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Transcription

jbr staffing

Enc 00
Cannock Chase CCG Governing Body Meeting (in public)
to be held on Thursday 6th November 2014 14:00 – 16:30
Aquarius Ballroom, Victoria Shopping Park, Hednesford,
WS12 1BT
AGENDA
A=Approval R=Ratification D=Discussion I=Information
Enc
Lead
A/R/D/I
JM
I
1.
Welcome by the Chairman
Verbal
2.
Apologies for Absence
Verbal
JM
I
3.
Declaration of Conflicts of Interests
Enc 01
JM
I
4.
Glossary of Terms
Enc 02
JM
I
5.
Minutes of the meeting held on 4th September
2014
Enc 03
JM
A
6.
Action List
Enc 04
JM
A
7.
Cannock Chase Hospital, Minor Injuries Unit
(MIU) Consultation Feedback
Enc 05
LM/MH
A
8.
Quality Impact Assessment – Minor Injuries
Unit
Enc 06
VJ
I
To follow
9.
Personal Health Budgets
Enc 07
RL
A
10.
Medicines Waste Campaign
Enc 08
LM
A
11.
NHS Health Checks (NHSHC) in Cannock
Chase CCG 2013/14
Enc 09
David
Sugden,
Public
Health
I
Enc 00
Enc
Lead
A/R/D/I
12.
Human Resources Policies
Enc 10
SY
R
13.
Chair’s Report
Verbal
JM
I
14.
Quality Report
Enc 11
VJ
D/I
15.
Performance Report
Enc 12
RL
D/I
16.
Finance Report
Enc 13
PS
D/I
17.
Chief Officer Report
Verbal
AD
I
18.
Items for information
Audit Committee Minutes 13th August 2014
Enc 14
NC
I
Finance, Performance & Contracting Minutes
Enc 15
PS
I
Communications & Engagement Committee
Minutes 16th July 2014
Enc 16
PG
I
19.
Any Other Business
Verbal
All
I
20.
Questions from members of the public
Verbal
All
I
Date of Next Meeting to be held in public:
Thursday 5th February 2015 (14:00 – 16:30)
The Aquarius Ballroom, Hednesford
Item: 03 Enc: 01
Declarations of Interest Register for
Cannock Chase Governing Body
Name
Position/Role
Designation
Dr Johnny McMahon
Date of
Declaration
01.09.2014
Chair
GP
Cannock Chase
CCG
Newhall Street
Surgery
Dr Tim Berriman
16.07.2014
GP
Red Lion Surgery
Dr Murray Campbell
30.08.2014
GP
Newhall Street
Dr Mohammed Huda
01.07.2013
GP
Aelfgar Surgery
Dr Anna Onabolu
06.05.2014
GP
Nile Practice
Neil Chambers
31.03.2014
Lay Member for
Governance
CC & SaS CCG
02 July 2014
Potential or actual area where interest
could occur
Director Fransen Investments Ltd
Partner at Newhall Street Practice
Spouse Nurse Director at Dudley Group of
Hospitals
Shareholder - Astra Zeneca
Shareholder - Galaxo Smith Klein
Shareholder Cache Box TU Ltd - Maternity
& Children's Watershed Secute
Chippawa LLP (Member) North America
Partner in MIDISIE (a pan European Breast
Screening Project using innovative nonmolecular technology)
Shareholder Run3D based at Nuffield
Orthopaedic Centre, Oxford
Cambridge Cognition Holdings plc
TrialReach Ltd
Step-son Mental Health Nurse SSOTP,
Tamworth
Step-daughter District Nurse SSOTP,
Cannock
Practice registered in GP First
Berrifree Limited
Spouse works for SSSFHT Trust
GP First
Red Lion Surgery
Partner - Newhall Street Surgery
Sessional Employment NHS England Offender Health
Practice Member GP First
GP Appraiser
Partner Aelfgar Surgery
Practice registered with GP First
Partner at Nile Practice
Practice Member GP First
President of Lions Club International,
Castle Bromwich (not related to NHS
Contracts)
Working across both CCGs.
Non Exec Board Member Wyre Forest
Community Housing Group
Page | 1
Item: 03 Enc: 01
Paul Gallagher
18.03.2014
Lay Member for
PPI
Cannock Chase
CCG
Chair IFR (individual funding request)
Chair NHS England Performers List
Decision Panel
Janet Toplis
04.10.2013
Lay Member
(Non Statutory)
Cannock Chase
CCG
Vice Chair of Adoption Panel for Walsall
Borough Council
Paul Woodhead
30.10.2014
Lay Member
(Non Statutory)
Cannock Chase
CCG
PEW Consultancy Limited
Practitioner – Tutor De Montfort
University Faculty of Health & Life Sciences
Chair of Governors, St Peter’s C of E (VC)
Primary School, Hednesford
Consultant through PEW Consultancy
engaged by Staffordshire County Council
via Entrust
Support Services Ltd to support Governor
Development within the County
PEW Consultant Ltd also engages in
Environmental & Waste Consultancy
Services for a private client base
principally through Albion Environmental
Ltd
Parent Governor Representation of
Staffordshire County Council – Prosperous
Staffordshire Select Committee
Member Staffs School Forum
Presenter on Cannock Radio
Paul Simpson
06.10.2014
CC & SaS CCG
Andrew Donald
17.03.2014
Director of
Finance
Chief Officer
CC & SaS CCG
Working across both CCGs
Spouse - Chief Operating Officer North
division Staffordshire & Stoke on Trent
Partnership Trust.
Val Jones
24.03.2014
Director Quality
& Safety/ Chief
Nurse
CC & SaS CCG
Non- voting – In attendance
Lynn Millar
18.03.2014
Head of Strategic
Change
CC & SaS CCG
Tim Rideout
22.04.2014
Director of
Transition
CC & SaS CCG
MD/Owner, Tim Rideout Ltd
Director, Hazel Court Management
Company
Chair of Governors, Reepham Primary
School
Acting Chair of Governors, Ellison Boulters
Academy
02 July 2014
Page | 2
Item: 03 Enc: 01
Name
Position/Role
Designation
Sally Young
Date of
Declaration
15.04.2014
Head of
Governance
CC & SaS CCG
Potential or actual area where interest
could occur
Alex Bennett
22.07.2013
Director of
Delivery
CC & SaS CCG
Tamsin Carr
15.04.2014
Adele Edmondson
09.04.2014
Locality
CSU
Communications
& Engagement
Lead
Communications CC & SaS CCG
& Engagement
Manager
02 July 2014
Work for the CSU
Work across both CCGs
Freelance as a newsreader at Signal Radio
Page | 3
Acronyms
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
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45.
46.
47.
48.
49.
50.
A&E
ALE
AED
ADP
AHP
ALAN
ALOS
ANNP
APMS
AQP
BCH
BEN
CAG
CAMHS
CAS
CBSA
CC
CCG
CGA
CHAI
CHI
CHPP
CIAMs
CIG
CIP
CNST
CoE
COPD
CPN
CQC
CQR
CQUIn
CQINS
CMT
CRT
CSIP
CSW
CWG
DC
DCC
DES
DIPC
DN
DoH
DoLs
DPD
DPP
DQF
DRS
DTC
Accident & Emergency
Auditors Local Evaluation
Automated External Defibrillator
Accelerated Development Programme
Allied Health Professional
Adult Literacy and Numeracy
Average Length of Stay
Advanced Neonatal Nurse Practitioner
Alternative Provider Medical Services
Any Qualified Provider
Birmingham Children’s Hospital
Birmingham East and North PCT
Commissioning Advisory Group
Children and Adolescent Mental Health Service
Clinical Assessment Service
Commissioning Business Support Agency
Cannock Chase
Clinical Consortia Group
Comprehensive Geriatric Assessment
Commission for Health Auditing Inspection
Commission for health Improvement
Children’s Health Promotion Programme
Commissioning Investment Asset Management Strategy
Clinical Informatics Group
Cost Improvement Programme
Clinical Negligence Scheme for Trusts
Care of the Elderly
Chronic Obstructive Pulmonary Disease
Community Psychiatrist Nurse
Care Quality Commission
Care Quality Review Meetings
Commissioning for Quality and Innovation
Cancer Quality Improvement Network System
Contract Management Team
Crisis Response Team
Clinical Services Implementation Programme
Clinical Support Worker
Clinical Working Group
Day Care
Direct Clinical Care
Direct Enhanced Service
Director of Infection Prevention & Control
District Nurse
Department of Health
Deprivation of Liberty Standards
Dental Practice Division
Developing Patient Partnerships
Data Quality Facilitator
Dental Reference Service
Delayed Transfer of Care
51.
52.
53.
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101.
EAU
ECDL
ECIST
EDD
EL
EMS
ENT
ESR
EWISS
EWTD
FE
FIG
FIMS
FIT
FET
FNOF
F&P
GAAP
GDC
GDS
GMS
GPWSI
GSF
HALO
HCC
HCIA
HEFCE
HEFT
HIS
HPA
HPS
HPSS
HRG4
HROD
HSJ
IFRS
IP
IPC
IPR
ISA
ITT
IV
IWL
JCI
JCU
JSP
KPI’S
LAA
LCCB
LCP
LDP
Emergency Admissions Unit
European Computer Driving Licence
Emergency Care Intensive Support Team
Expected Discharge Date
Elective
Escalation Management System
Ear Nose Throat
Electronic Staff Record
Emotional Well Being in Stafford & Surrounds
European Working Time Directive
Frail Elderly
Financial Improvement Group
Financial Information Management System
Funding Individual Treatment – now FET
Funding Exceptional Treatment
Fractured Neck of Femur
Finance and Performance
Generally Accepted Accounting Principles
General Dental Council
General Dental Services
General Medical Services (Practice)
GP with special interest
Gold Standard Framework
Hospital Ambulance Liaison Officer
Healthcare Commission
Healthcare Acquired Infection
Higher Education Funding Council for England
Heart of England Foundation Trust
Health Informatics Service
Health Protection Agency
Health promoting Schools
Health promoting Schools Scheme
Healthcare Resource Group 4
Human Resources Organisational Development
Health Service Journal
International Financial Reporting Systems
Inpatients
Infection Prevention & Control
Individual Performance Review
Intermediate Support Assistant
Invite to Tender
Intravenous Therapy
Improving Working Lives
Joint Clinical Investigation
Joint Commissioning Unit (SCC)
Joint Staff Partnership
Key Performance Indicators
Local Area Agreement
Local Collaborative Commissioning Boards
Liverpool Care Pathway
Local Delivery Plan
102.
103.
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152.
LES
LH
LHE
LIN
LINks
LMC
LMS
LOC
LSC
LSP
LTC
LTFM
MAU
MAT
MDT
MFCA
MHRA
MICOT
MLU
MORI
MOI
MPIG
MSFT
MUR
NCAS
NCB
NCT
NEL
NES
NICE
NHSU
NRPSI
NTDA
OBD
OOH
OP (D)
OT
PA
PAED
PALS
PASS
PAU
PBC
PBR
PC
PCR
PCT
PCTDS
PEAT
PEC
PRF
Local Enhanced Service
Local Hospital
Local Health Economy
Local Intelligence Network
Local Involvement Networks
Local Medical Council
Local Medical Services
Local ophthalmic Committee
Learning Skills Council
Local Strategic Partnership
Long Term Conditions
Long Term Financial Model
Medical Assessment Unit
Maternity
Multidisciplinary Team
Multi Factorial Comprehensive Assessment
Medicines & Healthcare products Regulatory Agency
Minor Injuries Community Outreach Team
Midwife-led Unit
(Market & Opinion Research International)
Memorandum of Information
Medical Practice Income Guarantee
Mid Staffordshire Foundation Trust
Medicine Use Review
National Clinical Assessment Service
National Commissioning Board
National Childbirth Trust
Non-Elective
National Enhanced Service
National Institute for Clinical Excellence
NHS University
National Register of Public Service Interpreters
NHS Trust Development Authority
Occupied Bed Days
Out of Hours, also Out of Hospital
Outpatients (Department)
Occupational Therapist
Programmed Activities
Paediatrics
Patient Advice and Liaison Service
Professional Advice and Support Service
Paediatric Assessment Unit
Practice Based Commissioning
Payment By Results
Planned Care
Patient Charge Revenue
Primary Care Trust
PCT Dental Service
Patient Environment Action Team
Professional Executive Committee
Patient Report Form
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203.
PiP
PIP
PIS
PLT
PMO
PMS
POPP
PPI
PPV
PQQ
PRISM
PROMs
PT
PTL
PWSI
QIF
QIPP
QOF
RAG
RAG
RCA
RWHT
SALT
SARC
SCC
SCG
SCR
SCIO
SCBU
SCWP
SDB
SHA
SI
SIB
SIC
SLAM
SPA
SPEC
SSHLF
SSOTP
SSPAU
SSSHCFT
SUI
SUS
UCC
UDA
UHB
UHNS
UOA
VT
VFM
Partners in Paediatrics
Productivity Improvement Programme
Prescribing Incentive Scheme
Protected Learning Time
Programme Management Office
Personal Medical Services
Partnerships for Older People Projects
Patient and Public Involvement
Post Payment Verification
Pre Qualifying Questionnaire
Personnel Resource Information System for Management
Patient Related Outcome Measures
Physical Therapist
Patient Target List
Pharmacist with Special Interest
Quality Improvement Framework
Quality, innovation, productivity and prevention.
Quality and Outcomes Framework
Responsible Authorities Group
Red Amber Green
Root Cause Analysis
Royal Wolverhampton Hospital Trust
Speech & Language Therapist
Sexual Assaults Referrals Centre
Staffordshire County Council
Strategic Commissioning Group
Strategic Change Reserve
Staffordshire Consortium of Infrastructure Organisations
Special Care Baby Unit
Social Care Workforce Planning
Service Delivery Board
Strategic Health Authority
Serious Incident
Service Improvement Board
Statement of Internal Control
Service Level Agreement Model
Supporting Programmed Activities
Strategic Public Engagement Committee
South Staffordshire Health Libraries Federation
Staffordshire & Stoke on Trent Partnership Trust
Short Stay Paediatric Assessment Unit
South Staffs & Shropshire Healthcare Foundation Trust
Serious Untoward Incident
Secondary User Services
Urgent Care Centre
Units of Dental Activity
University Hospital Birmingham
University Hospital North Staffordshire
Units of Orthodontic Activity
Vocational Trainee
Value for Money
204.
205.
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207.
208.
209.
VO
WIC
WCC
WMQRS
WMSCG
WTE
Variation Order
Walk in Centre
World Class Commissioning
West Midlands Quality Review Service
West Midlands Strategic Commissioning Group
Whole Time Equivalent
Item: 05 Enc: 03
Cannock Chase CCG Governing Body Meeting
Thursday 4 September 2014
2.00 pm – 4.30 pm
Aquarius Suite, The Aquarius Ballroom and Banqueting Suite,
Victoria Shopping Park, Hednesford, WS12 1BT
Present
Johnny McMahon (JM)
Dr Tim Berrimen
Jacqueline Brown (JBr)
Neil Chambers (NC)
Andrew Donald (AD)
Paul Gallagher (PG)
Dr Mohammed Huda (MH)
Val Jones (VJ)
Dr Anna Onnabolu (AO)
Paul Woodhead (PW)
Chair – CCG Chair, Cannock Chase
Clinical Lead
Director of Finance
Lay Member
Chief Officer
Lay Member
Clinical Lead
Director of Quality & Safety and Chief Nurse
Clinical Lead
Lay Member
In attendance
Jonathan Bletcher (JBl)
Adele Edmondson (AE)
Claire McHugh (CLM)
Lynn Millar (LM)
Sally Young (SY)
Director of Strategy and Transformation
Communications and Engagement Manager
Executive Assistant – Minute Taker
Head of Primary Care
Head of Governance
Action
1.
Welcome
JM welcomed attendees and the members of public attending. JM
confirmed the meeting time as actually 2.00 pm – 4.30 pm, not 5.00 pm
shown on the agenda.
JM informed the meeting that AD would be joining the meeting following
his attendance at Local Transition Board (LTB).
2.
Apologies
Alex Bennett (AB)
Dr Murray Campbell (MC)
Dr Peter Gregory (PG)
Jan Toplis (JT)
3.
Declaration of Interest
Action
All Governing Body Members confirmed no conflict of interest in relation to
items on the Agenda, however, conflict of interest was noted for all GPs
should GP First related items arise.
4.
Glossary of Terms
The Glossary of Terms was noted for information by the Governing Body
and members of the public.
5.
Minutes of the Meeting held on 3 July 2014
The Committee considered the minutes and the following was noted:
Page 4: Item 8 – Primary Care Strategy
Committee expressed concern about item relating to reduction in the
number of practices. Minutes should be amended to show that it is the
consideration of the CCG that practices will reduce from 27 to 20 in
coming years. This is not a directive and needs further consideration.
Page 3: Item 7 – Staffordshire and Stoke on Trent Five Year Strategic Plan
AO drew the Committee’s attention to the paragraph:
“Discussions were held in relation to improving the approach to
prevention and further engagement with Staffordshire Public Health
to identify areas for improvement will be required.”
JBl explained that there should be engagement between Staffordshire
Public Health and the Borough Councils. AO asked if there should be an
action associated with this element of the minutes and JM confirmed that
this is part of the Five Year Plan and consequently not an action for this
Meeting.
The minutes of the last meeting were noted as a true and accurate record
subject to the appropriate clarification to Item 8 detailed above.
Action:
6.
Revise minutes of 03/07/2014 and record as approved.
CLM
Actions
SY identified that actions within the minutes had not been included on the
Action List.
Action:
6.1
Copy all actions from 03.07.2014 to Action List
CLM
Actions were reviewed and updated. SY asked members to ensure that
2
Action
they identify if an item is ‘complete’ to ensure that things do not remain on
the Action List.
7.
Board Assurance Framework (BAF)
SY explained that the BAF will be presented at the next GB when she has
had opportunity to discuss with the individual Directors because there is
further work to be done. JM asked if this could be shared prior to the GB
to enable members to give due thought and consideration to the BAF. SY
suggested that the BAF should be issued prior to the GB papers.
Action:
SY share BAF with GB at least two weeks prior to the
GB
SY
PG wanted to congratulate the CCG on the quality of the work that has
been/is being done to produce the document. NC reiterated by explaining
that it could have been brought to GB some time ago but it would not have
been good use of the GB time to present the document in its raw state.
NC wanted to assure Members that the risks are still being managed whilst
the BAF is being produced.
PW added that Audit Committee would welcome the opportunity to review
this and JM/SY agreed that the document should be a ‘live’ document. NC
explained that Executive Directors will be called to account with regard to
the BAF.
8.
Chairs Report
8.1
Primary Care Strategy (PCS)
Networks described in the PCS are now in place and they will be meeting
in October 2014. Some networks are progressing more quickly than
others.
As expected, there was concern from Members regarding the suggestion
of a reduction from 27 to 20 practices.
There is a strategy to go to one computer system, this will enable practices
to support each other. Work is being done to establish what hardware is
needed.
8.2
Secondary Care Consultant
An advert has been placed for one Consultant for each CCG, and there
has been some interest registered. This role will be especially useful in
working with RWT.
8.3
Dissolution of MSFT
This takes effect 01/11/2014 and JM believes that this will be a very
3
Action
difficult time. AD is meeting weekly with Comms colleagues from all
involved Trusts and partners to ensure that information to patients is
consistent and accurate. This meeting will be Chaired by a member of
NHS England who is experienced in this field. JM suggested that AD will
report on this within his Agenda item.
TB asked if there is any value to inviting Wolverhampton GPs/Consultants
to meet with Cannock Chase GP/Consultants.
JM confirmed to NC that the reduction of practices is not within the CCG
legal powers to undertake. JM also explained that although there are
contracts in place it is the decision of the Membership Board to make any
reductions.
AO reiterated that this is not about patients and asked to note that there is
no evidence that larger practices are better for patients. NC clarified that
this is about the work needed to improve practices for patients.
JM talked about the Local Medical Committee (LMC) and explained their
role to those present. JM suggested to the LMC that they should
encourage Members input to decision making.
9.
Quality Report
VJ presented her report assuming that members had digested the content
previously and highlighted key points within the report. VJ reported that
since the report, some areas have improved.
JM identified that in Q4 Assurance Cancer was highlighted as an issue
and it appears that this has not improved.
JM asked about the Ambulance diverts and whether there is any
performance improvement. JBl explained that the diverts started mid July
2014 and so figures are not yet available regarding this. More resources
are being put in, however, there needs to be capacity to accommodate the
increased resources ie, staffing.
JBr asked VJ about MSFT recruiting issues and how much of the
performance issues are relative to the staffing issues. VJ agreed that the
fragility of the staffing at the Trust will affect performance and will be more
acute as the transition date approaches. Staffing levels are being
monitored on a daily basis. New national standards for transparency
require the Trusts to display wards staffing levels and this is being
implemented at MSFT. In addition there is national benchmarking for each
Trust on the numbers and skill mix and acuity of patients.
Complaints and incidents at MSFT have reduced and part of this is due to
the fact that Ward 11 is now closed. Some complaints previously were
4
Action
related to the capacity issues where staff did not feel they had the time to
speak with patients.
VJ reassured TB where RWT and UNHS are recruiting overseas nurses
which is happening across the country there is a verification process to
ensure that staff have the requisite qualifications and skills. This is
generally a shared responsibility between the recruiting Trust and the
NMC. There is also an extensive orientation/induction process where the
overseas nurses are also subject to supervision regimes to monitor
competency.
PG asked for clarification regarding the figures for Friends and Family Test
because the information was not available at the CCG Joint Quality
Meeting in the previous week. He understood that Walsall had not held a
CQRM in either July or August and was concerned that this would affect
the level of assurance for the GB. VJ responded that Walsall have not
missed or cancelled July or August CQRM however RWT did cancel
August due to number of apologies.
Action:
VJ to provide up to date FFT figures for RWT and WHT
for the next meeting.
VJ
VJ informed the meeting that the CCG transition process for MSFT
services included a transitional CQRM from November 2014 until March
2015 for each of the receiving Trusts which would be attend respectively
by representation from RWT and UNHS. This would involve meeting with
the lead CCGs for each provider to agree commissioner priorities and
actions in relation to the providers. The proposal for Cannock CCG to lead
on the associate commissioning for RWT for all the South CCGs will
provide a stronger negotiating position.
Action:
VJ to provide a paper to the GB on role of CCG in the
assurance process for the transition of services for
MSFT to RWT and UHNS.
VJ
TB queried the fact that UHNS have not any reported pressure ulcers
(PUs) for more than two months. VJ confirmed this and reminded
Members that only Grade 3 & 4 PUs are reportable as serious incidents.
TB asked whether this was a recording error and VJ suggested that it is
more probable that this is due to good detection of PU rusk. Early
identification at Grade 2 should prevent them escalating to a Grade 3 or 4.
Action:
VJ to confirm reporting of pressure ulcers from UHNS
at the December meeting
VJ
NC talked to Members about a recent visit conducted with HealthWatch
which encountered difficulties. It appeared that HealthWatch had an
agenda for the visits. VJ is aware of this visit and is aware of this
previously.
5
Action
Action:
VJ to liaise with Health Watch regarding future visits
VJ
JM reiterated concern regarding RWT and whether they would commit to a
transitional CQRM and JBl explained that he is in discussion with key
members.
JM identified that the RWT/WHT breakdown of complaints is by hospitals
whereas MSFT also provide a breakdown by Wards, which is more helpful.
Action:
10.
VJ to explore the possibility of complaints from
RWT/WHT to also include in addition to the global
numbers break down by Ward.
Performance Report
JBl presented the report on behalf of AB. Effort is being focused around
the performance of Cancer 62 day wait and Ambulance Services.
JBl believes that Urology is a problem across the CCGs ie, not isolated to
CC and Stafford & Surrounds. JM highlighted the importance of this issue,
but does not want to duplicate. Problems relating to this should be
addressed through performance to identify what the problems are.
Secondary Care Consultants have to refer to tertiary services within 42
days but this is not happening. Late onward referral is also affected by
patient choice. JM identified that following the dissolution, referrals will
potentially be made ‘in-house’. JBl confirmed to AO that more information
will be reported to GB next month.
Action:
Full cancer report regarding referrals to be brought to
next GB if there is not board assurance.
AB
Ambulances
An additional 4% growth has been invested in the contract but this has
been surpassed to 9%. There will be a re-established commissioning
group for West Midlands Ambulance Service (WMAS) and there will be a
shift from service improvement to performance improvement. An Action
Plan is required during September 2014 and JBl recommends that Quality
is represented at that meeting. There continues to be deterioration in Red
1.
PW reported that AB presented to Finance, Performance and Contracts
Committee (FPC) in August and this is an active agenda item which she
will report on and FPC will monitor.
6
Action
JBr informed that additional monies were funded around the closure of
A&E and the diverts to assist the service. She expressed concern that
continued investment is not necessarily improving the service. JM
suggested that more consideration needs to be given about options for the
future and whether the service need to be delivered in a different way.
JBl key message is that since Quarter 1 performance has not improved
and the CCQ are increasing their monitoring of this. NC asked how many
Ambulances service Staffordshire and whether this is part of the problem.
Action:
Establish how many Ambulances are in service
AB
11.
Finance Report
JBr presented the report.
JBr sought approval for additional costs regarding the dissolution of MSFT.
This is the cost relating to the closure of some contracts against other
contracts, there is currently no budget but JBr identified that the risk
associated with not approving this cost is greater than if it is not approved.
John Doyle, Director of Finance – MSFT, has been informed that the cost
will be assigned to him.
JBr informed NC that some of the costs relate to CSU costs, amongst
others and JBr confirmed to NC that there is an indication that funds will be
made available from other sources for these extra-ordinary costs that are
being incurred. This is the first occasion when a Foundation Trust has
been dissolved and there is no precedent for the costs involved.
JBr explained to TB that from 01/11/2014, the budgets allocated to MSFT
will be reassigned to UHNS and RWT appropriately.
NC left the meeting
The Members approved the additional budgets for transition costs.
12.
Chief Officer Report
JM presented the report for AD in his absence.
Mid Staffordshire NHS Foundation Trust (MSFT)
AD’s role will be key to the transition and JM reiterated the importance of
the Communications being done effectively.
NC returned to the meeting
7
Action
Local Transition Board (LTB)
AD/JM attended LTB earlier and have informed by LTB that the Stemming
the Flow/Winter Monies is not available. AD/JM have informed LTB that
the CCG are not willing to finance this.
15:48 AD joined the meeting
Work is now undergoing for the dissolution of MSFT. There is a lot of work
that must take place by 26/09/2014. It has been agreed today that a
meeting will take place on 10/09/2014 that AD and JBr will be required to
attend.
Discussion followed regarding new ways of working and the meeting were
informed that more money will need to be invested in community services
to facilitate the reduction in beds.
AO asked for reassurance that the LTB have considered the risk of the
dissolution taking place over the critical months of November-January,
historically difficult months. AD explained that it is the responsibility of the
CCG to carry out Quality Impact Assessments.
JM asked AD to update regarding the Communications meeting that he
had attended. This has not previously been the responsibility of the CCG,
however, AD was asked to bring Communications leads from all partners
involved and today the Trust Development Authority have joined the
meeting. There is now a very clear narrative around communications
relating to services and patients, and a shared strategy to prevent
situations such as the news around obstetrics that was not effectively
communicated recently.
It is clear what Cannock GPs want and it has been agreed that PALs will
co-ordinate communications to patients in this area, particularly for
gastroenterology and neurology.
JM suggested that blogs are produced that are shared with GP surgeries
so that it can be displayed on their live noticeboards. AO expressed
concern regarding patients who do not have access to the internet and AD
explained that it has been agreed that there will be a leaflet drop to all
households.
PG expressed concern that surgeries are not sharing information eg,
recent communication was not shared with patients from GP practices.
AD said that communication has not been good and that there are some
good things happening that are not being shared eg, Cannock Hospital are
providing excellent services and this is not being shared.
AD said that consistent messages need to be shared with the public, 7,000
patients who will be affected by the change, GPs, staff within providers
plus significant others such as MPs, Councillors etc.
8
Action
JBr recommended that different routes are considered such as posters in
public places such as hairdressers, bill boards etc.
13.
Items for Information
13.1
Finance, Performance and Contracts Committee Minutes – 12/06/2014
NC asked for an update of QIPP, particularly in light of the Q1 Assurance
taking place on 05/09/2014. PW identified that this may be necessary to
bring to the November 2014 GB.
Action:
PW to bring QIPP update to November 2014 GB
13.2
Communications & Engagement
SY explained that at the September 2014 meeting, there will be a review of
how C&E will move forward
13.3
Joint Quality Committee
AD highlighted that the CQRM will handle the legacy of the transition.
14.
Any Other Business
14.1
Scheme of Delegation
SY informed the meeting that the Scheme of Delegation has been
updated.
Agenda Item 06/11/2014
14.2
Scheme of Delegation
PW
SY
Minor Injuries Unit (MIU) Consultation
There will need to be a formal session as part of the October GB.
Agenda Item 02/10/2014
MIU Consultation
14.3
Extra-Ordinary Governing Body
There will be a meeting w/c 22/09/2014 and must be quorate. CLM asked
if quoracy can be achieved with some members allowed to dial in.
17.
Questions from Members of the Public
LM
Questions from members of the public are recorded by Communications
Team.
18.
Next Meeting
The next meeting ‘in public’ will be:
9
Action
Date:
Time:
Venue:
Thursday 6 November 2014
2.00 pm – 4.00 pm
4.00 pm – 4.30 pm – public questions
The Aquarius Room, Aquarius Ballroom and
Banqueting Suite, Victoria Shopping Park, Hednesford
WS12 1BT
10
Item: 06 Enc: 04
Cannock Chase Clinical Commissioning Group
Governing Body Meeting
ACTION LIST
Date
Raised
Action
5.
Minutes of the
Meeting held on 3
July 2014
04.09.14
Revise minutes of 03/07/2014 and record as
approved.
CLM
06.11.14
6.
04.09.14
Copy all actions from 03.07.2014 to Action List
CLM
02.10.14
04.09.14
SY share BAF with GB at least two weeks prior
to the GB
SY
23.10.14
04.09.14
VJ to provide up to date FFT figures for RWT
and WHT for the next meeting.
