton on Tees CCG
NHS South Tees CCG
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Public
Governing Body
Agenda Item: 2.4
Purpose of Paper
Title
Responsible
Recommendation(s)
Summary
Legal/Regulatory
Implications
Assurance
Framework/Risk
to the NHS
Constitution
Public Involvement
and/or Implications
Has an Equality
Analysis been
completed?
Attachments
Please detail any
For Decision
BOC – Home Oxygen Service contract extension
Craig Blair, Associate Director of Commissioning, Delivery and
Operations
Dave Welch, Senior Commissioning Manager
The Governing Body is requested to consider the information provided
and to approve the proposed extension of the BOC Home Oxygen
Delivery service’s current contractual arrangement for a period of two
years; pending a re-procurement exercise in line with the NFA
timescales.
To ensure compliance with current national direction and procurement
rules the CCG Executive Group recommends that the Governing Body
approves the option to extend the BOC Home Oxygen Service contract
by two years to bring the timeframe in line with the National Framework
Agreement hosted by the Department of Health.
The estimated spend for 2015/16 on the Home Oxygen Service is in the
region of £1,263,000.
To ensure compliance with current legislation and procurement law.
Procurement advice has been sought and there is a minimal level of
risk associated with the extension of the contract.
Principle 2 - Access to NHS services is based on clinical need, not an
individual’s ability to pay
Principle 4 - The NHS aspires to put patients at the heart of everything
it does
Principle 5 - The NHS works across organisational boundaries and in
partnership with other organisations in the interest of patients, local
communities and the wider population.
Principle 6 - The NHS is committed to providing best value for
taxpayers’ money and the most effective, fair and sustainable use of
finite resources.
Principle 7 - The NHS is accountable to the public, communities and
patients that it serves
To be progressed as part of the future reprocurement exercise.
Not completed to date. To be progressed as part of the future
reprocurement exercise.
Item 2.6 - BOC Home Oxygen Service contract extension
South Tees CCG Executive Group 14th October 2015
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Item 2.5 – BOC Home Oxygen Service contract extension
Introduction & Background
South Tees Clinical Commissioning Group is currently party to a contract in place with BOC for the
provision of a high standard, cost effective oxygen delivery service to the patients we serve. The key
deliverables of the service are outlined as follows:


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




To receive and process the Home Oxygen Order Forms (HOOF) and contact patients to
arrange delivery
Supply and install the equipment as required
Provide a 24 hour a day customer contact centre
Effectively train the patient and/or the Carers in the use of equipment
Re-supply and restock oxygen supplies, equipment and consumables as clinically appropriate
Deal with reimbursement of electricity costs for patients where applicable
Provide reports to the CCGs to enable service management
Service and maintain the equipment
The existing contract covers a five year period; 7th November 2011 to 6th November 2016 with the
option to extend for 2 years.
The management of the Home Oxygen Delivery service runs concurrently with support provided by
the Department of Health which provides the following central functions:


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

Authoring the National Framework Agreement (NFA) with the agreement of the NHS
Overseeing that local contractual disputes where escalated
Advising on legal issues in relation to the NFA and contractual interpretation
Providing clinical advice and supporting role out of Assessment and Review services
Working to continue driving patient safety
Dealing with parliamentary business and other queries
The terms set out in the NFA originally set an expiry date of 5 years from date of signature
(November 2011 – November 2016) and came into force covering the former PCTs and now all 12
CCGs. The NFA following consultation has now been extended by an additional 2 years (November
2011 – November 2018) following national consultation and agreement that lead CCGs would run
mini call-off arrangements (a form of procurement) against the extended NFA of which BOC Home
Oxygen Supply is part of.
As the NFA has been extended for 2 years it is felt that it is necessary to enact the option to extend
the BOC Contract for a period of 2 years to bring it in line with the national timescales.
Finance
The estimated spend for 2015/16 on the Home Oxygen Service is in the region of £1,263,000.
Rationale for extension
It is felt that there are some real benefits that an extension can provide to the CCG:
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

Prices will be fixed from April 2016 until the end of the extension giving certainty of cost
level to the NHS for budgeting purposes
BOC will offer a monthly rebate from November 2016; this will total £800,000 across the
contract for the period of the extension. The total rebate for South Tees CCG will be
£116,458.94
BOC will work with the North East region to implement the new specification of the Contract
including Saturday working as per the contract variation currently under review by the
Department of Health
BOC will endeavour to implement a Portal solution to facilitate the management of the
contract for the North East commercial and financial teams as well as assisting the regions'
clinicians in managing their patients and Oxygen Assessment services
In addition to the benefits outlined above BOC have agreed further initiatives to improve the service
and deliver further financial opportunities:




Implementation of the electronic HOOF from January 2016
Closer working with the clinical assessment teams to ensure value for money where
appropriate and deliver further financial savings.
Improved working with hospital discharge teams to reduce the number of emergency
installations and delivery which are not cost effective
Introduction of next day delivery to reduce the number of 4 hour emergency deliveries
which are significantly more expensive to the health economy
Recommendation from Executive Group
The Executive Group have considered the above at the meeting held 14th October 2015 and
recommend the following to the Governing Body:

To approve the extension of the BOC Home Oxygen Delivery service’s current contractual
arrangement for a period of two years; pending a re-procurement exercise in line with the
NFA timescales.
David Welch
Senior Commissioning Manager
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Official
Governing Body
Agenda Item: 2.5
Purpose of Paper
Title
Responsible
Recommendation(s)
For Decision
Summary
On 12th June 2015 NHS England announced that the North East and
Cumbria would be one of five national Fast Track areas for
Transforming Care for people with a learning disability.
Legal/Regulatory
Implications
Assurance
Framework/Risk
to the NHS
Constitution
Public Involvement
and/or Implications
Has an Equality
Analysis been
completed?
Attachments
Please detail any
Learning Disability Fast Track Update
Jean Golightly, Executive Nurse
Donna Owens, Joint Commissioning Manager
The Governing Body is asked to
1. Note the progress against the Transformation Agenda and
accept the proposals to deliver sustainable community
infrastructure, including the need to provide £135,000 of match
funding.
2. Nominate the CCG’s Executive Nurse, Jean Golightly as the
Governing Body lead for this programme.
A Regional Plan that is underpinned by local proposals to deliver
community based alternatives to inpatient care, alongside the reduction
in commissioned beds has been developed and supported through the
Regional Transformation Board
Financial modelling in relation to how investment can be released from
current commissioned beds is being progressed.
The delivery of the Tees proposals is dependent on the allocation of
match funding from NHS England
None identified as a result of this report
The ability to deliver the required reduction in beds will require a
sufficiently resourced and robust community response. Failure to
develop this area will result in continued demand for beds, which may
result in an increase of out of area placements and higher financial
impact
Does it relate to any of the 7 principles- Yes
Does it relate to any of the NHS values- Yes
Does it relate to patient’s rights-Yes
The development of the Fast Track Plan has included the involvement
of people with a learning disability, families and carers. In addition, a
Confirm and Challenge Group is also in place to oversee the progress
and delivery of the transformation plans.
Not in relation to this report
None
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Learning DisabilitiesFast Track
South Tees CCG
November 2015
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Fast Track- Transforming Care
November 2015
1.
Introduction and Background
This briefing is to provide the CCG Governing Body with an update in relation to the
Learning Disability Transformation Fast Track Programme.
During the 1990s and 2000s there were many resettlement programmes for people
with learning disabilities. However, there is still an over reliance on hospital settings
for the care of people with learning disabilities. Following the Winterbourne View
scandal and the Sir Stephen Bubb report, a Transformation Programme has been
developed.
By improving the community infrastructure, supporting the workforce, avoiding
crisis, earlier intervention and prevention we will be able to support people in the
community, avoiding the need for a hospital admission. This will result in
systematic closure of learning disability in-patient hospital beds over the next three
years across the North East and Cumbria.
The Transforming Care guidance highlights the importance of local partnership
working between commissioners from local government and the NHS, with an
emphasis on the oversight and support of Health and Wellbeing Boards.
The focus for the North East and Cumbria region has been on reducing the reliance
on in-patient beds, and increasing community based capabilities, to meet the
recommendations of the Bubb report; these aims being:





Less reliance on in-patient admissions
Developing community alternatives
Prevention and support to avoid crisis
Better management of crisis when it happens
Better, more fulfilled lives
Prior to the announcement of the National Fast Track Programme, the Northern
CCG Forum had already identified learning disabilities as a ‘large scale’
transformational change programme. The Northern CCG Forum also agreed the
Terms of Reference and governance arrangements to oversee this programme of
work by establishing the North East and Cumbria Learning Disability Transformation
Board to oversee and manage the development and delivery of the learning
disability transformation programme.
NHS England have published a national plan to develop community services and
close inpatient facilities for people with a learning disability and/or autism who
display behaviour that challenges, including those with a mental health conditions .
‘Building the Right Support’ builds upon the work being undertaken across the
country and in particular the fast track site progress.
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2.
Regional Planning Process
Through the Transformation Board, CCGs, Local Authorities and other key
stakeholders have been working together to develop the overarching regional
transformation plan. A baseline assessment of needs and services has been
completed and there has been further analysis of the data with identifying how
many people are in various community settings.
The reduction in inpatient beds across the North East and Cumbria region has been
of significant focus nationally. A trajectory produced for the Region will bring the
current bed base of 146 down to 70, For NHS England this is projected to be from
109 to 62 across low and medium secure beds.
For Tees Esk and Wear Valley NHS FT (TEWV) this represents a reduction of 55%
of their commissioned beds. More detailed discussion as to where and how this can
be achieved is currently taking place. Some units are already small and the
reduction of too many beds on one site could challenge the service sustainability.
3.
Local Update
A joint proposal has been developed across Teesside with the four Local Authorities
Hartlepool and Stockton CCG and South Tees CCG. These locality proposals have
been developed through the Tees Integrated Commissioning Group which has been
working on the post–Winterbourne transformation agenda and has been effective in
securing successful community discharges and developing a number of joint
frameworks, strategies and initiatives.
The group has been actively gathering and assessing local intelligence from front
line support staff, inpatient services, Care and Treatment Reviews (CTRs) and
safeguarding alerts, to inform future models of care that can prevent avoidable
admissions and support effective discharges.
There are three elements to the Tees proposal;
1. Crisis Care and Early Intervention
The development of a North of Tees ‘Time to Think’ provision (to offer
increased availability and support the current South of Tees facility that is
shared across the Tees area)
2. Workforce Development phase 1
Embedding the community function and creating sustained progress- training
and alignment of pathways
3. Community Infrastructure
The pilot of a 7 day enhanced locality community nursing and social work
team. This will support the existing enhanced community support team pilot
delivered by TEWV
Assurance meetings have been established within secure services in relation to
patients progressing to rehabilitation and are being used to inform future planning. It
is likely that the flow of patients will increase, especially in relation to patients
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requiring complex rehabilitative services, given the expected bed reductions across
the secure services also.
Workforce requirements are significant and achievement of the proposed
trajectories will require transformation of the workforce across the region. There are
risks in relation to the pace and number of bed closures for the CCG.
Supporting the reduction in admissions will be the implementation of the CTR
process. A CTR is triggered at the point when a person is identified as “at risk” of
being admitted to a specialist learning disability or mental health inpatient setting.
This should facilitate a process of seeking alternatives to admission if possible and,
if not, follows them through any subsequent admission, period of
assessment/treatment and towards discharge.
4.
Finance: Transformation Funding for Learning Disability Services
The funding requested across the region to deliver the Fast Track Plan was
£2,710,900 and was a level which the Chief Finance Officers believed prudent and
would support deliverable and cost effective approaches to successfully moving the
projects forward.
The Tees Plan requested that the non-recurrent funds be matched against
investment already made by the CCGs, which was £320,000 for NHS South Tees
CCG. The proposals will require an additional £135,000 of match funding from the
CCG. The workforce development hub proposal has been expanded to a full
regional bid so has been removed from the Tees proposal.
Notification was received from NHS England in October that the North East and
Cumbria region had been successful in securing £1,432M. A further £623K has
been allocated following review of patient level business cases to assist in the
double running/ transition where required to ensure safe transition of service from
in-patient care to community based provision.
It should be noted that the allocated funding is not sufficient to cover the cost of the
original overarching plan and supplementary locality plans. The Transformation
Board has therefore developed a prioritisation process and will consider the Tees
proposals against others form the region for a share of the allocation. Locality
proposals are dependent on the allocation of fast track funding and the successful
negotiation of bed closures with release of investment with TEWV.
5.
Conclusion and Recommendations
The Governing Body is asked to
1. Note the progress against the Transformation Agenda and accept the
proposals to deliver sustainable community infrastructure, including the need
to provide £135,000 of match funding.
2. Nominate the CCG’s Executive Nurse, Jean Golightly as the Governing Body
lead for this programme.
Donna Owens
Joint Commissioning Manager (Learning Disabilities)
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Governing Body
Agenda Item: 2.6
Purpose of Paper
Title
Responsible
Recommendation(s)
Summary
For Decision
Appointment of Auditor Panels
Simon Gregory, Chief Finance Officer
The Governing Body is asked to;
1.
Consider the draft terms of reference for an Auditor Panel
2.
Establish an Auditor Panel in line with the legislation.
3.
Select the members of the panel
4.
Approve an amendment to the CCG constitution to include the
Auditor Panel
From 2017/18 onwards, NHS trusts and CCGs will appoint their own
auditors and directly manage the resulting contract and the relationship.
NHS foundation trusts already do this. The Local Audit and
Accountability Act 2014 specifies that all local public bodies covered by
the legislation must have auditor panels to advise on the selection,
appointment and removal of external auditors and on maintaining an
independent relationship with them.
A formal tendering process is expected to reduce the costs of the
CCG’s Annual Audit.
Legal/Regulatory
Implications
Assurance
Framework/Risk
to the NHS
Constitution
Public Involvement
and/or Implications
Has an Equality
Analysis been
completed?
Attachments
This paper is to ensure that the CCG complies with the requirements of
the Local Audit and Accountability Act 2014.
N/A
Please detail any
N/A
N/A
N/A
 Establishment of an Auditor Panel
 Appendix- Auditor Panel- Draft Terms of Reference
None
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Governing Body – November 2015
Establishment of an Auditor Panel
1.
Introduction
The Local Audit and Accountability Act 2014 changes the public audit regime in
England by replacing centralised arrangements for appointing external auditors to
clinical commissioning groups with a system that allows each CCG to make its own
appointment.
The key provisions set out in the 2014 Act are that:



2.
The Audit Commission closed on 1st April 2015 and so is no longer
responsible for the centralised system of appointing external auditors to health
service bodies.
There is a new approach to the regulation of local public audit and eligibility of
local auditors.
Local public bodies select and appoint their own auditors on the advice of
auditor panels
Background
From 2017/18 onwards, NHS trusts and CCGs will appoint their own auditors and
directly manage the resulting contract and the relationship. NHS foundation trusts
already do this. The 2014 Act specifies that all local public bodies covered by the
legislation must have auditor panels to advise on the selection, appointment and
removal of external auditors and on maintaining an independent relationship with
them.
The legislation sets out minimum standards around the formation of the auditor
panel, ensuring that vacancies for members are advertised to attract the broadest
range of candidates possible and the vacancy is filled in an open and transparent
process. It also ensures that health service bodies consider how auditor panel
members can be removed or how their resignation will be handled to ensure this is
fair and consistent.
The legislation specifies that


An auditor panel must have at least three members, including a Chair who is
an independent non-executive member of the governing body. A majority of
the panel’s members must also be independent and lay members of the
governing body but the panel may include a minority of members who are not
members of the governing body or who are not considered independent.
An auditor panel member may receive remuneration.
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