VJ
06.11.14
VJ
4.12.14
VJ
4.12.14
Agenda Item
Required by
Date Due
Comments/Actions
Actions from 04.09.14
Actions
7.
Board
Assurance
Framework (BAF)
9.
Quality Report
9.
Quality Report
04.09.14
VJ to provide a paper to the GB on role of CCG
in the assurance process for the transition of
services for MSFT to RWT and UHNS.
9.
Quality Report
04.09.14
VJ to confirm reporting of pressure ulcers from
UHNS at the December meeting
04.09.14
VJ to liaise with Health Watch regarding future
visits
9.
Quality Report
VJ
06.11.14
06.11.14 COMPLETE
Item 8 – Primary Care Strategy
amended accordingly.
06.11.14 COMPLETE
All actions transferred from
minutes of 03.07.14
Further work on the document
following Audit Committee, SY
to meet NC.
29.10.14 COMPLETE figures
are in this month’s quality
report.
29.10.14 Jan Sensier has been
contacted in regards to visits to
the SAS site.
Page 1 of 4
Item: 06 Enc: 04
Agenda Item
9.
Quality Report
10.
Performance
Report
10.
Performance
Report
13.
Items
for
Information – FPC
Minutes 12/06/2014
Date
Raised
04.09.14
Action
VJ to explore the possibility of complaints from
RWT/WHT to also include in addition
to the global numbers break down by Ward.
Required by
VJ
04.09.14
Full cancer report regarding referrals to be
brought to next GB if there is not board
assurance.
AB
04.09.14
Establish how many Ambulances are in service
AB
04.09.14
PW to bring QIPP update to November 2014 GB
PW
Date Due
Comments/Actions
4.12.14
06.11.14 COMPLETE
RWHT will provide data and a
full report to be submitted at
November GB
AB contacted WMAS for
information
06.11.14
Actions from 03.07.14
6.0
Matters Arising
– 17.0 AOB 16.03.14
03.07.14
11.
03.07.14
Quality Report
12.
Performance
Report
14.
Risk Register –
Risk 62
14.
Risk Register MSFT
14.
Risk Register –
Review Dates
03.07.14
LM to discuss with JM to finalise arrangements
(informal session for public to meet with the GB
Members)
AD to clarify with VJ (RAG rating for Rowley
Hall)
JBl to identify waiting/order times for RWHT to
source replacement robot.
LM
04.09.14 This needs further
discussion.
AD/VJ
JBl
03.07.14
SY to obtain update and amend
SY
03.07.14
SY to update register for approval at EMT
SY
03.07.14
SY to obtain updates for the register and
distribute an e-mail to all staff highlighting the
requirement to amend review date.
SY
04.09.14 JBl reported
matter is ongoing
Page 2 of 4
this
Item: 06 Enc: 04
COMPLETED ACTIONS (completed actions will be removed the meeting following their completion)
Date
Raised
Action
03.07.14
JBl to obtain formal note from AB (regarding
changes to clinical pathways and GPs
requesting emergency admissions)
JBl
03.07.14
SY to amend Joint Quality Committee ToR to
include JT.
SY
04.09.14 COMPLETE
This forms part of ongoing
discussions and is not required
on the action list.
04.09.14 COMPLETE
The ToR has been revised
03.07.14
SY to remove Manjit Obhrai from the ToR as the
names Secondary Care Consultant.
SY
04.09.14 COMPLETE
The ToR has been revised
6.0
Matters
Arising/Action List
03.07.14
Jan Topliss to supply AB with additional
information re: RWHT Waiting Times, if required
outside Governing Body
JT VJ
04.09.14
6.0
Matters
Arising/Action List
03.07.14
SY to confirm dates and times of the RWHT
Board of Directors to be held in public in the
Cannock Chase area.
SY
04.09.14
PW highlighted that JT is recorded as having
ADMIN
04.09.14
Agenda Item
6.0
Matters Arising
– 7.0 Performance
Report – 03.04.13
9.
Committee
Terms of Reference
(ToR) - Revised
9.
Committee
Terms of Reference
(ToR) - Revised
5.0 Minutes of the
03.07.14
Required by
Date Due
Comments/Actions
04.09.14 COMPLETE
This matter will be pursued by
Joint Quality.
COMPLETE
04/09/14: SY will inform when
the Board Meeting ‘in public’ is
to take place.
01/09/14: Response received
from Adrian Sargent, Board
Secretary,
to
confirm
a
meeting is being arranged for
the autumn and the date is yet
to
be
released.
RWHT
welcome the attendance of
members
of
the public,
Governing
Body
and
Membership Board members.
04.09.14 - Complete as per
Page 3 of 4
Item: 06 Enc: 04
COMPLETED ACTIONS (completed actions will be removed the meeting following their completion)
Agenda Item
Meeting held on
01.05.14
Date
Raised
Action
given apologies and in attendance. JT confirmed
her attendance at the meeting held on the 1st
May 2014.
Required by
Date Due
Comments/Actions
action.
PW also queried whether Colin Groom, Deputy
Chief Finance Officer attended the meeting on
behalf of JBr and whether the minutes should
reflect this. The Governing Body agreed to the
above changes.
Page 4 of 4
Item No: 07 Enc: 05
REPORT TO THE Clinical Commissioning Group
TO BE HELD ON: Thursday 6th November 2014
Subject:
Proposal to reduce the hours of the Minor Injuries Unit
Board Lead:
Dr Mo Huda
Officer Lead:
Lynn Millar
Recommendation:
For
Approval

For
Ratification
For
Discussion
For
Information
PURPOSE OF THE REPORT:
•
•
•
•
•
•
To outline the proposal to reduce the hours of the Minor Injuries Unit in Cannock (MIU)
To detail the CCGs statutory requirements with regards to service reconfiguration
To describe the preferred option for change
To report the outcomes of the consultation exercise on the proposed change
To set out the learning and mitigating actions to the consultation
To outline recommendations and next steps
KEY POINTS:
• The CCG currently has a £9m financial deficit. The CCG has a duty to report under Section 19 of the
Audit Commission Act 1998 the breach in the revenue resource limit and to therefore act effectively,
efficiently and economically.
• Cannock Chase CCG has a statutory role for carrying out consultations in relation to proposed service
change.
• The CCG’s Disinvestment and Decommissioning Strategy outlines the need to review service provision
in order to ensure we commission high quality services that are cost effective and financially
sustainable. The MIU was one of the services identified for review with a view to delivering a £250,000
per annum saving.
• Four options have been considered:
1.
2.
3.
4.
Do nothing
Closure of the MIU
GP led MIU
Reduced opening times – preferred option
Page | 1
Item No: 07 Enc: 05
• The preferred option is to reduce the opening hours to 10.30am to 6.30pm to reflect when the highest
numbers of patients attend the Unit.
• The proposed reduction in hours have been led clinically and supported by the Cannock Chase
Membership Board.
• The preliminary Quality Impact Assessment demonstrates that overall the quality and safety impact of
reducing the MIU operation hours is very low.
• The 4 week consultation period was approved by the Healthy Staffordshire Select Committee on 11th
August 2014.
• The consultation ran from 1st September until 28th September.
• Responses to the proposed reduction in hours highlighted a number of key themes:
•
•
•
•
•
•
Access to GPs and appointments/GP recruitment
Signposting to services and knowing where to go/Communications and engagement with the public
and patients/Self-care and education
Additional pressures on A&E
Safety concerns
Efficacy of current GP Out of Hours service
MIU opening hours
• The CCG has listened to the public and has put actions in place now to ensure the quality of care is
maintained and there is minimal disruption to services.
Relevance to Key Goals
To reduce health inequalities across
Cannock Chase through targeted
interventions.
Yes, the Choose well campaign, primary care strategy
and the work to improve access to primary care aims to
reduce variation between practices
To identify and support patients with
Long Term Conditions to ensure care
delivery closer to home.
N/A
To improve and increase overall life
expectancy.
N/A
To develop integrated services with
simple, easy access.
Yes, the introduction of localities will improve access;
deliver better coordinated and integrated services.
Page | 2
Item No: 07 Enc: 05
Implications
Legal and/or Risk
Risk that the consultation process does not meet statutory requirements. However,
four ‘Lansley’ tests have been met in relation to service reconfiguration.
CQC
N/A
Patient Safety
Mitigating actions have been put in place to improve access in primary care.
Alternative services are in place 24/7 365 days per year for patients with an injury.
Patient Engagement
Four week consultation carried out as recommended by the Healthy Staffordshire
Select Committee Working Group and ratified by the full Healthy Staffordshire Select
Committee
Financial
The proposed reduction in hours of MIU delivers a QIPP saving to the CCG.
Sustainability
The proposed reduction in hours of MIU is deemed to be the most sustainable option
Workforce / Training
N/A
RECOMMENDATIONS / ACTION REQUIRED:
The CCG Governing Body is asked to:
1. Note the report and the response to the consultation.
2. Approve the recommendation in the case for change to reduce the hours of the MIU to 10.30am until
6.30pm from 1st December 2014 subject to the following:
•
•
•
•
•
The ‘Choose Well’ campaign is launched so all residents of Cannock Chase are able to make the
most appropriate choices when they are unwell.
Further focused engagement with parents and young adults is conducted.
Feedback to the Governing Body, demonstrating measures put in place to improve access in
primary care.
A robust monitoring process is put in place to ensure the reduction in hours does not have an
adverse impact on other services.
A review of progress and benefits is undertaken by the CCG at six and twelve months.
KEY REQUIREMENTS
Yes
Has a quality impact assessment been undertaken?
Y
Has an equality impact assessment been undertaken?
Y
No
Not
Applicable
Has a privacy impact assessment been completed ?
N/A
Have partners / public been involved in design?
N/A
Are partners / public involved in implementation?
Are partners / public involved in evaluation?
Y
N/A
Page | 3
Item: 07 Enc: 05
Outcome of the consultation on the proposals for changes to the
Cannock Minor Injuries Unit
1.0 Purpose
•
•
•
•
•
•
To outline the proposal to reduce the hours of the Minor Injuries Unit (MIU)in Cannock
To detail the Clinical Commissioning Group’s (CCG) statutory requirements with regards to
service reconfiguration
To describe the preferred option for change
To report the outcomes of the consultation exercise on the proposed change
To set out the learning and mitigating actions to the consultation
To outline recommendations and next steps
2.0 Statutory Requirements
Cannock Chase CCG currently has a £9m financial deficit. It has a duty to report, under Section
19 of the Audit Commission Act 1998, the breach in the revenue resource limit and, therefore, to
act effectively, efficiently and economically to pay back the cumulative deficit over the next 3 years.
On this basis, the CCG must put actions in place to deliver the agreed financial control total in
2014/15 and beyond.
Cannock Chase CCG has a statutory role for involving patients and the public in relation to
proposed service change. Section 242 of the NHS Act 2006 and Sections 13Q and 14Z of the
NHS Act 2006 (amended 2012) set out CCGs’ duty to involve the public in commissioning
decisions, including:
•
•
•
The planning of commissioning arrangements.
The development and consideration of proposals for changes in commissioning
arrangements where implementing the proposals would have an impact on the range or
manner of delivery of services.
Decisions affecting the operation of commissioning arrangements that, if implemented,
would have a significant impact as above.
The CCG has undertaken consultation concerning proposed changes to the Minor Injuries Unit.
The consultation process was approved by NHS England Shropshire and Staffordshire Area
Team.
This report demonstrates how the CCG has discharged its statutory responsibilities.
3.0 Background
Cannock Chase CCG’s Disinvestment and Decommissioning Strategy outlines the need to review
service provision in order to ensure we commission high quality services that are cost effective and
financially sustainable. The MIU was one of the services identified for review with a view to
delivering a £250,000 per annum saving.
The MIU was opened in 2006 at Cannock Chase Hospital and is provided by Staffordshire and
Stoke on Trent Partnership Trust (SSOTP). It is a nurse-led unit, open seven days a week, 365
days a year, from 8am until midnight.
1
Item: 07 Enc: 05
Members of Cannock Chase CCG attended Staffordshire County Council’s Healthy Staffordshire
Select Committee (HSSC) to present the CCG’s two-year Operational Plan in the context of the
organisation having a £9 million financial deficit. The CCG’s proposals were outlined to County
Councillors including the intention to decommission Cannock’s Minor Injuries Unit. At the request
of the HSSC, a workshop was held with members of the HSSC on 24th July 2014 to discuss the
review and the proposed options:
1.
2.
3.
4.
Do nothing
Closure of the MIU
GP led MIU
Reduced opening times – preferred option
On the 11th August, the HSSC agreed that the proposal to reduce the hours was deemed a service
change that required the CCG to undertake a four week public consultation exercise to gain the
views of other organisations, service users, carers and members of the public.
4.0 Four Tests for Service Reconfiguration
The previous Secretary of State for Health, Rt Hon Andrew Lansley MP, identified four key
tests for service change, which were designed to build confidence within the service, with
patients and communities. The tests were set out in the revised ‘NHS Operating Framework
for 2010-11’ and require existing and future reconfiguration proposals to demonstrate:
•
•
•
•
Support for change by local GP Commissioners
Plans are based on sound clinical evidence
Strong public and clinical engagement on any proposals
Promoting choice for patients
The four tests were assessed at the start of the consultation and have also been revisited to
ensure that the tests have been met:
4.1 Support for change by local GP Commissioners
The proposal to review MIU was debated by clinical leads at the Quality Improvement Productivity
and Prevention (QIPP) Delivery and Accountability workshop on 15th May 2014.
GP clinical leads and practice teams have been closely involved in the ongoing development of the
proposal and the consultation exercise, having weekly meetings and conference calls.
A local workshop was held on 10th June 2014, facilitated by the NHS Improving Quality Programme
and attended by practice managers, practice nurses and GPs from all localities in Cannock Chase,
along with CCG staff.
Cannock Chase CCG Membership Board is formed of a representative from each of the 27 GP
practices across the Cannock Chase area. The Board meets monthly to discuss the
commissioning of services to deliver better outcomes for patients. The Board has been fully
involved in the development of the proposals for the MIU in Cannock. The preferred option to
reduce opening hours was supported by the majority of member practices (26 out of 27) at the
Cannock Membership Board on 9th July 2014.
The Cannock Chase CCG Membership Board met on the 14th October 2014, where they were
informed of the findings of the public consultation with regards the proposed changes to MIU. The
Board discussed the feedback at length and a number of GPs raised concerns about the proposed
opening hours of 11am until 7pm. It was proposed that 10.30am until 6.30pm would provide a
better patient experience.
2
Item: 07 Enc: 05
4.2 Plans are based on sound clinical evidence
The proposals to reduce the hours of the MIU are based on a wide range of clinical and activity
data, including attendances by hour/day/month, diagnosis, demographic data, discharge outcome
and geographical location.
The plans for change have been led by GPs and shared with SSOTP who run the service to
ensure the assumptions around activity are sound.
As with any service transformation, the CCG Quality Team has completed a preliminary Quality
Impact Assessment (QIA) to understand the quality and safety implications of the proposal. The
QIA identifies that reducing the hours poses minimal clinical risk and affects a relatively low
number of people.
4.3 Strong public and clinical engagement on any proposals
Prior to the public consultation, the CCG engaged with a number of stakeholders. A ‘Quality
Improvement Productivity and Prevention (QIPP) Delivery and Accountability’ workshop was held
on 15th May 2014, where a range of clinical leaders and governing body members were present.
The Healthy Staffordshire Select Committee were informed from the early stages, including the
discussions regarding decommissioning the MIU and the subsequent changes to the plans for the
Unit, and approved the four week consultation on the CCG’s preferred option of reduced hours.
A patient survey was carried out in the MIU at Cannock Chase Hospital before the consultation
period began which aimed to seek patient views on current use of the service. The outcome of this
fed into the proposals for change at the Unit.
Further detail about actions taken by the CCG can be found at section 6.1.
The consultation process has demonstrated that there has been strong public and clinical
engagement on the proposals, for example through public attendance at engagement events, the
Governing Body and Annual General Meeting (AGM), media interest and petition.
The CCG has been committed to ensure the consultation was fully debated by the public and other
bodies and has been responsive to public feedback. For example, following public feedback, the
CCG provided an additional evening consultation session to give working adults in Cannock town
the opportunity to feed into the process. The public reported that they had heard about the
consultation largely through word of mouth and GP practices, therefore, the CCG paid for further
advertising in local media to ensure that events were widely circulated to the public.
The consultation has involved a wide range of interested parties including members of the public,
general practitioners (GPs), providers, Healthwatch, local authorities, Overview and Scrutiny
Committees, other statutory and voluntary sector organisations and local Members of Parliament.
4.4 Promoting choice for patients
The proposal to reduce the opening hours does not reduce service user choice during the opening
hours. Service users will continue to be able to access the MIU during the proposed new hours
and will have access to other services when the unit is closed, they may choose to self-care or
decide to wait until the unit is open to seek treatment for their minor injury. Patients with a minor
illness are not affected by the reduced hours as they will continue to have access to a GP in hours
as well as a GP out of hours service based in Cannock Hospital. Patients with more serious
injuries or acute illness will continue to be able to access A&E.
3
Item: 07 Enc: 05
5.0 Proposal for Change
After detailed consideration, it was proposed that the preferred option would be to reduce the
opening hours to 11am until 7pm but to maintain a 7 day service, 365 days per year (Option 4).
The proposal to reduce the opening hours were driven by the lower volume of patients that
attended the unit after 7pm (Table 1).
Table 1. Average Number of MIU attendances by hour of arrival
In addition, while the majority of patients attending the unit had a minor injury, data shows that up
to 40% of patients attended for a minor illness and could have been more appropriately treated by
a GP, pharmacist or managed at home caring for themselves.
In the 5 hours between 7pm and midnight, on average, only 6 people are seen for a minor injury.
This is not a cost-effective use of nursing time, particularly when others services are available
during this time.
The majority of patients currently attend the Unit between the hours of 9am and 7pm, however,
remaining open for that time would span more than one standard shift pattern and would therefore
incur higher costs and would be operationally difficult.
The option to include a GP in the MIU was withdrawn as it was felt that the nurse led model was
most appropriate to treat the identified cohort of patients and would not deliver the required
efficiency requirements.
On this basis, the preferred option would be to reduce the opening hours to 11am until 7pm,
covering one standard shift pattern when the majority of patients (62%) attend the Unit.
4
Item: 07 Enc: 05
5.1 Quality Impact Assessment (QIA) of the Proposed Reduction in opening Hours
A Quality Impact Assessment of the proposed reduction in opening hours of MIU has been carried
out by the CCG’s Director of Quality and Safety. The assessment demonstrates that overall the
quality and safety impact of reducing the MIU operation hours is very low. Each potential risk has a
planned mitigation and therefore a low residual risk score.
The low impact is centred on 2 facts:
1. The service is commissioned for MINOR injuries and therefore is not considered a high risk
service, clinically.
2. There are a range of services that can offer appropriate support to patients who would have
otherwise attended the MIU.
Assuming that the mitigations are enforced as planned, and the additional recommendations are
completed, there is no reason to believe that this service change will negatively affect the quality
and safety of care given to patients.
6.0 The Consultation Process
6.1 How we engaged with patients prior to the Consultation
The CCG uses a range of mechanisms to continually engage with patients and the public. This
ongoing engagement enables the CCG to understand some of the wider issues that matter to local
residents prior to any specific engagement activity.
In 2013, Cannock Chase CCG and Stafford and Surrounds CCG launched ‘Conversation
Staffordshire’ to get a clearer perspective of what the public would like to see from local health
services in the future. This was followed by a number of listening events in 2014 under the banner
of ‘A Call to Action’, which looked at how patients could be supported to help themselves and how
services delivered from different providers could be better integrated.
The consensus from these events was that people supported a drive towards more self-care and
prevention, with an increased focus on delivering more services in the community rather than in
hospital settings.
The CCG invites regular contributions from its network of Patient Participation Groups (PPGs) and
attends a range of community and voluntary sector organisations to update them on CCG activities
and any opportunities for them to feedback on specific projects or consultations.
The CCG Governing Body is held in public on a bi-monthly basis and MIU has generated
discussion in the public questions. Further debate regarding MIU was also had at the Cannock
Chase CCG AGM held on 4th September 2014.
In addition to monitoring clinical data, the CCG specifically sought feedback from people attending
the MIU at various times of day, to understand the reasons for patients attending and their
knowledge of alternatives places to seek treatment. The CCG surveyed nearly 200 patients at the
MIU prior to the consultation in order to understand why people chose to go to the Unit. The three
most common reasons were:
•
•
•
‘Closer to home’
‘Injury was only minor so most appropriate place’
‘Unable to get same day GP appointment’
5
Item: 07 Enc: 05
Patients attended for a variety of reasons including minor injuries and minor illness. 71% of
patients surveyed had considered or tried their GP prior to attending, highlighting the need to
ensure patients know where to go when they are unwell.
6.2 The Consultation
A consultation document was produced which outlined three options, including the preferred option
to reduce the opening hours of the MIU from 11am until 7pm (Option 4). The option of a GP-Led
unit (Option 3) was not included due to the decision to withdraw this option as explained in section
5.0. The consultation ran from the 1st September 2014 to the 28th September 2014 and prompted a
significant amount of debate.
Cannock Chase CCG has endeavored to ensure that all residents of Cannock Chase have had the
opportunity to comment on the proposals throughout the process. A number of responses were
received after the consultation period closed, however, the CCG wanted to seek as many views as
possible and so these have been included in the final evaluation.
The consultation revealed that there was limited feedback from the under 35 age group. The
activity data shows that this group is a high user of the MIU and therefore there will be a need for
further focused work with parents and younger adults.
The detailed comments and responses to the consultation have been compiled in a separate
report which is available to view at www.cannockchaseccg.nhs.uk. This report has been circulated
to Governing Body Members electronically for information.
6.3 Petition against the closure of MIU
On 29th September, a petition was submitted to the CCG containing circa 828 signatures against
Option 2 Closure of the MIU:
1. The petition asks specifically for signatures against the closure of the MIU.
2. The forms received clearly state that the petition has been led by a local political party.
In response, the CCG supports Option 4, the reduction in hours, as a more sustainable option.
7.0 Learning from the Consultation
The MIU Consultation Report compiled by Midlands and Lancashire Commissioning Support Unit
(MLCSU) identified a number of themes, they are:
•
•
•
•
•
•
Access to GPs and appointments/GP recruitment
Signposting to services and knowing where to go/Communications and engagement with
the public and patients/Self-care and education
Additional pressures on A&E
Safety Concerns
Efficacy of current GP Out of Hours service
MIU opening hours
The CCG has put measures in place to ensure that the quality of patient care is maintained.
These actions are described below:
7.1 Access to GPs and appointments/GP recruitment
Access to primary care has been a consistent theme throughout the consultation discussions.
However, Cannock Chase CCG performs well when compared to other CCGs nationally. The
latest National GP Survey highlights that 75% of patients in Cannock Chase are able to get an
appointment to see or speak to someone compared to 73% nationally. 48% are able to get a
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same day or next day appointment compared to 49% nationally. 48% of respondents found the
appointment offered ‘very convenient’ compared to 46% nationally.
We recognise that access to a GP can be variable across the Cannock Chase CCG area and that
access can be an issue in some practices. We have introduced a number of initiatives that are in
place now with the aim of increasing capacity in primary care.
•
•
•
•
•
•
•
•
•
•
Acute Visiting Service - providing urgent afternoon visits for patients unable to wait for a GP
to visit after evening surgery, who would otherwise go to A&E or call an ambulance.
Primary Care Strategy - approved by Cannock Chase CCG member practices to improve
quality and increase capacity and capability in primary care.
Locality networks - collaborative working between practices across three locations;
Cannock Town, Great Wyrley/Cheslyn Hay and Rugeley areas, to improve quality and
access to services, for example, extended hours, flu vaccinations.
Locality business case demonstrating how local GP practices will collaboratively achieve
locally agreed targets
The introduction of locality Patient Participation Groups to ensure local primary care
services are responsive to local needs.
Care facilitators assigned to every practice to support patients with dementia and their
carers.
Unplanned Care Direct Enhanced Service – Care planning and direct access phone line to
patients with a long term condition.
Extended Hours Direct Enhanced Service - providing planned evening and weekend
appointments
Attracting GPs to Cannock - discussions with Health Education West Midlands regarding
increasing the numbers of training practices in the Cannock area, creating a rotational
programme for trainee GPs and promoting the allocation of trainees to the Cannock
practices.
Improving Access project - Workshop held on 22nd October 2014 to identify the key issues
with access and to introduce systems and processes for improving access across all
practices in Cannock Chase, including ways that practices can work more collaboratively to
address the issues. Initial actions from the group include an advanced access audit and full
support of the ‘Choose Well’ campaign to educate patients.
7.2 Signposting to services and knowing where to go/Communications and engagement
with the public and patients/Self-care and education
A common theme throughout the consultation relates to patients being unclear where to go when
they are unwell. As a result of this, the CCG has launched the ‘Choose Well’ campaign to raise
awareness of where to go to access healthcare when they need it. The CCG has commenced the
campaign in GP practices, pharmacies, supermarkets and other public places, such as council
buildings and leisure centres. The CCG is also working closely with South Staffordshire Council,
Cannock Chase District Council and Stafford Borough Council to promote the ‘Choose Well’
campaign. A full communications strategy will support the roll out of the campaign, including
leaflets sent to every household in Cannock Chase in early December 2014.
7.3 Additional pressures on A&E
The CCG has engaged with Mid-Staffordshire NHS Foundation Trust, Walsall Healthcare NHS
Trust and the Royal Wolverhampton NHS Trust as part of the consultation process.
On average, 13 minor injury patients per day could attend A&E at three neighbouring hospitals, by
hour this would equate to:
•
•
•
•
1 to 2 patients between 8am and 9am
2 to 3 patients between 7pm and 8pm
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•
•
•
•
0 to 1 patients between 11pm and 12am
Based on previous service reconfigurations and the fact that these patients have a minor injury, it
is expected that the majority of patients will not decide to attend A&E. Instead, they may wait until
the MIU is open, self-care or go to their GP (as indicated by the patient survey). For those patients
who do go to A&E, it is expected that most patients would not all attend the same A&E and
therefore the operational impact on neighboring services would be minimal.
7.4 Safety Concerns
Safety concerns have been raise by patients and MIU staff around patients who do present with a
minor illness which requires urgent, same day treatment. While the CCG expects this to reduce in
the future, patients will continue to be treated by MIU staff or triaged to an appropriate alternative
service in the short term.
7.5 Efficacy of current GP Out of Hours service
The reduced opening hours largely effects the period when practices are closed and the GP out of
hours service takes over. Therefore, patients with a minor illness will continue to receive advice or
to be seen by a GP if they need it.
The CCG has met with the current provider to discuss some of the issues raised by the
consultation and has put in place a number of measures:
•
•
Healthcare professional phone line - for MIU staff to triage patients with a minor illness if
they need urgent medical attention out of hours.
Response car based in Cannock town - to improve response times for Cannock Chase
patients.
In addition, the CCG is in the process of procuring a new GP out of hours service which will
commence in April 2015. The new service will be based in Cannock Hospital and will offer a
number of benefits to patients.
7.6 MIU opening hours
Feedback from a neighbouring Trust suggested that the new opening time of MIU should be
brought forward to 10am until 6pm to reduce the operational impact of patients waiting for the unit
to open and also to reflect the slightly higher volume of patients in the morning.
Other providers, including GP practices indicated that 10.30am until 6.30pm would be a better
compromise as there would be a smoother transition into the GP Out of Hours service which,
overall would result in a better patient experience. Consequently, the proposed opening hours will
now be 10.30am until 6.30pm.
8.0 Conclusion
The Secretary of State for Health, Rt Hon Jeremy Hunt MP, requires the CCG to demonstrate that
it has reviewed the outcome of the consultation alongside the four “Lansley” tests; Support from
GP Commissioners, plans are based on sound clinical evidence, strong public and clinical
engagement on any proposals and that patient choice of where they want to be treated is
considered.
All of the above have been addressed as part of this consultation process.
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The CCG is required to demonstrate that it has carried out the consultation, regarding the
proposed changes to reduce the hours of the MIU, in line with statutory requirements which include
consulting for a period of four weeks (agreed by the HSSC).
The consultation has demonstrated that there are a range of issues that need to be addressed in
implementing the proposed reduction in opening hours.
The CCG has listened carefully to the debates undertaken through the consultation process and
believe that many of the matters raised can and have been addressed. These measures will
ensure that the recommended option to reduce opening hours can be implemented safely and in
an appropriate timescale to assure the public that access to high quality, safe services are
maintained.
The option to do nothing is not seen as a credible option as it is not financially viable.
The second preferred option to close the Unit was not considered viable as data showed that there
are a significant number of people with a minor injury who would otherwise go to A&E. Again this
would not be appropriate or financially viable.
The option to include a GP in the MIU was withdrawn as it was felt that the nurse led model was
most appropriate to treat the identified cohort of patients and would not deliver the required
efficiency requirements.
In conclusion, the preferred option is to reduce the opening hours to 10.30am until 6.30pm.
When making a final decision, the CCG Governing Body members should consider the following:
•
•
•
•
•
The CCG has a responsibility to ensure health services are financially viable.
The CCG has completed is statutory responsibilities to consult widely with the public
The outcome of the consultations was that the preferred option was ‘do nothing’.
The Petition led by a local Councillor opposed the closure of the unit.
There is support for the reduction in MIU hours from the majority of the CCG’s Member
Practices.
9.0 Recommendations
1. The Cannock Chase CCG Governing Body note the report and the response to the
consultation.
2. The Cannock Chase Governing Body approve the recommendation in the case for change
to reduce the hours of the MIU to 10.30am until 6.30pm from 1st December 2014 subject to
the following:
•
•
•
•
•
The ‘Choose Well’ campaign is launched so all residents of Cannock Chase are able to
make the most appropriate choices when they are unwell.
Further focused engagement with parents and young adults is conducted.
Feedback to the Governing Body, demonstrating measures put in place to improve
access in primary care.
A robust monitoring process is put in place to ensure the reduction in hours does not
have an adverse impact on other services.
A review of progress and benefits is undertaken by the CCG at six and twelve months.
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Minor Injuries Unit in Cannock Consultation
1st September to 28th September 2014 – Outcomes Report
1.0 Background
This report provides a summary of the process and outcomes of the formal public
consultation undertaken by Cannock Chase CCG between 1st September 2014 to
28th September 2014.