The quorum is two members or 50% of the membership of the panel
(whichever is the greater). The proceedings of the meetings are valid if a
majority of members present are independent.
This ensures proper representation on auditor panels and that the
independence of the auditor panel from the health service body’s governing
board/ body and executive management is maintained.
The auditor panel should advise the governing body on the purchase of ‘nonaudit services’ from the auditor.
Prospective members not already on the governing body must be appointed
in response to an advertised vacancy and after submitting an application to fill
that vacancy; the body must adopt a set of rules for the removal or resignation
of auditor panel members and its Chair.
The governing body must assess a prospective auditor panel member’s
independence by considering whether his or her circumstances could affect
his or her judgement and by a number of factors – for example, recent
employment with the health service body, close family ties to its directors,
members, advisors or senior employees or a material business relationship
with the health service body.
The new approach to local audit does not come into play until 2017/18. Between now
and then, we are in a transition period. As appointments for 2017/18 must be made
by the end of 2016, the auditor panel needs to be in place early in 2016 so that it can
fulfil its responsibilities in relation to the procurement and appointment of auditors.
The guidance and associated regulations allow three options for the panel to be
established:
a.
use an existing Audit Committee.
b.
With members of the Audit Committee forming a new group.
c.
In association with one or more other organisations who are ‘relevant
authorities’, ie. CCGs.
3.
Proposal
It is proposed, therefore, that the auditor panel will be established from the existing
membership of the Audit Committee; that being the Lay members and Secondary
Care Doctor. This will ensure independence of the panel and an independent (nonexecutive) approach to the function of the group. The Auditor Panel will meet
independently from the Audit Committee.
A draft terms of reference is attached as Appendix 1
115
4.
Action required
The Governing Body is asked to;
1.
2.
3.
4.
Consider the draft terms of reference
Establish an Auditor Panel in line with the legislation.
Select the members of the panel
Approve an amendment to the CCG constitution to include the Auditor Panel
Simon Gregory
November 2015
116
Appendix 1
Auditor Panel
DRAFT Terms of Reference
1.
Constitution
The Auditor Panel of the Clinical Commissioning Group is a statutory committee
established as a sub-committee of the Governing Body, in accordance with the
constitution, standing orders and scheme of reservation and delegation.
These terms of reference set out the membership, remit, responsibilities and
reporting arrangements of the audit committee and shall have effect as if
incorporated into the CCG constitution and standing orders.
2.
Principal Function
The auditor panel must advise the CCG on:


The maintenance of an independent relationship with the appointed auditor
The selection and appointment of the local auditor
The auditor panel’s key role is to check that:



3.
Contract arrangements (ie procurement and the selection of external auditors)
are appropriate
The relationship and communications with the external auditors are professional
Conflicts of interest are effectively dealt with.
Membership
The membership of the auditor panel will consist of,
i.
The Lay Member of the Clinical Commissioning Group who leads on audit
and conflict of interest matters
ii.
At least one other Lay Member of the Clinical Commissioning Group
iii.
One other member with the relevant skills and experience as nominated by
the Governing Body
117
4.
Chair
The panel will be chaired by the Lay Member leading on audit and conflict of
interest matters.
The Chair has the responsibility to ensure that the panel obtains appropriate advice
in the exercise of its functions.
5.
Secretarial support
The Corporate Secretary shall be Secretary to the panel and shall ensure that a
minute of the meeting is taken and provide appropriate support to the Chair and
panel members.
6.
Quorum and decision making
A quorum shall be two members of the panel, or 50% of the membership,
whichever is the greater. This will include the Chair.
In the event of the Chair of the panel being unable to attend all or part of the
meeting, he/she will nominate a replacement from within the membership to
deputise for that meeting.
Generally it is expected that decisions will be reached by consensus. Should this
not be possible then a vote of members will be required. In the case of an equal
vote, the person presiding (i.e. the Chair of the meeting) will have a second, and
casting vote.
7.
Frequency of meetings
Meetings of the auditor panel will be held as and when required.
Members will be expected to attend each meeting.
In exceptional circumstances and where agreed in advance by the chair, members
of the committee or others invited to attend may participate in meetings by
telephone, by the use of video conferencing facilities and/or webcam where such
facilities are available. Participation in a meeting in any of these manners shall be
deemed to constitute presence in person at the meeting.
8.
Remit and responsibilities of the panel
i.
The auditor panel is an advisory body – it advises on the selection and
appointment of external auditors. Responsibility for the actual procurement
and appointment of the auditors remains with the governing body.
ii.
The auditor panel should advise the CCG on the purchase of ‘non-audit
services’ from the auditor.
118
9.
iii.
The panel will consider any liability limit suggested by the external auditors
as part of the procurement process and advise the governing body on
whether or not it is fair and reasonable.
iv.
Maintain commercial confidentiality e.g. prices included in contract
documentation.
Reporting arrangements
The auditor panel reports to the CCG Governing Body.
The minutes of the auditor panel meetings shall be formally recorded and submitted
to the Governing Body. The Chair of the panel shall draw to the attention of the
Governing Body any issues that require disclosure to the relevant statutory body or
require executive action.
The Governing Body will hold the auditor panel to account for the delivery of its
remit and responsibilities.
10.
Policy and best practice
The auditor panel will apply best practice in its decision making, and in particular it
will:
i).
comply with current disclosure requirements for remuneration;
ii).
ensure that decisions are based on clear and transparent criteria
iii).
comply with CCG policy and procedures for the declaration of interests
The auditor panel will have full authority to commission any reports or surveys it
deems necessary to help it fulfil its obligations.
11.
Conduct of the Auditor Panel
All members of the auditor panel and participants in its meetings will comply with
the Standards of Business Conduct for NHS Staff, the NHS Code of Conduct, and
the CCG’s Policy on Standards of Business Conduct and Declarations of Interest
which incorporate the Nolan Principles.
12.
Date of Review
The auditor panel will review its performance, membership and these Terms of
Reference at least once per financial year. It will make recommendations for any
resulting changes to these Terms of Reference to the Governing Body for approval.
119
No changes to these Terms of Reference will be effective unless and until they are
agreed by the Governing Body.
Approval Date:
Review Date:
120
NHS Confidential
NHS Protect
Public
Governing Body
Agenda Item: 3.1
Purpose of Paper
Title
Responsible
Recommendation(s)
Summary
Legal/Regulatory
Implications
Assurance
Framework/Risk
to the NHS
Constitution
Public Involvement
and/or Implications
Has an Equality
Analysis been
completed?
Attachments
For Discussion
The Governing Body to receive the report and note its contents
Key Quality and Safeguarding messages for South Tees CCG
STHFT:
 Working with South Tees CCG and Hambleton, Richmondshire
and Whitby CCG it is planned to conduct a follow up NHSE
Quality Risk Profile for the Trust to quantify improvement
against the March 2015 position.
 Deteriorating Clostridium Difficile Infection (CDI) performance
NEASFT ambulance response times deteriorating performance
STees CCG:
 Increased focus on Transforming Care for patients with
Learning Disabilities.
 Arrival of Interim Head of Quality and Safeguarding following
secondment of substantive post holder.
N/A
Health and Social Care Act 2012, “quality duty”
The Children Act 1989 (2004)
No Secrets’ (2000) guidance
Mental Capacity Act 2005
Mental Capacity Act Deprivation of Liberty Safeguards (MCA Dols)
2009
Human Rights Act 1998
Equality Act 2010
Safeguarding Vulnerable Groups Act 2006
Care Act 2014
Quality issues as they arise are risk assessed and placed on the
corporate risk register in accordance with CCG requirements
The NHS aspires to the highest standards of excellence and
professionalism.
The NHS works across organisational boundaries and in partnership
with other organisations in the interest of patients, local communities
and the wider population.
The NHS aspires to put patients at the heart of everything it does.
Values: Working together for patients, commitment to quality of care
As part of delivering the Quality Agenda, patients and the public are
involved in providing assurance of the quality of care delivered by the
CCG’s commissioned services
Not applicable
Quality and Safeguarding Report – at end of October 2015
121
Please detail any
Information has previously been routed through QPF committee
at which this paper
has previously been
tabled
122
Governing Body Meeting
November 2015
1.0 Purpose of report
The purpose of this report is to provide NHS South Tees Clinical Commissioning Group
(STees CCG) Governing Body with a Quality and Safeguarding exception report which
headlines the key issues within the CCG’s commissioned services and provides assurance
that actions are being undertaken where appropriate. This paper reflects the position as at
the end of October 2015.
2.0 Introduction
This report provides information relating to the CCG’s position and that of its main healthcare
providers with an NHS contract:
2.1 South Tees Hospitals NHS Foundation Trust (STHFT)
2.2 Tees, Esk and Wear Valleys NHS Foundation Trust (TEWVFT)
2.3 North East Ambulance Service (NEASFT)
2.4 Where appropriate independent sector providers are also included.
Additional information is also included in relation to the CCG’s statutory duties and
responsibilities in relation to Safeguarding Children and Adults.
3.0 Key Quality and Safeguarding messages for STees CCG
3.1 STHFT:
 Working with STees CCG and Hambleton, Richmondshire and Whitby CCG it is
planned to conduct a follow up NHSE Quality Risk Profile for the Trust to quantify
improvement against the March 2015 position.
 Deteriorating Clostridium Difficile Infection (CDI) performance
3.2 NEASFT ambulance response times deteriorating performance
3.3 STees CCG:
 Increased focus on Transforming Care for patients with Learning Disabilities.
 Arrival of Interim Head of Quality and Safeguarding following secondment of
substantive post holder.
4.0 South Tees Hospitals NHS Foundation Trust (STHFT)
5.1. Patient Safety
 Mortality concerns are increasing in relation to Hospital Standardised Mortality
Ration (HSMR) which is now being recognized as an outlier. This is negatively
impacted by the Trust’s specialist palliative care provision which is once again
subject to capacity constraints. The Trust has also received two CQC
mortality outlier alerts relating to Fluid and Electrolyte disorders, and
Intracranial injuries. As advised in previous Governing Body Quality papers
and at the bi-monthly Quality, Performance and Finance committees, STHFT
has extensive processes around the review of mortality cases. This is in line
with the regional approach to mortality monitoring and investigation which
enables the Trust to both inform and benefit from the growing body of
collective knowledge. As a result of this the required audit, investigation and
remedial actions associated with addressing these are part of the
Final STees CCG Quality Report: 11 2015
123
4.1
collaborative mortality approach adopted across the region, and are therefore
almost complete.
HCAI
 In response to the deteriorating performance there is increasing STees CCG
engagement with other CCG partners, NHSE and all Trusts on this agenda.
 The CDI numbers and performance against trajectory continue to deteriorate,
and now exceed the year to date position for 2014-15. It is still anticipated that
the recent changes in senior personnel, the appointment of Antibiotic Medical
Champions and revised cleaning schedules and protocols will begin to realise
improvements.
 The CCG is actively investigating antibiotic prescribing in Primary Care to
identify and implement remedial actions in the associated areas for
improvement.
4.2 Regulator Actions

CQC: Inspection findings of “Requires Improvement” grade overall is still the
focus of improvement actions within the Trust. The associated action plans for
improvement continue to be a focus for both Commissioner Assurance Visits to
the Trust and CQRG meetings. Progress is also monitored at the Trust Contract
Management Board meetings.

Monitor: Following the increase in the scope of regulatory actions the CCGs,
Trust and Monitor continue to work closely to address the underlying issues and
monitor the performance and effectiveness of actions.
4.3 Safeguarding Children mandatory training compliance

This issue has again been escalated to the South Tees Contract Management
Board process.
5.0 North East Ambulance Service NHS Foundation Trust (NEAS FT)
5.1 Patient Safety
 The major patient safety concern for this Trust relates to their continuing poor
performance in relation to response times for the different categories of patient
acuity. This is being discussed and challenged at both Quality and Performance
related meetings and both Trust and Commissioners are actively looking to
identify additional actions that can be implemented to improve this position.
 Although the Trust have provided assurances around improvements in processes
and compliance to reduce the time it takes to complete a Root Cause Analysis
(RCA) investigation and disseminate the learning, this has not yet translated to
an improvement in performance. In the September 2015 Quality report they were
reported as having 17 open incidents, as at 31.10.15 they were reported as now
having 21 open incidents with 2 of them relating to STees CCG patients.
5.2 Innovative practice
 Further details on the rollout of innovative Winter Pressure schemes for the
Teesside geography are still awaited from the Trust. These were to include a
Cardiac arrest unit for Teesside and also included the continued development of
Physician response units potentially operating from both NTHFT and STHFT
(James Cook University Hospital). It is anticipated that these initiatives will have
both a positive impact on patient outcomes, as well as potentially enabling some
admission avoidance.
124
6.0 Tees, Esk and Wear Valley NHS Foundation Trust (TEWVFT)
6.1 Patient Safety Serious Incidents (SIs).
 The Extraordinary CQRG with the Trust and also subsequent Commissioner
Assurance Visits (CAV) associated with the review of Mental Health Homicides is
to be rescheduled.
6.2 Adult and Children’s Safeguarding training compliance has not yet reached the
nationally recommended and contractually mandated compliance. This will once
again be a focus area for discussion during the forthcoming CQRG.
6.3 Regulators: No concerns identified.
7.0 Safeguarding
7.1 Adult Safeguarding

Working collaboratively with Local Authority and CQC colleagues the Adult
Safeguarding team continue to monitor and support the quality of care for
patients in nursing homes in the STees CCG geography. The challenges of
some Hartlepool nursing homes continue to be monitored to ensure they do not
inadvertently impact upon South Tees capacity, and particularly every effort is
being made to mitigate the impact of this upon the discharges from the STHFT
as they also receive patients from this locality. However, the safety of residents
remains the priority and all agencies continue to work together to ensure that the
quality and safety of care is maintained.

The challenges to capacity and provision of learning disabilities nursing home
care continue to cause concern on Teesside. Several nursing homes providing
care to this specific patient demographic are currently under close scrutiny,
supervision and support due to quality concerns. This is another example of all
partner agencies, including providers, working together for the ultimate benefit of
our joint patient populations.

The Transforming Care (formerly Winterbourne View concordat) agenda and
associated actions continue to remain a high profile area of work for the CCG
and NHSE. Recently following NHSE policy announcements the joint work
previously underway has now undergone a step change in both national,
regional and local interest and scrutiny. This has led to a positive increase in
actions to validate the current position of the patient population and promptly
identify suitable community provision to meet their individual needs whilst
maintaining their comfort and safety.
7.2 Safeguarding Children

The collaborative work continues in relation to the design and implementation of
the North Tees Multi-Agency Children’s’ Hub (MACH). The proposed costings
exceed the financial envelope of partners current cost allocations, therefore
funding of the revised structure remains challenging and discussions are ongoing
with Local Authority Public Health and NTHFT colleagues regarding the
resources. STees CCG is represented on this project board by their Executive
Nurse, and both Middlesbrough and Redcar & Cleveland Local Authorities are
also represented to facilitate implementation of learning when designing the
South Tees Multi-Agency Childrens Hub.

Following the July 2015 CQC review for Children Looked After and Safeguarding
(CLAS) in Middlesbrough, the report was published on 15th September 2015 with
a number of recommendations relevant to both South Tees CCG and STHFT.
125


This has been shared with Hartlepool and Stockton-on-Tees CCG as several of
the providers involved span the Tees area. The resulting action plan has now
been submitted to the CQC and is currently being progressed.
The CCG, in conjunction with Public Health and NHS England colleagues, has
been involved with a Peer Review led by the Local Government Association
(LGA) into the ‘Early Help’ agenda. The independent review provided provisional
feedback on 18th September however the final report is not yet available.
A review of the Performance Management Framework (PMF) and associated
data has been commissioned by the 4 Local Safeguarding Children Boards and
led by Hartlepool. As a partner agency, the CCG is contributing to this review
and has met with the designer to provide input into the design and data set.
9.0 Recommendation
The Governing Body is asked to receive this report for information and discussion.
Author:
November 2015
126
NHS Confidential
NHS Protect
Public
Governing Body
Agenda Item: 3.2
Purpose of Paper
Title
Responsible
Recommendation(s)
For Discussion
Finance Report
The Governing Body is asked to note;

The current forecast outturn for 2015-16.