The consultation concerned a proposal to reduce the hours at the Minor Injuries Unit
(MIU) in Cannock from 8am until midnight to between 11am and 7pm.
The proposals for change were presented to the Healthy Staffordshire Select
Committee (HSSC) on 9th June 2014, at this meeting it was decided a joint workshop
between the HSSC and the CCG would take place to examine in details the
proposals which included closure of the MIU. Following that workshop which took
place on 24th July 2014 the HSSC Working Group recommended to the full HSSC
that the CCG consult on a proposal to reduce opening hours and that the formal
consultation should last for four weeks starting on 1st September and finishing on
28th September. This was ratified by the HSSC on the 11th August 2014.
The consultation process was verified by the NHS England Staffordshire and
Shropshire Local Area Team in line with their assurance processes.
The consultation was conducted in line with the requirements under NHS Act 2006
(amended 2012) Section 242 sections 13Q and 14Z.
The report will provide the information from the consultation to the CCG governing
body, staff, patients and members of the public. It aims to summarise the many
views which were given. HealthWatch Staffordshire members in their independent
scrutiny role have given their approval of the methodologies used in the summation
and analysis of the consultation feedback.
The Cannock Chase CCG governing body will make the decisions on the future for
the MIU services which have been the subject of this consultation. These decisions
will be informed by the recommendation of commissioning managers and clinical
leads, taking into account the outcomes of the consultation.
Cannock Chase CCG will give feedback where possible to the many organisations
and local people who contributed to the consultation. This feedback will explain what
has been said during the consultation and what the CCG has decided. This report in
full and the report to the board will be public documents available through the
internet on the website of the CCG and hard copies will be sent to anyone who
requests them. This can be done by
contacting [email protected] or calling 0300 404 2999 ext 6852.
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1.1 The Proposals
The consultation asked patients, the public and key stakeholders to record their
agreement or disagreement to a proposal to reduce the MIU opening from 8am until
midnight to 11am until 7pm. The survey asked people to record their answer using a
Likert scale rating via a survey and asked for suggestions about how services could
be improved.
The consultation document explained that:•
•
•
The service was neither affordable or sustainable in its current form
40% of the attendances were for minor illness NOT minor injury
That the attendance drops significantly after 7pm and that only 63% of people
who attend after 7pm attend with a minor injury.
We received 19 formal responses from the stakeholders and the public, 124
completed surveys and received feedback from the four public meetings and the 54
attendees where the proposal was discussed.
In the survey we asked whether consultees agreed or disagreed with the proposal
and invited them to offer feedback, comments and suggestions for future
improvements.
This report has been prepared to provide an overview of all the feedback received
via surveys, meetings and formal response letters.
1.2 The Consultation Process
We aimed to engage as many people as possible about our proposal using a wide
range of communication methods.
A 12-page consultation document was produced which included the survey and this
was distributed widely to key stakeholders along with an explanatory letter from the
Chair of the CCG. A full list of formal stakeholders can be found in (Appendix 1).
A dedicated section of the CCG’s website was created about the MIU consultation
at www.cannockchaseccg.nhs.uk where details of the proposal, the consultation
document and an on-line survey were available to complete.
A dedicated email ([email protected]) was also created so
people could submit further questions about the consultation or send in a response
to the survey.
A freepost address was available so that people were able to send in hard copies of
the survey free of charge.
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1.3 Publicity
Four press releases were issued in relation to the consultation to the media on the
following dates: (Appendix 2)
•
•
•
•
28th April 2014 – Announcing Public Consultation on future of Cannock Chase
MIU.
Monday 11th August 2014 – announcing that the Healthy Staffordshire Select
Committee has asked the CCG to carry out a four week public consultation
into the MIU proposal
Tuesday 26th August 2014 – Details of the consultation meetings
Tuesday 9th September 2014 – Details of further evening meeting announced
This resulted in coverage in the Cannock Chronicle, Staffordshire Newsletter, the
Express and Star and Signal Radio.
Full-page adverts were also placed in the Express and Star on September 11th 2014
and in the Cannock Chronicle on September 12th 2014 (Appendix 3)
1.4 Meetings
Three public meetings were held where the CCG gave a presentation and then
answered questions from the public (Appendix 3.) The meetings were held
throughout September and people who attended the consultation events were asked
to fill in an individual survey response at each event:
•
•
•
Wednesday September 3rd 2014, 2pm – 4pm, Avon Business and Leisure
Centre, Avon Road, Cannock, WS11 1LH - 13 people attended, including a
representative from HealthWatch Staffordshire, an Express and Star reporter
3 members of MIU staff and a GP.
Wednesday September 10th 2014, 10am – 12 noon, the Aquarius Ballroom,
Victoria Shopping Park, Hednesford, WS12 1BT - 11 people attended,
including a representative from HealthWatch Staffordshire, 2 representatives
from Cannock Chase District Council and one member of MIU staff
Thursday September 18th 2014, 6pm - 8pm Rugeley Rose Theatre and
Community Hall, Taylors Lane, Rugeley, WS15 2AA – 5 people attended,
including a representative from HealthWatch Staffordshire, a representative
from Rugeley Town Council, 2 members of MIU staff and a member of the
public
The CCG also arranged a further evening meeting in Cannock in response to public
feedback. This was held on:
•
Wednesday September 24th 2014, 6pm - 8pm, Civic Ballroom, Cannock
Chase Civic Centre, Beecroft Road, Cannock. 25 attended, including 2
members of MIU staff, a representative of HealthWatch Staffordshire, and 4
Councillors
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The CCG also met with those stakeholders who asked for specific meetings
including: South Staffordshire District Council on Wednesday 17th September and
the Health Overview and Scrutiny Committee of Cannock Chase District Council on
Thursday 25th September.
The public and stakeholders were also given an opportunity to ask questions at the
CCG’s Annual General Meeting on Thursday September 4th at the Aquarius
Ballroom, Victoria Shopping Park, Hednesford, WS12 1BT.
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2.0 Consultation Outcomes
2.1 Analysis of the information
All of the comments received from surveys whether sent electronically or
handwritten, as well as comments noted at meetings and submitted in any other form
have been entered into an excel database.
The database allows comments to be searched and segmented by self-described
nature of the respondent, e.g. service users, carer, organisation etc.
The Midlands and Lancashire Commissioning Support Unit (MLCSU) have
supported the CCG throughout the consultation process, including full analysis of the
consultation feedback and data.
The CSU on behalf of the CCG invited HealthWatch Staffordshire in their role as
independent scrutiniser to a meeting to discuss and review the analysis
methodologies and HealthWatch Staffordshire were supportive of them and found
them to be open and transparent.
2.2 Overview
The report is categorised into the following feedback sections
•
•
•
Survey respondent feedback
Respondent feedback from public meetings
Respondent feedback via e mail, letter or from formal consultees
The main themes that come from the aggregated feedback from the three areas are
in order of feedback priority:•
•
•
•
•
•
•
•
•
•
•
•
•
•
Access to GPs and appointments
Signposting to services and knowing where to go
Additional pressures on A and E
Holistic approach to urgent care with joined up services
Safety concerns
Asking for enhanced services at the current MIU including plastering and
X- Ray facilities
Finance
Communications and engagement with the public and patients
Efficacy of current GP out of hours service
Alternative services availability
Self-care and education
Transport access
GP recruitment
Involvement of stakeholders and patients from outside the Cannock area
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•
Robustness of evidence base
2.3 Survey Respondent Feedback
There were 124 surveys returned in total, of which 94 were completed in every
section (including the free text response, question 4).
•
94.2% of the respondents said they were completing the survey as an
individual 5.8% as an organisation
Those responding described themselves as:
Member of the
public %
NHS staff %
Service user %
Unpaid carer %
49.2
13.1
36.1
1.6
2.4 Demographics
2.4.1 Location
•
•
•
•
75.0 % said they lived in Cannock
10.0 % in Stafford
5.3% in Walsall
4.5% in Rugeley
2.4.2 Ethnicity
•
•
•
•
94.2% of respondents described themselves as White
British/Irish/Scottish/Welsh
2.5% preferred not to say
0.9% gypsy or Irish Travellers
0.8% Asian
2.4.3 Gender
•
75.8% of respondents described themselves as female.
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In terms of age, the breakdown was as follows:
Up to 17 years %
25 - 34 years % 35 - 44 years % 45 – 54 years % 55 – 64 years % 65 – 74 years %
1.7
3.4
18.1
19.8
21.6
22.4
75 + %
Prefer not to
say %
12.1
0.9
It is noted that there is lower response rate for people under the age of 35 years
however this is in line with the local population distribution.
There is also a lower response rate from men and the response rate from minority
ethnic populations is 0.17% versus a local population average of 4%
We also asked people how they heard about this consultation – and the responses
were as follows:
Where did you hear about this consultation?
30.0
25.0
20.0
15.0
10.0
5.0
0.0
26.3
19.3
15.8
13.2
9.6
4.4
3.5
3.5
3.5
0.9
It is clear that local communications are most valued by the respondents with most
people gaining their information via word of mouth and the local newspaper.
2.5 Summary of responses
The percentages disagreeing with the proposal were significantly higher than those
agreeing, and this applied across all interest groups, with NHS Staff having the
smallest difference and members of the public the highest:
All
Strongly disagree or disagree
Strongly agree or agree
71.7
17.5
Member of the
public
37.5
6.7
NHS staff
Service user
Unpaid carer
6.7
5.8
25.8
5.0
1.7
0.0
There were 10.8% who neither agreed nor disagreed with the proposal.
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2.6 Overall Results
I strongly agree
with the plans %
I agree with the
plans %
I neither agree nor
disagree with the
plans %
I disagree with the
plans %
I disagree strongly
with the plans %
5.0
12.5
10.8
22.5
49.2
2.7 Members of the public
I strongly agree
with the plans %
I agree with the
plans %
I neither agree nor
disagree with the
plans %
I disagree with the
plans %
I disagree strongly
with the plans %
8.5
5.1
10.2
27.1
49.2
43 comments
Eight of these comments related to accessing GPs, respondents felt that the MIU is
used due to ‘not getting appointments with their GP’ and ‘the GP service not having
the capacity to cover what the public need’. This is the current position without extra
pressure from the MIU closing.
Access to alternative services was raised by eight respondents who felt that if the
MIU was not available they would struggle to access alternatives due to “stress of
financial and travelling’” this being a particular problem for “young families’’.
Eight comments raised financial concerns, these ranged from ‘stop paying the
decision makers top money’ to the proposal being a ‘cost cutting exercise’.
Increasing the pressure on A&E provision was stated in seven comments, the
‘knock on effect’ of the proposals will be ‘to increase the numbers of patients to A &
E’, that are already ‘stretched’.
Five comments related to adequate staffing and the need to ‘ensure adequate
staffing’ is in place and not reduced which would put ‘extra stress and pressure’ on
the staff.
Five comments suggested to extend the current services in place, two of these
comments included the suggestion for ‘xray facilities’ and the other comments
related to ‘opening longer hours’.
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2.8 NHS Staff
I strongly agree
with the plans %
I agree with the
plans %
I neither agree nor
disagree with the
plans %
I disagree with the
plans %
I disagree strongly
with the plans %
6.3
37.5
6.3
0.0
50.0
12 comments
Five comments related to the theme access to GP in terms of ‘improving support for
local GP’ and ‘making access to GP easier so appointments are available within 2448 hours’.
Improving and extending the current service was raised in four comments, two of
these comments suggested that the service would benefit from offering “x-ray and
interpretation” The other two comments were more general to ‘improve the service
rather than reduce it’ and to ‘open for more than 11-7’.
Patient Safety was raised in two comments, firstly ‘turning patients away without
proper triage and assessment’ and overall risking ‘public healthcare’.
One comment supported the proposal describing the current service as ‘a total waste
of time’.
2.9 Service User
I strongly agree
with the plans %
I agree with the
plans %
I neither agree nor
disagree with the
plans %
I disagree with the
plans %
I disagree strongly
with the plans %
0.0
14.0
14.0
23.3
48.8
33 comments
Twelve of these comments raised the need for adequate staffing in the MIU,
respondents felt that ‘nursing numbers should remain at full staffing level’ and
‘should not be reduced drastically’.
Four of the twelve respondents raised concerns over staffing and patient safety.
Patient safety was raised in seven comments, detailing that cutting access is
‘dangerous’ and one respondent raised concerns that ‘people will suffer and people
will die!’.
Seven comments from respondents stated that the current service in place needs
extending and developing to include ‘xray and plastering’.
Increasing the pressure on A & E was a concern captured in six comments stating
that if no alternative was in place then ‘they would have to go to A&E’ and this was
commented to be ‘counter-productive’.
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Access to GPs was identified by six respondents who felt that ‘contacting GP
surgeries is impossible’ and also the limitation of the service that GPs offer, for
example, ‘GP does not dress wounds’.
Three comments related to transport in terms of using public transport to travel a
distance with ‘such injuries’.
2.10 Unpaid Carer
I strongly agree
with the plans %
I agree with the
plans %
I neither agree nor
disagree with the
plans %
I disagree with the
plans %
I disagree strongly
with the plans %
0.0
0.0
0.0
50.0
50.0
One comment received incorporated three themes; the hours of current services at
Stafford and Walsall need to be extended otherwise there would be an increased
use of A&E and the issue of transport if they had to travel to other services. The
respondent felt that ‘not everyone in the area has access to a car or taxi’ and also
the cost of this.
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3.0 Meeting Feedback
Feedback was captured from the four meetings that took place attended by 54
people. The responses were grouped into categories in relation to interest group and
themed in accordance with the survey responses.
3.1 Event Attendees
131 comments were received from event attendees. The two main themes that were
gathered were
Signposting/Information - patients needing to know where to go (41 comments) and
Access to GP (26 comments).
Of the 41 comments received on signposting/information - patients needing to know
where to go, 16 stated that there wasn’t enough clarity regarding the information that
is available, one attendee stating ‘I am 80-years old, I live on my own, where do I
go? It isn’t cut and dry. I need a paper in front of me, telling me where to go.’
There were 5 comments regarding improvements to ‘education regarding self-care’
and that there was a need for better ‘external communications and engagement’.
3 comments were made surrounding the Badger GP out of hour’s service, asking if
decisions could be reached following the re-tendered Badger GP out of hour’s
service.
From the 26 comments received regarding GP access there are a large number of
concerns surrounding the ‘shortage with GPs’ and ‘are there enough GPs?’
Two respondents felt that existing services should be made more robust, before
further changes are implemented, requesting a ‘review of GP out of hours service’
and stating that ‘111 are providing incorrect information’.
10 attendees raised the issue of access to GP appointments and if there is suitable
provision in place?
Finance was a concern for 12 of the event attendees. Among the questions raised
were ‘What are you looking to save/spend?’ and ‘How does the cost differ per
patient, if they use their GP, MIU or A and E?’ One attendee observed ‘4pm until
midnight would be better as there are GP services in place in the day - Why don’t
you look at different time slots as you would have better cover for people?’
There were also more generalised observations made by some members of the
public, surrounding the budget deficit of the CCG as part of a national comparison.
Following on from these, access to alternatives was revealed to be of interest to 12
people. 3 voiced concerns regarding both Badger GP out of hours service and NHS
111 services. Comments included ‘I go to MIU because it is the only competent
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Item: 07 Enc: 05
service. My family have used Badger and have made six complaints about them and
have no response’ and ‘Inappropriate referrals from 111’.
There were 5 attendees that had mentioned Patient Engagement had been an issue.
Among the comments were ‘The timescale does not provide sufficient time for
patients to respond.’ Also ‘What patient engagement has been done?’ One attendee
stated that they had been advised by their GP surgery that ‘It should have been
given to GPs to publicise’.
3.2 Councillors
From the 17 comments received from Councillors, eight of these comments related
to access to GPs. Respondents said that ‘Improved access to and capacity within
local GP services’ was needed as ‘it would appear that patients are using the MIU
rather than their local GP’. They felt that ‘there is a clear need to improve access to
and capacity within local GP services, both primary care and out of hours’ when
considering a reduction in services at the MIU. They also thought that there was a
particular issue with waiting times to access GPs as ‘local residents struggle to
secure appointments within a reasonable timescale’ at many of the GP practices
across Cannock Chase.
Six of the comments received related to issues around signposting and patients
needing to know where to go for treatment. Councillors stated that there is a ‘need
for clear communication and engagement with the public’. They added that ‘in talking
with constituents Councillors have picked up expressions of both confusion and
mistrust’ and ‘wanted to know how the public would know where to go’. They
commented further that ‘directing patients to the appropriate services’ is a necessity
with a number of ‘cases presenting to the unit being minor illnesses which could be
treated by GPs, a local pharmacist or self-care’.
Respondents summarised that ‘there would appear to be a need to better inform and
signpost residents to the most appropriate service’ and ‘communication materials
should be widely distributed informing residents of the appropriate service for
different conditions and different times of day’. Access to alternatives was a theme
captured in a further six comments. The respondents felt ‘that the public were getting
a raw deal in Cannock’ as there is ‘no overnight A&E at Stafford and patients are not
able to get same-day GP appointments’. They also stated that ‘the out of hour’s
service provided by Badger is not adequate’.
Four comments related to an increased pressure on A&E. Respondents felt that
‘extra pressures are put on our already stretched local A&E services’ and that
‘without the MIU, residents who are not able to get a GP appointment will go to their
local A&E department’ which ‘will put massive pressure on the local A&E’.
Councillors who attended the consultation events raised the same points, however,
further comments were made in relation to finance. A respondent stated that the
12
Item: 07 Enc: 05
proposed reduction in hours at MIU ‘is about saving money’ and ‘you’re only saving
£290,000’.
3.3 HealthWatch Staffordshire
HealthWatch Staffordshire were in attendance at all the scheduled events and raised
that there was an issue relating to signposting and patients needing to know where
to go to be treated, requesting further information about the Urgent Care Centre
model and whether this ‘would provide good continuity of care’ for patients.
3.4 MIU Nurse
One comment was received from an MIU nurse regarding the lack of practice nurses
in GP surgeries. She stated that that there is a ‘problem with practice nurses. In one
shift I saw 6 practice nurse patients.’ The nurse went on to ask ‘Where will these
patients go?’ indicating a need to educate both practices and patients on where to go
to be treated.
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Item: 07 Enc: 05
4.0 Letters, E mails and Formal Reponses to the Consultation
Note there were 8 of the 19 responses to the consultation that arrived after the
deadline of 5pm on 28th September. The CCG has decided to include these formally
in the consultation in interests of inclusivity despite their arrival after the deadline.
4.1 Councillors, Parish, District and Town Councils
Feedback was received from a number of parish, town and district councils as well
as from councillors and prospective parliamentary candidates.
The feedback is summarised below in relation to the proposed reduction in hours at
the MIU:•
•
•
•
•
•
•
•
•
•
6 comments about - Access to primary care service
5 comments about - Current out of hours services
5 comments about - Need for a more holistic approach to view MIU in the
context of wider urgent care system
5 comments about - Pressure on A and E services
3 comments about - Communications with public and patients about services
available
2 comments about - Overall performance and efficacy of the urgent care
system
2 comments about - Process of the public consultation and approach to
engagement
1 comment about - Development of the urgent care centre
1 comment about - Engagement with the public outside of Cannock
1 comment about - Transport service
4.2 Health overview and scrutiny committees
The Healthy Staffordshire Select Committee (HSSC) recommended that the
reduction in hours be consulted upon rather than the complete closure of the service
and as such their joint workshop with the GPs, staff from the CCG and Health Select
Committee members was HSSC response to the consultation
4.3 Cannock Chase District Council
Cannock Chase Health Overview and Scrutiny Committee (HOSC) formally
responded to the consultation raising a number of concerns included in the analysis
in 41and said that they did not support the reduction in service.
Cannock Chase District Council Cabinet responded to the consultation raising a
number of concerns included in the analysis in 4.1 above and said that they did not
support the reduction in service
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Item: 07 Enc: 05
The CEO of Cannock Chase District Council forwarded the Cannock Chase District
Council HOSC response to the consultation to the Secretary of State for Health for
information only.
Note this does not constitute a formal referral as only Staffordshire County Council’s
Healthy Staffordshire Select Committee can formally refer to the Secretary of State
for Health.
4.4 Local Health Economy Partners
There was one formal response from providers and partners in the local health
economy who raised concerns about the impact of closures on A and E services.
4.5 Member of Parliament
An MP letter was received that raised a number of issues. Comments were made
regarding extension of the current service at the MIU, with the MP stating that there
is a ‘lack of diagnostic facilities at the site’ meaning that ‘one in four of the patients
who visit MIU are sent to another NHS service’. Issues were also raised regarding
access to GPs commenting that ‘if the change to the opening hours at the MIU is to
go ahead, it is vital that this is coupled with an increase in GP and other primary care
provision’. The MP also stated that it had been identified that the proposal to reduce
the hours at the MIU could lead to an ‘increase in attendance to local A&Es’, and that
assurances need to be provided about ‘access to an improved GP out of hour’s
service to avoid them visiting A&E’. Comments were also made regarding
signposting and patients needing to know where to go for treatment. Patients need to
be ‘properly informed and educated’ about what local health services are available to
them and when. It was suggested that the ‘Choose Well’ leaflet should be ‘widely
distributed’ to aid this.
4.6 Members of the Public
From the seven letters received from members of the public, five of these comments
related to accessing GPs. Respondents felt that GPs ‘clearly cannot cope with the
patient levels they have already’ which ‘will this put added pressure on A&E, GPs
and out of hours GPs on weekends?’.
Engagement was also raised by 2 respondents as they would struggle to attend the
meetings that had been scheduled due to ‘Cannock and Hednesford meetings are
being held during the working day’ and questioned whether ‘when organising any
more meetings would it be possible to have more in the evenings’. This being a
particular problem for those who work during the day.
Increasing the pressure on A&E provision was stated by a further two respondents
who felt that it would be difficult to access alternatives if there is a ‘lack of reasonable
opening hours’ which ‘simply leads to people defaulting to local A&E’.
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Item: 07 Enc: 05
The need for enhanced communication with the public about services and options
was raised by 3 respondents and one respondent wanted more focus on self-care
and education. 2 respondents want more enhanced services at the MIU, whilst one
wanted ‘more focus on recruiting GPs locally’ and 2 respondents wanted a wider
engagement and consultation on the broader urgent care landscape.
4.7 HealthWatch Staffordshire
HealthWatch Staffordshire responded to the public consultation in detail and a
summary of the feedback is outlined below
•
•
•
•
•
•
•
•
•
•
•
Patient safety and unmitigated risks versus finance
Limitations on the proposals for consultation and the level of public and staff
engagement in the process.
Robustness of the evidence base and the involvement of the public
Level of collaboration with HealthWatch Staffordshire and general
communication
Impact of proposal Stafford hospital and tender of GP out of hours service
Future plans for an Urgent Care Centre are not currently defined
Bottlenecks at opening and closing times if the hours are reduced
Impact of planned changes to Telford A and E provision
Ability of GP out of hours provider to cope with increased demand
Adherence to the guidance provided by NHS England in relation to
consultation
Access to primary care services via GPs.
HealthWatch Staffordshire felt that the consultation did not comply with NHS
guidance and could not support the reduction in hours unless assurances were given
in relation to the GP access pilot and the revision of the GP out of hour’s service.
4.8 Petition
The prospective Parliamentary Candidate for Cannock (Lab), Cllr Toth presented the
CCG with an 828 named petition that stipulated that: “We, the undersigned demand
the decision to close Cannock Hospital’s Minor Injuries Unit is reversed and that its
future is guaranteed.”
The petition is not dated so we are unable to ascertain how many people signed the
petition before it was announced that the CCG had reviewed its proposal and was no
longer planning to shut the unit. As the petition has been submitted in relation to the
closure and not the proposed revision to hours the petition has not been submitted
formally to the consultation. The decision not to include this in the consultation
feedback is formally acknowledged here.
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Item: 07 Enc: 05
5.0 Clinical Engagement
The proposal to review MIU was debated by clinical leads at the Quality
Improvement Productivity and Prevention (QIPP) Delivery and Accountability
workshop on 15th May 2014. GP clinical leads and practice teams have been closely
involved in the ongoing development of the proposal and the consultation exercise,
having weekly meetings and conference calls.
A local workshop was held on 10th June 2014, facilitated by the NHS Improving
Quality Programme and attended by practice managers, practice nurses and GPs
from all localities in Cannock Chase, along with CCG staff.
Cannock Chase CCG Membership Board is formed of a representative from each of
the 27 GP practices across the Cannock Chase area. The Board meets monthly to
discuss the commissioning of services to deliver better outcomes for patients. The
Board has been fully involved in the development of the proposals for the MIU in
Cannock. The preferred option to reduce opening hours was supported by the
majority of member practices (26 out of 27) at the Cannock Membership Board on 9th
July 2014.
The Cannock Chase CCG Membership Board met on the 14th October 2014, where
they were informed of the findings of the public consultation with regards the
proposed changes to MIU. The Board discussed the feedback at length and a
number of GPs raised concerns about the proposed opening hours of 11am until
7pm. It was proposed that 10.30am until 6.30pm would provide a better patient
experience.
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Item: 07 Enc: 05
6.0 Appendices
6.1Formal consultees
6.2 Press Releases
6.3 Publicity and Posters
18
Item: 07 Enc: 05
Appendix 6.1 Formal Consultees
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
HealthWatch Staffordshire
Staffordshire & Stoke on Trent Partnership NHS Trust
NHS England, Shropshire & Staffordshire Area Team
Badger Out Of Hours
Walsall Healthcare NHS Trust
Royal Wolverhampton NHS Trust
Mid-Staffordshire NHS Foundation Trust
Mid Staffordshire MIND
GP Suite - Cannock Chase Hospital
NHS Community Mental Health Team
All Cannock Chase CCG GP Practices
Trust Special Administrators
South Staffordshire & Shropshire Healthcare NHS Foundation Trust
Cannock Chase Membership Scheme
Amanda Milling, Conservative PPC
Healthy Staffordshire Select Committee
Aidan Burley MP
Janos Toth, Labour PCC
Cannock Chase District Council
Bridgtown Parish Council
Whittington and Fisherwick Parish Council
Cheslyn Hay Parish Council
Blithfield Parish Council
Brereton and Ravenhill Parish Council
Penkridge Parish Council
Hednesford Town Council
Great Wyrley Parish Council
Colton Parish Council
Heath Hayes & Wimblebury Parish Council
Cannock Wood Parish Council
Rugeley Town Council
Longdon Parish Council
Cannock Chase District Council - 'Chase Matters Magazine'
Hamstall Ridware Parish Council
Saredon Parish Council
Brindley Heath Parish Council
Cllr Brian Edwards - South Staffs District Council
Cllr Mike Wilcox - Lichfield District Council
Cllr Roger Lawrence - Wolverhampton District Council
Cllr Michael Heenan - Stafford Borough Council
19
Item: 07 Enc: 05
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
Julian Mott - East Staffordshire Borough Council
Cllr Sean Coughlan - Walsall Council
Chase Day Service
VAST Head Office
Chase Council for Voluntary Service
Citizens Advice Bureau - Cannock
Citizens Advice Bureau – Chase
Landywood District Voluntary Help Centre
Citizens Advice Bureau - Cheslyn Hay
Chase Council for Voluntary Service
Homestart Lichfield and District
Carers Association South Staffordshire
Chase Dental Practice
Chase Dental Care
Christopher Bird Dental Care
Cannock Dental Practice
Cannock Dental Care
Oasis Dental Care Ltd
Dentaire Dental Care
Valley Centre Dental Practice
ADP Dental Care Ltd
Heath Hayes Dental Care
Avondale House Dental Practice
Khiroya Dental Surgery
Birchwood Dental Practice
Armitage Dental Practice
Wrights Dental Practice
Hanbury House
Barton House Nursing Home
35 Hill Top View
Hawksyard Priory Care Home
Ashcroft Hollow Nursing Home
The Old Vicarage Nursing Home
Vicarage Court Nursing Home
White Lodge Respite Unit
Oak Tree House
Marlyn House
Grace Moor Court Sheltered Housing
Abbey Court Nursing Home
Alma Court Care Centre
Marquis Court - Tudor House
Marquis Court - Windsor House
Kingsley Cottage
Hathaway House
20
Item: 07 Enc: 05
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
102.
103.
104.
105.
106.
107.
108.
109.
110.
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.
121.
122.
123.
124.
125.
126.
127.
128.
Needwood House Nursing Home
Leafdown
The Heathers
Marquis Court
The Grange
Briar Hill House
Copperdown Residential Home
Talbot House Nursing Homes
Hill Top View
Lakeview Care Homes
Waters Edge
The Conifers Nursing Homes
Catherine Care
Hob Meadow
Horse Fair Care Home
Four Seasons Nursing Home
Nethermoor House
Lanrick Cottage
Lanrick House
Lee Winters
Mavesyn Ridware House
Cannock & District Multiple Sclerosis Society
National Ankylosing Spondylitis Society
The Stroke Association
Mencap Homes Foundation
Mencap
Pain Management, Sandy Lane Health Centre
Darby & Joan Club (WRVS) - Cannock (Norton Canes)
Lively Tiger - Tai Chi
Countywide Handyperson Service in Staffordshire
Abbots Bromley Community Transport Scheme
Dollond & Aitchison
Chase Eyecare
Boots Opticians
Philip Howard Opticians
Vision Plus Cannock
Boots Opticians
Portland Eyecare
Vision Plus Rugeley
Kelcher Optometrists
Co-operative Pharmacy – Hednesford Street Cannock
Boots the Chemist - Cannock Orbital Retail Park
Co-operative Pharmacy -Market Place
Minster Pharmacy- Cannock
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Item: 07 Enc: 05
129.
130.
131.
132.
133.
134.
135.
136.
137.
138.
139.
140.
141.
142.
143.
144.
145.
146.
147.
148.
149.
150.
151.
152.
153.
154.
155.
156.
157.
158.
159.
160.
161.
162.
163.
164.
165.
166.
167.
168.
169.
170.
171.
172.
Your local Boots Pharmacy - Rugeley
Co-operative Pharmacy Bideford Way
Cornwells Chemists Limited – Chadsmoor
Boots Pharmacy – Church Street Cannock
Sainburys Pharmacy
Co-operative Pharmacy - Pye Green Road
Nucare Pharmacy
Lloyds Pharmacy Limited Hednesford
Co-operative Pharmacy – Norton Canes
Rawnsley Pharmacy
Co-operative Pharmacy – Market Hall Street
Bains Pharmacy Limited
Tesco In-store pharmacy
Lloyds Pharmacy Limited Hednesford – Valley Health Centre
Colliery Pharmacy
Brereton Pharmacy
Lloyds Pharmacy Limited- Victoria Shopping Centre Hednesford
Boots the Chemist – Rugeley
Your local Boots Pharmacy - Armitage
Cornwells Chemists Limited
Stevenson Pharmacy
Lloyds Pharmacy Limited – Sandy Lane Health Centre – Rugeley
Fernwood Drive Pharmacy
Northwood Dispensing Chemist Limited
Morrisons Pharmacy
Childrens Centre - Churchfield
Children’s Centre - Western Springs
Children’s Centre - Cannock
Children’s Centre - Norton Canes
Children’s Centre - Bridgtown
Children’s Centre - Hednesford
Children’s Centre - Hungtington
Children's Voice Project
Cannock Girl Guiding
Cannock & District Scout Association
St John Ambulance (plus Cannock Badgers)
Cannock Youth & Community Centre
Chase Village Kids Club
New Crazy Saints Youth Club
Norton Canes Family Fun Club
Tiddlywinks Pre-School
Jubilee Playgroup
ADHD Lighthouse Support Group
Moorhill Pre-School & Fun Club
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Item: 07 Enc: 05
173.
174.
175.
176.
177.
178.
179.
180.
181.
182.
183.
184.
185.
186.
187.
188.
189.
190.
191.
192.
193.
194.
195.
196.
Heath Hayes Youth Club
Friends of Longford Primary
Chase Area Pregnancy Centre
Redhill Robins Daycare Centre
Essington Youth Council
Ridgeway PTFA
Little Angels Playgroup
RACE for Independence (YMCA)
Chase Young Farmers
BCYS - Our Lady of Lourdes Youth Club
Donna Louise Trust
Action 4 Children
Florence Street Methodist Church Youth Group
Acorn's Children Hospice
Rascowls B4 & After School Club
YMCA Rugeley
Rugeley Young People's Partnership
Hill Ridware Youth Club
Little Springs
Parent Champions
Prince of Wales Youth Theatre
Green Turtles Swimming Club
KONCAS Youth Club
Heath Hayes Early Learners
23
Item: 07 Enc: 05
Appendix 62 Press Releases
Press Release
Date: 28 April 2014
Public Consultation Announced on Cannock Minor Injuries Unit
Health bosses have announced that they are to carry out a statutory three month
consultation into the future of Cannock Minor Injuries Unit.
Representatives of Cannock Chase and Stafford and Surrounds Clinical
Commissioning Groups attended the County Council’s Healthy Staffordshire Select
Committee today to outline their priorities over the next two years.
The CCGs set out their proposals which have been developed as they both face
multi-million pound financial deficits. As part of this, the CCG’s decommissioning and
disinvestment proposals were outlined to councillors.
In Cannock, the two main areas for discussion were:
•
•
•
The potential closure of the Minor Injuries Unit (MIU) in Cannock. This is a
small unit within the hospital that provides a nurse practitioner led minor injury
service. Current analysis shows that up to 40% of cases at the unit are for
minor illnesses, which could be more appropriately managed within Primary
Care or through self-management. The unit does not have radiology provision
so that patients who need an x-ray are seen and assessed before being sent
on to an acute hospital meaning they have to go to two places for treatment.
The permanent closure of Littleton Ward at Cannock Chase Hospital. Littleton
Ward is a GP run ward that provides health care services for patients that
don’t need to be in an acute hospital or need care before they are sent home.
In December 2013 the MSHFT informed the CCG that it would not be able to
provide nursing staff for Littleton Ward. As a result the ward was closed,
temporarily. Over the past four months, the CCG has been investigating the
opportunity to move care from the acute hospital into the community.
Councillors told the CCG that they want them to carry out a three-month
public consultation on the potential closure of the MIU. They noted the other
24
Item: 07 Enc: 05
proposals.
•
•
•
The CCG also outlined the pressures they faced in 2013 with a significant rise
in the number of people being referred to hospital, attending Accident and
Emergency Departments and increases in emergency admissions to hospital.
There have also been further increases in costs of:
Continuing Health Care
Specialised services
Prescribing Costs
The decommissioning and disinvestment proposals form part of a number of actions
to bring down excess costs and help deliver savings.
Cannock Chase Chair Dr Johnny Mcmahon CCG said: “We know that the current
configuration and healthcare service provision in Cannock is both clinically
unsustainable and unaffordable. The CCG is going to have to make some very tough
decisions in order to balance the health needs of our patients within the financial
resource available to ensure the services we deliver are clinically and cost effective.
As a result the CCG’s Governing Body has approved a ‘Decommissioning and
Disinvestment of Services Policy,’ and the future of some services including the
Minor Injuries Unit will be considered using this policy. This isn’t just about balancing
the books – this is about looking at whether existing services are fit for purpose and
whether we are using our resources as effectively and efficiently as possible. Our
figures show that up to 40% of the activity carried out at the MIU is for patients with
minor illnesses which should be managed within primary care or by patients selfmanaging these ailments themselves. We also now of course have NHS 111 which
patients can access 24-7 as well as the Out of Hours Service.
The CCG’s Chief Officer Andrew Donald said: “The Keogh Report in 2013 also set
out the vision of emergency and urgent care as having urgent care centres closer to
home and if there were to be a change in service in the future, the CCG will consider
developing an urgent care centre in the town. We will be carrying out a full
consultation exercise with the public to get their views, explain our reasoning and
discuss future provision for the town.”
The CCG will now be pulling together the consultation document that will be shared
publically and will be issuing details shortly on the consultation process.
To read the Decommissioning and Disinvestment Policy please go to either of the
CCG’s websites.
www.cannockchaseccg.nhs.uk/ or www.staffordsurroundsccg.nhs.uk/
Ends
For more information contact
Richard Caddy
Communications and Press Manager
Tel: 01782 298 167
Email: [email protected]
25
Item: 07 Enc: 05
Press Release
Date: 11 August 2014
Consultation launched on plans for Cannock Hospital's Minor Injuries Unit
Leading doctors in Cannock Chase are urging the public to offer their thoughts on
plans to operate reduced hours at the Minor Injuries Unit at Cannock Hospital.
Members of Staffordshire County Council’s Healthy Staffordshire Select Committee
today (August 11) recommended Cannock Chase Clinical Commissioning Group
(CCG) undertake a four-week public consultation on the plans.
The scrutiny committee have been reviewing the proposals in detail since they were
submitted as part of the CCG’s operational plans for 2014/15 – 2015/16 on 9 June
2014.
The Healthy Staffordshire Select Committee met with members of the CCG and
Cannock-based GPs on 24 July, who presented four options for reconfiguration of
the current service – with a description which included the benefits, risks and costs
of each – which were discussed in detail.
The preferred option – on the basis of thorough analysis of the data – is for the MIU
to operate reduced hours with support from primary care.
Chief Officer of Cannock Chase CCG, Andy Donald, said: "It is important to
acknowledge that the need to look at alternative arrangements for Cannock
Hospital’s MIU is nothing to do with the current service provided by the staff of that
unit.
“The team at the MIU do an exceptional job,” he said. “However, it became clear to
us that the service was not being used as it was first envisaged.
26
Item: 07 Enc: 05
“We are determined to work with staff to deliver a vibrant and efficient service, that
offers the people of Cannock Chase the care they are deserve, under any new
arrangements.
“In accordance with the recommendations of the Staffordshire County Council’s
Healthy Staffordshire Select Committee to conduct a four-week consultation with the
public over the proposals, the CCG will now produce a full consultation document,
outlining the background and context to the proposal, and the ways in which local
people and other stakeholders can feed back their views."
The public consultation is set to take place between September 1 and September 28
and more information about ways in which the public can participate will be made
available over the coming weeks.
Ends
Richard Caddy
Tel: 01782 298 167
Robin Scott
Press and PR Officer
Tel: 01782 401048
27
Item: 07 Enc: 05
Press Release
Date: 26 August 2014
Cannock Minor Injuries Unit Consultation Details Announced
The consultation into the Cannock Minor Injuries Unit will start next month.
Cannock Chase Clinical Commissioning Group (CCG) has announced details of the
forthcoming consultation which will run from Monday September 1st to Sunday
September 28th.
The CCG want to engage with as many stakeholders, patients and members of the
public as possible on their proposal to operate a reduce hours service at the Minor
Injuries Unit. The CCG’s preferred option is to retain the unit but reduce its opening
hours so that it remains open when patients use it the most. It comes after CCG
data shows the number of patients attending the unit drops significantly after 7pm.
A consultation document outlining the background and context to the proposal in
more detail and the way in which stakeholders and the public can feed back their
views is being produced. It will be publically available from September 1st 2014.
A series of meetings have also been arranged, which the public are invited to attend
so they can share their views on the proposal:
•
•
•
•
Wednesday September 3rd 2014, 2pm – 4pm, Avon Business and Leisure
Centre, Avon Road, Cannock, WS11 1LH
Wednesday September 10th 2014, 10am – 12 noon, The Aquarius
Ballroom, Victoria Shopping Park, Hednesford, WS12 1BT
Thursday September 18th 2014, 6pm – 8pm, Rugeley Rose Theatre and
Community Hall, Taylors Lane, Rugeley, Staffordshire, WS15 2AA
The CCGs Annual General Meeting (AGM) is taking place on Thursday
September 4th 2014 between 6:30pm and 8:30pm. It is an opportunity for the
public to attend to hear about the CCG’s achievements and priorities over the
last 12 months and its aims for the future. There will also be time to ask any
28
Item: 07 Enc: 05
questions you may have at the end of the AGM. It’s being held at the Aquarius
Ballroom, Victoria Shopping Park, Hednesford, WS12 1BT.
CCG Chairman Dr Johnny Mcmahon said: “I would urge as many people as possible
to book a place and attend one of our meetings so they have chance to feed into the
consultation process and into the final decision. We are using a range of ways to
engage with people as part of the consultation, via face to face meetings, through an
on-line survey and people can also fill in a hard copy of the consultation document
which they can request a copy of.
He added: “This consultation is about a proposal to reduce the hours at the Minor
Injuries Unit from 8am until midnight to 11am until 7pm. This is because our data
shows that the majority of patients use the unit during certain time periods.
“We need to ensure that local people are able to access the services they need at
the Minor Injuries Unit, at times our data shows they need access to it the most. At
the same time we also need to ensure that the service we are providing is cost
effective,” Dr Mcmahon said.
To book a place at one of the events, request a hard copy of the document once it is
available, or to find out more please email [email protected] or
call 0300 404 2999 ext: 6852
You will also be able to find out more detail and fill in an on-line survey at our
website www.cannockchaseccg.nhs.uk from September 1st 2014.
Ends
Notes to Editor
Cannock Minor Injury Unit (MIU) was opened at Cannock Chase Hospital in 2006
and is run by Staffordshire and Stoke on Trent Partnership NHS Trust (SSOTP). It is
a Nurse-Led Minor Injury Unit which is open seven days a week, 365 days a year
from 8am until midnight. Access to the unit is open and people can walk in, be seen
and treated without the need for an appointment. The ‘Out of Hours’ service (OOH)
also operates from the same site, in a different part of the hospital, 6:30pm until
midnight with further service being supported from the Walsall Healthcare NHS
Trust, Manor Hospital site from midnight until 8am.
In the past few years the MIU has seen an influx of patients seeking treatment for
minor illness. Patients have arrived to get treatment for illnesses like asthma,
toothache, headaches and earaches, which the MIU was not set up to treat. Clinical
Commissioning Group (CCG) information shows that up to 40% of cases at the unit
are for minor illnesses, which could be treated by a GP, at a community pharmacy or
by self-care in the home.
Nearly one in four of all patients who come to the MIU are sent to another NHS
service for further treatment because the unit does not have access to X-ray
equipment or other tests and as it is nurse led there are no doctors on site. There is
also no access to a hospital doctor if further medical advice is needed. For these
services, and other services, patients are sent on to Accident and Emergency (A&E)
29
Item: 07 Enc: 05
at another hospital. This means that patients are seen in two different places
unnecessarily and, as well as being inconvenient for the patients themselves this
also leads to extra costs for the CCG.
Richard Caddy
Tel: 01782 298 167
Robin Scott
Tel: 01782 401048
30
Item: 07 Enc: 05
Press Release
Date: 09 September 2014
Further Cannock Minor Injuries Unit Consultation Meeting Announced
Health bosses have organised a further evening meeting as part of the consultation
into the Cannock Minor Injuries Unit - in response to public feedback.
Cannock Chase Clinical Commissioning Group (CCG) held the first consultation
meeting last week where the public flagged that they wanted to see a further evening
meeting arranged in Cannock.
The CCG listened and announced today that another meeting will be held on
Wednesday 24th September at the Civic Ballroom at Cannock Chase District Council,
between 6pm and 8pm, which the public are invited to attend.
The CCG want to engage with as many stakeholders, patients and members of the
public as possible on their proposal to operate a reduce hours service at the Minor
Injuries Unit.
The CCG’s preferred option is to retain the unit but reduce its opening hours so that
it remains open when patients use it the most.
It comes after CCG data shows the number of patients attending the unit drops
significantly after 7pm.
A consultation document outlining the background and context to the proposal in
more detail and the way in which stakeholders and the public can feed back their
views has been produced.
The public and stakeholders are invited to attend the public meetings below so they
can share their views on the proposal:
31
Item: 07 Enc: 05
•
•
•
Wednesday September 10th 2014, 10am – 12 noon, The Aquarius
Ballroom, Victoria Shopping Park, Hednesford, WS12 1BT
Thursday September 18th 2014, 6pm – 8pm, Rugeley Rose Theatre and
Community Hall, Taylors Lane, Rugeley, Staffordshire, WS15 2AA
Wednesday September 24th, 6pm – 8pm, Civic Ballroom, Cannock Chase
Council, Beecroft Road, Cannock, Staffordshire, WS11 1BG
CCG Chairman Dr Johnny McMahon said: “We have listened to public feedback and
arranged an evening meeting in Cannock for later this month and I would urge
people to attend so they can really have their say.
"The public also told us they wanted to see more information communicated about
the range of health services available and as a result we are advertising them this
week in a series of newspapers.
"As we head towards the autumn and into winter, as a CCG, we will ensure that we
continue to promote the health services available to the public of Cannock and
surrounding areas, in a range of ways.
He added: “In terms of the consultation I would urge as many people as possible to
book a place and attend one of our meetings so they have chance to feed into the
consultation process and into the final decision.
"We are using a range of ways to engage with people as part of the consultation, via
face to face meetings, through an on-line survey and people can also fill in a hard
copy of the consultation document which they can request a copy of.”
To book a place at one of the events, request a hard copy of the document, or to find
out more please email [email protected] or call 0300 404 2999
ext: 6852
You will also be able to find out more detail and fill in an on-line consultation survey
at our website www.cannockchaseccg.nhs.uk
Ends
Notes to Editors
Cannock Minor Injury Unit (MIU) was opened at Cannock Chase Hospital in 2006
and is run by Staffordshire and Stoke on Trent Partnership NHS Trust (SSOTP). It is
a Nurse-Led Minor Injury Unit which is open seven days a week, 365 days a year
from 8am until midnight. Access to the unit is open and people can walk in, be seen
and treated without the need for an appointment. The ‘Out of Hours’ service (OOH)
also operates from the same site, in a different part of the hospital, 6:30pm until
midnight with further service being supported from the Walsall Healthcare NHS
Trust, Manor Hospital site from midnight until 8am.
In the past few years the MIU has seen an influx of patients seeking treatment for
minor illness. Patients have arrived to get treatment for illnesses like asthma,
toothache, headaches and earaches, which the MIU was not set up to treat. Clinical
32
Item: 07 Enc: 05
Commissioning Group (CCG) information shows that up to 40% of cases at the unit
are for minor illnesses, which could be treated by a GP, at a community pharmacy or
by self-care in the home.
Nearly one in four of all patients who come to the MIU are sent to another NHS
service for further treatment because the unit does not have access to X-ray
equipment or other tests and as it is nurse led there are no doctors on site. There is
also no access to a hospital doctor if further medical advice is needed. For these
services, and other services, patients are sent on to Accident and Emergency (A&E)
at another hospital. This means that patients are seen in two different places
unnecessarily and, as well as being inconvenient for the patients themselves this
also leads to extra costs for the CCG.
The MIU’s current opening hours are from 8am until midnight. The CCG’s proposal
would be to reduce the hours so that it opens between 11am and 7pm. CCG data
shows that the majority of patients use the unit during certain time periods and the
numbers attending reduce after 7pm.
Richard Caddy
Tel: 01782 298 167
Robin Scott
Tel: 01782 401048
33
Item: 07 Enc: 05
Appendix 6.3 Publicity
34
Item: 07 Enc: 05
35
Item: 07 Enc: 05
36
Item No: 09 Enc: 07
Subject:
Board Lead:
Rob Lusuardi
Officer Lead:
Christine Brown
Recommendation:
For
Approval

For
Ratification
For
Discussion
For
Information
To seek approval of the attached Policy from the Board
To provide assurance to the Board of the actions taken and being taken to ensure the CCG complies
with its legal duties and responsibilities in relation to the implementation of Personal Health budgets.
KEY POINTS:
Personal Health Budgets (PHBs) are part of a model of person-centred care that also includes support
for self-management, shared decision making, improving information and understanding, and
promoting prevention
All 211 Clinical Commissioning Groups across England have signed up to the NHS England personal
health budget support programme
From April 2014 people eligible for NHS Continuing Health Care have had the “right to ask” for a
personal health budget. From October 2014 this will be strengthened and this group will have the “right
to have” a personal health budget.
From April 2015 people with long term conditions must have a personalised care plan (which could
include a PHB if the CCG think they would benefit).
The National Health Service Commissioning Board and Clinical Commissioning Groups
(Responsibilities and Standing Rules) Regulations 2012, the National Health Service Commissioning
Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment)
Regulations 2013 and the National Health Service Commissioning Board and Clinical Commissioning
Groups (Responsibilities and Standing Rules) (Amendment) (No. 3) Regulations 2014 along with the
National Health Service (Direct Payments) Regulations 2013 and the National Health Service (Direct
Payments) (Amendment) Regulations 201317 set out CCGs’ legal duties relating to NHS Continuing
Health Care and Continuing Care rights and personal health budgets. These include duties to
Page | 1
Item No: 09 Enc: 07
publicise and promote their availability, to provide information, advice and support, to consider
requests for personal health budgets and to ensure they have the systems and processes in place to
be able to make this provision.
Staffordshire CCGs had set up a Personal Health Budgets (PHBs) Steering Group in 2013, and have
engaged the services of a project manager from within Staffordshire County Council to roll out PHBs
out locally across Staffordshire
A part-time interim PHB Lead was also appointed to progress the work in February 2014 to support
the PHB Project Manager in the production of the attached PHB Policy for the Staffordshire CCGs in
line with the National guidance and in the development of patient information, and guidance for
practitioners.
Further partnership work is ongoing with Shropshire CCG in the recruitment of PHB Implementation
Manager and Care Manager to take PHBs forward with the CHC team and to work with the CCG
Commissioners to support the roll out of personal health budgets to people with long term conditions in
April 2015.
RELEVANCE TO KEY GOALS
Cannock
Chase
through
targeted
interventions.
N/A
To identify and support patients with The implementation of Personal Health Budgets should
Long Term Conditions to ensure care increase patient choice and control, and enhance patient
experience for those in receipt of CHC and those with long
term conditions.
expectancy.
N/A
To develop integrated
N/A
services
with
Page | 2
Item No: 09 Enc: 07
IMPLICATIONS
Legal and/or Risk
People who are already receiving NHS Continuing Care will have a “right to
ask” for a personal health budget from April 2014 and from October 2014
this group will further be given the “right to have” a Personal Health Budget .
Governance frameworks required to mitigate financial and clinical risks to
the CCGs
CQC
The wellbeing of the individual is paramount. Access to a personal health
budget will be dependent on professionals and the individual agreeing a care
plan that is safe and will meet agreed health and wellbeing outcomes. There
should be transparent arrangements for continued clinical oversight,
proportionate to the needs of the individual and the risks associated with the
care package.
Patient Safety
The implementation of Personal Health Budgets should increase patient
choice and control, and enhance patient experience for those in receipt of
CHC and those with long term conditions.
Patient Engagement
From October 2014 all patients eligible for continuing healthcare funding
living in the community have the right to have for a personal health budget
Financial
The CCG needs to acknowledge that this is a very different way of working,
and it may be a challenge for professionals to balance the need to work
alongside a service user to deliver their choices, and a concern over whether
a proposed activity or service provision will meet the need and deliver the
outcomes.
The implementation of PHBs should provide the patient with more autonomy
and control of his care
Equality of access to personal health budgets will be imperative
Sustainability
All staff in contact with patients in receipt of Continuing Healthcare will require
various levels of PHB training
• To approve the attached Personal Health Budgets Policy for the future management of care
provision to patients eligible for Continuing Health Care Funding and future patients with long
term conditions across Cannock Chase
Page | 3
Item No: 09 Enc: 07
KEY REQUIREMENTS
Yes
No
Not
Applicable






Page | 4
Item: 09 Enc: 07
Personal Health Budgets Operational Policy:
Executive Summary
From April 2014 everyone eligible for Continuing Health Care had the right to ask for their care to be
delivered as a Personal Health Budget (PHB) and CCGs needed to be in the position to respond to any
requests. From October 1st 2014 those eligible for Continuing Health care NHS funding will have the right to
have a PHB. The right has also included children with special educational needs and disabilities who are in
receipt of an integrated budget. As of April 2015, CCG Commissioners should be ready to offer a PHB to
anyone with a long term condition who could benefit from one.
This summary explains the purpose and contents of each document contained within the Personal Health
Budget Operational Policy. The key documents that the CCG need to note, are the Financial Framework and
the Delegation of Level 3 tasks policy. Other documents have been produced and will be made available to
support the practical implementation of PHBs for service users, carers and practitioners
Risk Management
CCGs are required to commit to the promotion of Personal Health Budgets to service users, as well as
supporting them to manage risks positively, proportionately and realistically. Supporting people to make
informed decisions with an awareness of risks in their daily lives enables them to achieve their full potential
and to do the things that most people take for granted.
Enabling people to exercise choice and control over their lives, and therefore their own management of risk,
is central to achieving better outcomes for individuals. A degree of risk can be accommodated within the aim
of enhancing the quality of people’s lives.
CCGs are required to acknowledge that service users who have the mental capacity to make a decision, and
choose to live with a level of risk, are entitled to do so. CCGs are required to assure that Care Providers
document clearly any evidence of decision making and rationale in relation to the management and
reduction of risk where appropriate or necessary. This will be considered as part of the PHB approval process
that has been put in place clinically and financially for the CCGs across Staffordshire.
Health Professionals will be required to ensure that any clinical and financial risks identified are fully
understood and managed in the context of ensuring that the individual’s needs and their best interests are
safeguarded and that appropriate governance arrangements are in place.
The CCG needs to acknowledge that this is a very different way of working, and it may be a challenge for
professionals to balance the need to work alongside a service user to deliver their choices, and a concern
over whether a proposed activity or service provision will meet the need and deliver the outcomes.
The Staffordshire CCGs PHB Steering Group will be required to support the development of a shared forum
of clinical and finance staff to discuss complex, unusual or higher risk PHB requests which will include
representation from the appropriate CCG. This will support shared learning, and the development of a
shared approach to improving quality of care to the service user and identifying possible financial risks.
1. PHB Operational Policy
The Operational Policy outlines the principles for achieving the implementation of personal health budgets
by balancing choice, risk, rights and responsibilities. It recognises that, in the right circumstances, a positive
approach to risk can promote a culture of choice and independence that encourages responsible support
and shared decision making. The Government's aim is that in future, everyone in England who could benefit
Enc 06-2 CC CCG GB - PHB policy exec summary, Created October 14
Item: 09 Enc: 07
from one will have the option of a personal health budget. This commitment includes introducing personal
budgets for parents of children with special educational needs and disabilities which may include funding
from Social Care and Education.
Contents of the PHB Operational Policy
Policy document
Appendices and associated documents
CCG Responsibility
1. PHB Operational Policy
(V3 280714)
a. PHB Financial Framework (V2)
b. Delegation of Level 3 tasks CCG Policy 2013
for Staffordshire PHB clients (V2.1)
c. Practical guidance for Personal Health
Budgets in Continuing Healthcare (V4)
This requires ratification
by each CCG Governing
Body
2. PHB Financial
Framework (V2)
a.
b.
c.
d.
This is required to be
agreed by each CCG
Finance and
Performance Committee
This requires approval by
each CCG Quality
Committee
3. Delegation of Level 3
tasks CCG Policy 2013
for Staffordshire PHB
clients (V2.1)
4. Practical guidance for
in Continuing Healthcare
(V4)
PHB Agreement for CCGs (Staffordshire) (V3)
PHB Budget Setting Guidance (V2)
PHB Budget Setting Tool (V1.6)
What can a PHB be spent on (V1)
a. CHC and PHB approval process (V3)
b. Support plan summary and checklist (V3)
c. PHB Risk Enablement Panel Referral Form
(V2)
d. Risk Enablement Guidance Notes (V3)
e. PHB Support Plan Template (V4)
f. Seven criteria for a good health support plan
(V1)
Incorporated in the
policy for ratification by
CCG Governing Body
Guidance has been
agreed by the PHB
Steering Group
2. Financial Framework
The Financial Framework document describes the financial mechanisms to be used by Staffordshire CCGs to
deliver Direct Payments for Healthcare in line with the requirements in the National Health Service (Direct
Payments) Regulations 2013 as amended by the National Health Service (Direct Payments) (Amendment)
Regulations 2013.
Direct payments for healthcare are one way of managing a personal health budget. An agreement is required
by the CCGs to approve this new additional way in the future commissioning and finance management of
care provision to patients eligible for Continuing Health Care Funding and future patients with long term
conditions.
a. PHB Agreement for CCGs
This agreement will be signed by personal health budgets holders and CCGs when the individual chooses to
take a direct payment. It covers the responsibilities of direct payment holders to spend the money in
accordance with the agreed support plan. Regular checks will be undertaken to ensure that the money is
being spent in line with the agreed care and records are kept accordingly. This agreement has been shared
with the CCG solicitors for approval.
Item: 09 Enc: 07
b. Budget Setting Guidance
This document explains the process for setting provisional (indicative) budgets for prospective personal
health budget holders. When possible, the approach will use existing cost of an individual’s care package.
Other methods to support the calculation of the provisional budget are the use of a care specification that is
completed by a CHC Nurse and a budget setting tool.
c. PHB Budget Setting Tool
The tool will be used for the calculation of provisional (indicative) budgets. This is required to provide an
estimate of the budget that will be made available to people and families before they begin support
planning. It is based on the scores in the categories covered by the Decision Support Tool. (for CHC patients
only)The tool has been adapted from one that was developed during the Manchester PHB pilot programme.
A key principle of personal health budgets is to provide people with an estimate of the funding that will be
made available. Best practice in support planning states that providing an early upfront amount can help
people to better plan their care and support. The tool will be used when an existing cost is unavailable;
instances when this may occur are detailed in the Budget Setting Guidance.
d. What a PHB can be spent on
This summarises the principles of how personal health budgets should be used; with a focus on outcomes
and what can be achieved rather than what it is being spent on.
There is also a list of what a personal health budget cannot be spent on which is based on national guidance.
3. Delegation of Level 3 tasks CCG Policy 2013 for Staffordshire PHB clients
This guidance provides clarity on the key issues relating to delegation of care from employed registered
professionals to third party individuals who are not employed by Staffordshire and Stoke on Trent Clinical
Commissioning Groups (CCGs). This will provide assurance that delegation is always undertaken within the
clear parameters of safe delegation as stated by the Nursing and Midwifery Council (NMC).
This document needs to be ratified by each Clinical Commissioning Group in order for people that are
receiving a personal health budget who wish to employ their own personal assistants to meet their care
needs can, if they choose to, delegate clinical care tasks to them.
4. Practical guidance for Personal Health Budgets in Continuing Healthcare
The practical guidance is a resource for staff involved in the delivery of personal health budgets for
Continuing Healthcare patients. It breaks down the seven step process that has been adopted in
Staffordshire; explains what tasks should be undertaken as part of each step, who will be responsible for
ensuring that these tasks are completed and also the likely individuals that will, or could, carry out each
tasks.
At present the guidance is a proposed approach for how personal health budgets will operate when a
dedicated PHB team is established and the following has been developed to assist practitioners with the
process
.
Item: 09 Enc: 07
a. CHC and PHB approval process
This process flow describes the stages of the approval process and specifically the involvement of Continuing
Healthcare with the personal health budget process, highlighting additional tasks that need to be carried out
when a personal health budget is being set up.
b. Support plan summary and checklist
This document will be used as part of the approval process of support plans. It is made up of three parts. The
Support Plan summary should be signed by the service user or their representative, the appropriate clinician
overseeing the support plan, the PHB Lead and the CHC Lead.
c. PHB Risk Enablement Panel Referral Form
Where there is a complex or challenging risk issues in relation to provision of a PHB a clear process has been
identified to assist in resolving the issues. The referral form is also included as part of the support plan
summary and checklist.
d. Risk Enablement Guidance Notes
These notes support the Risk Enablement Panel.
e. PHB Support Plan Template
This template is to form part of the information pack that will be given to people who express an interest in
having a personal health budget.
Best practice in support planning is to promote self-directed development of support plans and that it can be
presented in a way that best suits them. In combination with the Support plan summary and use of the
seven criteria for a good health support plan this should allow people
f. Seven criteria for a good health support plan
This document explains the criteria that must be covered by a support plan. This is to be used as reference as
part of the approval process for evaluation of the quality of support plans to ensure that what is included is
lawful, likely to be effective, affordable and appropriate.
Item: 09 Enc: 07
PHB Policy
Version 3
July 28th 2014
Operational Policy
Date Approved
Date Ratified
Signature
Reference Number
Version
Lead Officer
Review Date
03
Christine Brown
Table of Contents
1.