The CCG’s reserves and pipeline of current and expected
projects

The strategic issues that will have a financial effect in future
years
The opportunities for reviewing efficiencies identified in
benchmarking data
This report provides a summary of the final financial position for the
year to October 2015.

Summary
The report also includes high level benchmarking information that will
inform future financial plans and should be considered with the CCG’s
commissioning intentions for 2016-17.
As set out in the report.
Legal/Regulatory
Implications
Section 14Q NHS Act 2006
Each CCG must exercise its functions effectively, efficiently and
economically.
Section 223H NHS Act 2006
Financial duties of clinical commissioning groups: expenditure
(1) Each clinical commissioning group must, in respect of each financial
year, perform its functions so as to ensure that its expenditure which is
attributable to the performance by it of its functions in that year does not
exceed the aggregate of—
(a) the amount allotted to it for that year under section 223G,
(b) any sums received by it in that year under any provision of this Act
(other than sums received by it under section 223G), and
(c) any sums received by it in that year otherwise than under this Act for
the purpose of enabling it to defray such expenditure.
Section 223I NHS Act 2006
Financial duties of clinical commissioning groups: use of resources
(3) A clinical commissioning group must ensure that its revenue
resource use in a financial year does not exceed the amount specified
by direction of the Board.
Assurance
Framework/Risk
There are no additional Risk Register implications.
127
The CCG operates in line with all elements of the constitution.
to the NHS
Constitution
Details of Patient and Public Involvement and/or Implications
N/A
N/A
Has an Equality Analysis been completed?
Attachments
Finance Report
Please detail any
None
128
Governing Body Finance Report
October 2015
1.
Introduction
1.1.
This report provides a summary of the current financial position for the year to October 2015
including forecast outturn and reserves.
1.2.
This report updates the Governing Body on potential future pressures and includes some high
level benchmarking information that will inform future financial plans.
2.
Forecast Outturn
Risk
Target Detail
Revenue Allocation – Programme To deliver a 1% surplus
Performance against the running To keep expenditure within
cost limit
allocation
Internal Audit Reports
No more than 2 limited or nonassurance reports in year
Better Payment Practice Code
To pay CCG creditors within 30
days of receipt of invoices or
goods
QIPP Delivery
To deliver £4.6m savings in
year
Year to
Date
Position
Forecast
Position




5,028


0


98.84%


5,339
£000
6,076
2.1.
At this point in the year, the CCG has five months of validated activity information that has been
used for financial projections. The CCG is currently on target to deliver the forecast outturn
position.
2.2.
The QIPP target for 2015/16 is £4.6m. Of this target, the CCG’s running costs are planned to
reduce by 10% to the Value of £716k and is on target to deliver this QIPP saving. Although
emergency activity is reducing, the costs are not reducing at the same rate, which could pose a
financial risk to the delivery of QIPP and BCF financial performance. To date, the BCF target cost
reduction is being delivered, but this is before we experience the impact of the winter period.
During the review of the IMProVE implementation of new community based services, we have
identified further transformational QIPP savings of £1.1m to support investment into community
services.
2.3.
The South Tees FT Acute contract is currently forecast to be broadly in line with plan. As the
outpatient waiting list is growing, a provision has been made in the forecast position to account
for additional planned care activity at the latter end of the financial year, to reduce the waiting
list and improve RTT performance. As we approach the winter period, system resilience group
(SRG) schemes that were in place for 2014/15 have been evaluated and continued for 2015/16,
which will support the continued reduction in emergency admissions. Unlike other health
economies, the CCG has allocated its SRG funding early, ahead of the winter period. As at
August 15, and compared with the same period last year, data has indicated that emergency
129
activity has reduced by 7.9%; early data for September has indicated that this trend has
continued.
2.4.
The CCG is continuing to see significant growth in the cost and activity in relation to Continuing
Health Care. This currently equates to a forecasted 12% rise in costs in comparison to 2014/15.
The CHC Contract Management Board with the CSU is now fully established. Monthly activity
and finance performance monitoring reports now provide the CCG with a better understanding
of the pressures faced by the services in the medium to long term. This will allow the CCG to
improve how it makes future plans and establish a strategic direction for the service. The CCG is
discussing options for the future with both the commissioning support unit and the local
authorities.
2.5.
The CCG has set aside uncommitted reserves to mitigate risks, particularly to account for any
underperformance on the QIPP projects and to maintain financial balance.
3.
Reserves and Contingency
3.1.
Reserves
Current
Reserves
Annual
Budget
Reserves
Non Committed
0.5% Contingency
Risk Reserves
Other Reserves
Committed Reserves
NR Backpain Pathway
Overseas visitors adjustment
New Allocations
Total Reserves
Current
Reserves
Forecast
Current
Reserves
Forecast
Underspend
£000s
£000s
£000s
2,076
1,000
3,168
2,076
1,000
208
0
0
-2,960
232
135
1,607
8,218
232
135
1,607
5,258
0
0
0
-2,960
3.1.1. The CCG received a partial refund in 2014/15 for the contribution to the CHC Restitution
national scheme of £931k. NHS England has advised that in 2015/16 the balance of this funding
should be used to increase the CCGs planned 1% surplus. The intention may be that the funding
will be allowed to be drawn down and spent in a future period yet to be formally agreed.
3.2.
Future Allocations and Tariffs
3.2.1. Funding Forecast to 2019/2020
Allocation
Programme Allocation
Running Cost Allowance
Non Recurrent Carry Forward
Better Care Funding
Total Baseline Allocation
New Allocations in year to Month 7:
Recurrent
R Neo Natal Audiology
2015/16
2016/17
2017/18
2018/19
2019/20
£000s
£000s
£000s
£000s
£000s
392,938
6,076
8,311
6,775
414,100
399,618
6,039
5,028
6,775
417,460
406,411
6,003
4,175
6,775
423,364
413,320
5,969
4,234
6,775
430,298
420,346
5,969
4,303
6,775
437,393
90
92
93
95
96
130
R Tier 3 Wheelchairs Transfer
R Tier 3 Neurology Transfer
R Named GP Safeguarding
Non Recurrent
N/R GPIT
N/R GPIT
N/R ETO Tariff impact support
N/R Waiting List
N/R Initial eating disorders
N/R Pneumonia Project
N/R Liaison Psychiatry - MH
N/R UEC Vanguard sites
Revised Total Allocation
Recurrent Allocation at Month 7
Non-Recurrent Allocation at Month 7
483
801
25
749
440
1,059
12
174
132
71
66
418,202
407,188
11,014
Programme Growth
491
815
25
500
828
26
508
843
26
517
857
27
418,883
424,811
431,770
438,890
1.70%
1.70%
1.70%
1.70%
3.2.2. Monitor has proposed plans that allow commissioners to consider new tariff mechanisms for
unplanned care from April 2016. The intention is to allow more flexible funding of integrated
care models and support urgent and emergency care networks. This approach will require
significant cooperation across all local providers and commissioners for it to become effective.
3.2.3. The CCG expects more clarity on allocations for 2016 and beyond during December 2015.
4.
Commissioning and Investment Plans
4.1.
Project Pipeline
4.1.1. The CCG’s work on its commissioning intentions for 2016/17 is near finalisation. The Governing
Body will be advised of the expected costs and savings resulting from our plans.
5.
Activity Trends
5.1.
Demographic Trends
5.1.1. As part of the commissioning intention work we will refresh the demographic data used for the
annual planning process for 2016/17.
6.
Likely Impact of Innovation and Technology
6.1.
Generic Medicines - Nothing to update.
6.2.
Primary Care Medicines - Nothing to update.
6.3.
New Drugs - Nothing to update
6.4.
Expiring Patents - Nothing to update.
6.5.
Secondary Care drugs excluded from hospital tariffs - Nothing to update.
6.6.
Drug Shortages
6.6.1. Price increases could result in an estimated additional average monthly spend of £8,185 based
on September data (£98 thousand annually) for the CCG.
131
Product Name
Pack Size
Digoxin_Tab 125mcg
Digoxin_Tab 250mcg
Digoxin_Tab 62.5mcg
Fosinopril Sod_Tab 20mg
Mefenamic Acid_Cap 250mg
Lamotrigine 5mg dispersible tablets sugar free
Trazodone 50mg/5ml solution sugar free
Diclofenac 50mg
Celiprolol 200mg
Cimetidine 400mg
28
28
28
28
100
28
120
28
28
60
Prices
affected
from
Feb-15
Feb-15
Feb-15
Apr-15
Apr-15
Aug-15
Aug-15
May-15
Jul-15
Jul-15
Drug
Tariff
Price
Monthly Prescribing before price
(month
change
before
price
change)
Cost
Items
Quantity
£
1.07 £ 3,216
811
19,287
£
1.01 £
897
182
5,633
£
1.44 £ 1,140
362
7,595
£
2.03 £
44
6
215
£
6.68 £
240
38
3,099
£
2.02 £
42
4
630
£ 48.38 £ 1,307
19
4,090
£
0.93 £ 1,250
556
40,095
£
3.88 £
352
78
2,723
£
1.76 £
65
50
2,233
Total
£
APRIL
MAY
JUNE
JULY
AUGUST
8,555
Latest
Months
Price
Monthly Additional
Cost
CCG
based on Monthly
latest Cost (new £
price
vs. old £)
£
3.45 £
£
3.75 £
£
4.45 £
£ 15.40 £
£ 12.20 £
£
9.38 £
£ 117.00 £
£
2.73 £
£ 19.83 £
£
6.09 £
2,376
754
1,207
118
378
211
3,988
3,909
1,928
227
-£
-£
£
£
£
£
£
£
£
£
840
143
67
74
139
169
2,680
2,659
1,577
162
£ 15,097 £
6,543
SEPTEMBER Total YTD
£ 9,424 £ 11,760 £ 7,197 £ 8,153 £ 6,036 £ 6,543 £ 49,113
6.7.
Implications of new NICE Guidance on Prescribing
6.7.1. NICE TA 352 - Vedolizumab for treating moderately to severely active Crohn’s disease after
prior therapy. It is recommended as an option for treating moderately to severely active
Crohn’s disease only if:
o
o
A tumour necrosis factor‑alpha inhibitor has failed (that is, the disease has responded
inadequately or has lost response to treatment) or;
A tumour necrosis factor‑alpha inhibitor cannot be tolerated or is contraindicated.
6.7.2. Vedolizumab is recommended only if the company provides it with the discount agreed in the
patient access scheme. A number of adverse events can be reduced by using the drug. These
include serious infections, lymphoma, acute hypersensitivity reactions and melanoma skin
cancer. The financial impact to South Tees CCG (based on national prevalence data) is £16,500
(although please note total implementation costs of £113,769).
7.
Medium Term QIPP Strategy
7.1.
QIPP
7.1.1. The CCG’s quality, Innovation, productivity and prevention strategy is based on a process of;

Benchmarking the costs, quality and performance of services against peers and national
standards.
 Working with our work streams, clinicians, patient representatives and other partner
organisations to;
o Adopt and implement new and innovative technologies as they become available.
o Identify inefficiencies in health care provision with a view to eliminating waste.
o Develop the related commissioning intentions.
7.2.
Acute Elective Activity Benchmarking
7.2.1. The have been no updates to the national payment by results benchmarking since the last
governing body meeting.
132
7.2.2. We are reviewing other comparative metrics and the table below compares Inpatient Elective
Admissions as a percentage of All First Outpatient Attendances for 2015/16 (April to August)
across North East CCGs. The numbers require some interpretation as in some specialities some
providers will record significant numbers of outpatient procedures that are recorded as day
cases in other trusts. This may explain some differences for urology and ophthalmology for
example.
Conversion rates :
Treatment
function analysis
by CCG
Cardiology
Clinical
Haematology
Ear Nose & Throat
South
Tees
CCG
Darlington
CCG
DDES
CCG
HAST
CCG
NcastleGhead
Alliance
CCG
North
Durham
CCG
North
Tyneside
CCG
N/land
CCG
South
Tyneside
CCG
Sunderla
nd CCG
19%
15%
20%
26%
15%
17%
21%
29%
31%
45%
530%
555%
433%
369%
217%
389%
173%
201%
312%
386%
18%
14%
18%
21%
19%
22%
19%
18%
20%
22%
Gastroenterology
151%
139%
139%
58%
161%
358%
146%
164%
150%
138%
General Medicine
27%
525%
493%
355%
219%
402%
162%
170%
97%
180%
General Surgery
49%
87%
133%
268%
61%
75%
41%
54%
108%
140%
Gynaecology
30%
22%
26%
40%
22%
25%
25%
33%
25%
22%
Ophthalmology
58%
63%
84%
77%
50%
87%
54%
56%
113%
112%
Paediatrics
35%
8%
5%
7%
8%
3%
3%
3%
13%
9%
Plastic Surgery
Respiratory
Medicine
Rheumatology
Trauma &
Orthopaedics
Urology
71%
64%
53%
65%
38%
53%
53%
65%
61%
71%
15%
7%
19%
19%
12%
6%
13%
15%
21%
44%
48%
119%
69%
67%
43%
57%
62%
40%
68%
65%
39%
16%
29%
35%
37%
32%
36%
38%
31%
35%
40%
98%
103%
111%
80%
86%
56%
65%
84%
38%
7.3.
Prescribing Benchmarking
7.3.1. Cumulative expenditure data to August 2015 for medicines shows that the CCG continues to
have a high cost per capita prescribing cost.
1
2
3
4
5
6
7
8
9
10
11
Weighted per capita prescribing costs
£
NHS Durham Dales, Easington & Sedgfield CCG
NHS South Tees CCG
NHS Sunderland CCG
NHS South Tyneside CCG
NHS Newcastle Gateshead CCG
North East & Cumbria
NHS Hartlepool & Stockton on Tees CCG
NHS North Tyneside CCG
NHS Darlington CCG
NHS Northumberland CCG
National
NHS Cumbria CCG
20.90
20.63
20.13
19.85
19.40
19.34
18.97
18.92
18.61
17.44
17.33
17.29
17.27
Variance Variance
from
from
Region England
10.2%
8.8%
6.1%
4.6%
2.3%
2.0%
-0.3%
-1.9%
-8.1%
-8.6%
-8.9%
-9.0%
20.9%
19.3%
16.4%
14.8%
12.2%
11.9%
9.7%
9.4%
7.6%
0.9%
0.2%
-0.1%
Spend per head of population (August 2015)
133
7.3.2. The CCG prescribing costs are £4 million above the regional average and £8 million above the
national average.
8.
Risks, Mitigations and Underlying Position
8.1.
Risks
8.1.1. The CCG has the identified the following financial risks in the NHS England return for October
based on our assessment of current pressures. The risk figures represent amounts that are not
accrued in the CCGs current financial position.
8.1.2. The risks are mainly linked to areas where contracts are funded on a per item basis and there
is limited control over cost growth management.
Risks
Probability
of Risk
being
realised %
Full Risk
Value
£000s
Acute - PbR growth and Non-Elective QIPP
Community – minimal risk
Mental Health – Spec Packages
Continuing Care – CHC Growth
Primary Care – minimal risk
Prescribing – Growth above 4.5%
Other – Failure of BCF to reduce non elective
2,040
70
2,230
2,480
70
1,000
530
Total
8,420
50.00%
50.00%
15.00%
50.00%
50.00%
50.00%
50.00%
Potential
Risk Value
£000s
Proportion
of Total %
1,020
30
330
1,240
30
500
260
30%
1%
10%
36%
1%
15%
7%
3,410
100%
8.2.
Mitigations
8.2.1. The CCG has identified uncommitted funds and opportunities to delay investments that could
be used to offset the risks identified above. These figures are also included the October return
to NHS England.
Mitigations
Full
Mitigation
Value £000s
Contingency Held
Contract Reserves
Delay / Reduce Investment Plans
Other Mitigations
2,076
2,208
2,000
200
Total
6,484
Probability of
success of
mitigating
action %
100.00%
100.00%
50.00%
90.00%
Expected
Mitigation
Value £000s
Proportion
of Total %
2,076
2,208
1,000
180
38%
41%
18%
3%
5,464
100%
8.3.
Underlying Position
8.3.1. In addition to assessing risks and mitigations the CCG also reviews the underlying recurrent
financial position each month. This is a new component of the monthly financial return. Its
purpose to ensure that the CCG does not commit more than 99% of its annual allocation to
recurrent expenditure. It also important to note that funding brought forward from previous
years cannot be committed recurrently.
134
Area of Spend
2015/16 Exit
Recurrent
Expenditure
Forecast
£000s
Acute
Mental Health
Community
Continuing Healthcare
Primary Care
Other Programme
Reserves
Running Costs
Total
200,341
49,868
35,234
28,901
59,244
20,611
253
6,076
400,527
2015/16 Recurrent Allocation
Headroom
407,188
6,661
Headroom %
1.64%
8.3.1
The underlying position indicates that the CCG will finish 2015/16 with recurrent expenditure
within the control target of 1.5% (0.5% contingency plus 1% non-recurring headroom).
9.
Conclusion
9.1.
The Governing Body is asked to note;
The current forecast outturn for 2015/16.
The CCG’s reserves and pipeline of current and expected projects
The strategic issues that will have a financial effect in future years
The opportunities for reviewing efficiencies identified in benchmarking data