INTRODUCTION ............................................................................................................ 3
2.
THE SCOPE OF THE POLICY ....................................................................................... 3
3.
UNDERPINNING PRINCIPLES ...................................................................................... 3
4.
IMPLEMENTATION OF THE POLICY............................................................................ 4
5.
PURPOSES AND PRINCIPLES OF PERSONAL HEALTH BUDGETS ......................... 4
6.
COMMUNICATION WITH PATIENTS ............................................................................ 5
7.
THE STAFFORDSHIRE APPROACH ............................................................................ 5
8.
PATIENT CHOICE.......................................................................................................... 6
9.
RESPONSIBLITIES OF KEY STAFF.............................................................................. 7
10.
THE PROCESS .............................................................................................................. 7
11.
TRAINING ...................................................................................................................... 8
12.
FINANCE ........................................................................................................................ 8
13.
REVIEWS AND MONITORING ...................................................................................... 8
14.
DISPUTES/DISAGREEMENTS ...................................................................................... 9
REFERENCES .......................................................................................................................... 9
APPENDICES ......................................................................................................................... 10
2
1. INTRODUCTION
1.1 Background
Following the evaluation of the national pilot programme for personal health budgets in
November 2012 the government announced that anyone eligible for NHS Continuing healthcare
will have “the right to ask” for a personal health budget. From October 2014 for people not in
residential or nursing homes placements this will become a “right to have”.
The government also re-confirmed a commitment in the NHS mandate that anyone with a long
term condition, who can benefit from a personal health budget will have the “right to ask” by
April 2015.
Staffordshire Clinical Commissioning Groups (CCGs) which includes Stoke-on-Trent are to
introduce personal health budgets (PHBs) to those eligible for NHS Continuing Healthcare.
This policy outlines the principles for achieving the implementation of personal health budgets
by balancing choice, risk, rights and responsibilities. It recognises that, in the right
circumstances, a positive approach to risk can promote a culture of choice and independence
that encourages responsible support and shared decision making. The Government's aim is
that in future, everyone in England who could benefit from one will have the option of a personal
health budget. This commitment includes introducing personal budgets for parents of children
with special educational needs and disabilities which may include funding from Social Care and
Education.
1.2. What is a Personal Health Budget?
A personal health budget is an amount of money to support a person's identified health and
wellbeing needs, planned and agreed between the person and their local NHS team.
By April 2014, people eligible for fully funded NHS continuing healthcare will have the right to
ask for a personal health budget, including a direct payment for healthcare. This becomes a
right to have a personal health budget in October 2014. The NHS will also be able to offer
personal health budgets more widely - for example to people with long term health conditions or
people with mental health problems that could benefit.
2. THE SCOPE OF THE POLICY
The policy applies to all patients who are eligible for continuing health care funding
living in the community (not in nursing or residential care homes) that are or were
registered with Staffordshire General Practitioners at the time of decision. This policy
builds on the existing collaborations and joint protocols between Multi Agencies and local
social care. Personal Health Budget will be discussed with the patient following their first three
month review or following their Continuing Care review.
3. UNDERPINNING PRINCIPLES
Notional Budgets and third party budgets could be carried out under existing NHS legislation
prior to the pilot programme. Direct payments required new legislation. The 2010 Health Act
allowed Primary Care Trusts (as they were then) to legally make direct payments using NHS
3
money. The Act stated that personal health budgets pilot sites with specific permission from the
Secretary of State for Health can make direct payments for the pilot period. Following the pilot
period, the Act allowed the Secretary of State to extend direct payments to other commissioning
organisations. Direct payments powers have been extended to all Clinical Commissioning
Groups in England. The principles in this policy are underpinned by the National Health Service
(Direct Payments) Regulations 2013 as amended by the National Health Service (Direct Payments)
(Amendment) Regulations 2013 and the National Framework for NHS Continuing Healthcare and
NHS funded care (DoH 2012)
Procedures relating to the protection of vulnerable adults, use of the Mental Capacity Act
(2005) will be followed and wherever appropriate interpreting or advocacy services will be
provided.
Local Multi-Disciplinary guidelines will be adhered to in conjunction with Staffordshire
Continuing Healthcare Policy.
4. IMPLEMENTATION OF THE POLICY
The successful implementation of this policy is based upon a robust system of MultiDisciplinary and inter-agency working wit h in lo ca l co m m u n it ie s . The Clinical
Commissioning Groups will work collaboratively with external organizations to ensure that t
the policy is a working document, which takes into account current legislation and local
policies and procedures.
5. PURPOSES AND PRINCIPLES OF PERSONAL HEALTH BUDGETS
The person with the personal health budget (or their representative) will:
•
•
•
•
•
be able to choose the health and wellbeing outcomes they want to achieve, in
agreement with a healthcare professional
know how much money they have for their health care and support
be enabled to create their own care plan, with support if they want it
be able to choose how their budget is held and managed, including the right to ask for
a direct payment
be able to spend the money in ways and at times that make sense to them, as agreed
in their plan.
The approach to personalisation and personal health budgets in the NHS:
• The NHS stands by its promise that it is there for everyone, based on need not ability
to pay.
• The NHS care and support you get should be safe and effective. It should be a
positive experience.
• Personal health budgets should help people to get a better service not make things
worse.
• You will not have to get healthcare in this way if you do not want to.
• You should have as much control over decisions as you want
4
6. COMMUNICATION WITH PATIENTS
The right to ask for a PHB will be communicated to every patient who is screened in for
an assessment for NHS Continuing Healthcare from 1 st April 2014. The right to have a
PHB will be communicated to every patient who is screened in for an assessment for
NHS Continuing Healthcare after 1 st September 2014
The right to ask and the right to have a PHB will be communicated also to patients in
receipt of continuing health care funding in advance of their review date. When the
CCG has been asked to communicate with their representative of the patient, this
communication will be sent to the representative. Where the patient is under 18 the
letter will be sent to any person with parental responsibility.
This communication will include an easy read version of “Understanding Personal
Health Budgets” produced by the Department of Health (2013)
7. THE STAFFORDSHIRE APPROACH
7.1 Seven Step process
In Staffordshire and Stoke-on-Trent we have adopted a seven-step process support for patients
to get a personal health budget.
7.2 Eligibility
From April 2014 people who are eligible for fully-funded Continuing Healthcare will have the
right to ask for a personal health budget. In October 2014 this will become a right-to-have.
From September 2014 Children and families who are eligible for Continuing Healthcare will
have be able to have a personal health budget as part or whole of an Education, Health and
Care Plan.
The approach we will take in Staffordshire is to ensure that everyone who is eligible is offered
the opportunity to access a personal health budget as a way to receive their healthcare and
support.
If a patient, who is eligible for full Continuing Healthcare, asks for a personal health budget the
5
seven step process will commence at the three month review following eligibility.
In deciding whether to offer a direct payment for healthcare, the CCG must consider:
• The indicative budget that the CCG is willing to offer(likely to be based on the cost of a
traditional care package)
• The CCG’s alternative offer of care
• Whether a direct payment is appropriate given the patient’s condition
• The impact of that condition on the patient’s life
The CCG will also consider both the complexity and any changing nature of the patients health
needs
Where a patient (or their representative indicates to the CCG their wish to exercise their right to
ask for/have a PHB, arrangements will be made to discuss this with them, including the form of
PHB may be most appropriate to them
A patient who becomes eligible for continuing healthcare on a “fast track” will also be entitled to
be considered for a PHB. However, as such the patient will have a terminal condition that will
rapidly deteriorate; therefore the CCG will prioritise arranging a suitable care package for them.
7.3
How Personal Health Budgets are used:
Personal health budgets are intended to give people a high level of choice and control in how
their care and support is provided and the flexibility to try creative and innovative solutions.
During the national pilot programme people used their personal health budget in a variety of
ways; employing their own care staff (personal assistants) to support them in their home,
physiotherapy, equipment and training to improve managing their own care more effectively and
respite care in alternative settings..
What the patients choose to purchase through their personal health budget will be linked to their
health needs and personal outcomes that are described in their support plan
8. PATIENT CHOICE
Patients and their carers are to be actively involved in all decisions regarding their care. In
the majority of cases patient choice will be to return to their own home if at all possible. When
this cannot be achieved safely a patient may need to transfer to a care home of their choice.
Patients and Carers are to be provided with as much information and support as possible to
allow for informed decision making.
Where the CCG has been made aware that the individual may not have capacity to consent to
the making of a PHB for them, the CCG will arrange for their capacity to be tested, in line with
the Mental Capacity Act (2005). Where that person does not have capacity to consent for a
PHB a best interest decision will be taken as to whether they should have a personal health
budget.
6
9. RESPONSIBLITIES OF KEY STAFF
Responsibilities of key staff are laid out in detail in the National Framework for Continuing
Healthcare (2012) Medical staff, Ward Nurses, Therapists, Community Nurses, Social
Services and Care Co-ordinators.
As a general principle, health and social staff will be responsible for the continuing healthcare
assessments of patients, which do require the involvement of multi-agency services and
identification of a named Care Co-ordinator.
A Delegation of Level Three tasks to Personal Assistants employed through Personal Health
Budgets for Staffordshire CCGs patients
Guidance has been developed for health
professionals regarding their responsibilities in identifying the key clinical skills and training is
required and identifying what of these skills can be delegated to Personal Assistants (PAs)
employed by patients(or their representatives) (see Appendix 1) Clinicians involved with the
patient will have an important role to play helping to determine and agree the clinical
competences that PAs need but decisions about how training to reach these competences
needs to be identified with the patient during the support planning stage and agreed and signed
up to by the patient.
10. THE PROCESS
Practice Guidance has been developed to allow health and social care professionals to
understand the process and where their responsibilities lie in terms of the development of the
patients personal support plan. (See appendix 2) The Support Plan will be completed by their
Support Planner with the appropriate health care professional. This will include what is
important to the person, what they want to see changed, how they want to be supported, how
support will be managed, how the person will stay in control of their life, how the person will
make the plan happen. From this will emerge a clear set of health and personal outcomes from
which to commission the services required as well as a framework in which to review the
patient’s care.
To enable the Personal Support Plans to be approved by the CCG the proposals for meeting
the patients assessed health needs will be:
•
•
•
•
Lawful - the proposals will be legitimately within the scope of the funds and resources
that will be used. The proposals will be lawful and regulatory requirements relating to
specific measures proposed will be addressed
Effective - the proposals must meet the patient’s assessed eligibility needs and support
the patient’s independence, health and well-being. A risk assessment will be carried out
and any risks identified that might jeopardise the effectiveness of the plan or threaten the
safety or wellbeing of the patient or others must be addressed. The proposals will make
effective use of the funds and resources available in accordance with the principle of
best value.
Affordable - All costs will be identifies and can realistically be met within the budget.
Appropriate - the patients support plan will have clear and strong links to the patients’
health and social care outcomes.
A strategic overview flowchart can be seen in appendix 3
7
11. TRAINING
A joint health and social care training programme on PHBs will be arranged across
Staffordshire for health and social care professionals
12. FINANCE
The support planning process helps the patient decide how they would like the PHB fund to be
managed. Some people will simply not want employer’s responsibilities, and in these cases a
third party arrangement may be preferred, where all money, purchases and employment
contracts are handled on the patient’s behalf. Though legal responsibilities lie with the third
party organisation the patient retains choice and control.
It is vital that the Continuing Healthcare budget setting methods is fully transparent t to the
patients (or their representative) from the outset. No Personal Health Budget will be allocated
unless the potential Personal Health Budget Holder demonstrates to the Support Planner full
appreciation of the implications of PHB uptake. If a direct payment is chosen, the patient is
required to sign a service agreement with the CCG, committing them to spend the budget as
agreed in their support plan. They take on full employer’s responsibilities, including advertising
for staff, decisions on rates of pay and employee requirements The Support Planner may help
with some of these tasks. The PHB may also fund extra staff training on certain clinical tasks
which has been identified within the Support Plan and also consider a contingency fund to
factor in long term sickness and redundancy costs to the patient, this mechanism would allow
the CCG to monitor PHB efficiency more closely
Where the PHBs are underspent, the balance will be returned to the CCG. The patient will not
be permitted to spend funds on anything not identified in their personal support plan. Guidance
of the process is found in Appendix 4 (Personalising Healthcare - Framework for Direct
Payments of Personal Health Budgets Guidance)
National guidance provides a list of inappropriate spend:
• Alcohol
• Tobacco
• Gambling
• Debt repayment
• The purchase of primary care services provided by GPs
• Urgent or emergency treatment services
• To pay a close family carer living in the same household except in circumstances when
“it is necessary to meet satisfactorily the patient’s need for that service; or to promote the
welfare the welfare of a patient who is a child”
• The employment of people in ways which breach national employment regulations
13. REVIEWS AND MONITORING
The National Framework for Continuing Healthcare and Funded Nursing Care ( Nov. 2012)
recommends that patients who have been deemed eligible for continuing healthcare funding
should be reviewed initially at 3 months and then annually unless there are any changes in the
patients’ needs. There is no national guidance regarding PHB reviews however the frequency of
the reviews and monitoring should be guided by the needs of each individual and their
circumstances. Some people may have relatively straightforward care arrangements others
8
may have more complex arrangements and particularly vulnerable. At the minimum, new PHB
holders will have a review at three months and twelve months and yearly thereafter as the CHC
Framework states. Individuals will have access to the Support Planner contact details if at any
point healthcare needs change.
14. DISPUTES/DISAGREEMENTS
The Staffordshire and Stoke on Trent CCGs and the Local Authorities have the right to insist on
a different support package, or end a Personal health budget if there is serious concern that the
care being funded via the personal health budget is not achieving the agreed outcomes
identified in the patient’s support plan, involves an inappropriate level of risk, or is proving
harmful to the patient.
Complains by patients, families, professionals will be addressed in the first instance through the
appropriate organisations Complaint teams
REFERENCES
Department of Health (2012) Personal health budgets guide: implementing effective care
planning London
Department of Health (2012) Budget setting for NHS Continuing healthcare London.
Department of Health (2012) National Framework for NHS Continuing Healthcare and NHS
funded care. London
Department of Health (2014) Guidance on Direct Payments for Healthcare Understanding the
Regulations. London
NHS England (2013) The CCG Assurance Guide 2013/4: Operational Guidance London
9
APPENDICES
10
Appendix 3
11
Delegation of level 3 tasks to Level 3 PAs
Appendix1
Item: 09 Enc: 07
Delegation of Level 3 tasks to Personal Assistants
employed through Personal Health Budgets for
Staffordshire CCGs clients
Agreed at Cannock Chase Governing Body
Date: …………………………………………………………………..
Signature: …………………………………………………………….
Designation: ………………………………………………………….
Review Date: ………………………………………………………….
Agreed at Stafford & Surrounds Governing Body
Date: …………………………………………………………………..
Signature: …………………………………………………………….
Designation: ………………………………………………………….
Review Date: ………………………………………………………….
Date: 07.03.13
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Version: 2 (Draft)
Page 1 of 18
Partners in Care
This is a controlled document. It should not be altered in any way without the express permission of
the author or their representative.
On receipt of a new version, please destroy all previous versions.
Document Information
Date of Issue:
Version:
Author:
Directorate:
Next Review Date:
Last Review Date:
1
Christine Brown
Quality
Approval Route
Approved By:
Date Approved:
Links or overlaps with other CCG Documents:
Amendment History
Issue
Status
Date: 07.03.13
Version: 2 (Draft)
Date
Reason for Change
Authorised
Page 2 of 18
Contents
1
Introduction ......................................................................................................... 4
2.
Statement / Objectives………………………………………………………………...4
3.
Definitions and Principles.....................................................................................5
4.
Roles & Responsibilities ...................................................................................... 5
5.
Deciding on Delegation………………………………………………………………..6
6.
Principles of Delegation……………………………………………………………….7
7.
Consent ………………………………………………………………………………...9
8.
Supervision and Training………………………………………………………………9
9. Governance Framework ................................................................................... .11
10. Monitoring, auditing, Reviewing & Evaluation……………………………………..11
11. Bibliography………………………………………………………………………….. 12
Appendix 1 Decision Matrices and Descriptors ……………………………………….13
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Page 3 of 18
1 Introduction
This guidance provides clarity on the key issues relating to delegation of care from
employed registered professionals to third party individuals who are not employed
by Staffordshire and Stoke on Trent Clinical Commissioning Groups (CCGs) This
will provide assurance that delegation is always undertaken within the clear
parameters of safe delegation as stated by the Nursing and Midwifery Council
(NMC),
1.1
Many terms have been used to describe the practitioner who is responsible
for delegating a task. This is a professional who is on a register for that
particular profession, i.e., the Health Professions Council (HPC) or the
Nursing and Midwifery Council (NMC). The code: Standards for Conduct,
Performance and Ethics for Nurses and Midwives, states "You must establish
that anyone you delegate to is able to carry out your instructions." "You must
confirm that the outcome of any delegated task meets the required
standards." "You must make sure that everyone you are responsible for is
supervised and supported."
1.2 The terminology used to describe this group of support workers and their
management, varies within and across professions and so for the purposes of
this guidance, the following terms have been used:
Third party Personal Assistant (PA)
There is currently no national policy that determines a single
name for this group of workers. Numerous titles exist to reflect
the many and varied roles carried out. For the purposes of this
guidance the term ‘PA’ describes the third party worker who has
a role or task delegated to them. This may include unskilled
friends, relatives or other individuals identified by the service
user and/or their family. This can be either under a private
employment arrangement or through an independent contractor.
Registered Practitioner
This is the professional who is on a register for that particular
profession, i.e., the HPC or the NMC.
2. Statement/Objective
2.1 The purpose of this guidance is to encourage all groups of staff, employed
and not employed, who are engaged in the delivery of health and social care
to reflect collaboratively on tasks proposed for delegation to third party PAs, in
order to ensure that clients receive safe and effective care from the most
appropriate person.
2.2
Health and Social Care in the UK is undergoing rapid change as healthcare
organisations restructure the delivery of services in order to provide the most
efficient and effective care to service users. A wide range of drivers has led to
PA roles growing both in terms of number and in the scope of activities being
undertaken. This has prompted an increasing number of enquiries to
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professional bodies and trade unions about their management and support.
This guidance has therefore been developed to help clarify the delegation
process for registered practitioners and third party PAs and the associated
issues of accountability and supervision.
2.3
The issue of delegating tasks to third party PA’s is increasing in significance,
as patient choice, the service user making decisions about their own care, the
promotion of personalized and inclusive care and care being delivered in the
community setting become accepted methods of healthcare delivery.
3. Definitions & Principles of Interpretation
3.1 Delegation is the process by which the delegator allocates clinical or nonclinical
treatment or care to a competent person (the delegatee). The delegator will
remain responsible for the overall management of the service user, and
accountable for the decision to delegate. The delegator will not be accountable
for the decisions and actions of the delegatee.
3.1.1 The registered practitioner is accountable for delegating the task and the
PA is accountable for accepting the delegated task, as well as being
responsible for his/her actions in carrying it out.
3.1.2 The registered practitioner cannot delegate their accountability. The PA
holds accountability for their actions and could be taken through a civil court.
3.2 Level 3 Tasks: Tasks using specialised techniques. This may include:
•
•
•
rectal administration, e.g. suppositories, diazepam (for epileptic
seizure)
insulin by injection
administration through a Percutaneous Endoscopic Gastrostomy
(PEG)
3.3 If the task is to be delegated to a PA, the healthcare professional must be
trained and competent in the skill themselves to ensure adequate training for
the PA and be satisfied they are competent to carry out the task. The training
provided to the PA is client specific therefore the new skills learnt are not
transferable.
4. Roles & Responsibilities
4.1. Registered professionals are regulated within statute and are accountable to
their regulatory body- i.e. Nursing and Midwifery Council (NMC) for nurses,
midwives and health visitors and, Health Professions Council (HPC) for
physiotherapists, dietitians, speech and language therapists and so on.
4.2. Although PAs are not currently regulated by statute they remain aaccountable
for their actions in several ways, including:
•
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to the patient/client - civil law (duty of care). The PA is accountable
for their actions and omissions when they can reasonably foresee
that they would be likely to injure people, or cause further discomfort
Page 5 of 18
or harm, e.g. If an PA failed to report that a patient had fallen out of
bed;
•
to the public – criminal law e.g. If a PA were to physically assault a
patient, then they would be held accountable and could be
prosecuted under criminal law, as well as being in breach of their
contract of employment.
5. Deciding on Delegation
(See Appendix 1 - Decision Matrices and Descriptors)
5.1. Delegation of activity is determined in the context of the relationship that exists
between the person who delegates and the person to whom some aspect of
practice is delegated. A number of factors have been identified that are
significant for those who delegate tasks when deciding on whether to pass a
task on to a PA, and the person who is responsible for the decision to delegate
should follow the decision making flow-chart contained in Appendix 1 if they are
in any doubt as to the appropriate decision making process to be followed.
5.2. A personalised assessment of the service users needs should be carried out
and documented by the registered professional(s) involved with the service user
and should include:
•
•
•
•
•
•
mental capacity;
the use of contracts;
costs and funding/ direct payments;
risk assessment;
who will best meet the need of the patient?
is there a need for a third party to carry out the task?
5.3. Where it is identified that the service user lacks mental capacity to decide that a
PA can undertake the specific task for them, then the healthcare professional
delegating is responsible for ensuring that a discussion has been held with
family (and/or those individuals who are deemed to have responsibility for the
care of the service user) of the service user and that a decision is made in the
service users best interest. A consent form must be completed before the task
is delegated and the delegator must ensure this is clearly evident in the service
user’s notes. Appropriate individuals who may be deemed to have responsibility
for the care of a service user can include:
• next of kin;
• social worker; or
• General Practitioner
5.4. The question of who should carry out which task depends on a number of
factors. The central elements involve:
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•
the individual PA’s skills, competence, attitudes and experience;
•
•
the requirements of the service user and their own choice;
the nature of the task in the specific circumstance; or
Page 6 of 18
•
if there is a need for a change or introduction of equipment or
technology to help in meeting the need.
5.5. Risk assessment is not a substitute for professional judgement and experience
and should be informed by the worker’s knowledge, skill and expertise. It is a
process involving thinking about the dangers and risks that individual’s face,
recording these and considering where the responsibility will appropriately lie.
Equally it should not be used as an excuse not to do things unless the likely
benefits are outweighed by the likely danger. A risk assessment will need to be
a part of and refer to the multi-disciplinary assessment so that the process can
be understood.
5.6. When delegating to a PA specified by the service user then the service users
personal care plan should be used to highlight any risks and to set up an
agreed contingency plan. As part of the care plan consideration needs to be
given to how care is provided if PA care breaks down.
5.7. The employer of the PA, whether this is an agency or the service user should
be aware of and agree to the training, assessment and task delegated.
6. Principles of Delegation
6.1. The delegation of skilled, specific care interventions must always take place in
the best interests of the service user that the professional is caring for and the
decision to delegate must always be based on an assessment of their individual
needs.
6.2. Every delegation has to be safe; the primary motivation for delegation should be
to meet the health and social care needs of the service user.
6.3. The registered practitioner is responsible for the service user’s involvement in
the assessment of care and developing a personalised care plan.
6.4. Appropriate assessment, planning, implementation and evaluation of the
delegated role must be complete and documented.
6.5. The PA delegated to undertake a task must be in an appropriate role or
relationship, with the right level of experience and competence to carry it out.
6.6. Registered practitioners must not delegate tasks and responsibilities to an PA
that are beyond their level of skill and experience.
6.7. The task to be delegated must be discussed and both the delegator and the PA
should feel confident about the decision, before the delegated task is carried
out.
6.8. The PA must feel able to refuse to accept a delegation if they consider it to be
inappropriate, unsafe or that they lack the necessary competency.
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6.9. Supervision and feedback must be provided appropriate to the task being
delegated. This will be based on the recorded knowledge and competence of
the PA the needs of the service user, the service setting and the tasks
assigned.
6.10.The delegator must either ensure that PA’s have the competencies required to
carry out any tasks required or alternatively provide training to ensure the
competencies required are met by the PA. The delegator is also strongly
advised to keep their own record of training given and copies of the competency
assessment documentation.
6.11.All staff, including agency staff or directly employed individuals have a
responsibility to intervene if they consider any delegated task to be unsafe.
6.12.An PAs must be aware of the extent of their expertise at all times and seek
support from available sources when appropriate.
6.13.Documentation, including the details of the task and delegation is completed by
the appropriate person and within protocols and professional standards and
codes of practice.
6.14.The delegation to the PA must always be for the individual named service user
only.
6.15.Existing national and local policies as set out by the registered practitioner must
be used.
6.16.Where a third party (such as an employer) has the authority to delegate an
aspect of care, the employer becomes accountable for that delegation.
6.17. The employer will also be responsible for organising any training with the
agreement of the registered practitioner in an appropriate and reasonable
manner.
6.18.The decision whether or not to delegate an aspect of care and to transfer and/or
to rescind delegation is the sole responsibility of the registered practitioner and
is based on their professional judgment.
6.19.The registered practitioner has the right to refuse to delegate if they believe that
it would be unsafe to do so or if they are unable to provide or ensure adequate
supervision.
6.20.The decision to delegate is either made by the registered practitioner or the
employer and it is the decision maker who is accountable for it.
7. Consent
7.1. Service users have the right to know who is treating them and expect that those
who provide care are knowledgeable and competent.
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7.2. In many circumstances consent would be inferred by co-operation with the task
being performed. Consent would be required in circumstances where the
delegation itself might pose a potential risk, albeit that the delegation remains
appropriate, or where it could have a material impact on a service user.
8. SUPERVISION AND TRAINING
8.1.
Supervision
8.1.1.
Where there is no registered practitioner as the delegator, then there
must be a supervision system provided by a registered practitioner to
the PA.The exception to this is Level 3 Tasks which must only be
delegated and not offered through supervision. On-going supervision is
used to assess the PA’s ability to perform all other delegated task and
capability to take on additional roles and responsibilities. It is normally
expected that a named supervisor is identified within the personal care
plan.
8.1.2.
The following should apply:
8.1.3.
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•
there should be a documented system in place for PA’s to
access supervision and clinical advice as required;
•
regular supervision time is agreed between the registered
practitioner and the PA and a record is made of each session;
•
the PA shares responsibility for raising issues in supervision and
may initiate discussion or request additional information/support;
Supervision can vary in terms of what it covers. It may incorporate
elements of direction, guidance, observation, joint working, and
discussion, exchange of ideas and co-ordination of activities. It may be
direct or indirect, according to the nature of the work being delegated.
The decision concerning the amount and type of supervision required
by a PA is based on the registered practitioner’s judgment and is
determined by the recorded knowledge and competence, the needs of
the service user, the service setting, and the delegated tasks. Factors
to be considered by the registered practitioner therefore include:
•
the level of experience and understanding of the PA relevant to
the task being delegated;
•
regular assessment of the PA’s competence relevant to the
delegated task;
•
the complexity of the delegated tasks (i.e. whether the delegated
task is a routine activity with predictable outcomes);
•
the stability and predictability of the service user’s health status;
Page 9 of 18
•
the environment or setting in which the delegated task is to be
performed and the support infrastructure available (e.g. whether
working in a community, or school setting);
•
availability of and access to support from an appropriate
registered practitioner;
•
periodic review and reassessment of the service user’s
outcomes;
•
an identified process for recording and reporting.
8.2. Training of Third Party Personal Assistants
8.2.1.
Support must be given to service user and registered practitioners to
make the decision re delegation.
8.2.2.
The PA’s competence & level of tolerance must be assessed.
8.2.3.
Training needs must be identified and documented
8.2.4.
The professional delegating the task is responsible for all training and
assessment of competence of any delegate.
8.2.5.
If equipment is to be used then the manufacturing company can train in
use of equipment if appropriate. This must be overseen by the
equipment prescriber.
8.2.6.
There must be a documented training and re assessment plan
personalised and discussed with the service user.
8.3. Plan for On-going Monitoring
8.3.1.
A plan for on-going monitoring must be made and reviewed at least
monthly. This must include:
•
•
•
•
•
•
•
competence of the PA assessed and monitored at least monthly;
on-going and regular reviews
the on-going frequency of the task;
contingency plans to cover sickness, holiday etc;
an opt-out plan for the PA undertaking the task;
on-going supervision arrangements;
a continuing risk assessment, where necessary.
8.4. Documentation
8.4.1.
Competence and assessment documentation must be available to
provide audit trail of the PA’s competence and training.
8.5 Outcome Measures
8.5.1.
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Achieving outcomes should be measured by service user satisfaction,
incidents, complaints, capacity, reduction in emergency admissions,
Page 10 of 18
reduced acute episodes leading to increased support from community
services and carer satisfaction.
9. Governance Framework
9.1.
Clinical and corporate governance frameworks, strategies and practices
should act as an enabler and not a barrier to delegation;
9.2.
Healthcare Governance systems will be in place across all areas to support
patient safety through personalisation.
9.3.
On-going monitoring and review of current clinical practice should support
delegation.
9.4.
Clear lines of accountability should be in place as part of the wider
governance responsibilities.
9.5.
To support delegation and clarify accountability it is imperative that all
professional codes of conduct are interpreted consistently and understood
across the organisation.
10. Monitoring, Auditing, Reviewing & Evaluation
10.1. This guidance will be reviewed in 12 months from ratification, and
periodically thereafter.
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Page 11 of 18
11.Bibliography
Department of Health. Regulation of health care staff in England and Wales: a
consultation document. London: DOH; 2004.
http://www.dh.gov.uk/assetRoot/04/08/51/72/04085172.pdf
Skills for Care (2010) Personalisation and Partnership – A Successful Working
Relationship: What Factors Disabled People Feel are Important in their
Relationships
with their Personal Assistants, Carers and Support Workers.
http://www.solnetwork.org.uk/uploads/successful-workingoct2010.pdf
Working for personalised care: A framework for supporting personal assistants
working in adult social care. (2011) London: DOH
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyA
ndGuidance/DH_128733
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Appendix 1 – Decision Matrices and Descriptors
Decision Matrix One – Assessment of Task
(to be read in conjunction with descriptor table for assessment of task)
Start
Yes
Has the task been
successfully
delegated in the
past?
No
Yes
Can this task only be
performed by a registered
professional?
No
No
Can the task be
delegated?
Yes
Do the benefits
outweigh the
risks?
No
Yes
No
Do you need to
gain service user
consent?
Yes
Proceed to
Decision
Matrix 2
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Yes
Have you
gained service
user consent?
No
Do not
delegate
Page 13 of 18
DESCRIPTOR TABLE FOR ASSESSMENT OF TASK
This stage will assist delegators in deciding if the task can or cannot be delegated
Descriptor table for Assessment of Task
Question
Descriptor
Can the task be delegated?
When considering whether the task
can be delegated take into account
the level of the task, what skills the
PA would need to perform the task
and if this is a task that needs to be
delegated?
Can this task only be performed by
a registered practitioner?
Before this task is delegated it
needs to be considered whether
this task must be performed by
someone
authorised
in
the
profession.
Do the benefits outweigh the risks
to the service user?
Having conducted a benefit and
risk assessment, have the benefits
of delegating the task outweigh the
risks of delegating the task?
What risks have been identified?
Do you need to gain service user
consent?
In certain circumstances you may
need to gain service user consent
to carry out the task.
Have you gained service user
consent?
Have you consulted with the
service user and made them aware
that the task that is being
undertaken on them will be
conducted by an identified PA?
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Decision Matrix Two – Assessment of Individual
(to be read in conjunction with descriptor table for assessment of individual)
Start
Identify person
Is the
person able
to carry out
the task?
Yes
Does the person have
sufficient knowledge,
skills and training to
complete the task?
No
No
No
Yes
Take the appropriate
action to ensure that
the person has
complete the task.
Identify risks.
Yes
Is the person competent
and confident enough to
carry out the task?
Is it feasible for the
person to gain
complete the task?
No
Is it feasible for the
person to become
competent and
confident enough to
carry out the task?
No
Yes
Take appropriate action to
ensure that the individual
Yes
becomes competent
and confident enough to
carry out the task.
Are written procedures
available for proper
performance of the
task?
No
Yes
Take appropriate
action to develop
the appropriate
procedures
Is
supervision
required?
No
Yes
Delegate
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Yes
Is
Supervision
available?
No
Make sure
supervision
is available
Page 15 of 18
DESCRIPTOR TABLE FOR ASSESSMENT OF INDIVIDUAL
This stage will enable you to identify the correct individual to delegate the task
Question
Identify individual
Is the individual available to conduct
the task?
Does the person have sufficient
knowledge, skills and training to
undertake the task?
Descriptor
Having decided that the task is
delegable it is important to identify
whether there is someone available to
conduct the task.
Having identified the individual, are
they readily available to conduct the
task?
When
determining
whether
the
individual has sufficient knowledge,
skills and training to undertake the task
please bear in mind the following;
Has the individual been trained to carry
out this task before?
When was this training last given?
Has the task changed since training
was given?
Is the person competent and confident
to carry out the said task?
Has the PA's training been updated
since their last training session?
When considering whether the person
is competent and confident to carry out
the task please note the following;
Has the person expressed concerns
about the task?
Do you believe the person to be
competent to carry out the task?
Is the person confident in themselves
to carry out the task?
What risks have been identified?
Are written procedures available for
proper performance of the task?
Is supervision required?
Is supervision available?
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Before the person is given the
delegated task please check to see if
there are written procedure or policy
documents available to assist the
person when carrying out the task.
The delegator will need to decide
whether this task requires supervision.
When carrying out the delegated task
will the person have access to support
if required?
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1
Practical guide for Personal Health Budgets in
Continuing Healthcare (Version 4)
The Staffordshire approach
Page | 0
4. Practical guide for Personal Health Budgets in Continuing Healthcare Version 4, Matthew Oakley, July 2014
Contents
Preface ............................................................................................................................................................... 2
Introduction to personal health budgets ........................................................................................................... 3
Eligibility for a personal health budget .............................................................................................................. 4
Information and advice ...................................................................................................................................... 5
Budget setting .................................................................................................................................................... 6
Support planning................................................................................................................................................ 7
Approving the plan............................................................................................................................................. 9
Managing the budget ....................................................................................................................................... 11
Setting up the support ..................................................................................................................................... 12
Review the plan................................................................................................................................................ 13
Appendix .......................................................................................................................................................... 15
Glossary of terms ......................................................................................................................................... 15
Seven criteria for a good support plan ........................................................................................................ 17
Personal health budget process map .......................................................................................................... 20
Direct payment set up process .................................................................................................................... 23
Decision making for how a PHB could be managed .................................................................................... 24
Additional documents that supplement the practical guidance ................................................................. 25
Page | 1
Preface
The purpose of the practical guidance is to explain the seven step process for delivery of personal health
budgets in Staffordshire.
Tasks within the personal health budget work streams have been assigned to individual staff roles that will
be in place when Personal Health Budget team is established. This team will be responsible for service
delivery of personal health budgets on behalf of the Clinical Commissioning Groups. Should a team not be
established then the practical guidance will be reviewed and tasks reassigned to most suitable existing
roles.
In addition to listing the person who will carry out a task, other individuals that, in some circumstances,
could carry out this task are also included, with the main designated person listed first.
The tables breaking down each step also identifies those that are responsible for the oversight of a
particular task; ensuring that it is completed.
A summary of the roles
As part of the proposal to establish a single team to deliver personal health budgets several new roles have
been identified. These roles are defined as follows:
PHB Lead: an equivalent to a CHC Lead Nurse designated the clinical lead for personal health budgets on
behalf of the CCGs.
PHB Nurse: and equivalent of CHC Nurse Assessor; front-line support to people that are going through the
personal health budget process offering clinical input with support planning and the setting up of support.
PHB Admin: administrative support provided to the PHB team.
PHB Finance Lead: to provide financial oversight and support for the delivery of direct payments for
personal health budgets.
Head of CHC: the Head of the Continuing Healthcare team with overall responsibility for the delivery of
CHC support.
CHC Lead Nurse: the lead practitioner for the particular care category (e.g. Physical Disability, Mental
Health, Children, Learning Disability)
CHC Admin: administrative and business support that is in place in the Continuing Healthcare team.
CSU Finance:
CCG Commissioners:
Where tasks could also be carried out by an external organisation or third party (such as support planning)
this is listed as ‘External Support’ (in the case that a third party would assist but the role itself in unclear).
Page | 2
Introduction to personal health budgets
What is a personal health budget?
A personal health budget is an amount of money provided to someone with an identified health need, it
enables them to have more choice and control over how their needs are met and how they are supported.
This means they can select the treatments and services that meet these needs in a way that is most
appropriate to them.
Who can have a personal health budget?
Starting in April 2014 people who are eligible for full NHS Continuing Healthcare (NHS-funded long term
health and personal care provided outside hospital) will have the right-to-ask for a personal health budget,
including a direct payment. From October 2014 this will become a right-to-have a personal health budget.
The right-to-ask will then be extended to people with long term conditions at the beginning of April 2015.
What are the essential parts of a personal health budget?
At the centre of a personal health budget is the support plan. This plan helps the person choose their
health and wellbeing outcomes in agreement with a health care professional. They know how much money
is available and will set out how they will use the budget to achieve the outcomes in their plan and the
support needed to do this. The plan should also include information on how the budget will be managed
and what will be done to stay healthy and safe.
The Staffordshire and Stoke-on-Trent approach
To provide personal health budgets to people who are eligible for Continuing
Healthcare. Staffordshire and Stoke have adopted a seven-step process (right),
based on best practice guidance.
This guide will go through each of these steps and explain what will be required
at each point and the involvement and responsibilities of healthcare
professionals. The appendix includes a process map that breaks down each task
within the seven steps with the practical guidance going into more detail on
what each step means and how each task should be approached.
This guide does not cover the approach for personal health budgets for people
who are not eligible for NHS Continuing Healthcare – but the seven-step
process could be adapted.
Page | 3
Eligibility for a personal health budget
To have a personal health budget an individual must be eligible for fully-funded Continuing Healthcare
(CHC). Having a personal health budget does not change how eligibility is determined; this will be done in
line with existing CHC processes.
For people who already receive full CHC funding, a discussion about a personal health budget should take
place when their CHC package and eligibility is reviewed, with the offer to send local information if they
want further information.
For people who have recently become eligible, a personal health budget can be discussed at their threemonth review. In some circumstances, to ensure continuity of care, (e.g. if when a person is already
employing their own care staff or they have a direct payment) people should be supported to keep any
existing support as an interim budget to be reviewed after three-months.
A person or family may request a personal health budget at any time, if a review is required then this
should be scheduled and be conducted by a CHC Nurse before referring to the PHB Team.
Task
When does this happen
Who will do this
Eligibility ratification
Following submission for
eligibility.
After 3-month review for new
patients.
CHC Panel
PHB Offer / Letter (to inform
person of family of the
availability of personal health
budgets)
Notify PHB Team
Set up ‘interim PHB’ to allow
continuity of care
CHC Admin
CHC Nurse
Who is responsible
for ensuring this
happens
Head of Continuing
Healthcare
CHC Lead Nurse
Head of CHC
CHC Admin
CHC Nurse
PHB Team
CHC Lead Nurse
Head of CHC
CHC Lead Nurse
After annual review for
existing CHC patients (only
required once).
When someone who is
already eligible for CHC
expresses an interest in PHBS.
When a letter or information
pack has been shared.
When a person already has a
direct payment / or employs
personal assistants
Employing family members in the same household
Paying family members who live in the same household can only be done when it is an exceptional
circumstance, when it is necessary to meet the needs of the person having tried or discussed other options
that are available.
These decisions should be made on a case by case basis and in the majority of cases it would be expected
that this would decision would be referred for consideration to the Risk Enablement Panel.
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Information and advice
Following the expression of interest and sending of letter to the person or family the PHB Team would
begin to work through the rest of the process.
To ensure people and families can make an informed decision about whether or not a personal health
budget would be suitable for them a range of information is available. This can be passed on in different
ways; the local information pack, online resources and face-to-face conversations with a member of the
CHC team, a CCG representative, peer or other professional.
Local Information pack
This pack includes:








Seven-steps to a personal health budget booklet
Direct payments guidance
A template support plan (electronic versions are available)
An example support plan
Consent form
Employing personal assistants DVD (hard copy packs are available)
Support planning guidance
Preparation for PHB discussion form
Online resources
The current resource for information on personal health budgets in Staffordshire is
www.staffordshirecares.info/phb. Each Clinical Commissioning Group website has information about
Professionals may want to sign-up to the national learning network for additional support and access to
the forum if they have any questions or information they wish to share:
www.personalhealthbudgets.dh.gov.uk/
Websites that professionals may want to direct people or families that are interested in personal health
budgets include: www.peoplehub.org.uk/ and www.nhs.uk/personalhealthbudgets.
Face-to-face engagement
When talking with people and families staff should be familiar with the key aims and messages of a
personal health budget:
 It gives more choice and flexibility for how people meet their healthcare needs.
 People can have as much control over their healthcare and support as they need.
 A support plan that describes how they will be supported and how they want to spend their budget
must be completed as part of the process.
 Having a personal health budget should be a positive experience and help people get a better service.
 People can now choose to manage their budget themselves via a direct payment.
 People can employ their own care staff.
 Help is available to develop a support plan, set up a direct payment and to recruit and employ your own
staff.
Page | 5
 Personal health budgets are intended to be used to meet people’s health and well-being needs with
consideration also given to how it can improve their quality of life.
 Having a personal health budget will not require people to make a contribution.
 People do not have to have a personal health budget it they do not want to.
Information and advice should be readily available at any time and determined by a person or families
interest in having a personal health budget
Task
Who will do this
Provide PHB Info Pack
Following a 3-month review
PHB Admin
and confirmation the person is PHB Nurse
still eligible for CHC.
CHC Nurse
Who is responsible
for ensuring this
happens
PHB Lead
PHB Nurse
CHC Lead Nurse
Following conversation and
request for pack from person
or family.
PHB Conversation
(to answer any further
questions to help an individual
make an informed decision
about whether or not they
want a PHB)
When a person or family
requests one (following PHB
letter) or expresses
information in PHB.
At the request of a person or
family who are considering
pursuing a PHB.
PHB Nurse
PHB Lead
CHC Nurse
Peer support
PHB Lead
CHC Lead Nurse
Often this will be after an
information pack has been
sent.
Budget setting
When a person or family decides that they would like a personal health budget a ‘provisional budget’ (also
known as an indicative budget) should be provided before support planning begins.
What is a provisional budget?
A provisional budget is an estimate of how much money is required to arrange the care and support
needed to meet a person’s health needs and outcomes. The provisional budget is not a fixed amount that
cannot be exceeded or a target to be reached, but a guide to make the support planning process more
effective by providing an indication of how much money will be available for the person’s care and
support.
Working out the provisional budget
For people with existing CHC packages the provisional budget will be based on the current cost of their
care. If, when a review has taken place, a person’s levels of need (as recorded on the Decision Support
Page | 6
Tool) have increased or decreased the budget setting tool can be used to assist with the calculation of a
provisional budget.
Budget setting tool
The tool can be used when someone is new to Continuing Healthcare or has had a significant change in
their needs or circumstances that the existing cost of their package would not be meet their needs
effectively. This tool should be used to support the identification of a provisional budget. It is not intended
to replace professional judgement on the level of need or care required but can be used to assist
professionals in calculating a budget that can allow support planning to begin.
See the appendix for instructions on how the budget setting tool is used.
Final budget
During support planning a ‘final budget’ will be worked out. This is the actual total cost of the care and
support that make up the personal health budget. It may be higher or lower than the provisional budget. If
there is a significant difference (where the final budget is more that 10% above or below the provisional
budget) this should be highlighted during the approval of the support plan and where necessary referred
to the Risk Enablement Panel.
Process
Who will do this
Identify existing cost
When the person or family
has decided that they want a
PHB.
CHC Admin
CHC Nurse
Use budget tool (if required)
Agree provisional budget
Share provisional budget (to
the family or person and
support broker)
When the budget has been
worked out there should be
confirmation that it is an
acceptable amount so support
planning can begin.
This should be sent out in a
letter or communicated over
the phone.
Who is responsible
for ensuring this
happens
CHC Lead Nurse /
PHB Nurse
PHB Nurse
PHB Lead
PHB Admin
CHC Lead Nurse &
PHB Nurse
PHB Lead
PHB Admin
PHB Nurse
PHB Nurse
CHC Lead Nurse
Head of CHC/ PHB
Lead
Support planning
Support planning is central to having a personal health budget, it places the individual or family at the
centre of deciding the best way to meet their health and wellbeing needs.
At this point the person should have had a discussion about a personal health budget, been provided with
an information pack and have a provisional budget. Although people may start thinking about what is
working and what they would like to change, once they receive the provisional budget they can begin to
look in more detail at how they can use their budget.
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A support plan can take any form, although there is a template available, however a ‘Support Plan
Summary’ should be completed when the plan is submitted for approval.
What is the purpose of support planning?
Support planning should involve conversations with health care professionals, family and friends and other
support that people may have. The support plan itself should represent a summary of these conversations
and the key decisions that have been made about how they would like to spend their personal health
budget. Throughout the process a healthcare professional should be involved to provide input and
assistance with the clinical parts of the plan, in particular when this relates to the delegation of clinical
tasks that would require training.
What needs to be in a support plan?
There are seven criteria* that need to be met in a support plan. The table below shows these criteria and
expands on what information this should relate to:
Criteria
1. What is important to
me (and important for
me)
2. What is working well
and what I want to
change
3. How I will be supported
4. How my personal
health budget will be
spent
5. How my support,
treatment or care will be
organised and managed
6. How I will stay in
control of decision making
Key elements of this criteria
A description of the person, the things and people that are most important to
them, their strengths and what is essential to their health and wellbeing.
The things that people want to keep the same and what people want to
change or achieve.
SMART outcomes (S – specific, M – measurable, A – achievable, R – realistic, T
– time-limited)
A description of their health needs and the care and treatments to support
them
A breakdown of how the budget will be spent and the care, treatment and
services that will be purchased
Who will be responsible for setting up the support, what training is needed,
what are the risks and a contingency plan.
A care-coordinator should be identified as part of the plan.
What will happen to ensure the person is in control of decision making
relating to their care
What decisions can the person make, what decisions do others make on their
behalf and who makes the final decision
What are the steps that will be taken to put the plan in place and the
outcomes these steps support?
7. What I will do to make
this happen (an action
plan)
*For a detailed breakdown of these criteria and what they mean see the appendix of this guide.
What are outcomes?
Outcomes are the differences made to a person’s life as a result of having a personal health budget. The
emphasis of personal health budgets is on an outcomes focused approach. They may relate to quality of
life, how support is delivered or changes and improvements that a person would like to accomplish. These
could be short-term or long-term to focus on over a 12 month period.
Page | 8
Some outcomes will be simple and achieved with little difficulty. Others may be more complex or seen as
risky, so a healthcare professional should be part of discussions around how they can be achieved.
What help is available for support planning?
Support planning starts with the person or family; however assistance may be required with certain parts
of the plan. This could be provided by existing networks of support (e.g. CHC Nurse, a social worker or
other healthcare professionals) or they could be directed to peer support (someone who already has a
personal health budget). Additional support is available from organisations or individuals (often called
brokers or planners) that can help with support planning.
Process
When
Who will do this
Refer to planning help
When the person requires
support planning assistance
the options that are available
should be discussed.
If the person already has an
existing support plan or one
that has been used in the past
it may be easier to update this
rather than create a new one.
Provided to the person or
family when they have a
provisional budget and have
agreed they would like help to
develop the plan.
PHB Nurse
PHB Lead
PHB Admin
Existing / Original plan
Support planning assistance
Share plan for approval
When the plan has been
finished and the person or
family are happy for it to be
submitted.
This includes completion of
page 1 of the support plan
summary.
Who is responsible
for ensuring this
happens
PHB Lead
CHC Lead Nurse
PHB Nurse
Person or Family
CHC Lead Nurse
Support broker
External Support
(input could also
come from PHB
Nurse, CHC Nurse,
Social workers and
other healthcare
professionals)
PHB Nurse
External Support
Person or family
Person or family
PHB Lead
PHB Nurse
CHC Lead Nurse
Person or family
PHB Nurse
CHC Lead Nurse
Approving the plan
The principles that form the approval a support plan are that what is included will be lawful, likely to be
effective and affordable within available resources.
For the support plan to be approved the seven criteria must be met. These criteria cover clinical and
financial governance as well the person’s choices and preferences. See appendix for a detailed breakdown
of the seven criteria - this includes reasons why a support plan may not be approved.
Page | 9
To assist with the approving of plans a checklist is part of the support plan summary and should be
completed as part of the approval process.
There are some restrictions on what a personal health budget can be spent on:
• Emergency or acute services
• The vast majority of primary services (including visits and assessments) as GPs provide a
comprehensive, registration-based service
• Anything illegal
• Gambling
• Debt repayment
• Tobacco
• Alcohol
• Treatments (such as medicines) that the NHS would not normally fund
Agreeing the plan
The support plan should be agreed and signed off from the following three perspectives: Personal, Clinical
and Financial.



Personal: that the supports plan satisfactorily represents how the person or family wants to use
their personal health budget to meet their needs and personal outcomes. This signature should
come from the person or their representative.
Clinical: that the care and support and that will put in place will meet the person’s needs safely and
effectively and that acceptable considerations for training and clinical governance have been
identified. This signature should come from a health professional.
Financial: that the final budget in the support plan will satisfactorily pay for the care that is
required, will be managed appropriately and is not below or above the provisional budget (within a
10% range) which may mean there is not enough care to meet their needs and leave them at risk,
or more care than is required and could impact upon their independence or would not be a suitable
use of NHS resources.
To assist with the agreement and overall approval process the following guidelines should be used when
approving a plan:


The ‘7 criteria for a good health support plan’ document should all be met (see appendix).
The final budget falls within 10% above or below the provisional budget.
When a plan is not agreed
If a support plan is not approved the person or family should be informed of the reasons why and provided
with advice on changes that could be made to the plan in order for it to be approved in the future.
Information provided should support the person or family to re-submit a plan that will be approved at a
second attempt. If a plan is not approved for a second-time this should be referred to the appeals process.
The plan could be partially approved; with elements of the budget starting whilst other aspects can be
revisited before approval to avoid delays for the person or family.
When a plan is submitted for a third time approval it should be escalated to the Risk Enablement Panel
(please see Risk Enablement Panel guidance).
Page | 10
If the plan is not approved then the person or family should be advised to follow the CCG’s Complaints
Procedure
Process
When
Who will do this
Approval decision (the final
sign off the plan)
The plan has been submitted
by the person and
CHC Lead Nurse
PHB Lead
Referral to REP for advanced
approval
If an approval decision cannot
be reached after two
attempts.
When the CHC Lead Nurse
feels it is necessary for the risk
enablement panel to input on
the decision.
The support plan has been
through the approval process
and part or the entire plan is
not agreed. The feedback
should be based upon the
approval checklist.
When a plan has not been
approved for a third time
PHB Nurse
CHC Lead Nurse
Advanced approval
Provide feedback
Advise the person of the CCG
complaints procedure
Who is responsible
for ensuring this
happens
Head of CHC
CCG
Commissioners
PHB Lead
Head of CHC
Risk Enablement
Panel
Head of CHC
PHB Admin
PHB Nurse
CHC Lead Nurse
PHB Lead
PHB Admin
PHB Nurse
PHB Lead
CCG Directors
Managing the budget
When the support plan has been agreed the chosen option for managing the budget should be put in
place.
There are three main ways in which a personal health budget can be managed; a notional budget, as a
direct payment or by a third party. In some instances people could also have a mixture of these three
options.
Notional budget
The person will know the amount of money available but the care and support will be arranged in the
traditional way in line with current Continuing Healthcare procedures.
Direct payment
The person (or representative) receives the money to purchase the care and support that has been agreed
in the support plan. They will be responsible for arranging the care, although some support may be
provided by a third-party (such as managing payroll or recruitment).
They will need to have a separate bank account and keep receipts of how the direct payment is spent.
The direct payment will be made every four weeks and managed by the Staffordshire & Lancashire CSU.
Page | 11
If the person has previously had a direct payment and the account in still open, this account could be used.
Third party
This option sees the budget paid to a different organisation or trust who holds the money for the person or
family.
This organisation will also be responsible for setting up and monitoring the care and support that has been
agreed within the support plan.
Process
When
Notional budgets
When the support plan has
been approved and a notional
budget (managed by CHC) is
chosen.
Direct payment
This would include setting up a been approved and a direct
direct payment bank account
payment will be used to
by the person or their
manage the budget. Bank
representative
account details should be
confirmed.
Refer to third parties
been approved and a third
party will manage the budget
(this may be a decision that is
made during the support
planning process)
Third party budget
When the plan is approved
and the person or family is
working with the third party.
Set up ‘interim PHB’ to allow
When a person already has a
continuity of care
direct payment / or employs
personal assistants
Who will do this
PHB Admin
CHC Admin
Who is responsible
for ensuring this
happens
PHB Nurse
CHC Lead Nurse
PHB Admin
PHB Nurse
Person and family
PHB Nurse
PHB Lead
PHB Finance Lead
CHC Lead Nurse
PHB Nurse
PHB Admin
External Support
Person or family
PHB Nurse
PHB Lead
CHC Lead Nurse
External support
Person or family
Person or family
Third party
CHC Finance Lead
PHB Lead
CHC Lead Nurse
PHB Admin
PHB Nurse
CSU Finance
Setting up the support
When people employ their own staff
If they do not have a copy already, the person or family should be provided with an ‘Employing personal
assistants ‘guidebook, and will be provided with information on:



‘Personal Assistant Training Programme’ (to be developed)
Payroll providers
Carematch website
Page | 12
Process
When
Who will do this
Notional budget setup
When PHB has been approved
and the support will be
arranged by CHC/PHB team
When PHB has been approved
and the person is recruiting
their own staff.
When PHB has been agreed
and recruitment has been
completed and training needs
are required. This could also
be training for agency staff.
This should be done at regular
intervals as agreed in the
support plan
PHB Nurse
CHC Nurse
Who is responsible
for ensuring this
happens
PHB Lead
CHC Lead Nurse
External Support
Person or family
PHB Nurse
CHC Lead Nurse
Person or family
External support
(based on training
plans outlined and
agreed in plan)
This will be done
through the
process agreed in
the support plan –
it may vary from
case to case.
PHB Nurse
CHC Lead Nurse
PA Recruitment
Other support
Refer to third party support
Person or family
CHC Lead Nurse
Review the plan
There are three key reviews that should be undertaken as part of a personal health budget; review of
eligibility, review of the support plan and outcomes and a review of the use of direct payments.
As part of the support planning process the purpose of reviewing the personal health budget should be
discussed with the person or family. Reviews should be undertaken together, where possible, but this
should be in the agreement of the person or family.
Eligibility and need
Eligibility for Continuing Healthcare will be reviewed in line with current Continuing Healthcare policy and
processes.
When the level of need of an individual changes, or their circumstances have changed significantly (such as
fewer hours of informal support), the provisional budget may need to be reviewed and the support plan
amended to reflect this.
Support plan
The review of the support plan and overall effectiveness of the personal health budget should be outcomes
focused. The outcomes that were detailed in the original support plan should be reviewed top ensure that
the outcomes have been achieved. If outcomes have not been achieved then there should be a
conversation to understand why.
Direct payments
Are the direct payments being spent in line with what was agreed in the support plan?
Page | 13
If there is a surplus amount that has not been spent then this money could be clawed back or payments
suspended
Process
When
Who will do this
Eligibility review for CHC
funding
Support plan review and
outcomes
As part of annual review
CHC Nurse
CHC Lead Nurse
PHB Nurse
CHC Lead Nurse
Direct payments review
Joint funded review
Competency & Skill Review
(where someone is employing
their own personal assistants)
As part of annual review
A person or family could look
to review the outcomes and
update this as part of the plan.
As agreed in the support plan
(generally on a yearly basis)
In line with annual review
process but incorporating
external funding organisations
As agreed in the support plan
– but should take place at
least once a year
Who is responsible
for ensuring this
happens
Head of CHC
PHB Lead
Head of CHC
PHB Nurse
External Support
PHB Nurse
CHC Lead Nurse
CHC Lead Nurse
CCG PHB Leads
PHB Lead
Head of CHC
Person or family
(external health
support)
PHB Nurse
CHC Lead Nurse
Person or family (if
employer)
Third party (if this
arrangement is in
place)
Reviews should take place after three months and then annually. If the individual has a fluctuating
condition or there is a greater risk reviews could be undertaken more frequently.
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Appendix
Glossary of terms
Term
Actual budget
Brokerage
Carer
Continuing
healthcare
Direct
payment
What this means
The agreed amount of money of a personal health budget agreed once
a support plan has been written.
A service that identifies the care and support a person needs. A
Support Broker can also arrange services and may also help with a
support planning. Brokerage may be done by voluntary organisations,
private companies or an individual.
A person providing care who is not employed to do so by an agency or
organisation. A carer is often a relative or friend looking after someone
at home who is frail or ill; the carer can be of any age.
NHS continuing healthcare is free care outside of hospital that is
arranged and funded by the NHS. It is only available for people who
need ongoing healthcare and meet the eligibility criteria.
Where the agreed budget is paid to the person to allow them to
arrange the care and services that are agreed in their plan.
Other terms
that might be
used
Final budget
CHC, Fully
funded NHS
Care
Joint budget,
A budget that is made up of money provided by different organisations
Individual
(e.g. health, social or education funding).
budget
Where a third-party receives the money on behalf of the person or
Managed
Holding
family, but does not provide support with other aspects of the
account
account
personal health budget .
Domiciliary
Home care
Care and support provided in an individual’s home
care
The money is held by the NHS and they arrange services and support.
Managed
Notional
The person still has a clear understanding of the budget available and
budget, virtual
budget
has been involved in developing a support plan.
budget
Outcomes
The impacts or end results of services on a person's life.
Personalisation The process by which services can be adapted to suit an individual.
A personal assistant is a person employed to provide someone with
social care and support in a way that is right for them.
Personal
A personal assistant may help with tasks such washing, using the toilet,
assistant
shopping and cooking. They can be employed directly by the individual
or they can be arranged through an agency.
Personal
An amount of money your council makes available to help you meet
budget
your social and support needs
A personal health budget is an amount of money to support a person’s
Personal
identified health and wellbeing needs, planned and agreed between
PHB
health budget
the person and their local NHS team.
The amount of money which is identified at an early stage in the
process to inform care and support planning. It is a prediction – a best
Provisional
Indicative
guess – of how much money it is likely to cost to arrange the care and
budget
budget
support that would be sufficient to meet the assessed health needs
and achieve the outcomes in the care and support plan.
Integrated
budget
Page | 15
Self-directed
support
Support plan
Third party
budget
Third sector
A change to the way the health and social care system operates to give
you choice and control over the support you receive.
A Support Plan describes what a person wants to change about their
life and how they want to spend their personal health budget to meet
their outcomes.
Care plan,
Personal health
plan,
Personalised
care plan
When an organisation independent of the NHS and the person holds
some or all of the money on the person’s behalf and supports the
person to achieve the outcomes agreed in their plan.
Includes the full range of non-public, non-private organisations which
are non-governmental and ‘value-driven’; that is, motivated by the
desire to further social, environmental or cultural objectives rather
than to make a profit.
Page | 16
Seven criteria for a good support plan
Support plan is the name for the plan that shows how someone’s personal health budget will be spent. In order
for the money for the budget to be released, those responsible must be able to see and agree a plan that meets
clear criteria.
Support plans can be written in different ways. They may be short or long - with pictures or just text. Crucially
this plan must be an integrated co- designed plan between the individual and the clinician. It must contain
information about clinical diagnosis and options for treatment or care but be balanced with contextual
information from an individual about lifestyle and the impact of their health condition on that lifestyle.
People need to be given time and space to develop their plan and understand what genuine choices they can
make.
The budget holders and decision makers will need to make sure that the plan answers these seven questions:
1 What’s important to you & what’s important for you
If someone reads the plan, they should get a good sense of your lifestyle. They should get an
understanding of who you are, and your interests and hopes for the future (e.g. Lifestyle, People,
Interests, Dreams), all the things that are ‘important to’ you. They should also be able to read clinical
information about diagnosis & treatment/care options for your health condition and the impact it has on
your lifestyle and quality of life
What this means
Plan would not be agreed
Providing appropriate information, using all clinical
Your plan will not be agreed if the information in
information from assessment(s)
the plan treats you like a stereotype, and does not
express your individuality.