Simon Gregory
November 2015
135
NHS Confidential
NHS Protect
Public
Governing Body
Agenda Item: 3.3
Purpose of Paper
Title
Responsible
Recommendation(s)
Summary
For Discussion
QPF Committee Update- 4th November 2015
Dr John Drury, QPF Chair
The Governing Body is asked to note Quality, Performance and
Finance Issues raised by the QPF Committee
The attached infographic highlights key issues identified at the QPF
committee. The size of the information blocks is linked to the economic
size of the services commissioned.
Quality Issues
C diff performance is exceeding the 2015-16 trajectory, and is also
worse than 2014-15 performance at the same point of the year.
“Open” Serious Incidents: following extensive collaborative working with
the Trust the number of ST CCG related incidents continue to reduce.
Performance Issues
Cancer 62 days
Performance of the 62 Day Urgent GP standard remains an area of
concern for the Trust. Figures for Sep-15 report the Trust noncompliant for the 6th consecutive month in a row with performance at
76.9% against the 85% operational standard. Indicative figures for Oct15 show that the Trust are likely to fail the target again. The Trust has
failed to achieve compliance in Q2. The Trust were aware that failure of
Q2 may possibly instigate a Monitor review due to on-going
underperformance however the Trust have discussed with Monitor who
have informed they have until Q3 to improve performance before any
review will be instigated. There is still a risk around Q3 performance
against this indicator.
The Trust confirmed that individual Tumour Site Specific Action Plans
have been developed with those tumour sites failing to achieve the 85%
operational standard. The Deputy Director of Performance (Sarah
Danieli) will be presenting these action plans to Commissioners at the
SRG on 18th Nov-15. Quarter 2 performance indicated an additional
failing tumour site of Lower GI.
RTT & Incomplete 52 week waits
Although STHFT have continually achieved this indicator the Trust has
seen a recent drop in performance (2.5% drop from Apr-15 to Aug-15).
The Trust is working closely with the specialties to utilise all theatre
space
136
NEAS
The last financial year and this year, to date, have been challenging for
NEAS. Though there has been an overall decrease in absolute incident
numbers, influenced by an increase in the Hear and Treat rate, Red
performance has been below the three national standards. Influences
over NEAS’ performance include:
•
Vacancies
•
National change to Red 1 categorisation (October 2014)
•
Red incident demand
•
Hospital delays
•
Increase in alternative dispositions
•
Ambulance Response Programme
To address the current performance situation, NEAS is looking to the
following actions over the course of this year:
•
Deep dive into the Red rate
•
HALOs
•
End of Life vehicles
•
Clinical Hub
•
Co-responding with Fire and Rescue Services
•
REAP Level 3
NEAS is currently reviewing and consolidating previous action plans,
with the view to sharing a new action plan with commissioners.
Finance Issues
Expenditure on Continuing Health Care remains a significant financial
pressure for the CCG.
Legal/Regulatory
Implications
As set out above
Section 14R NHS Act 2006
The CCG must exercise its functions with a view to securing continuous
improvement in the quality of services provided to individuals for or in
connection with the prevention, diagnosis or treatment of illness.
The CCG must, in particular, act with a view to securing continuous
improvement in the outcomes that are achieved and, in particular,
outcomes which show the effectiveness of their services, the safety of
the services provided, and the quality of the experience of the patient.
In discharging this duty, the CCG must have regard to any relevant
guidance published by the Board.
Section 14P NHS Act 2006
The CCG has a duty, when exercising its functions, to –
(a) act with a view to securing that health services are provided in a way
which promotes the NHS Constitution; and
(b) promote awareness of the NHS Constitution among patients, staff
and members of the public.
Section 14Q NHS Act 2006
The CCG must exercise its functions effectively, efficiently and
economically.
Section 223H NHS Act 2006
Financial duties of clinical commissioning groups: expenditure
(1) The CCG must, in respect of each financial year, perform its
functions so as to ensure that its expenditure which is attributable to the
performance by it of its functions in that year does not exceed the
aggregate of—
(a) the amount allotted to it for that year under section 223G,
(b) any sums received by it in that year under any provision of this Act
(other than sums received by it under section 223G), and
137
(c) any sums received by it in that year otherwise than under this Act for
the purpose of enabling it to defray such expenditure.
Section 223I NHS Act 2006
The CCG must ensure that its revenue resource use in a financial year
does not exceed the amount specified by direction of the Board.
Assurance
Framework/Risk
to the NHS
Constitution
Public Involvement
and/or Implications
Has an Equality
Analysis been
completed?
Attachments
All risks identified at the QPF Committee will be added to the CCG Risk
Register and recorded in the meeting minutes.
Please detail any
None in this format.
A key element of the QPF Committee role is to monitor the delivery of
patients’ NHS constitutional rights.
N/A
N/A
Headlines from November 2015 QPF Report.
138
139
Quality, Performance & Finance Update- Glossary
*: denotes that there were performance and quality issues but insufficient space to depict these
fully on the graphic.
AQP: Any Qualified Provider (community Adult Hearing and Lymphoedema services)
BCF: Better Care Fund joint commissioning budget
C. diff: Clostridium difficile
Cat A Calls: Category "A" calls to 999 standard
Community Based Services: Enhanced services commissioned from GP Practices
Contingency: Reserves kept for unforeseen circumstances
CQC: Care Quality Commission
Earmarked: Reserves allocated to specific in-year programmes of work
FFT: Friends and Family Test
FT: Foundation Trust
Green Ambulance Dispositions: those determined to be non-life threatening incidents which are
triaged for a specific time band response
HCAIs: Healthcare Associated Infections
HSMR: Hospital Standardized Mortality Ratio
IAPT: Improving Access to Psychological Therapies
MRSA: Methicillin-resistant Staphylococcus aureus
NEAS: North East Ambulance NHS Foundation Trust
Newc’l: Newcastle-upon-Tyne Hospitals Foundation Trust
NTH: North Tees and Hartlepool NHS Foundation Trust
NTW: Northumberland, Tyne and Wear NHS Foundation Trust
PHBs: Personal Health Budgets
PTS: Patient Transport Services
QIPP: Quality, Innovation, Productivity and Prevention (quality-related efficiency savings)
SHMI: Summary Hospital-level Mortality Indicator
SI: Serious Incident
140
STHFT: South Tees Hospitals NHS Foundation Trust
141
REPORT CLASSIFICATION –
please refer to Report Classification Guidance and
NHS Confidential
NHS Protect
Public
Governing Body
Agenda Item: 3.4
25 November 2015
Purpose of Paper
For Discussion
Title
Responsible
Recommendation(s)
Assurance Framework
Jacqui Keane, Governance Manager
The Governing Body are asked to consider the attached update of the
Governing Body Assurance Framework.
Summary
The attached paper provides an update to the Assurance Framework.
The updates to the risks are a result of reviews by the responsible
director or risk owner, together with a comprehensive review of risks by
the Executive Group at its meeting on 8 October 2015 followed by a
review of the Risk Register and Assurance Framework by the
Governance and Risk Committee 11 November.2015.
The Executive Group’s discussion of the Risk Register ensures that
there is a greater depth of understanding and ownership whilst also
allowing for horizon scanning, cross-cutting themes, controls or actions
to be identified. These discussions then feed into the further updating
of the Register and the development of the Assurance Framework for
consideration by the Governance and Risk Committee.
Legal/Regulatory
Implications
Assurance
Framework/Risk
No additional risks have been added to the Assurance Framework since
the September Governing Body meeting, however, it is proposed that
risk number 1353 relating to restitution cases will be removed and
reframed to reflect new guidance.
There are no distinct financial implications in implementing the
Assurance Framework, however there may be financial implications
associated with the actions required to mitigate risk.
The Assurance Framework provides the Governing Body with
assurance that members are fulfilling their statutory obligations and
duties of quality, care, public and patient involvement as well as the
statutory financial duties. It also assists in the process for developing
the Annual Governance Statement and provides assurance that risks
which may affect the organisation’s ability to deliver its strategic
objectives are escalated and managed.
The Assurance Frameworks is a strategic risk register and is the
Governing Body’s tool to oversee and link wider risk management
issues.
The Assurance Framework provides a process for assuring that the
South Tees Governing Body – November 2015
142
to the NHS
Constitution
Public Involvement
and/or Implications
Has an Equality
Analysis been
completed?
Attachments
Please detail any
organisation is fulfilling its obligations whilst managing strategic risk and
this includes upholding the organisation’s obligations as defined in the
NHS Constitution.
The Assurance Framework provides a mechanism for identifying risks
which would potentially result in the organisation not fulfilling its duties
relating to equality analysis and, therefore, this is not required for this
document.
The Assurance Framework is a mechanism for identifying risks which
would potentially result in the organisation not fulfilling its duties relating
to equality analysis and therefore this is not required for this document
Assurance Framework 2014-15 – November 2015 update (v17)
This version has not been presented to any other fora.
143
GOVERNING BODY ASSURANCE FRAMEWORK (V17)
GOVERNING BODY – NOVEMBER 2015
The nature of healthcare naturally exposes the CCG to a number of risks. The Governing Body has
considered the nature and extent of the significant risks it is willing to take in achieving the CCG’s
objectives. It has been agreed that risks rated at level 12 and above would be included within the
Assurance Framework. These key risks, their level and mitigating actions and assurances are
summarised in the tables below.
To demonstrate a measurable improvement in the quality and safety of the services that we
commission and the experiences of those who use them.
1038 – South Tees FT Clostridium difficile target
Residual risk
Risk description
16 Extreme
Risk
C4xL4 = 16
Risk of not improving C.Diff
performance and not addressing
issues affecting prevalence.
Consequent impact on quality
and system resilience.
Initial risk
Rating
C4xL4 = 16
Lead
Executive Nurse
Actions Required/ongoing
Continued monitoring and
increased monitoring of primary
care antimicrobial prescribing.
Deputy Lead Nurse meeting with
Trust to discuss opportunities to
implement good practice from
other Trusts.
Mitigation
Controls
- Board to Board meetings between CCG and Trust in line with CCG
escalation process.
- Trust action plans reviewed bi-monthly at Clinical Quality Review
Group.
- Executive level discussions
- Additional external reviews being carried out to review
effectiveness of systems and controls within the Trust.
--Schedule of announced and unannounced visits by the CCG to
triangulate discussions and assurances that have been provided by
the Trust with demonstrated practices on wards.
- Continued involvement of the CCG in programme of 'Board to
ward' visits in the Trust.
-Multi-agency meetings with CCGs, Trust and Local Authority.
-Reviews of reporting arrangements
-Contract monitoring meetings
- Primary care antimicrobial prescribing monitoring
-GPs received advice and guidance re C.Diff and prescribing.
-Discussions between GB GPs and STHFT Chiefs of Service
-Working Group being established between STHFT and primary
care re C.Diff
Internal Assurance
Board to Board meeting with Trust and CCG.
Regular Contract Review meetings with providers.
Quality, Performance and Finance Committee.
Executive Group
Clinical Quality Review Group Quality Surveillance Groups
Primary care antimicrobial prescribing is monitored via QPF Cttee.
External Assurance
Care Quality Commission Reports Local Area Team.
Enhanced scrutiny and reporting to Monitor
CCG’s continued dialogue with Monitor
Additional external reviews being carried out to review
Independent review of processes and procedures carried out in
December 2013.
Progress of evidence against action plans is rigorously challenged.
Confirmation received by NHS England of Trust’s progress against
Wilcox recommendations.
CHANGES FROM PREVIOUS GOVERNING BODY:
Continued monitoring is taking place. Additional action identified.
144
1040 – CCG failure of C.Diff target as result of main providers ability to deliver their own
Clostridium difficile target
Residual risk
Risk description
16 Extreme
Risk
C4xL5 = 20
As a consequence of main
provider’s failure to meet C.Diff
target the CCG could be under
greater scrutiny and reputational
damage and scrutiny from NHS
England.
Initial risk
Rating
C4xL5 = 20
Lead
Executive Nurse
Actions Required/ongoing
Continued and increased
monitoring of primary care
antimicrobial prescribing.
Deputy Lead Nurse meeting with
Trust to discuss opportunities to
implement good practice from
other Trusts.
Mitigation
Controls
Board to Board meeting in line with CCG’s escalation process.
Trust action plan reviewed bi-monthly at South Tees FT Clinical
Quality Review Group.
Exec to Exec meetings.
QPF Committee reporting
Governing Body reporting.
Review of community acquired cases.
Continued programme of announced and unannounced
commissioner assurance visits which helps to triangulate other
data.
Medicines management educational programme established for
GPs re antimicrobial prescribing in order to reduce inappropriate
prescribing.
Monthly GVIS reporting to include prescribing reduction
information
Daily monitoring of Trust’s C.Diff levels.
Internal Assurance
Regular Contract Review meetings with providers.
Discussions at Quality, Performance and Finance Committee.
Discussions at Executive Group
Discussions at Clinical Quality Review Group Quality Surveillance
Groups
Primary care antimicrobial prescribing is monitored via QPF Cttee.
External Assurance
Care Quality Commission Reports Local Area Team.
Enhanced scrutiny and reporting to Monitor
CCG’s continued dialogue with Monitor
Additional external reviews being carried out to review
Progress of evidence against action plans is rigorously challenged.
Confirmation received by NHS England of Trust’s progress against
Wilcox recommendations.
145
1352 - Capacity of Continuing Health Care Team
Residual risk
Description
Mitigation
High Risk
C3xL4 = 12
The core capacity of the CHC
team contributes to broader
system pressures, eg. impact on
delayed transfers of care in the
acute sector and potential
financial implications for the CCG.
Controls
Workload and activity review carried out.
Initial Risk Rating
C3xL4=12
Lead
Actions Required
Executive Nurse continued
discussions with Trust re
timeliness of nursing assessments
and avoidance of peaks &
troughs in activity.
CMB discussions with Trust re
avoidance of peaks & troughs in
nursing assessments.
Transformation action plan to be
developed for the CHC service
following the appointment of
CCG’s Strategic Lead for
Transformation
Finances reviewed fortnightly with the CSU CHC finance team.
Monitoring through QPF Committee.
Increased monitoring of SLA.
Additional investment had been allocated by the CCG to assist
with pressures.
Monitoring at CHC Contract Monitoring Board.
Internal Assurance
Monitoring at CHC Contract Management Board.
Evidence demonstrates that the higher risk packages are
being carried out as greater priority.
Gathering of improved data to ensure appropriate actions
are undertaken.
Reporting and discussions at QPF Committee.
External Assurance
Financial reporting to Area Team.
Meetings with Executive teams of Local Authorities.
Inclusion within internal audit plan.
NECS Service Audit Report
Gaps
Further evidence required to support performance management
process.
146
Partnership working to improve health and wellbeing of patients and communities.
836 - Implementation of the Better Care Fund
Residual risk
Description
Mitigation
16 Extreme
Risk
C4X4
Implementation of Better Care
Fund will require funding to be
transferred from acute
emergency care to support more
integrated social and health care
services. This will result in
£14m to be released from acute
Care contracts. Reputational risk
of non-delivery of schemes in the
BCF re system transformation,
particularly around primary care
transformation.
Controls
Joint working with external agencies to ensure that all investment
has health impact.
Executive Group meetings.
Governing Body reporting.
BCF Plan completed and agreed with stakeholders.
Revised emergency admissions target to 3.5% in 2015/16 five year
plan to achieve the required 15%.
Monitoring of process and metrics.
Regular updates received via the Programme Board.
Internal Assurance
Meetings with Executive Teams of Health & Wellbeing Board.
Submission and acceptance of plan by NHS England.
Integration Executive to include finance representation via the
Chief Finance Officer.
Initial risk rating
C4xL4 = 16
Lead
Actions Required
Continue joint working with
partners and stakeholders to
ensure all elements of 5 year plan
guidance is delivered.
Ongoing monitoring
A deep dive into elements of this
risk is scheduled for the
December Audit Committee.
External Assurance
Plans have been approved by NHS England ‘with support’
Health and Wellbeing Board
Meetings with Executive teams of Local Authorities.
NHS England monitoring.
Gaps
Although targets have been achieved, a number of BCF schemes
are not yet in place. Requirement for a BCF risk log and
monitoring.
Additional action identified, following which a further review of the risk and its rating will take place.
147
Reduce waste and increase productivity’ enabling delivery of our statutory obligation to deliver
financial balance.
1353 – Ineffective use of resources for management of CHC restitution cases.
Residual risk
Description
Mitigation
12
C3XL4
Risk that additional CCG
resources for CHC restitution are
not utilised effectively to carry
out this work. Delays in the
process may create a financial
risk.
Controls
Workload and activity review carried out.
Finances reviewed fortnightly with the CSU CHC finance
team.
Internal Assurance
CHC Contract Management Board established.
Gaps
Initial risk rating
C3xL4 = 12
Lack of benchmarking across other CCG CHC teams.
Lead
Actions Required
Continued close monitoring.
Close risk and reframe to
reflect new guidance.
Discussions have been held between the responsible Director and Risk Owner in light of revised guidance
impacting upon this risk. The risk as it currently stands will be removed and replaced with a new risk.
148
Reduce waste and increase productivity’ enabling delivery of our statutory obligation to deliver
financial balance.
1060 – Delegation of GP IT budget
Residual risk
Description
Mitigation
12
C3XL4
NHS England GP IT budget
delegated to the CCG, however,
there is a reduction on the
historic spend from c£7 per head
of population to £3.50. This may
result in rationalisation and
prioritisation of GP IT
expenditure with consequent
impact on Practices.
Controls
Review by NECS of GP IT expenditure
Continuing to work with the CSU re the transitional funding
plan.
Bridging funding secured for 2015/16.
CCG met costs of medicines advice software.
Meetings between CFO and GP IT Lead.
Regular updates to Primary Care Co-Commissioning
Committee.
Initial risk rating
C3xL4 = 12
Internal Assurance
Lead
Ongoing monitoring and discussions with IT and Practices.
Actions Required
CSU IT team considering
alternatives to SMS service
Gaps
None identified.
Continued communication in
order to identify fully impact
and mitigate against risks.
This risk continues to be monitored. An update on primary care IT was presented to the Primary Care CoCommissioning meeting on 11 November 2015.
149
NHS Confidential
NHS Protect
Public
Governing Body
Agenda Item: 3.6
Purpose of Paper
Title
Responsible
Recommendation(s)
Summary
For Information
Delivering our Strategic Aims 2015/16: Progress Report
on behalf of Amanda Hume, Chief Officer
Carl Gowland, Business Delivery and Operations Manager
And Alex Sinclair, Head of Programmes and Delivery
The Governing Body is asked to note the content of the report and
progression made in regard to the delivery of the organisation’s
strategic aims during 2015/16.
The report presents an overview of the progress made in delivering the
CCG’s 6 strategic aims during 2015/16.
The strategic aims are as follows:
 To ensure the populations we serve are able to access healthcare
services that are safe, effective, person centred and high quality
both now and in the future
 To support and encourage people and their carers to take control
of their own health and make informed choices about where and
when to access healthcare
 To work with our populations and partners to reduce preventable
differences in physical, mental and social wellbeing across the
populations we serve
 To ensure the decisions we make are informed by best evidence
alongside the needs and views of local people
 To ensure we get the best possible health benefit for every pound
we spend
 To explore and develop integration of the health and social care
system to benefit the populations we serve
Legal/Regulatory
Implications
Assurance
Framework/Risk
to the NHS Constitution
Public Involvement
and/or Implications
Has an Equality
Analysis been
completed?
Attachments
None at this stage
None at this stage
Please detail any
None
None at this stage
Relates to constitutional principle number 7: “The NHS is accountable
to the public, communities and patients that it serves”.
Patient and public involvement in the development of the paper is not
applicable; however detail of patient and public involvement throughout
2015/16 is contained within the paper.
No. Not required at this stage
Delivering our Strategic Aims 2015/16- Progress Report
150
151
Delivering our Strategic Aims 2015/16- Progress Report
1.0 Purpose of the report
This report demonstrates our progress to date in 2015/16 against the six agreed
strategic aims. These refreshed aims were approved at the Governing Body
meeting in May 2015.
The CCG strategic aims are:
 To ensure the populations we serve are able to access healthcare services
that are safe, effective, person centred and high quality both now and in the
future
 To support and encourage people and their carers to take control of their
own health and make informed choices about where and when to access
healthcare
 To work with our populations and partners to reduce preventable differences
in physical, mental and social wellbeing across the populations we serve
 To ensure the decisions we make are informed by best evidence alongside
the needs and views of local people
 To ensure we get the best possible health benefit for every pound we spend
 To explore and develop integration of the health and social care system to
benefit the populations we serve
2.0 Strategic Aim 1: To ensure the populations we serve are able to access
healthcare services that are safe, effective, person centred and high quality
both now and in the future
The quality of commissioned services continues to be scrutinised through robust
quality assurance processes, which has involved clinical challenge at Clinical Quality
Review Groups, Contract Management Boards and through regular performance
management meetings. The programme of quarterly visits to South Tees Hospitals
Foundation Trust (SHTFT) and Tees, Esk and Wear Valley Mental Health Trust
continues to be implemented to gain assurance on the quality of services and
understand patient experience; and information has been utilised to inform
improvement in care pathways and service delivery.
As part of the Integrated Management and Proactive Care for the Vulnerable and
Elderly (IMProVE) programme, a pilot is being established via the Care Closer to
Home work-stream, in collaboration with STHFT, to implement a community
assessment unit for the frail and elderly. The model will provide a more innovative
multi-disciplinary approach to frail and complex care by reducing transfers of care
within and between organisations and promoting integrated working between health,
152
social care and mental health services. The model has been worked up and is due to
go live in December 2015.
A new Primary Care support pathway has been developed by the Quality in Primary
Care work-stream. This pathway allows variation to be monitored at practice level
across an agreed set of quality indicators and direct support will be offered, where
appropriate, to reduce variation in practice performance. The agreed quality
indicators mirror the NHS England indicators for consistency.
South Tees CCG prescribers are working hard to decrease the volume of
inappropriate antibiotic prescribing. Prescribers are being supported to utilise a suite
of resources to assist them in their prudent use of antibiotic prescribing. Discussions
at locality prescribing leads meetings have been encouraging in terms of practice
and practitioner engagement, with practices engaging their prescribers in peer
review discussions around antibiotic choices. When comparing September 13 August 14 prescribing to September 14 - August 15, there has been a 1.5%
decrease in total volume of antibiotic prescribing. Over the same period there has
also been a decrease in 4C antibiotic prescribing by almost 30%. (The 4C antibiotics
are more closely linked to C. diff prevalence).
The CCG has made good progress with neighbouring CCGs, working together
with acute hospital foundation trusts and other partners, to move forward with the
Securing Better Health Services (SeQiHS) project, which is exploring alternative
configurations for delivery of health services across Durham, Darlington and Tees to
deliver improved compliance with agreed clinical standards. The SeQiHS
communications and engagement work-stream, led by the Chief Officer of South
Tees CCG, has undertaken a number of stakeholder events over the last few
months to inform next steps and work is well underway to prepare for engagement
with the public, in line with the next phase of the project.
3.0 Strategic Aim 2: To support and encourage people and their carers to take
control of their own health and make informed choices about where and when
to access healthcare
A full review of the Lifestore service, situated in the Cleveland Centre, has been
undertaken. The review group was established to consider the current service model
and consider alternative options to address the issues of access, clinical benefit and
value for money. This work included a review of access and identification of possible
outcomes for interventions. A Governing body decision on the next steps will be
made at the November 2015 Governing Body meeting.
153
The Improving Access to Psychological Therapies (IAPT) framework has been
refreshed to raise awareness of the service to the public and healthcare
professionals and other third sector and community groups. A top-up tariff has been
introduced to support providers dealing with patient’s whose needs are more
complex, such as where there are linguistic and cultural barriers. Provisional access
figures for September 2015 have shown 806 new referrals in-month, which is the
highest number of monthly referrals this year. In addition, we are developing plans
for a public promotional campaign to build on this increase and further move towards
delivery of the 15% access standard.
4.0 Strategic Aim 3: To work with our populations and partners to reduce
preventable differences in physical, mental and social wellbeing across the
populations we serve
The CCG continues to support the Deep-End working group to improve quality and
reduce health inequalities by supporting practices at the ‘Deep-end’ of high
deprivation. The group, consisting of GP’s from 9 member practices coupled with
management support, has proposed a number of initiatives to support a reduction in
health inequalities across the South Tees area. These initiatives are now being
developed, via a full business case, which subject to approval; will see the Deep-End
move into the implementation phase.
A Heath Inequalities Steering Group has been established, including representation
from executive GPs from South Tees CCG and the Directors of Public Health from
Middlesbrough Local Authority and Redcar & Cleveland Local Authority. This
steering group provides strategic direction to ensure delivery of the CCG’s statutory
duties in respect of health inequalities. The Steering Group will ensure effective
collaboration between the CCG and public health partners to ensure a system-wide
health inequalities agenda, making best use of available resources.
We continue to attend the Health and Wellbeing Boards across both Middlesbrough
and Redcar & Cleveland and contribute to the development sessions to ensure all
stakeholders are focussing on the key priority areas for the population of South
Tees.
The CCG Mental Health Strategy was signed off by the Governing Body in July
2015. The strategy sets out the CCG’s approach to tackling mental health across
four key areas i.e access to the right services at the right time; services that consider
the whole person; services that empower people to act; and evidence-based
commissioning. The strategy will now be taken forward via an implementation plan.
154
We have undertaken a review of diabetes using a technique developed by health
economists at the London School of Economics. This concept is an innovative
approach to priority setting, with a firm emphasis on improving health outcomes. It
combines a technical value-for-money analysis with extensive stakeholder
discussion to highlight the cost-effectiveness of interventions, which has been
successfully used in the UK and elsewhere around the world. It consists of two
decision conferences which are interactive workshops that allow local
commissioners to involve the wider community in evaluating the benefits of current
or potential interventions for a specific clinical area. The outcome of the review will
be considered by the Health Inequalities Steering Group to determine how this can
be used to inform our commissioning decisions relating to diabetes pathways.
5.0 Strategic Aim 4: To ensure the decisions we make are informed by best
evidence alongside the needs and views of local people
The CCG actively seeks innovative approaches to commissioning and delivering
healthcare and services, supported by a CCG manager, Governing Body lead and a
clinical lead from the practice membership. The CCG has, for the last three years,
launched a Community Innovation Fund to pump prime projects and services with a
view to assessing their value and development as potential future commissioning
plans if they demonstrate benefits to patients and the CCG. In addition, the CCG has
supported an innovation scheme to benefit patients in primary care, and has been
successful in securing additional funding from the Academic Health Sciences
Network to further develop the enthusiasm, appetite and infrastructure for innovation
within the organisation.
The CCG established a Patient and Public Advisory Group (PPAG) in June 2015.
This group allows patient and public representatives to advise the CCG on any
proposals that would significantly impact on service delivery and/or the range and
choice of NHS health services available to the patient population of South Tees.
Recently the group have provided a patient focussed view on the Urgent Care
appraisal criteria and were supportive of our approach.
The South Tees CCG Annual General Meeting was hosted this year at Redcar &
Cleveland Community Heart. The event was extremely well attended and was
coupled with a health fair which was supported by a wide range of health
organisations.
As part of the commissioning intentions process for 2016/17 a number of public
engagement events have been held to ensure the views of local people and
organisations are taken into account. These events have helped to shape the
intentions for next year prior to sign-off and have allowed the CCG to gain a wide
range of views from different backgrounds and across the demographic spectrum,
155
whilst also providing opportunities for open discussions on people’s experience of
accessing the services to help shape the future development of local healthcare and
health services.
The CCG continues to directly engage with member practices through a series of
practice visits by the Chief Officer, Chair and Partnerships & Innovations Manager.
These visits provide a valuable opportunity to speak with practice teams about
commissioning and understand how we can most effectively work together to benefit
local people.
6.0 Strategic Aim 5: To ensure we get the best possible health benefit for every
pound we spend
The CCG has commenced an Urgent Care review with the aim to deliver on the
consultation and procurement of a new Urgent Care strategy by October 2016. This
strategy will then form the basis of an implementation plan to integrate urgent care
services. To date, this review has seen a number of public engagement events take
place, with further engagement planned as the project progresses. This
engagement, through the form of listening exercises, has been critical in developing
our urgent care strategy.
This year we have refined our portfolios and reporting arrangements and have also
undertaken a work-stream governance review culminating in the streamlining of
work-stream reporting. This process has resulted in an assignment of commissioning
support staff solely to South Tees CCG, increasing the project support for clinical
and work-stream leads to deliver their individual work programmes. Whilst this new
model has increased commissioning support to the CCG, it is important to note this
has resulted in no additional cost to the CCG.
This year has seen the CCG move into new premises. The increased space allows
us to deliver savings through a reduction in reliance on external venues and also
promotes closer working with partner organisations through co-locating staff.
7.0 Strategic Aim 6: To explore and develop integration of the health and social
care system to benefit the populations we serve
The CCG has refreshed its organisational development (OD) plan. This plan is
aligned to the CCG Assurance Framework 2015/16 and to the strategic aims and
objectives of the CCG which were approved at the Governing body in May 2015. The
final version of the OD plan will be ratified by the end of the year.
156
This year the CCG has continued to build on the strong foundations established by
the Mental Health Concordat Group. The group operates across a range of
organisations including Cleveland Police, North East Ambulance Service, TEWV,
A&E, Middlesbrough and Stockton Mind and both South Tees and Hartlepool and
Stockton CCGs. The group has an action plan, with key priorities to reflect areas of
high impact. These include the implementation of a 24/7 open access Crisis
Assessment Suite at Roseberry Park in Middlesbrough, development of a
specification for ambulance conveyance of people in crisis, and the ‘Cohort 30’
project. The ‘Cohort 30’ group has analysed the most frequent users of all
emergency services and determined that five distinct cohorts emerge, each of whom
consume significant resources, but for different reasons and in different patterns,
which has provided better commissioning intelligence for future service planning.
The CCG continues to support the integration agenda through the Integration
Programme Board and Integration Executive Group (IEG). These bodies, consisting
of representatives from five partner organisations across South Tees, are
establishing innovative and integrated health and social care services which promote
prevention, eliminate waste and duplication, and are planned around the needs of
the individual, in pursuit of the shared vision that “All care is planned care". The IEG
manages the Better Care Fund (BCF), which is a scheme designed to promote NHS
and local government working closely together around people, placing their wellbeing as the focus of health and care services. The BCF target is a 3.5% reduction in
non-elective admissions and, to date, we are seeing a continued reduction,
exceeding this trajectory.
A successful integration event was held in November 2015. This event brought
together colleagues from Primary and Secondary care in relation to the ongoing BMJ
campaign ‘Too Much Medicine’ highlighting the threat to human health posed by
over diagnosis and the waste of resources on unnecessary care.