Offering choices to enable people to make informed
choice about treatment / care options; Listening
Your plan will not be agreed if it is written in very
well
general terms.
Managing conflict of interest, Awareness of
boundaries, Facilitating, Negotiating, Respecting
Your plan will not be agreed if you can’t see a
lifestyle choices
balance of ‘important to/and important for’
information from both the perspective of the
individual and clinician
2 What’s working and what’s not working
The plan should describe what is working well about your life and that you want to maintain and what is
not working well and you want to change. This could be about: support, paid & unpaid, work, where you
live, family, what you do (hobbies/ interests/ how you spend your day)
About your health condition: treatment/ care options, maintaining current lifestyle within the context of
worsening health. The plan should describe the outcomes you wish to achieve with these plans.
What this means
As above
The plan will not be agreed if it is not clear what you
would like to both maintain about your life and
health condition and what you would like to change.
High level of awareness of needs and solutions
Page | 17
The plan will not be agreed if there is no clear
outcome from what you are planning.
It will not be agreed if it looks like what is planned
would make your life worse
3 How you will be supported
The plan should describe what is needed to support you with the above to live my chosen lifestyle and
manage my health condition. It should tell us: what support you need, where you need that support,
when you need support, who will give you that support.
It should indicate how to support your health and safety. It should identify any risks that there may be to
you and how these risks will be managed. It should describe support to help you stay well and also the
support you need when you are unwell or when your health condition is worse.
What this means
You will need to consider the following questions;
The plan will not be agreed if;
Is what is planned safe?
Does it require a risk assessment
There are no detailed plans for support
Does it fit with Professional Codes of Conduct?
If it looks like the support will make your life
Can you defend it?
If there are no clear risk management strategies
Does it make use of professional expertise where it
exists?
4 How your personal health budget will be spent and managed
The plan must set out how you are going to use your Personal Health Budget.
The money allocated will be for a year and you must show how this annual allocation will be spent to get
the support you have outlined in the plan.
It must also indicate how the budget will be received and managed, i.e.
Notional budget-. Once an individual’s health outcomes have been agreed, possible options for meeting
these outcomes within the amount normally spent on their healthcare can be discussed. As a result the
individual understands the amount of funding available to them and is able to contribute to decisions
about how the budget is used. The PCT still commissions services, manages contracts etc. Notional budgets
could be an option for individuals who want more choice and control over their healthcare but who do not
feel able or willing to manage a budget.
Real budget managed by a third party – you will need to indicate who the third party is. This maybe a
budget holding lead professional, a GP, a Trust or an organisation like a community interest company.
Direct healthcare payment – this option is not currently available but when it is possible the plan would
need to indicate who is managing the budget
What this means
Support with managing the money
The plan will not be agreed if the plan does not say
Support with reporting expenditure
how your money will be used.
Page | 18
Supporting in identifying which budget
management model will work best for the
individual and their family/carers.
The plan will not be agreed if the service costs more
than the amount that has been agreed.
The plan will not be agreed if you are going to do
anything illegal!
5 How your support will be organised and managed
The plan will must describe how your support, treatment or care will be organised and managed. It must
describe the following; your role in this, The role others may take, How you will comply with any legal
requirements i.e. employment law. Practical arrangements, Managing well/ unwell plans, Risks and review,
Training issues, Continued Professional Development
What this means
Could be a Co-ordination role
The plan will not be agreed if; It is not clear how
Authorising spending
your support treatment and care will be managed. If
Communication
it looks like you might not be safe. It is not legal.
There are no contingencies in place
6 How you will stay in control
The plan must describe how you will stay in control of your decision making. It should show; How you
make decisions, How information should be presented to you, When your capacity for decision-making
maybe affected and how that is supported, Advanced care plans/ directives where appropriate.
What this means
Capacity assessments > assuming capacity
The plan will not be agreed if it looks like others are
making decisions for you or there is no evidence
Following local guidance
that a conversation about decision making has
taken place
Shared decision-making
Respect for individual’s decision-making
7 What I will do to make this happen? (action plan)
The plan should set out real and measurable things that will happen in the future. In that way it is possible
to look back and see whether the plan is working or not.
The plan should say who will be responsible for each action and when it will be done. The plan should say
how you will check your action plan to ensure that problems can be dealt with as they arise.
It should be clear how these actions will help you to make the changes that you said you wanted to make.
What this means
The plan should not be agreed if you just said some
general things that need to happen. There need to
be clear actions that will make sure your plan will
happen.
Page | 19
Personal health budget process map
Who will do
this
Governance
arrangments
PHB
eligibility
Information
and advice
Budget
setting
Support
planning
Approving
the plan
Managing
the budget
Setting up
the support
Review the
plan
PHB Policy
PHB Policy
PHB Policy
PHB Policy
PHB Policy
PHB Policy
PHB Policy
PHB Policy
DoH CHC/FNC
Framework
DoH Patient
Info Booklet
CCG PHB
Financial
Framework
PHB Practice
Guidance
CCG Risk
Enablement
Panel
CCG PHB
Financial
Framework
Delegation to
Level 3 PAs
CCG PHB
Financial
Framework
Staffordshire
Seven Steps
PHB Practice
Guidance
CCG Service
Agreement
Social care /
Health
professional
Continuing
Healthcare
11A. EXISTING /
13C. APPROVAL
18B. JOINT
2. PANEL
ORIGINAL
SUPPORT PLAN
DECISION FOR
JOINT FUNDED
PACKAGE
FUNDED REVIEW
APPLICATION
3. ELIGIBILTY
6. IDENTIFY
13A. APPROVAL
15A. NOTIONAL
16A. NOTIONAL
18. ELIGIBILTY
RATIFICATION
EXISTING COST
DECISION
BUDGETS
BUDGET SET UP
REVIEW
4. PHB OFFER /
8. AGREE PROV.
14. PROVIDE
15B.
LETTER
BUDGET
FEEDBACK
REFER TO
THIRD PARTIES
11B. SUPPORT
13D. ADVANCED
15C. DIRECT
16B. PA
19. DP REVIEW
PLANNING
ASSISTANCE
APPROVAL
PAYMENT
RECRUITMENT
15D. THIRD PARTY
17. OTHER
20. COMPETENCY
& SKILL REVIEW
BUDGET
SUPPORT
(could include
the person or
family)
(Temporary)
PHB Practice
Guidance
1. COMPLETE DST
External
Project Team
Delegation to
Level 3 PAs
18A. SUPPORT
PLAN REVIEW
5A. PROVIDE PHB
7. USE BUDGET
10. REFER TO
13B. APPROVAL
16C. REFER TO
INFO PACK
TOOL
PLANNING HELP
SUPPORT
5B. PHB
9. SHARE PROV.
12. SHARE PLAN
THIRD PARTY
SUPPORT
CONVERSATION
BUDGET
FOR APPROVAL
Page | 20
Step
Eligibility
1.
2.
3.
Information
& advice
Task
Complete DST
4.
Panel Application
Eligibility
Ratification
PHB Offer / Letter
5.
a) PHB Info Pack
b) PHB Discussion
Budget
setting
6.
Identify existing cost
7.
Use budget tool
8.
Agree Provisional
Budget
Share provisional
budget
Refer to planning
help
9.
Support
planning
10.
11.
12.
Approving
the plan
13.
a) Existing / Original
plan
b) Support planning
assistance
Share plan for
approval
a) Approval decision
b) Approval support
c) Approval decision
for joint funded
packages
14.
d) Advanced
approval
Provide feedback
Description
Decision support tool completed to make a recommendation
that an individual is eligible for Continuing Healthcare funding
DST and other supporting information sent to the CHC Panel
CHC Panel makes a decision on whether or not the eligibility
should be ratified
When the person is eligible for full CHC funding they receive
letter – included in this letter is information on PHBs
a) An information pack about personal health budgets is sent
to the individual or family that have expressed an
interested in personal health budgets.
b) Should they want further information a face-to-face or
telephone discussion can be arranged.
To set a provisional budget the existing cost of a person’s CHC
package will be used (subject to a CHC review)
Where someone is new to CHC but would like a PHB or has
had a significant change in need or circumstances a budget
tool can be used to help set the provisional budget.
Specifically when the budget tool has been used an
agreement that this is likely to be enough should be given.
The provisional budget is passed on to the person or family
(and support broker) so that they can begin support planning.
When a person or family requires assistance with support
planning they should be provided with options for who could
support them to do this.
a) The person may have an existing support plan that was
put together previously this should be considered as a way
to develop the plan so that the person or family do not
have to repeat a process.
b) Support planning assistance provided to a person or family
so that they can develop their support plan
When the plan is complete this should be sent to the CHC
Nurse for a decision on whether this plan and the PHB can be
approved.
a) The plan should be approved using the seven criteria and
approval checklist as a guide by the CHC Nurse
b) Support will be provided by PHB Project Team on behalf of
CCG – but only in an advisory role
c) If the package has other funding organisations then there
approval processes should be considered and where
possible a joint decision made.
d) If a plan cannot be agreed it can be passed on for
Advanced approval to a Risk Enablement Panel
When a decision has been reached this should be
communicated to the person or family (or a broker if they are
representing them). If the plan is not approved it should be
Page | 21
Managing
the budget
15.
Setting up
the support
16.
a) Notional budgets
b) Refer to third
parties
c) Direct payment
d) Third party
budgets
a) Notional budget
set up
b) PA Recruitment
Review the
plan
17.
18.
c) Refer to third
party support
Other support
Eligibility review
a) Support plan
review
b) Joint funded
package review
19.
DP Review
20.
Competency & Skills
Review
explained the reasons behind this (which should be recorded
as part of the approval checklist.
a) When the services that are agreed in the support plan are
arranged and set up in the traditional way.
b) Provision of the options of third parties that people
c) The person would need to set up a separate bank account
d) Third party budget would be managed by a separate
organisation on behalf of the individual.
a) This is when support would be arranged in a traditional
way, most likely with support provided by a care agency. It
may include respite.
b) If a person chooses to employ their own personal
assistants then the following should be covered when
recruiting: job descriptions, advertising, interviews, setting
up of payroll and training
c) If the PHB is being managed by a third party this should be
referred to the person or family
An annual review to determine that the person is still eligible
for CHC funding should take place.
a) A review of the support plan should be conducted – to
determine if the person is achieving their outcomes and
that the support in place is meeting their needs effectively
b) If the package is jointly funded then the other
organisations should be involved.
If the person is using managing their PHB with a direct
payment a review should take place to ensure that this is
being managed correctly and that the money is being spent in
line with the agreed support plan.
If there are specific clinical healthcare tasks that have been
delegated to a personal assistant (employed by the person or
a third party) then the competency and skills should be
reviewed.
Page | 22
Direct payment set up process
To be added.
Page | 23
Decision making for how a PHB could be managed
Do you make your own
decisions about how you are
supported?
Yes
I want a Direct
Payment
No
Is a Direct Payment the
only way to pay for the
support?
No
No
Yes
Managed Budget
Are you or your
representative
capable of managing
a Direct Payment?
Are you or your
representative
capable of managing a
Direct Payment?
No
Is a Direct Payment
the only way to pay
for the support?
Yes
Direct payment
No
Managed budget
Yes
No
Yes
Yes
Third-party
Page | 24
Additional documents that supplement the practical guidance
CHC and PHB approval process v3
Support Plan Summary and Checklist
Risk Enablement Panel Doc v2
Page | 25
Page | 26
Staffordshire PHBs Financial Framework
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Personalising Healthcare-Framework for Direct Payments of
1.0 Purpose of the document
This framework document describes the financial mechanisms to be used by Staffordshire
Clinical Commissioning Groups (CCGs) to deliver Direct Payments for Healthcare in line with
the requirements in the National Health Service (Direct Payments) Regulations 2013 as
amended by the National Health Service (Direct Payments)(Amendment) Regulations 2013 .
Direct payments for healthcare are one way of managing a personal health budget.
2.0 Introduction
Direct payments for healthcare are essentially money in lieu of services made by the NHS to
individuals (or to a representative or nominee on their behalf) to allow them to purchase the
care and support they need. Personal Health budgets, including direct payments have been
piloted in Staffordshire and Stoke on Trent since 2010 as part of a national programme.
Direct Payments for healthcare are one of the ways of providing all or part of a personal
health budget. There are essentially three ways for people to receive and manage their
personal health budget
•
•
•
A direct payment
A notional budget
A third party budget
Notional budgets (where the CCG makes the arrangements for the agreed care and support)
and third party budgets( where someone independent of the individual and the NHS holds
the budget and makes the arrangements for the agreed care and support) However, while
the requirements in the regulations only apply to direct payments for healthcare, most of the
steps, such as care planning, budget setting, and the principles around empowering people
to make decisions about their own care, will be the same irrespective of the way the
personal health budget is provided. Wherever personal health budgets are being provided,
the use of direct payments will be considered by the CCG.
3.0 Who can receive a Direct Payment?
The individual will need to live in Staffordshire geographical area and be registered with a
GP attached to Staffordshire.
From 1st April 2014, everyone receiving NHS Continuing Healthcare now has the right to ask
for a personal health budget, including a direct payment. From October 2014 this “group” will
have “a right to have” a personal health budget. Also the Mandate to NHS England sets an
objective that from April 2015 anyone with a long term condition who can benefit from a
direct payment should have the right to ask for a personal health budget.
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4.0 Calculating a Direct Payment
Within NHS Continuing Healthcare, following the decision by the CCG that the person is or
remains eligible for NHS funding and the person seeks a direct payment to fund for their
care to meet their health and social care needs an indicative personal health budget will be
calculated based on the person’s Continuing Healthcare assessment (Decision Support
Tool) utilising Staffordshire PHB Indicative Budget Calculator
The Continuing Health Care team will be required to consult the CCGs “Equity Choice and
Resource Allocation” Guidance to consider any options for delivering the assessed support
and care of the individual; however, there may be significant cost differences in providing
care in different care settings. The CCG will, where possible, accommodate the wishes of
the individual and their family/carer when arranging the location of care. However, the CCG
is only obliged to provide services that meet the reasonable requirements of a care package
that meets those of the individual’s current assessed needs which the CCG has agreed to
support.
The indicative personal budget will be internally allocated for the person from the CCG
Continuing Healthcare budget and a final personal health budget is calculated once the
Personal Health Budget process has been completed and approved by the CCG.
5.0 Services that Direct Payments cannot be used for
A direct payment cannot be used to purchase primary medical services provided by GPs, as
part of their primary medical services contractual terms and conditions nor is a direct
payment suitable for the following public health services:
•
•
•
•
Vaccination or immunisation, including population-wide immunisation programme;
Screening
The national child measurement programme; and
NHS Health Checks
A direct payment cannot be used for urgent or emergency treatment services, such as
unplanned in-patient admissions to hospital or accident and emergency
A direct payment cannot be used for surgical procedures.
A direct payment cannot be used to pay for any NHS charges, e.g. prescriptions, dental
charges
A direct payment cannot be used
•
•
•
To purchase alcohol or tobacco
For gambling
To repay a debt
In addition they cannot be used to purchase anything illegal or unlawful
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6.0 What a direct payment can be spent on.
A direct payment can be spent on a broad range of things (except for the services and items
mentioned in section 4) that will enable the person to meet their health and wellbeing needs.
A direct payment will only be spent on services agreed in the care plan. The care plan must
be agreed by both the CCG and the person receiving care, or their representative. Before
signing off the care plan the CCG will need to be reasonably satisfied that the health needs
of the patient can be met by the services specified in the Care plan. The person receiving
the direct payment (whether it is the individual requiring support, their nominee or a
representative) is responsible for ensuring that it is only used as specified in the care plan.
Deciding not to offer a Direct Payment
The CCG may decide not to provide a patient with direct payment if for example it considers
•
•
•
•
•
That the person (or their representative) would not be able to manage them;
That it is inappropriate for that person given their condition or the impact on that
person of their particular condition;
That the benefit to that individual of having a direct payment for healthcare does not
represent value for money;
That the providing services in this way will not provide the same or improved health
outcomes;
That the direct payment will not be used for the agreed purposes.
If the CCG decides not to give someone a direct payment, the person will be informed in
writing and the CCG reasons.
The person, their nominee or representative may request the CCG reconsiders its decision
not to give a direct payment. They may also provide additional evidence or relevant
information to inform that decision. The CCG will reconsider their decision in light of any new
evidence and then notify and explain the outcome in writing. The CCG will only reconsider
the decision not to give direct payment once in any six month period
Even if someone is not suitable to receive a direct payment, they may still benefit from more
personalised care. The CCG will, where possible, consider whether other forms of personal
health budget, such as a notional budget or a budget held by a third party might be suitable.
7.0 Consent
Direct payments will only be made where appropriate consent has been given by:
•
•
•
A person aged 16 or over who has the capacity to consent to the making of direct
payments to them
The representative of a person aged 16 or over who lacks the relevant capacity to
consent
The representative of a child under 16
8.0 Capacity to consent
The CCG will assume that a person aged 16 and over has the capacity to make decisions
about the making of direct payments, unless the person has been assessed to lack capacity
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(Mental Capacity Act 2005). As far s possible people will be supported to make decisions
which affect them. The Mental Capacity Act requires that a person should not be treated as
unable to make a decision unless all practicable steps to support them to do so have been
unsuccessful. Therefore before the decision that someone lacks capacity the CCG will
satisfy that it has taken all practicable steps to try and help the person make their own
decision.
9.0 Nominees for people with capacity
If a person aged 16 or over who is receiving care has capacity, but does not wish to receive
direct payments themselves, they may nominate someone else to receive them on their
behalf. A representative (for a person aged 16 or over who does not have capacity or for a
child) may also choose to nominate someone (a nominee) to hold and manage the direct
payment on their behalf.
The CCG will need to be satisfied that a person agreeing to act as a nominee understands
what is involved, and had provided their informed consent, before going ahead and providing
direct payments. Before the nominee receives the direct payment the CCG will also give its
consent and considered whether the person is competent and able to manage the direct
payments.
If the proposed nominee is not a close family member of the person, living in the same
household as the person, or a friend involved in the person’s care, then the CCG will ask the
nominee to apply for an enhanced Disclosure and Barring Service (DBS) Certificate and
consider the information before giving their consent.
If the proposed nominee is a close family member of the person, living in the same
household as the person or a friend involved in the person’s care, the CCG cannot ask them
to apply for a DBS certificate In these circumstances there is no legal power to request these
checks
10.0 Representatives
If a person does not have capacity and so may not receive a direct payment personally, the
CCG will establish whether someone could act as that person’s representative.
A representative is someone who agrees to act on behalf of someone who is otherwise
eligible to receive direct payments but cannot do so because they do not have the capacity
to consent to receiving one, or because they are a child. Before someone can become a
representative, they must give their consent to managing the direct payment. The CCG will
ensure that the representative is fully informed , and provided with sufficient advice and
support when making their decision and consider whether the person is competent and able
to manage direct payments, on their own or with whatever assistance is available to them.
A representative can be:
•
•
•
A deputy appointed by the Court of Protection to make decisions relevant to
healthcare and direct payments
A donee of a lasting power of attorney with the power to make the relevant decisions;
A person vested with an enduring power of attorney with the power to make the
relevant decisions
4
•
•
•
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The person with parental responsibility, if the patient is a child
The person with parental responsibility, if the patient is over 16 and lacks capacity; or
Someone appointed by the CCG to receive and manage direct payments on behalf of
a person, other than a child, who lacks capacity.
11.0 Personal Care Planning (or Support Planning)
The personal care plan is at the heart of a personal health budget. The CCG will work with
NHS Healthcare Providers and local authorities to ensure that the person has a personal
care plan covering their health and social care needs (for patients eligible for NHS
Continuing Healthcare funding).This plan will include all the services and support traditionally
commissioned by the CCG and have had full involvement of the person receiving the care,
their nominee or representative and their Care Planner. For children with special educational
needs and disabilities, who have a single education, health and social care plan, this will
also include their educational needs
The Personal Care Plan used by Staffordshire CCGs is an agreement between the CCG and
the person receiving direct payments, and includes responsibilities on both sides. It will
clearly set out the health needs that the direct payment to be made by the CCG is to
address, it also sets out the outcomes that are intended to be achieved, and specifies the
services secured by the direct payment in order to achieve these
12.0 Agreeing the Personal Care Plan
Before a direct payment is made, the personal care plan will need to be agreed by the CCG.
The personal care plan will include;•
•
•
•
•
•
•
•
•
•
The health needs of the individual and desired outcomes to be achieved through
purchase of care provision/services
What the direct payments will be used to purchase
The size of the direct payment and how often it will be paid
The name of the Care Planner and the Health Professional responsible for
managing the care plan
Who will be responsible for monitoring the health condition of the person receiving
care
The anticipated date of the first review and how it will be carried out
Where necessary procedures and protocols in managing any significant potential
risks which could include; risk arising from employing members of staff, risk of the
direct payment being misspent, going missing or being subject to fraud, risks to the
person’s health
Where the person lacks capacity or is more vulnerable the plan will also consider
safeguarding, promoting liberty and where appropriate, set out the restraint
procedures: and
The period of notice if the CCG decides to reduce the amount of the direct payment
Joint sign off by the person receiving the care, Health Professional involved and/or
nominee/representative
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Before any monies is released the CCG will need to know that the Care Plan is likely to work
The CCG needs to assure that the personal care plan is
Lawful- does it take into account any laws or regulations that may apply to what the person
wants to do? Is what the person proposed to spend the money on legal?
Safe:-Does it expose the person to potential abuse by others that they may not be able to
protect themselves from?
Effective: Will it achieve the agreed outcomes? Will it keep the person healthy, safe and
well?
Affordable: - Does it show that the cost of carrying it out can be met from the money that is
available?
The personal care plan will be presented to the PHB Lead and CHC Lead for agreement
before funding can be released and signed off by the CCG Head of Continuing Healthcare.
The costed personal care plan will then be submitted to the CCG approval panel (presently
the PHB Steering Group) Approval will only be given if a person has demonstrated that their
agreed outcomes will be met and the care and support to be provided is appropriate to meet
their identified needs, and the CCG PHB Agreement has been signed by the person (see
appendix 1) the plan is then ratified and the personal health budget will be released
13.0 Reviewing and Revising the Personal Care Plan
The Personal Care Plan will be reviewed at clinically appropriate intervals. It will be initially
reviewed within the first three months and then at least annually. In case of a change in a
person’s condition the personal care plan will be reviewed, adapted to meet their changing
needs and agreed as soon as possible
14.0 Managing the money
Direct payments will be set at a level sufficient to cover the full cost of the care identified in
the personal care plan. When calculating the budget the CCG will ensure that it recognises
all relevant costs eg if a person is employing Personal Assistants it will ensure that there is
sufficient funding available to cover the additional necessary costs of employment such as
Tax, National Insurance, training and development, pension contribution, any necessary
insurance such as public liability.
The Direct Payment will be paid monthly in advance, as NHS services are free at the point of
delivery and the person will not have to pay for the services themselves and be reimbursed
The Direct Payments will be paid into a separate bank account used specifically for this
purpose and held by the person receiving them. When receiving direct payments the person
holding the account will be asked to keep records of both the money going into the account
and where it is spent. The person will need to provide evidence that the direct payment was
used as agreed in the care plan
The CCG will cease paying direct payments if;•
A person, with capacity to consent, withdraws their consent to receiving direct
payments
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A person who has recovered the capacity to consent, does not consent to direct
payments continuing; or
A representative withdraws their consent to receive direct payments and no other
representative has been appointed.
The CCG may also stop payments if they are satisfied that it is appropriate to do so; e.g.
•
•
•
•
•
•
•
•
The person no longer needs care
Direct payments are no longer a suitable way of providing the person with care
The CCG has reason to believe that a representative or nominee is no longer
suitable to receive direct payments and no other person has been appointed
A nominee withdraws their consent, and the person receiving care or their
representative does not wish to receive the direct payments themselves
The person has withdrawn their consent to the nominee receiving direct payments on
their behalf
The direct payment has been used for purposes other than the services agreed in the
care plan
Fraud, theft, or an abuse in connection with the direct payment has taken place; or
The person has died
If, for whatever reason, the person receiving care is no longer able or willing to manage the
direct payment the CCG remains responsible for fulfilling the contractual obligations the
person entered into. After a direct payment is stopped, all rights and liabilities acquired or
incurred as a result of a service purchased by direct payments will transfer to the CCG.
In some cases, it may be necessary to stop the direct payment immediately, for example if
fraud or theft has occurred, The CCG will protect public money as far as possible, whilst
being mindful that the CCG is still under a duty to provide healthcare if the individual requires
it. Where possible the CCG will endeavour to continue to provide a personalised service and
maintain a continuity of care
15.0 Repayment of a Direct Payment
Direct Payments will be reclaimed by the CCG if;•
•
•
•
•
•
Monies has been spent that was not agreed in the personal care plan
Theft, fraud or other offences have occurred
The person receiving care has died, leaving part of the direct payment unspent
The personal care plan has changed substantially resulting in surplus funds
The persons circumstances have changed substantially such as admission to
hospital resulting in the person not using the direct payment to purchase their
care
A significant proportion of the direct payment has not been used to purchase the
services specified in the care plan resulting in money being accumulated
including any interest accrued in year
If the CCG decides to seek repayment, reasonable notice of four weeks in writing or
immediate if fraudulent activities have occurred will be given stating
•
The reason for their decision.
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The amount to be repaid.
The time in which the money must be repaid; and
The name of the person responsible for making the repayment.
16.0 Employment of Personal Assistants
If the person receiving care employs a Personal Assistant, the person shall also:
•
•
•
•
•
Maintain employers liability insurance cover with a reputable insurer in a minimum
sum of £3 million pounds and provide the CCG on request a copy of their current
insurance policy certificate and satisfactory evidence to confirm payment of the
current insurance premium;
Comply with the Employers Liability (Compulsory Insurance) Act 1969 and any
statutory orders/regulations made under the Act.
Ensure that appropriate arrangements have been made with the Inland Revenue for
the proper payment of the income tax and national insurance payable in respect of
their Personal Assistants wages;
Use their reasonable endeavour to provide their Personal Assistant with a safe
working environment;
Retain a copy of each Personal Assistants contract of employment or service
contract for inspection by the CCG
When recruiting, appointing and employing Personal Assistants the person will not
discriminate against them on the grounds of their ethnic origin, religion, disability, or sexual
orientation.
17.0 Employing Close Relatives residing in the Same Household
Unless the CCG is satisfied that is necessary to meet the person’s needs, it may not allow
people to use Direct Payments to secure services from a spouse, from a partner, or from a
close relative who live in the same household as the Direct Payment recipient
This restriction is not intended to prevent people from using their direct payments to employ
a live-in personal assistant, provided the person is not someone who would primarily be
residing in the same household on a personal basis.
18.0 Complaints/Disputes
Where the person is not happy with the amount that the CCG sets the PHB or Direct
Payment at, requirements of the Direct Payments processes or any other aspect of the PHB
system, all efforts to address the matter will be taken informally. Should informal procedures
not prove satisfactory then the individual has the right to use the CCG complaints procedure.
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Appendix 1
Service Agreement
Staffordshire Clinical Commissioning Groups (CCGs) [
2014]
This is an agreement between you and ………………………Clinical Commissioning
Group (CCG). If you have any doubts about its contents you should seek your
Support Planner assistance. ………………Clinical Commissioning Group (CCG)
encourages you to take independent advice before signing this agreement.
Parties
This Agreement is between:(1)
…………………………. Clinical Commissioning Group (CCG) (Address) (“us” or
the ”CCG”) and
(2) [Patient’s Name and Address] (“you” or the “patient”)
1.
The Agreement
1.1
This is an agreement between you and us which is made pursuant to Section 12A of
the National Health Service Act 2006 and the National Health Service (Direct
Payments) Regulations 2013.
1.2
Defined terms have the meaning given in Clause 1.6 of this Agreement.
1.3
The CCG has assessed your need for Support and is satisfied that you are capable of
managing by yourself or with such assistance as may be available to you to receive
your Personal Health Budget as a Direct Payment from the CCG to your Bank
Account. The Direct Payment will be made by the CCG itself in accordance with this
Agreement and any other agreement and terms and conditions referred to in this
Agreement.
1.4
Your Bank Account into which Direct Payments under this Agreement are paid by the
CCG will be used by you or your Representative only for the purposes of securing
Support as agreed with the CCG in your Personal Health Budget Plan by means of
Direct Payments and for no other purpose.
1.5
This Agreement will come to an end with immediate effect upon any change in the law
which will make it unlawful for you and the CCG to carry out your and our obligations
under this Agreement. Upon termination of this Agreement under this Clause 1.5 all
monies held by you or your Representative shall be repaid to us immediately or as
directed by us.
1.6
Definitions
Agreement means this agreement between you or your Representative and the
CCG to use your Bank Account to receive your Personal Health Budget as a Direct
Payment from the CCG and incorporates the terms and conditions referred to in
Schedule 1.
Bank Account means the bank account held by you or your Representative with
your nominated bank and approved by the CCG into which Direct Payments are paid
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under the terms of this Agreement and which may also include, subject to approval
by the CCG, any existing bank account you or your Representative may solely hold
for the purpose of receiving direct payments for health and social care needs from
your Local Authority.
Care Coordinator means the person nominated by the CCG to monitor and review
the making of Direct Payments in accordance with Paragraph 2.2 of Schedule 1.
DBS means Disclosure and Barring Service or any replacement or successor
organisation to it.
Direct Payments means the payments made to you in accordance with clause 3 of
this Agreement and paid into the Bank Account by the CCG itself .
Employment Costs means costs associated with the employment of staff by you or
your Representative for the purpose of this Agreement including (but not limited to)
wages, DBS checks, national insurance, training, payroll, insurance and emergency
cover, tax and any other costs.
Guidance means the HFMAs Direct Payments for Healthcare – Practical Guide
Personal Health Budget means the budget for provision of health care services to
you made by way of Direct Payments in accordance with this Agreement.
Personal Health Budget Plan means the plan you develop with appropriate
personalised assistance, which describes the health outcomes you want to achieve
and the services to be secured by means of Direct Payments to achieve the health
outcomes. This plan is agreed by you or your Representative and the CCG.