8.0 Recommendations
The Governing Body are asked to note the progress made to deliver the CCG’s
strategic aims.
157
REPORT CLASSIFICATION –
Official
please refer to Report Classification Guidance and
NHS Confidential
NHS Protect
Public
Governing Body
Agenda Item: 4.1
Purpose of Paper
Title
Responsible
Recommendation(s)
Summary
Legal/Regulatory
Implications
Assurance
Framework/Risk
to the NHS
Constitution
Public Involvement
and/or Implications
Has an Equality
Analysis been
completed?
Attachments
Please detail any
For Information
360° stakeholder survey action plan update
Simon Gregory, Chief Finance Officer, STCCG
Phillipa Poole, Partnership Project Officer
It is recommended that the Governing Body:
 Note the content of the action plan
The action plan follows our annual stakeholder survey conducted by
Ipsos Mori on NHS England’s behalf and identifies our plans to
continuously improve our engagement of all stakeholders.
Not related to this report.
Does it relate to any of the 7 principlesPrinciple 4- The NHS aspires to put patients at the heart of everything it
does
Principle 7- The NHS is accountable to the public, communities and
patients that it serves
The results of the survey will be considered as part of our commitment
to improving our involvement activities.
Not required/for this report.
Action plan attached.
None in this format.
158
NHS South Tees CCG 360° Stakeholder action plan
Motivated by our drive for excellence we now propose to focus our attention on areas of improvement. The action plan below
identifies the survey results which require our focus alongside the areas for development. The plan has identified leads for each
action.
It should be noted that the stakeholders from Health and Wellbeing Boards did not complete the survey in 2015. This will be picked
up outside of this action plan. The action plan will focus on 2 categories of survey results:
1.
2.
Drop in performance from 2014
Scoring slightly less that ‘All CCG’s’ score
=
=
PRIORITY ACTION
ACTION TO IMPROVE
Action plan
#
Question
1. Extent that the CCG
has taken on board
suggestions when
provided
Our survey result
(2015)
69% (38 people)
Strongly agree / Tend
to agree
7% (4 people) Strongly
/ Tend to disagree
Our survey
result 2014
73% Strongly
agree / Tend
to agree
Reason for Area of Development
action
Drop
in 1. Include wider stakeholders in the
performance
Commissioning Intentions process.
from 2014 = 2. Review the CI process and develop
ACTION
lessons learnt to improve the process
PRIORTY
for next financial year.
3. Review process for explaining why/
when suggestions can/cannot be
acted upon and share process with
stakeholders.
4. To develop communications plans to
ensure feedback on why decisions
have been made
Lead
Hannah
Jeffrey
Hannah
Jeffrey
Hannah
Jeffrey
Phillipa
Poole
159
#
Question
2.
I understand the
reasons for the
decisions that the
CCG makes when
commissioning
services
3.
To what extent do
you agree the CCG’s
plans will deliver
continuous
improvement in
quality within the
available resources?
Our survey result
(2015)
67% (37 people)
to agree
11% (6 people)
Strongly / Tend to
disagree
65% (36 people)
to agree
/ Tend to disagree
Our survey
result 2014
75% Strongly
agree / Tend
to agree
67% Strongly
agree / Tend
to agree
action
Drop
in 1. Work with stakeholders such as
performance
Healthwatch to enable them to have a
from 2014 =
clear understanding of the decision
ACTION
making process the CCG has in place
PRIORTY
when commissioning services
2. Support our member practices
to understand the decision making
process when commissioning
services- opportunity at practice visits
to revisit the rationale for decision
making
3. Share the process for decision
making ensuring the CCG is
transparent and the process
understandable.
4. When local people, partners and
stakeholders have contributed to
CCG
activities explain where this has been
incorporated and if this hasn’t been
incorporated into plans and decisions
explain why.
5. Develop communications plans to
ensure feedback on rationale as to
why decisions have been made
1. Enable our member practices to be
Drop
in
assured of continuous quality
performance
improvement via practice visits and
from 2014 =
through the Patient Engagement and
ACTION
Support Officers.
PRIORTY
2. Share updates with other CCG’s to
maintain relationships and share best
Lead
Julie Bailey
Julie Bailey
Craig Blair
Julie Bailey
Phillipa
Poole
Julie Bailey
Executive
160
#
Question
Our survey result
(2015)
Our survey
result 2014
To what extent do
you agree or disagree
with the following
statements about the
clinical leadership of
the CCG? The
clinical leadership of
the CCG is delivering
continued quality
improvement
69% (38 people)
to agree
/ Tend to disagree
67% Strongly
agree / Tend
to agree
action
practice.
1. Continue to develop and engage with
Scored
local networks. Our CCG scored well
slightly less
for the last two years though our CCG
than
‘All
cluster scored in the middle third of
CCG’s’
the comparison group which is the
scored
=
reason for this development action.
ACTION
There is an opportunity for improving
TO
the cluster score and using this as a
IMPROVE
benchmark to improve.
2. Executive Team and Governing Body
members to promote successful
outcomes achieved in quality
improvements in network meetings.
3. Evidence that quality improvement is
at the heart of the CCG’s business
plan.
Lead
Team
Amanda
Hume
161
NHS Confidential
NHS Protect
Public
Governing Body
Agenda Item: 4.2
Purpose of Paper
Title
Responsible
Recommendation(s)
Summary
Legal/Regulatory
Implications
Assurance
Framework/Risk
to the NHS
Constitution
Public Involvement
and/or Implications
Has an Equality
Analysis been
completed?
Attachments
Please detail any
For information
Report from the Primary Care Co-Commissioning Committee
Mr David Brunskill, Lay Member and Committee Chair
Jacqui Keane, Governance Manager
The Governing Body are asked to note the business transacted by the
Committee.
The Primary Care Co-Commissioning Committee is a formally
constituted committee of the Governing Body and has powers
delegated to it from the Governing Body in order that it may make
decisions and approve actions in relation to the co-commissioning of
primary care services in partnership with NHS England.
This report provides a summary of business transacted by the
Committee at its August and November meetings.
None in relation to this report.
The Committee operates within the legal framework and Constitution of
the CCG and NHS England with regard to joint commissioning
arrangements.
There are no specific risks relating to the report.
Transparency and probity of decisions.
Relevant patient and public involvement will be sought in relation to
specific issues, but not in relation to this report.
Equality analyses will be completed as appropriate.
Report from the Primary Care Co-Commissioning Committee
None
162
SOUTH TEES CCG GOVERNING BODY MEETING
WEDNESDAY 25 NOVEMBER 2015
REPORT FROM THE PRIMARY CARE CO-COMMISSIONING COMMITTEE
1.
Introduction
The Primary Care Co-Commissioning Committee is a formally constituted committee
of the Governing Body and has powers delegated to it from the Governing Body in
order that it may make decisions and approve actions in relation to the cocommissioning of primary care services in partnership with NHS England.
The CCG’s Constitution requires that a report is produced for the Governing Body
outlining the workings of the Committee at least twice per year. This report provides
a summary of business transacted by the Committee at its meetings in August and
November 2015.
It is important that the Committee operates with high levels of transparency and
probity and in line with the Terms of Reference approved by the Governing Body and
NHS England and, as such, both meetings were held in public and included
representation, in a non-voting capacity, from HealthWatch, Health & Wellbeing
Boards and the Local Medical Committee.
Although the Committee membership includes at least one Governing Body GP, this
is a non-voting position. Potential or actual conflicts of interest have been, and will
continue to be, considered at each Committee and appropriate action will be taken
should a conflict arise
2.
Key areas of discussion
The following summarises the key discussion areas from the August and November
meetings:
a.
Primary Care Strategy
The Committee approved the CCG’s Primary Care Strategy which addressed
three main priority areas:
i. to stabilise and strengthen General Practice focussing on workforce;
ii. to deliver an integrated service delivery between General Pratices,
community services, hospital services and social care, and
iii. to work with Public Health to promote patient education and self care.
The strategy had been initially developed building upon the engagement work
undertaken as part of the Clear and Credible Plan development as well as
through more recent discussions with all member practices. Work was also
ongoing with the Patient and Public Advisory Group to produce a patient
facing version of the strategy to ensure wider understanding of the CCG’s
vision for primary care.
163
b.
Review of PMS and APMS Contracts
NHS England provided the Committee with an update and options on the
reviews of the PMS and APMS contracts for the Fulcrum, Haven, Resolution
and Eston Grange Practices. This provided the Committee with a good level
of understanding of the work undertaken by NHS England and associated
risks and benefits. It was agreed to extend the contracts of Resolution and
Eston Grange Practices. Further work is being carried out on finalising
options for Haven and Fulcrum Practices.
c.
Urgent Care Strategy Development
The Committee was updated on the process undertaken to-date to develop
the draft Urgent Care Strategy which had included extensive public and
stakeholder engagement.
The Governing Body would be discussing
proposed options at a meeting in December.
d.
Application for Fully Delegated Primary Care Commissioning
The Committee was informed that the majority of member Practices were in
favour of the CCG applying to NHS England for fully delegated
commissioning. A formal response to the application was awaited from NHS
England.
e.
South Tees Access and Response Scheme (STAR) Update
The South Tees Access and Response (STAR) scheme was formed in
response to the Prime Minister’s Challenge Fund with a vision to provide a
simple, accessible, high quality General practice extended hours service with
a person-centred approach that promoted self-care. The scheme is led and
owned by local GPs and will work towards being fully integrated; sharing full
patient records.
South Tees service hubs were located at Redcar Primary Care Hospital,
Linthorpe Surgery in Middlesbrough and, potentially, from a hub at the James
Cook University Hospital. To-date, feedback from users had been positive.
f.
Reports re GP Access
The Committee discussed a Healthwatch report on their findings from an
independent survey on access to GP services in Middlesbrough. In addition,
the Director of Public Health for Redcar and Cleveland confirmed that a
scrutiny process was taking place in Redcar & Cleveland around GP access.
g.
CQC visits to Practices
The Committee was assured that, to-date, no concerns had been raised as a
result of CQC visits to South Tees Practices.
h.
General updates
The Committee received routine updates on the contracting positions of the
CCG and NHS England, GP information technology, draft quality in primary
care commissioning intentions and primary care infrastructure and estates
issues. There were no areas of concerns.
164
4.
Required from Governing Body
The Governing Body are asked to note the business transacted by the Committee
David Brunskill
Lay Member
Chair of Primary Care Co-Commissioning Committee
12.11.2015
165
NHS Confidential
NHS Protect
Public
Official
Governing Body
Agenda Item: 4.3
Purpose of Paper
Title
Responsible
Recommendation(s)
Summary
Legal/Regulatory
Implications
Assurance
Framework/Risk
to the NHS
Constitution
Public Involvement
and/or Implications
Has an Equality
Analysis been
completed?
Attachments
Please detail any
For Information
Urgent Care Update
Craig Blair, Associate Director of Commissioning, Delivery and
Operations
Julie Stevens, Commissioning & Delivery Manager
Note contents of report for information
Paper gives an update on progress on the development of the CCG’s
Urgent Care Strategy as well as national and regional urgent and
emergency care initiatives.
Financial implications for delivery of a potential new model of care will
be detailed in a future business case to be presented to the Governing
Body in December, 2015. Currently urgent care costs the CCG £8.5M
– it is expected that future models will be at least cost neutral.
The CCG will be required to formally consult on any future models
which will require significant reconfiguration. We will continue to work
with OSC to adhere to legal requirements.
A new service model will require procurement and as a result, the CCG
will need to adhere to procurement, patient choice and competition
regulations.
Resource capacity to deliver consultation and subsequent
implementation plans.
Reputational risk to the CCG if we fail to follow due process
Political risk – Risk of local political objection to changes in the way we
deliver services and current lack of certainty around national guidance
on GP 7 day working contracts and
This work relates specifically to all 7 of the NHS Constitution principles
and its values. It also relates to patient rights, 1,2,3,4,6 and 7.
A public engagement exercise has been carried out to support
development. A separate report on this engagement is available but
key themes are included within the presentation.
Will be carried out at next stage of process (business case
development)
Briefing Paper Enclosed
None
166
Urgent Care Update
Briefing Paper for South Tees Governing Body
Meeting 25 November 2015
Purpose
The purpose of this briefing paper is to update South Tees CCG Governing Body on:
 the development of a South Tees CCG Urgent Care Strategy; and
 progression of national and regional urgent and emergency care initiatives.
Development of South Tees CCG Urgent Care Strategy
Stage 1 Pre-Engagement
Over the course of July and August 2015 1,013 people have given their views on
urgent care services across the South Tees area through a combination of general
and targeted engagement. This information was further supplemented in September
by further work with community groups, users of urgent care services, people living
in care homes and large employers in the South Tees area.
The main themes/issues emerging from the engagement were:
 People find the system confusing (reinforced what we know)
 Most people try and care for themselves before accessing services
 When they do access a service, most people prefer to see a GP
 The majority of people get an appointment with their GP when they need one
(though some might not get one the same day)
 The majority of people reported having a positive experience of using our walk
in centres
 The majority of people thought it was important to see the right health
professional, in the right place at the right time
 The majority of people said that A&E should only be used by patients who
have a life threatening condition
 People think that it is important for their health records to be shared between
services
As well as engaging with our public, we sought feedback from other key
stakeholders, including members from the South Tees Urgent Care Resilience
Group, our wider GP membership and local authority colleagues through Health and
Wellbeing Boards and Overview and Scrutiny. We also undertook a market
engagement exercise, to receive views from potential providers on future service
models for delivery of urgent care services.
Stage 2 – Scenario Development
During our period of engagement best practice examples and suggestions from key
stakeholders around potential scenarios for delivering future models of care were
collated and documented. In addition, NHS England also announced guidance
167
which will fundamentally impact on our future urgent care strategy and models of
care.
In early October they published standards to be adhered to when commissioning
integrated 111, an integrated treatment and advice service and out-of-hours
services. CCGs are being ‘encouraged’ to work together to commission an
integrated service, adopting a lead or co-ordinating commissioner approach. The
new model aims to enhance the existing 111 service, making it easier for the public
to access urgent health advice and care.
There will also be a focus on changing the process around green ambulance
dispositions (those determined to be non-life threatening incidents which are triaged
for a specific time band response) and implementing enhanced clinical triage before
an automated referral is sent to the local ambulance service. This builds on
evidence from a pilot in London which has shown a reduction of 800 green
ambulance dispositions per week.
In the same month the Department of Health announced its intention to implement
by April 2017, a new GP contract which will include 7-day access to services. The
168
contract, expected to be voluntary until 2020, will require practices to work together
to deliver 7 day working (8 a.m. – 8 p.m.) for populations of at least 30,000. The
contracted is expected to be phased but starting with those practices already
involved in the Prime Minister’s Challenge Fund and Vanguard programmes.
Stage 3 – Scenario Appraisal
In order to effectively appraise those ideas and potential models of care put forward
by stakeholders, we developed, refined and agreed weighted criteria. In order to do
this we sought the views of our South Tees System Resilience Group and then
further refined through a series of engagement events which included our Clinical
Council of Members, an evening event attended by clinicians, Healthwatch and
councillors, a CCG Patient and Public Advisory Group and an on-line survey with the
public via My NHS members.
In early November members of the CCG’s Urgent Care Operational Group which
included representatives from NHS England and both local authorities, overseen by
Healthwatch, applied the criteria to our list of potential scenarios. Those scenarios
with the highest scores are now being ‘worked up’ in further detail in order to assess
which are viable options to take forward. This further work will include more robust
analysis of activity flows, finance, workforce and the application of equality impact
assessments. The scenarios include:

In line with national guidance outlined above, the development/enhancement

Aligned to proposed new GP contract arrangements; extended GP opening
hours 8 a.m. – 8 p.m. 7 days per week delivered around populations of
around 30,000 replacing existing walk-in centres. Proposal on registered
elements of walk-in centres to be informed by NHS England.

Alignment of the out of hours period (to include home visits and appointment
booking) to the new GP in-hours arrangements with further exploration of
where and how many sites appointments could be delivered from.

A GP presence at front of house in A & E, triaging and diverting patients with
primary care needs. All life threatening emergencies (999 calls) directed
straight to emergency room. Additionally, patients attending A & E for primary
care needs potentially are given a direct appointment into another service
(including GP practices).

The potential for:
o two minor injury units, one in James Cook and one based in Redcar
which has x-ray and GP cover with opening times which correspond to
demand; or;
o one 24/7 minor injury unit at James Cook Hospital.
of the NHS 111 model.
169
Next Steps
 Our potential scenarios will be presented to Joint Overview and Scrutiny on
the 17th November, 2015 to gain their view on whether we need to formally
consult with the public. (To fit with procurement timetables, we would need to
commence consultation by the 11th of January 2016).
 Scenarios will be shared with key stakeholders to gain further views. Key
stakeholders will include Health and Wellbeing Boards, local MPs, GPs and
System Resilience Group members.
 Produce a business case to be presented to Governing Body on the 16th of
December, 2015 for a decision on options to go out to formal consultation if
required.
 A consultation plan/timetable (if required) will be shared with the Governing
Body on the 16th of December and with Joint Overview and Scrutiny on the
18th of December, 2015.
North East & Cumbria Urgent and Emergency Care Strategic
Network and Vanguard Progress
Accountable to NHS England, a North East & Cumbria Urgent and Emergency Care
Network Board has now been established which meets bi-monthly. These networks
have been established across the country in order to improve the consistency and
quality of urgent and emergency care. Their aim is to address challenges in the
system which would be difficult for System Resilience Groups to tackle in isolation.
Membership has been drawn from Executive Directors and Senior Clinical Leaders
from SRG’s across the North East. North Cumbria and Hambleton, Richmondshire
and Whitby are also ‘linked’ to the group. One of the key aims of the Network is to
produce an overarching North East Urgent and Emergency Care strategy and to
participate in the delivery of the Urgent and Emergency Care Vanguard Programme.
The purpose of the successful Vanguard application is to accelerate delivery of the
national urgent and emergency care review.
Vanguard Progress
Following a site visit by the national Vanguard team and a visioning event in
October, key programme deliverables have been agreed with establishment of five
workstreams in order to progress work:





Primary and Community Care (Chair – Dr Mike Milner)
Mental Health (Chair - TBC)
New financial modelling and payment (Chair Mark Pickering)
Integrated Care (Chair – TBC)
Clinical Reference Group (Chair – Dr Stewart Findlay)
These workstreams will oversee a number of projects including: Communications
and Engagement; I.T.;111; Out of Hours and Ambulance Services; Outcome
Measures; Self-Care; and Workforce.
170
The key deliverables being considered for 16/17 are:
System Leadership
Create an overarching framework to deliver the objectives of the
UEC review, including a stock take of services, regional action
plan and implementation of revised NHS 111 Commissioning
Standards.
Address fragmentation and terminology of UEC services.
Implement standardised system wide metrics, supported by
academic partners to ensure rigour and benefits realisation.
Ensure consistent delivery of High Impact Interventions by
SRGs.
Deliver improved intelligence and modelling via the ‘flight deck’.
Undertake baseline assessment to inform proposed new costing
models and agree scenarios for shadow monitoring.
Self-Care
Promote self-care for minor ailments and self-management for
long term conditions through the development of online health
tools, initially focusing on parents of children under 5 years.
Primary Care
Increase direct booking into GP appointments, in and out of
hours, to 50% of practices.
Standardise minor ailment schemes in pharmacies.
Integration
Expand the 111 Directory of Services (DoS) to include social
care.
Implement information sharing between providers, allowing
analysis of pathways and outcomes, by linking NHS identifiers
from 111, 999, A&E and admission data. This will inform future
pathway changes and payment reform.
Enhance Summary Care Records in association with the Health
and Social Care Information Centre.
Out of Hospital
Implement 24/7 early clinical assessment of green ambulance
and ED dispositions.
Implement 24/7 senior clinical decision Support through an
enhanced clinical hub, accessible by 111/999 and external
clinicians, including GPs, pharmacists, mental health, dental and
social care professionals.
Improve See & Treat and Hear & Treat.
Enhance mental health integration through rollout of 24/7 triage
services, psychiatric liaison, 7 day MH consultant working and 7
day street triage with mobile access to health records.
171
The Vanguard programme is expected to submit two value propositions (bids for
investment funding in order to deliver key activities). The first is to be submitted by
30th November to support those deliverables to be achieved by the 31 st of March,
2016. The second, more detailed bid for April 16 onwards, is due by the end of
December this year. A series of workshops are supporting development of the bids
but all organisations will have the opportunity to comment on the final proposals
before submission, although timescales for this are extremely challenging.
A core interim Programme Management team has been put in place to support the
next stages, however, a separate funding bid will be submitted to the Vanguard
Programme for appropriate management support to take the Programme forward
(around £500,000 from now until the end of March, 2015). A rapid recruitment
process needs to take place and it is anticipated that secondment opportunities will
be made available to all organisations within the network.
Julie Stevens
Commissioning & Delivery Manager
172
Audit Committee – Extra-Ordinary Meeting
Held on Wednesday 27 May 2015 at 1.00pm
At The Resource Centre, Meath Street, Middlesbrough, TS1 4RX
Present:
Peter Race MBE
David Brunskill
John Drury
In Attendance:
Simon Gregory
Stuart Irvine
Paul Hewitson
Rachel Brown
Yvonne Gibson
Mrs Liane Cotterill
Sandra Edwards
AC/26/15
Chair
PPI Lay Member – GB Member
Secondary Care Doctor – GB Member
Audit Manager - Audit North
Deloitte – External Audit
Deloitte – External Audit
Senior Finance Manager – North of England Commissioning
Support (NECS)
Senior Governance Manager – North of England Commissioning
Support (NECS)
Governance Officer, North of England Commissioning Support
(NECS) – Minute Taker
Apologies were received from John Whitehouse (Audit North). The Chair
welcomed Stuart Irvine, the Audit Manager from Audit North, the Internal
Auditors.
AC/27/15
There were no declarations of interest in relation to items on the Agenda.
AC/28/15
Draft Minutes of the meeting held on 21 April 2015
The Minutes of the previous meeting held on 21 April 2015 were
ACCEPTED and AGREED as a true record.
Audit – 27.05.15
173
AC/29/15
29.1
Matters Arising
29.1.1
Pension Costs
Mr Gregory said that no guidance had been received and currently there
were no changes to the standard template.
29.1.2
Service Auditor Report (SAR)
Mr Gregory advised that the CCG had not yet received the final SAR. Mr
Hewitson responded that there was nothing of further interest to note and
there were no further risks.
29.2
Action Log
29.2.1
AC/77/14 – Significant Audit Risks – this would be covered in Mr
Hewitson’s report so would be closed today.
29.2.2
AC/01/15 – Governance & Risk Management – meetings had taken
place and a timetable of ‘deep dives’ would be brought to the next Audit
Committee. It was agreed this action should now be closed.
29.2.3
AC/02/15 – National Payment by Results Tariff - Updated and it was
agreed this action should now be closed.
AC/30/15
Final Annual Accounts for 2014-15
30.1
Mr Gregory tabled a revised version of the 2014-15 Final Accounts.
30.2
The Chair asked for clarification on whether the Audit Committee was
being asked to approve the final accounts or to recommend approval of
the accounts to the Governing Body. Mrs Cotterill clarified that the Audit
Committee should make a recommendation for approval by the
Governing Body.
30.3
Miss Gibson highlighted the few changes from the previous draft seen by
the Audit Committee to enable recommendation to the Governing Body:
 Note 4.5 : Pension Disclosure – an amendment to wording following
guidance from NHSE
 Notes 1.6 and 35 : Pooled Budget Information – this information
had now been received from Middlesbrough Council and these notes
amended.
 Various Format Changes – these changes were made to the
accounts following External Audit amendments.
 Sickness Figures – these had been added to Note 4.3. The Chair
Audit – 27.05.15
174
noted that sickness figures were an average of five days per person
and queried whether this was in line with what was expected. Mr
Gregory said that it was and was not as high as other Trusts, though
the figure was high. Mr Brunskill pointed out that if there were longterm sickness the days could soon mount up. Mr Gregory volunteered
to provide comparative figures should they be required. The Chair
agreed.
Action AC/05/15 – Mr Gregory
 Formula Errors – two formula errors had been found which had been
rectified.
 Related Party Transactions – there were transactions relating to Drs
Drury and Milner and Ms Fruend’s name had been changed.
 Change to Error on Report used for Ledger – the report had been
calculated incorrectly but this had been reworked which increased the
percentage slightly. There were no changes to the ledger as the
figures had remained the same.
30.4
Mr Gregory thanked all those who had contributed to the Final Accounts.
30.5
The Chair advised he would make a recommendation to the Governing
Body to approve the final accounts if the Audit Committee agreed.
30.6
The Audit Committee unanimously AGREED that the Final Accounts
should be RECOMMENDED to the Governing Body.
30.7
The Chair thanked Miss Gibson and the team for all the work undertaken
to provide such a comprehensive report.
30.8
In turn, Miss Gibson thanked the auditors for all the help she had received
during the year. Mr Hewitson acknowledged the process had been far
more collaborative and straightforward this year compared with previous
years when room for improvement had been recognised.
AC/31/15
Interim Report for Year Ended March 2015
31.1
Paul Hewitson and Rachel Brown from Deloitte presented the Interim
Report.
31.2
Mr Hewitson explained that the Interim Report was to give an indication of
the present position with a Final Report when the final accounts were
signed off. The purpose of the Report was also to inform the Audit
Committee how the audit had gone, its conclusions and what was awaited
in order to sign off. Mr Hewitson expected to sign off on Thursday of this
week as the deadline was on Friday (a week ahead of previous
deadlines). Mr Hewitson pointed out that there had been an improved
process this year.
Audit – 27.05.15
175
31.3
Miss Brown advised the Committee there were some accruals
outstanding and she was awaiting information, remuneration and written
agreements. Mr Gregory responded that Ms Newson would send those
to Miss Brown.
31.4
In terms of the CCG’s Annual Report, Deloitte was waiting the updated
version following their amendment. Final statistics were awaited and a
letter from Neil Nicholson. An updated letter would be circulated giving an
additional line which recognised CHC.
31.5
Miss Brown pointed out that in terms of risks, work has been completed
on revenue risks, etc, and there were no issues with risks.
31.6
Mr Hewitson summarised that the work was mostly completed with the
small outstanding items being those at the ‘last minute’. The Report gave
the ‘Value for Money’ (VFM) conclusion and this work was now
completed. Deloitte had undertaken a risk assessment under guidance
and concluded they could give the VFM conclusion.
31.7
Mr Hewitson advised that on page 61 the work concluded was all ‘green’.
He pointed out that the Service Organisation Reports were out. The
reports were issued prior to the second CSU Report but neither had any
impact on the current report. There was one exception on the destruction
of back-up tapes. Northumbria had issued a ‘Letter of Comfort’. All
Service Auditor Reports had been received without a problem.
31.8
Mr Hewitson confirmed the following in his report:
 Responsibilities
 There were no uncorrected adjustments
 Fraud responsibilities and representations
 Deloitte confirmed their independence of the CCG and, therefore,
could give ‘opinion’
 Fees
31.9
The Chair thanked Mr Hewitson and Miss Brown for the Interim Report.
31.10
Mr Gregory confirmed that Miss Newson would send the latest Annual
Report with further updates being undertaken that evening. Mr Gregory
confirmed that he was awaiting progress on one accrual.
The Audit Committee NOTED and SIGNED OFF the Interim Report
for Year Ended March 2015.
Audit – 27.05.15
176
AC/32/15
Any Other Business
32.1
There was no further business to discuss.
32.2
The Chair thanked everyone involved for the work undertaken in pulling
such a comprehensive report together enabling the Audit Committee to
recommend approval to the Governing Body.
32.3
The Chair thanked Mr Hewitson for the sterling work Deloitte had
provided over the years they had worked with the CCG, wishing both him
and the company best wishes for the future.
AC/33/15
Date and Time of Next Committee
The next Audit Committee will be held on Wednesday 16 September
2015 at 2.00pm at North Ormesby Health Village.
The meeting closed at 1.30pm
Signed: ___________________________________
Peter Race MBE
Chair of the Audit Committee
Date: __________________
Audit – 27.05.15
177
Governance and Risk Committee
Held on Wednesday, 12 August 2015 at 2.00pm
In Large Meeting Room, Low Grange, Normanby Road, Eston
Present:
David Brunskill
Simon Gregory
Mrs Liane Cotterill
In Attendance:
Robin Marsden-Knight
Mrs Sandra Edwards
GR/35/15
Chair - Lay Governing Body Member – PPI
Senior Governance Manager – North of England
Commissioning Support (NECS)
HR - Item 41
Governance Officer, North of England Commissioning Support
(NECS) – Minute Taker
Apologies were received from Jacqui Keane (Governance & Risk Officer),
Ms Jean Fruend (Executive Nurse), and Dr Mike Milner (Caldicott
Guardian).
Due to proposed changes in the Terms of Reference, David Brunskill
chaired the meeting in place of Simon Gregory.
It was noted that from October, Dr Rajesh Khapra would become
Caldicott Guardian in place of Dr Mike Milner.
GR/36/15
There were no interests declared in relation to items on the Agenda.
GR/37/15
Unconfirmed Minutes of the previous meeting held on 13 May 2015
The Minutes of the previous meeting held on 13 May 2015 were
ACCEPTED as a true record.
178
GR/38/15
38.1
Matters Arising
There were no matters arising.
38.2
Action Log
38.2.1
The Committee discussed the actions which were currently open.
38.2.2
GR/60/14 – Governance Framework and Assurance Mapping – Mrs
Cotterill had a discussion with Mrs Forster when it was agreed to do a
pilot in one area in September. This action to remain open.
38.2.3
GR/03/15 – Business Continuity Plan – A new contract between
STCCG and CSU to be more like Trust contract; to include BCP and
compliance with best practice for fraud. This action is now closed.
38.2.4
GR/05/15 – Health & Safety – SOPs – awaiting feedback.
38.2.5
GR/09/15 – Research & Development – Qtr3 Summary – Looking at
Workstreams. This action remains open.
28.2.6
GR/11/15 – Equality Objectives Action Plan – This action now closed
38.2.7
GR/12/15 – Research Governance Assurance Report – Looking at
Workstreams. This action remains open.
38.2.8
GR/13/15 – Legislation Review – This action is now closed.
GR/39/15
Information Governance Strategy
39.1
Mrs Cotterill explained that STCCG was required to have an up-to-date
Information Governance (IG) Strategy which was refreshed annually. Any
impact as a result of the IG Toolkit would be included in the Strategy. The
IG Toolkit had been released at the end of May.
39.2
Mrs Cotterill highlighted the changes:
 Para 1.4 – the Care Act 2014 was included in the legislation
 Para 2.2 – Information Sharing Agreements between the CCG and
other organisations would grow as co-commissioning developed
 Para 6.1.4 – annual IG performance would be a new section within
the IG Annual Report which was presented to the Governance & Risk
Committee
 Para 6.1.5 – an internal audit of the IG Toolkit was now included as
part of the CCG’s Internal Audit Plan.
179
39.3
The IG Toolkit Action Plan was included as a snapshot for information, to
indicate what would be worked upon throughout the year and, therefore,
would be subject to change on a monthly basis.
39.4
Mrs Cotterill explained she had regular meetings with ST CCG to update
and discuss any issues of concern. Internal Audit scrutinised the Strategy
before it had been sent off at the end of March 2015. The Strategy had
been presented to February’s Governance & Risk Committee.
Action GR/14/15 – Mrs Cotterill
The Governance & Risk Committee APPROVED the updated
Information Governance Strategy.
GR/40/15
Policies
40.1
The following updated three policies and one procedure were presented
for approval.
40.2.1
Anti-Fraud, Bribery and Corruption Policy
The Committee agreed this Policy read very well and had no comments to
make.
40.2.2
Mr Gregory explained that in any new contracts between the CCG and
CSU there would be mention of anti-fraud to comply with best practice.
The CCG had submitted a draft return to Internal Audit with regard to
compliance with Anti-Fraud policies.
40.3
Internet & E-mail Acceptable Usage Policy
The Committee approved the updated Policy.
40.4
Social Media Policy
Mr Gregory noted that the Social Media Policy should be considered part
of mandatory training which could go further than the current on-line
training. The training component could be updated to include ‘derogatory
comments’. Discussion to place around how easily comments could be
misconstrued. The Social Media Policy covers use of social media in
one’s personal life whereby there should be no discussion of work-related
issues.
40.5.1
Information Labelling & Classification Procedure
Ms Cotterill explained that this procedure had been revised as a result of
new Government security classifications which could be applied to the
CCG as follows:
 Official, sensitive – commercial
 Official, sensitive – personal
There was also the category of ‘Official’ with most documents being
180
marked as such for good practice.
40.5.2
40.5.3
The rewritten policy had been adopted within NECS, therefore any NECS
documents will use the new classifications. It was the author of the
document who decides upon the classification. These classifications will
also apply to Committee and Governing Body papers, viz:
 ‘Official’ – Governing Body Public papers
 ‘Official : Sensitive’ – In Committee papers
 Draft papers could be marked as ‘Official : Sensitive – Commercial’
until they became public and then would be marked ‘Official’.
The Governance & Risk Committee APPROVED the following
policies:
 Anti-Fraud, Bribery & Corruption Policy
 Internet & E-mail Acceptable Usage Policy
 Social Media Policy
 Information Labelling & Classification Procedure
Mr Marsden-Knight entered the meeting.
GR/41/15
HR Policy Renewals
41.1
Mr Marsden-Knight explained there were 25 policies listed in the
Appendix which would roll over as there had been no changes. The initial
expiry date had been May 2015 so a further two-year roll over would allow
time for a rolling review programme to be initiated. Any legislative
changes would be noted and reviewed as, and when, they occurred. Mr
Gregory reminded Mr Marsden-Knight to ensure that the ST website was
refreshed when applicable. Mr Marsden-Knight offered to bring an update
to the next meeting in November.
Action GR/15/15 – Mr Marsden-Knight
41.2
The Whistleblowing Policy had been renewed in order to remain valid. It
was currently being discussed as a ‘standard’ throughout NHS
organisations. Mr Brunskill pointed out that some organisations call it
‘Professional Standards Reporting’. Mr Marsden-Knight stated that it
remained the ‘Whistleblowing’ Policy as everyone knew to what it
referred. This policy gave everyone the freedom to speak up and the
review pointed out there was a need to ensure that this was not seen in a
negative light.
41.3
Mr Marsden-Knight asked that the Committee ratify the policies noted in
Appendix for a further two years up to May 2017.
181
41.4
Flexible Working Policy
This policy was currently being reviewed as legislative changes had been
updated. The new policy would be issued within the next six months. Mr
Marsden-Knight would discuss this with Mrs Hume.
Action GR/16/15 – Mr Marsden-Knight & Mrs Hume
41.5.1
Other Leave Policy
There had been legislative changes which included fathers being able to
attend ante-natal appointments and gender reassignment.
41.5.2
Mrs Cotterill pointed out that the Other Leave Policy followed the
recognised structure but the other policies did not, particularly with regard
to Equality & Diversity Impact Assessments. Mr Marsden-Wright said that
he would feed this back as other changes were also being made. He
acknowledged that the majority of policies were based on the same
template and would ensure that they were consistent by discussing this
with HR Managers.
The Governance & Risk Committee APPROVED and RATIFIED the
Policies listed in the Appendix, and NOTED the changes in the
aforementioned Policies.
Mr Marsden-Knight left the meeting.
GR/42/15
Risk Management Report
42.1
Mrs Cotterill highlighted items of note in the report which covered the
period 13 May to 14 July 2015.
42.2
Mrs Elliott had attended a Risk Development meeting with Mr Gregory
and Mrs Keane and everything was on track.
42.3
Additions to the Risk Register
Two new risks had been added to the Risk Register.
 1352, relating to the core capacity of the CHC team to contribute to
broader system pressures, e.g. delayed transfers of care in the acute
sector which could negatively impact on the CCG. This had a
residual risk score of 12 amber.
 1353, relating to CCG resource for CHC restitution not being utilised
effectively. This had a residual risk score of 12 amber.
42.4
Movement of Corporate Red Risks
Red risk 377, which covered the failure to deliver QIP Plans and the
consequent failure to deliver reductions in unplanned care, had been
removed from the Risk Register by linking it to risk 836; implementation of
Better Care Fund will require funding to be transferred from acute
182
emergency care to support integrated social and health care, requiring
£214m to be released from acute care contracts. This reduced the
number of red risks from 5 to 4.
42.5
It was agreed that the Corporate Risk Register (red risks) would be
replaced by the Assurance Framework which consisted of risks rated 12
and above. Plans to amend the format of the Assurance Framework had
been added to the NECS work plan.
42.6
Mr Gregory suggested that a Corporate Team consisting of Mrs Hume, Mr
Blair, Mrs Keane and Mrs Sinclair should meet to discuss the consistency
of risks to give assurance on the various risks. A Corporate Session
would be held to identify these risks. This information would then be
presented to the Executive Team, Governance & Risk Committee and the
Governing Body.
Action GR/17/15 – Mrs Hume, Mr Blair, Mrs Keane, Mrs Sinclair
The Governance & Risk Committee NOTED the Risk Management
Report.
GR/43/15
Assurance Framework
43.1
This was mentioned within the Risk Management Report.
The Governance
Framework.
&
Risk
Committee
NOTED
the
Assurance
GR/44/15
Governance Assurance Report
44.1
The Governance Assurance Report covered the period 1 April to 30 June
2015 (Qtr 1).
44.2
Mrs Cotterill explained the new format of the Governance Assurance
Report which included new sections as part of Corporate Governance –
Legal and Claims:
 Claims Management Activity
 NHS Litigation Authority (NHSLA) update
 Legal Services Activity
44.3
The Claims Management Activity indicated there had be no claims during
Qtr 1. Mr Gregory queried whether that included CHC (Continued
Healthcare). Mrs Cotterill replied there was one claim in progress for an
application to the Court of Protection regarding CHC Funding.
183
44.4
Corporate Governance : Policy Management
The main points highlighted were:
 Governance & Assurance Manager (Aimee Tunney) had been
appointed covering CCG policy management and development – a lot
of progress had been made in three months
 Policy matrix had been shared with the CCG with RAG rating alerts at
90, 50 and 30 days.
 A forward plan has been developed for policies which have expired.
44.5
Three Corporate Policies had been presented to today’s Committee for
ratification:
 Anti-Fraud, Bribery and Corruption
 Internet and E-mail Acceptable Usage
 Social Media
44.6
The following policies would be presented to the Committee in November:
 Complaints
 Mental capacity and Deprivation of liberty
 Access and Choice
 Policy for Development and Approval of Policies
 Intellectual Property management and Revenue Sharing
 Safeguarding Children
 Serious Incidents
44.7
Information Labelling and Classification Procedure
This had been discussed earlier in the meeting.
44.8
HR Policies
Horizon scanning was now at a stage where a pilot system was in place.
The CCG receives a document on a weekly basis from Mrs Cotterill. With
the new online system, it will be possible to allocate actions which should
then be addressed and closed. Testing would shortly take place.
44.9
Incident Management and Reporting
In the last period there was one Information Governance and one security
incident. Both incidents have been managed and closed.
 The security incident related to the loss of a staff security badge which
was replaced. Old badges can be deactivated.
 The information governance incident related to inappropriate action
disclosing patient identifiable information.
44.10
Mr Gregory pointed out that the CHC Team seems to have better
systems. Mr Brunskill suggested that each form template should have a
warning in red advising not to include patient identifiable information. He
emphasised that it was the responsibility of the person submitting
documents and appendices to ensure that no patient identifiable
information was included.
184
44.11
In answer to a query, Mr Gregory said that breaches have to be included
in the Annual Report. Mr Brunskill suggested that breaches should be
anonymised and circulated to staff to make them aware of what
constituted a breach.
44.12
Risk Management Update
A new page ‘Risk’ page is under development by NECS and should be in
place by August 2015. This has been offered to all NECS’ CCGs. The
SIRMS Standard Operating Procedure (SOP) will then be revised and
staff trained accordingly. An e-learning package tailored to the CCG’s
requirements will be developed to support staff. When the new risk page
is live a thematic review report will be produced on a six-monthly basis.
44.13
Health &Safety
 SOPs were being developed and amended for approval by the CCG
 There are 5 outstanding DSE assessments out of 16. All staff have
been contacted to complete the assessments as soon as possible
(68.75% have been completed.)
 Quarterly Service Line meeting has been undertaken with Life Store
 Past security issues have been discussed with Life Store and actions
taken to deal with these.
 Health & safety mandatory training is above 80%
 All health & safety policies have been renewed and are due for
renewal in August 2018.
 Health & Safety Strategy to be renewed September 2016
 NECS Governance Manager for Health & Safety visited the new
offices to undertake appropriate inspections. He has been invited to
join the fortnightly conference calls.
44.14
Equality & Diversity
 Objective 1 – The CCG would be holding a Commissioning Intentions
event in the summer to garner public opinion on what should be
commissioned for 2016-17.
 Objective 2 – The CCG was encouraging the Trust to raise awareness
of the Friends and Family Test to ascertain the demographics of
patients accessing commissioned services. This would be included in
new literature appropriately.
 Objective 4 – Equality Analysis templates are now integrated in the
Project Initiation Documents. A number of staff undertook E&D
training which is refreshed every three years.
 Training – 100% of staff and 44% of Lay Members/Sessional GPs had
completed E&D mandatory training. DB asked that these figures be
split in future to show actual numbers.
44.15.1
Information Governance (IG)
During this quarter 64 IG requests were received; 61 have been
responded to and three have been put on hold and the clock stopped as
185
further clarity of the request is required. All completed responses were
responded to within the statutory 20 working day timescale with no
breaches.
44.15.2
One full exemption and one part exemption have been applied. A Section
22 exemption was applied as the information was intended for future
publication. The Section 12 exemption was applied as the work would
exceed appropriate time limits.
44.15.3
There have been 84 FOI requests up to 29 July 2015. 65 have been
completed, three are on hold and 16 are in progress. All completed
responses were within the statutory 20 work day timescale with no
breaches.
44.15.4
There have been no Subject Access Requests (SARs) from patients or
staff during Qtr 1.
44.15.5
ST CCG is using version 13 of the IG Toolkit which was released in June
2015. The CCG attained a robust level 2 in version 12 in all requirements
and will maintain the level 3s gained last year and gain some additional
level 3s which are to be determined. Minor amendments had been made
to version 13 of the Toolkit which related to the use of personal
information, confidential personal information, and confidentiality audit
procedures.
44.15.6
Monthly meetings are held between the Governance Officer (IG) and the
CCG to review progress of the toolkit. An evidence log is produced after
each meeting. The deadline for submission of the current Toolkit is 31
March 2016.
44.15.7
There was one IG incident reported which has already been discussed.
44.15.8
As at 30 June 2015 only 6% of CCG staff had completed their mandatory
IG training. The remainder of staff must complete this within the financial
year. Mr Brunskill asked that actual numbers be included as well as
percentages to give greater clarification.
44.16
Communication and Engagement
The activity undertaken within the period was listed.
44.17
Research & Development
The KPI 1 for South Tees CCG was 100% (target 80%)
44.18
Mr Gregory noted that the new format gave a much improved report.
The Governance & Risk Committee NOTED the Governance
Assurance Report.
186
GR/45/15
Information Governance Annual Report 2014-15
Reflection on Performance of IG for last year.
45.1
Self-Assessment
The CCG completed an IG Toolkit self-assessment in March with a score
of 71% (Satisfactory) which was a 3% improvement of the previous year.
45.2
Audit
The CCG Toolkit for 2014-15 was audited and significant assurance was
obtained. This will be undertaken annually and there will be a further audit
in Qtr 4.
45.3
Training
As at 31 March 2015 100% of CCG staff had completed IG training.
45.4
Freedom of Information (FOI) requests
 FOI requests had increased on the previous year (231 cf 184, an
increase of 46). Mr Brunskill suggested that a general election year
tends to have an impact. Mr Gregory noted that the very large projects
undertaken by the CCG had generated their own requests. Mrs
Cotterill pointed out there was a large number of requests relating to
procurement.
 There was one Subject Access Request (SAR) in the IG Team and 13
SARs received by the CHC Team.
45.5
Key Performance Indicators (KPIs)
 KPIs have been processed consistently throughout the year.
 No information risks were reported during the year but there was one
IG incident which was dealt with appropriately and guidance
documents were now in place.
 There were no serious incidents through the year.
45.6
45.6
Reporting
A quarterly Assurance Report is presented to the Governance & Risk
Committee.
Summary
The CCG has developed its Information Governance Framework
throughout the year. Highlights include:
 Level 2 Satisfactory performance in the IG Toolkit
 100% compliance with FOI requests
 100% compliance with Subject Access Requests
 100% staff trained in Information Governance
The Governance & Risk Committee NOTED the Information
Governance Annual Report for 2014-15.
187
GR/46/15
Duty to Consult Report
46.1
To be deferred to the next meeting
The Governance & Risk Committee NOTED that the Duty to Consult
Report was deferred.
GR/47/15
Legislation Review
47.1
Mrs Cotterill advised the meeting that new regulations pertaining to the
Health & Social Care Act 2015 come into effect on 1 October 2015. This
imposes a new duty to use a patient’s NHS number as a consistent
identifier when sharing information with other organisations directly
involved in that patient’s care and treatment.
47.2
National guidance would be available in September but it seemed to
relate to those who provide direct care. Mr Gregory wondered whether
GPs and Social Workers could share the information. Mrs Cotterill replied
that they could if they were involved in direct health care. It was only
those across the health and social care spectrum who could share the
information for the purpose of providing health and social care. Mrs
Cotterill advised that this went some way to alleviate issues but further
national guidance from NHSE would be available.
The Governance & Risk Committee NOTED the Legislation Review
Update.
GR/48/15
Any Other Business
There was no other business to discuss.
GR/49/15
Date and Time of Next Committee
The next Governance & Risk Committee will be held on Wednesday 11
November 2015 at 2.00pm-4.00pm at North Ormesby Health Village.
The meeting closed at 3.45 pm
Signed: ___________________________________
David Brunskill
Acting Chair of the Governing Body
Date: __________________
188

Governing Body - NHS South Tees CCG

Transcription

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