Clinical Commissioning Group (CCG) manages the provision of primary care
services in a specific area and will work with local authorities and other agencies that
provide health and social care locally to make sure that the local community's needs
are being met.
Regulations means the National Heath Service (Direct Payments) Regulations 2013
as amended or replaced by subsequent legislation.
Representative means a deputy, attorney, person with parental responsibility and
any other person, which the CCG may consider appropriate to receive and manage
Direct Payments on your behalf and named at Clause 2.5 of this Agreement.
Support means the arrangements made to meet your health care needs as specified
in your Personal Health Budget Plan.
References to “you”, “your” and “yourself” are references to the person first named
below as a signatory to this Agreement and references to “we”, “us” and “our” are
references to the CCG.
2
Representative
2.1
Any Representative to whom the CCG is to make Direct Payments under the terms of
this Agreement will:
a)
be considered appropriate by the CCG
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b)
agree to act on your behalf in relation to the Direct Payments;
c)
act in your best interest when securing the provision of services in respect of
which Direct Payments are made;
d)
be responsible as a principal for all contractual arrangements entered into for
your benefit and secured by means of Direct Payments;
e)
use the Direct Payments in accordance with the Personal Health Budget Plan
and the terms of this Agreement and the Regulations;
f)
cannot be receiving payment through the PHB for any respect, including to
help manage or administer the PHB, or to provide services funded by the PHB
g)
inform us immediately if you regain mental capacity and can manage the
Direct Payments.
h)
where required agrees to have a DBS check.
2.2
We will agree to the making of Direct Payments to the representative on your behalf
subject to being satisfied that the representative is capable of managing the Direct
Payments by themselves or with such assistance as may be available to them. If the
Representative is not one of your close family members or a friend involved in your
care, then we will require the representative to apply for an enhanced DBS check
certificate before giving our consent to making the Direct Payments to the
representative.
2.3
You agree to notify the CCG if you wish to change or withdraw your Representative.
Following such a notification we may stop the making of Direct Payments, consider
paying the Direct Payments to you directly or to a different representative and as
soon as reasonably possible review the Personal Health Budget and Personal Health
Budget Plan in accordance with the Regulations.
2.4
If Direct Payments to you are stopped under Clause 2.3, it will be you or your
Representative’s responsibility to ensure that any surplus monies held by you or your
Representative under this Agreement are repaid to us.
2.5
Details of the Representative are:
Name of Representative:
______________________________________________________
Relationship to the Patient:
______________________________________________________
Address:
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3
Payments
3.1
All Direct Payments as agreed by you or your Representative in the Personal Health
Budget Plan will be made by the CCG itself to you or your Representative as follows:
3.2
Single payments
You or your Representative will receive in your Bank Account a one-off
payment of £ [
]
3.3
Regular Payments
a) Your first payment may cover more than 4 weeks and may be after the
commencement of the service
b) Every 4 weeks, in advance, you or your Representative, will receive in your
Bank Account £ ____as your Direct Payment.
c) This is equivalent to £ ______ per week.
4.
General Provisions
4.1
All amendments and variations of this Agreement must be agreed between you or
your Representative and us and confirmed in writing, signed and dated by you or
your Representative and us and attached to this Agreement. You or your
Representative will receive not less than 4 weeks notice of any proposed review,
monitoring or changes to your Personal Health Budget leading to any such
amendments and variation to this Agreement.
4.2
Any notice to be given in connection with this Agreement will be in writing and may
be delivered by hand, post or facsimile, addressed to the recipient at the address set
out below or any other address notified to the other party in writing in accordance
with this clause as the address to which notices and other documents may be sent:
CCG Address
……………………………………………………………………
……………………………………………………………………
Your Address
…………………………………………………………………….
……………………………………………………………………….
Your Representative’s Address
________________________________________
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The notice, demand or communication will be deemed to have been duly served:
a)
if delivered by hand, at the time of delivery;
b)
if delivered by post, forty eight (48) hours after being posted (excluding
Saturdays, Sundays and public holidays);
c)
if delivered by facsimile, at the time of transmission.
4.4
This Agreement will be a legally binding contract made in England and Wales and
will be subject to the laws of England and Wales.
4.5
This Agreement together with Schedule 1 constitutes the whole agreement between
you or your Representative and the CCG and supersedes any previous arrangement,
understanding or agreement between you and the CCG relating to the subject matter
of this Agreement.
4.6
If any provision of this Agreement (or part of any provision) is found by any court or
other authority of competent jurisdiction to be invalid, illegal or unenforceable, that
provision or part-provision will, to the extent required, be deemed not to form part of
the Agreement, and the validity and enforceability of the other provisions of the
Agreement will not be affected.
4.7
You confirm that you have read and understood this Agreement including the terms
and conditions set out in Schedule 1.
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The CCG and you or your Representative agree to be bound by and to comply with
the terms and conditions set out in Schedule 1 to this Agreement and any other
applicable terms and conditions as referred to in this Agreement or as notified to you
or your Representative by the CCG.
Signed by the Patient ……………………………………………………………………..
Name …………………………………………………………………………
Address ………………………………………………………………………
………………………………………………………………………………..
………………………………………………………………………………..
………………………………………………………………………………..
Date ……………………………………………………………………….....
Signed by the Representative (if applicable……………………………………………………
Name …………………………………………………………………………
Address ………………………………………………………………………
………………………………………………………………………………..
………………………………………………………………………………..
………………………………………………………………………………..
Date ……………………………………………………………………….....
Signed on behalf of………………………….. Clinical Commissioning Group
Signature …………………………………………………………………….
Name ………………………………………………………………………...
Designation ………………………………………………………………….
Address: …………………………………………………………………………………
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SCHEDULE 1
YOU AND STAFFORDSHIRE CLINICAL COMMISSIONING GROUPs (CCGs)- RIGHTS
AND RESPONSIBILITIES
This document sets out the rights and responsibilities of the Agreement between you
or your Representative and the CCG
1.
Your Rights and Responsibilities
1.1
You or your Representative agree that your health needs can be met by provision of
the Support as identified in the Personal Health Budget Plan, as updated from time to
time in accordance with this Agreement or as required by any relevant law or
guidance, and that the amount of the Direct Payments is sufficient to provide for the
full cost of the Support identified in your Personal Health Budget Plan. You or your
Representative agree to use your Personal Health Budget made available to you as
Direct Payments for the purpose of securing services needed to help deliver your
agreed health outcomes as agreed by you in your Personal Health Budget Plan from
any service provider who meets the conditions set out at paragraph 1.9 of this
Schedule and does not fall under paragraph 2.5 of this Schedule.
1.2
You agree that your Direct Payments cannot be used for the purchase of the following:
a)
Supply or procurement of alcohol or tobacco; or
b)
Provision of gambling services or facilities; or
c)
Repay a debt otherwise than in respect of a service specified in your Personal
Health Budget Plan; or
d)
Primary medical services provided by general practitioners as indicated in the
Personal Health Budget Plan; or
e)
Urgent or emergency treatment services (including any unplanned hospital
admissions) as indicated in the Personal Health Budget Plan, or
f)
Support for social care (in the event direct payments for social care are paid
into your Bank Account by your local authority).
g)
Anything illegal, unlawful or harmful to yourself or others
1.3
You or your Representative must use Direct Payments to cover the cost of your
Support and for no other purpose.
1.4
You or your Representative agree to provide us every month a list detailing how you
or your Representative intend to spend your Personal Health Budget and upon our
request provide information or evidence relating to:
a)
your state of health or any health condition and any changes relating to your
health in respect of which Direct Payments are made;
b)
the health outcomes expected from the provisions of any service;
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any other information as we may consider necessary.
You or your Representative must let us examine, and where appropriate, take copies
or make extracts of all information and documentation relating to your Personal
Health Budget and the provision of the Support within 30 days of the end of the three
and nine months monitoring periods from the date you first receive the Personal
Health Budget as set out in paragraphs 1.11 and 1.12, or whenever the CCG
requests you or your Representative to do so. This information includes:
a)
all financial records (that is of income received and payments made through
your Bank Account which show clearly the Direct Payments received from us
and details of how you or your Representative have used the Direct Payments
as agreed in the Personal Health Budget Plan;
b)
Your Bank Account bank statements;
c)
Receipts for payment made;
d)
Agency invoices and receipts (if applicable); and
e)
Any other information as we may consider necessary.
Where you or your Representative are to provide us with information under this
Agreement, such information shall be provided in a legible format, accompanied by
authorisation for us to take copies or extracts of the information, with an explanation
of the information provided to us or a statement to the best of you or your
Representative’s knowledge and belief of where any information not provided to us is
held.
1.6
You or your Representative must keep all supporting documents relating to your
Personal Health Budget and the provision of the care for at least six complete
financial years from the date of the payment, even if the payments have stopped.
You or your Representative agree to provide us, upon our request, with an
explanation of the information you provide to us or a statement to the best of your
knowledge and belief of where any information you fail to provide to us is held.
1.7
You must keep a Financial Record which shows clearly:
a) payments you have received to meet your assessed needs; and
b) details of how you have used Direct Payments made into your Bank Account, as
agreed with your Support Planner.
1.8
You or your Representative must ensure that provisions are put in place for cover in
emergency situations to ensure that you have care when you need it.
1.9
You or your Representative must ensure that the organisation providing the Support:
a)
is reputable and can meet the standards of quality expected by us;
b)
has complied with all its registration obligations including with the Care Quality
Commission if carrying out regulated activities;
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c)
has adequate insurance and indemnity cover for the services to be provided
to you, if it is ascertained that the provider must operate under insurance or
indemnity cover;
d)
has the right skills and resources in place to provide the type of services you
require under the Personal Health Budget Plan;
e)
has adequate complaints procedures in place; and
f)
where applicable, is a registered member of a professional body affiliated with
the Council of Healthcare Regulatory Excellence.
1.10
You or your Representative, may request us to carry out on your behalf the enquiries
under paragraph 1.9(b) and (c) in respect of any particular service provider
organisation.
1.11
No later than three months from the date you first receive your Personal Health
Budget in your Bank Account there will be an initial review of the management of the
Personal Health Budget and a review and re-assessment of your care needs
(including a review of the quality of the Support arrangements you have made). Any
proposed changes to the Personal Health Budget and / or the support arrangements
will be the subject of discussions between you and us.
1.12
There will be subsequent financial monitoring of your Personal Health Budget at
months 3 and 9 in year one after the date you first receive the Personal Health
Budget and subsequently every 6 months and more frequently if there is a change in
circumstances, or where we become aware that the Direct Payment(s) have not been
sufficient to secure your Support, there will be a review of the management of the
Personal Health Budget and a review and re-assessment of your Support needs
(including a review of the quality of the Support you are receiving). Any proposed
changes to the Personal Health Budget and / or the Support will be notified to you or
your Representative in accordance with Clause 4.1 of the Agreement and will be the
subject of discussions between you, your Representative and the CCG.
1.13
If following a review of your Personal Health Budget under paragraphs 1.11 and 1.12
we decide to reduce the amount or stop the making of Direct Payments we will give
you or your Representative 4 weeks minimum notice in writing stating the reasons for
the decision. Upon receipt of such notice you or your Representative may require us
to undertake one further review and provide any relevant evidence or information to
consider as part of this further review. We will notify you or your Representative in
writing of our decision and the reasons for it.
1.14
You or your Representative, agree to notify us immediately of any substantial change
of your health conditions or the Personal Health Budget Plan or other relevant
circumstances (including: where you are admitted to hospital, move away from
Staffordshire, move to a different address in Staffordshire, leave the country for more
than four weeks, no longer wish to receive the Direct Payment, or need help to
comply with these terms and conditions).
1.15
Where we are satisfied that the whole or any part of a Personal Health Budget has
not been used to secure the Support to which it relates, the CCG on giving
reasonable notice reserves the right to:
a) demand repayment of the whole or part of the Direct Payment; or
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b) withdraw your Direct Payment and transfer it onto a notional budget managed
directly by us; or
c) arrange for a third party or accountancy service approved by us to take over the
management of your Direct Payment.
1.16
Subject to paragraph 2.7 of this Schedule, where we are satisfied that you, your
Representative or Nominee have not complied with any term or condition of this
Agreement then you or your Representative must repay the whole or part of the
Personal Health Budget if we so request.
1.17
You or your Representative (if so directed by you) have the right to bring this
Agreement to an end at any time by giving four weeks written notice (or less by
agreement) to your Support Planner
1.18
If this Agreement is brought to an end by you or your Representative or by us, we will
be responsible for settling any outstanding payments due to a provider organisation
whom you or your Representative have made arrangements to provide Support. If
there is a surplus Personal Health Budget held by you in a Bank Account under this
Agreement it must be repaid to us in accordance with our instructions.
1.19
Any repayment of the Direct Payments, in part or in whole, to the CCG under the
terms of this Agreement shall be made in accordance with our other instructions.
1.20
No transfer of Direct Payments monies to any bank account (other than the Bank
Account) held by you or your Representatives is permitted under the terms of this
Agreement.
1.21
You or your Representative may at any time during the term of this Agreement
request us to undertake a review of the Personal Health Budget. Upon receipt of
such a request we shall decide whether to undertake such a review and will notify
you or your Representative of our decision and the reasons for it.
1.22
When you intend to employ staff directly, you or your Representative must request
these staff to undertake DBS checks. When you intend to employ or contract with
persons known to you (such as a member of your family or friends) you will have
discretion as to whether to request them to undertake an enhanced DBS check to
ensure that person has no relevant criminal convictions which would preclude them
from being employed in such a role. If you intend to employ a person unknown to you
but known to your Representative, you shall require such person to undertake an
enhanced DBS check.
1.23
If you directly employ staff you are required to have in force employer's liability
insurance which includes public liability insurance. This is to be with reputable
insurers or underwriters with a minimum limit for any one claim (the limit to be
increased from time to time as reasonably required by us). The relevant insurance
policy and the premium receipts must be produced as and when required by us. An
allowance for these insurance policies is included within the Personal Health Budget.
1.24
You or your Representative (if so authorised by you) agree to notify in writing your
next of kin and/or or personal representative and your bank and/or building society
that the Bank Account does not form part of your estate and does not form part of
your personal income. A copy of such notification shall be provided to the CCG within
[…] days of being served on the relevant persons in accordance with this paragraph
1.24. In the event of your death we will assess the outstanding contractual
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responsibilities incurred by you or your Representative in respect of the use of the
Direct Payments for the purpose of determining whether any amount shall be repaid
to the CCG.
1.25
You must use an accredited/reputable payroll services to pay your personal
assistants or employees, if any.
1.26
Anyone employed by you using the Personal Health Budget will not be considered as
one of the CCG’s employees or agents.
1.27
All Employment Costs associated with the employment of any staff by you under this
Agreement shall be included within the Personal Health Budget as indicated in the
Personal Health Budget Plan.
1.28
You or your representative agree that the purchase of equipment with your Personal
Health Budget will be discussed with the CCG in regard of any costs of repairs,
insurance or replacement and will be clearly outlined in your Personal Health Budget
Plan.
2.
Our Rights and Responsibilities
2.1
We will agree with you and advise you or your Representative of significant potential
risks arising in relation to the making of Direct Payments and the means of mitigating
those risks.
2.2
We retain responsibility to review your health care needs and will therefore appoint or
identify the Care Coordinator to assess that your needs as agreed in the Personal
Health Budget Plan are being met. The Support Planner will be responsible for
reviewing the Personal Health Budget Plan and:
a) Monitoring your health needs and the making of Direct Payments to you or your
Representative;
b) Arranging for the review of Direct Payments under the terms of this Agreement;
c) Liaising between you or your Representative and us.
2.3
The sum of the Personal Health Budget we have agreed we will pay you for ‘start up’
costs for the regular provision of Support will be paid by us into your Bank Account.
2.4
The Personal Health Budget in the form of Direct Payments will be paid by the CCG
itself into your Bank Account for the purpose of you receiving payments for the cost
of the Support which we have assessed is needed by you in accordance with clause
3 of this Agreement.
2.5
We reserve the right to require that you or your Representative do not secure Support
from a particular service provider as indicated by us in this Agreement or otherwise
notified to you or your Representative by us. You or your Representative agree not to
use the Direct Payment to purchase the Support from a close family member if they
are living in the same household.
2.6
We may suspend or discontinue making payments to you or your Representative if we
become aware or are notified that the Personal Health Budget is not needed for a
period exceeding 28 days but before doing so we will discuss the matter with you or
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your Representative and take into account any contractual agreements and
continuing needs you may have.
2.7
Where we are satisfied that the whole or any part of the Personal Health Budget has
not been used to secure the provision of the care to which it relates or your Personal
Health Budget Plan has changed substantially then we may suspend, discontinue or
reduce the amount of Direct Payments but before doing so we will discuss the matter
with you and take into account any contractual agreements and continuing needs you
may have. If no contact can be made with you for a period of 4 weeks we reserve the
right to suspend or withdraw your Direct Payment.
2.8
Where we are satisfied that you or your Representative have not complied with any
term or condition of this Agreement then we may require you or your Representative
to repay us the whole or part of the Personal Health Budget we have made to you.
2.9
If we decide that a sum must be reduced or repaid under paragraphs 1.15, 1.16, 2.7,
and 2.8 we will notify you or your Representative within 4 weeks of making the
decision providing our reasons for making the decision and specifying the amount to
be reduced or repaid.
2.10 If we are satisfied that theft, fraud or another offence has occurred in connection with
the Direct Payments we may terminate this Agreement with immediate effect and
require you or your Representative to repay us the whole or part of the payment. We
will notify you or your Representative within 4 weeks of making the decision providing
our reasons for making the decision and specifying the amount to be repaid.
2.11 Upon receipt of a notice to repay the whole or part of the Direct Payments served
under paragraph 2.10 you or your Representative may require us to re-consider the
decision and provide evidence or information for us to consider as part of the
deliberation. We will notify you or your Representative in writing of our decision and
the reasons for it.
2.12 We have the right to bring this Agreement to an end by giving you or your
Representative 4 weeks notice in writing stating the reasons for the decision if it
appears to us that you are no longer capable of managing a Personal Health Budget
by yourself or with such assistance as may be available to you or you are a person
whose ability to arrange your Support is restricted by certain mental health or criminal
justice legislation (details of which we will give to you).
2.13 Even if you appear to us no longer to be capable of managing a Personal Health
Budget by yourself we may continue to make such payments if we are reasonably
satisfied that your inability will be temporary and a Representative is prepared to
accept and manage the Direct Payments on your behalf and your Representative
allows you to manage Direct Payments by yourself for any period for which we are
satisfied that you have capacity to do so.
2.14 We may bring this Agreement to an end by giving you or your Representative 4 weeks
notice in writing stating the reasons for the decision if it appears to us that your needs
for care can no longer be met by means of a Personal Health Budget or if you are no
longer registered with a GP practice covered by Staffordshire CCGs.
20
Version 2
2.05.14
Item: 09 Enc: 07
2.15 We may bring this Agreement to an end by giving you or your Representative 4 week
notice in writing stating the reasons for the decision if you or your Representative
have not complied with any term or condition of this Agreement.
2.16 We may bring this Agreement to an end with immediate effect and arrange
appropriate services if:
a) Your Representative refuses to receive Direct Payments; or
b) We consider that your Representative is no longer suitable to receive Direct
Payments.
2.17 Upon receipt of a notice served under paragraph 2.16 you may require us to reconsider the decision and provide evidence or information for us to consider as part
of the deliberation. We will notify you or your Representative in writing of our
decision and the reasons for it.
2.18 Any right or liability of you or your Representative (or personal representatives in case
of your death) to a third party acquired or incurred in respect of a Support secured by
means of a Direct Payment shall transfer to the CCG when the CCG stops making
Direct Payments to you or your Representative pursuant to termination of this
Agreement for whatever reason.
2.18
Throughout the duration of this Agreement we will provide information, advice and
support to you or your Representative as may be necessary.
2.19
We will ensure, where applicable, that any person involved in the management or
delivery of the Support has undertaken an enhanced DBS check. We will inform you
or your Representative of the results of any such checks.
2.20
The NHS complaints procedure will apply to any decision by us in relation to a
complaint brought by you or your Representative. We will ensure that you or your
Representative are aware of the process for accessing that procedure. We will also
ensure that you are aware of the procedure for escalating a complaint to the Health
Service Ombudsman should you or your Representative feel that it is necessary to do
so.
3
Your Bank Account
3.1
Your Bank Account will be held by you or your Representative and, subject to
approval by the CCG, be accessible by your Representative for the purpose of using
the Direct Payments under the terms of this Agreement and the Regulations.
3.2
In the event that direct payments for social care are paid into your Bank Account by
your Local Authority, you or your Representative will ensure that no monies paid
under this Agreement as Direct Payments are used for the purchase of social care
support.
21
Version 2
22
2.05.14
Item: 09 Enc: 07
Item No: 10 Enc: 08
Subject:
Medicines Waste Campaign 2014
Board Lead:
Lynn Millar
Officer Lead:
Sharuna Ready
Recommendation:
For
Approval

For
Ratification
For
Discussion
For
Information
Medicines waste is a concern both locally and nationally within the NHS. According to a 2010 report an
estimated £300million of medications are wasted annually within primary care in England which is
equivalent to over £750,000 within NHS Cannock Chase CCG.
Some wastage of medicines is inevitable however a lot of waste is preventable – around 50% of current
waste is thought to be avoidable by changing the processes surrounding medication ordering, supply and
use. The aim of the planned medicines waste campaign is to raise awareness of the issue to patients and
healthcare professionals to address the problem areas.
KEY POINTS:
Medicines waste can be due to reasons which are difficult to control – patients’ medications do change
due to dose changes or discontinuations due to side-effects, changes in the patients’ condition and
admission to hospital. However there are many causes of medicines waste which should be avoidable.
These include patient’s stock-piling medications at home, inappropriate ordering of repeat medication by
patients and community pharmacists and ineffective repeat prescription issuing processing in practices.
This medicines waste campaign is aimed at addressing these avoidable causes.
The medicines management team have been working with the CSU communications team to produce an
awareness campaign of the issue. This will include promotional items such as posters and leaflets, aimed
at the public, to be displayed in both practices and community pharmacies together with potential
advertising options. This work is still in development at present and further information will be circulated
when available.
The public medicines waste campaign will focus on the following key messages to patients:
1. Check what supplies you have at home before ordering your repeat prescription and only order the
items you require. Do not automatically order everything on your repeat every month. Do not order
“just in case”.
2. You do not need to order medication which is only used when required every month. Items will only be
removed if they have not been ordered for at least 6 months.
Page | 1
Item No: 10 Enc: 08
3. Ask your community pharmacist if you have any questions about your medications.
4. Let your GP or pharmacist know if you are not taking any of your medications or are not taking them in
exactly the same way which is on your prescription - by changing the quantity on your prescription
reduces the risk of unnecessary waste.
In addition to the public awareness campaign we will also be working on the following:
• Audits of the repeat prescription process: this will focus on who is requesting repeat
prescription items for patients. We will be working with the Local Pharmaceutical Committee and all
community pharmacies within the locality to ensure that appropriate SOPs are in place to cover the
appropriate ordering of repeat prescriptions on behalf of patients and that these are being used
effectively.
• Support and training to prescription administration staff within practices: ensuring that the
issuing process is as efficient as possible within practices is important to prevent unnecessary
waste. The medicines management team will be working with reception/prescription teams to
address potential issues and to provide training, where appropriate.
• Implementation of Electronic Prescribing Release 2 (EPS2): NHS Cannock Chase and is
currently beginning practice implementations of EPS2. When prescriptions are sent electronically
there is a full audit trail of the prescription and therefore requests for prescription reprints (from lost
or mis-placed prescriptions) will be significantly reduced – this should result in potential reductions
in medicines waste where duplicated prescriptions may previously have been dispensed.
The public awareness campaign is planned to start in mid-November 2014.
interventions.
N/A
N/A
expectancy.
N/A
N/A
Page | 2
Item No: 10 Enc: 08
IMPLICATIONS
Legal and/or Risk
N/A
CQC
N/A
Patient Safety
Improving the ordering systems for medicines and reducing medicines stockpiling will
have significant patient safety benefits.
Patient Engagement
N/A
Financial
Reducing medicines waste will have significant financial savings on the CCG prescribing
budget.
Sustainability
N/A
N/A
Approve and support a medicines waste campaign within NHS Cannock Chase CCG.
KEY REQUIREMENTS
Yes
No
Not
Applicable






Page | 3
Item No: 11 Enc: 09
Subject:
NHS Health Checks (NHSHC) in Stafford and Surrounds CCG 2013/14
Board Lead:
Andrew Donald
Officer Lead:
Andrew Donald
Recommendation:
For
Approval
For
Ratification
For
Discussion
For
Information

To share the NHS Health Checks in Cannock Chase (CC) CCG, 2013/14 – Executive Summary published
by Public Health Staffordshire (June 2014).
A key national programme driver relating to CCG targets is the strategic imperative to reduce health
inequalities due to Cardiovascular Disease (CVD) and to increase life expectancy from preventable CVD
conditions. Everyone between the ages of 40 and 74, who has not already been diagnosed with one of
the identified diseases shall be invited (once every five years) to have a check to assess their risk of heart
disease, stroke, kidney disease and diabetes and will be given support and advice to help them reduce or
manage their risk.
KEY POINTS:
The Executive Summary identifies the following recommendations:
• CC CCG encourages practices to participate in NHSHC delivery
• CC CCG encourages non-participating practices to share information with Public Health to enable
accurate denominators to be calculated
• CC CCG encourages non-participating practices to engage with the alternate provider
• CC CCG encourages practices that are under performing to avail themselves of the Practice Support
Service provided by Quintiles
• CC CCG encourages practices to address quality issues within NHSHC delivery in readiness for new
round of contracting
Page | 1
Item No: 11 Enc: 09
Cannock
Chase
through
targeted
interventions.
The provision of Health Checks will support health equality
across the CCG.
By taking part in the health check programme patients will
be aware of the potential issues sooner.
expectancy.
By taking part in the health check programme patients will
be aware of the potential issues sooner.
services
with
N/A
Implications
Legal and/or Risk
N/A
CQC
N/A
Patient Safety
NHS Health checks will help keep patients safe.
Patient Engagement
This is good service to promote through PPGs.
Financial
N/A
Sustainability
N/A
N/A
The CCG Governing Body is asked to note the content of the report.
KEY REQUIREMENTS
Yes
No






Not
Applicable
Page | 2
NHS health checks in Cannock Chase CCG, 2013/14
Executive Summary
CC CCG performance
There has been a significant improvement in performance for both the NHS health
checks coverage and uptake of invitations in 2013/14 compared to 2012/13.
Cannock Chase CCG is now just above national targets at 22% of the eligible
population invited and over half of the 20% annual target population receiving a
health check (11%) (Figure 1).
However, the CCG remains below the Staffordshire average (25%) for invitations
whilst 13 of the 26 NHSHC participating practices have not achieved the minimum
national target (10%) of their eligible population receiving a health check. Uptake of
invitations compares to the England average of 50% but could be improved.
Please see figure 1 for comparative activity in all Staffordshire CCGs, Table 3 for
outcomes from the NHSHC programme and Table 4 For Cannock CCG practice
detail ( which shows the wide variation in performance)
Table 1: Practices signed up to LES in Staffordshire, 2013/14
27
19
33
Number
signed up to
LES
26
17
33
Percentage
signed up to
LES
96%
89%
100%
31
26
84%
14
124
9
111
64%
90%
Number of
practices
Cannock Chase
East Staffordshire
North Staffordshire
South East Staffordshire and
Seisdon Peninsula
Stafford and Surrounds
Staffordshire CCGs
Source: Public Health Staffordshire, Staffordshire County Council
Table 2: Practices who have not engaged with the alternative provider or
provided denominator data
Red Lion Surgery (M83130)
Public Health Staffordshire
Page 1
Figure 1: Percentage of eligible people that were offered and received a health
check, 2013/14
Source: NHS health checks datasets, Public Health Staffordshire and http://www.healthcheck.nhs.uk
Whilst there has been some national controversy over the evidence for NHSHCs,
local programmes are already demonstrating benefits in terms of early diagnosis of
new CVD disease.
Table 3: Health benefits of NHSHC in Cannock Chase CCG
Cases identified
due to NHSHC.
(2013/14)
National model estimates of
prevalence based on 10-15%
eligible population receiving a
NHSHC*
Proportion of population receiving an
7%
NHSHC identified as having a CVD risk of
more than 20%
Number of people diagnosed with diabetes 16
42-64
Number of people diagnosed with chronic
1
109-164
kidney disease
Number of people diagnosed as
44
132-197
hypertensive/ taking antihypertensive
drugs
Number of people prescribed statins
11
178-267
1
2
3
Number of people who will given brief
1085 / 25
76-114
1
intervention / referred to physical activity
2
programme / increase their physical
3
activity
1
1
2
Number of people who were referred to /
59
296-443
2
complete a weight loss programme
1
2
Number of people given smoking
222 /45
1
cessation advice / referred to stop
2
smoking services
Number of people with AUDIT score of
143
eight or above and given alcohol brief
intervention
Source: *Public Health England NHS Health Check ready reckoner (Feb 2014)
Page 2
Table 4: Summary of NHSHC performance by practice 2013/14
Practice
code
M83001
M83016
M83033
M83048
M83063
M83080
M83107
M83109
M83129
M83130
M83139
M83608
M83613
M83616
M83637
M83638
M83639
M83662
M83698
M83703
M83717
M83719
M83722
M83727
M83738
Y02354
Y02594
Practice name
Horsefair Practice
High Street Surgery
Dr JS Chandra's
Surgery
The Nile Practice
Norton Canes Health
Centre
Landywood Lane
Surgery
Bideford Way
Surgery
Dr VK Singh's
Surgery
Heath Hayes Health
Centre
Red Lion Surgery
Moss Street Surgery
Great Wyrley Health
Centre
Wardles Lane
Surgery
GP Suite Surgery
Chadsmoor Medical
Practice
Hednesford Street
Surgery
Dr A Yi's Surgery
Newhall Street
Surgery
Southfield Way
Surgery
Brereton Surgery
Chapel Street
Surgery
Rawnsley Surgery
Dr M Murugan's
Surgery
Chapel Street
Practice
Aelfgar Surgery
Sandy Lane Surgery
Essington Medical
Centre
Cannock Chase
CCG
National targets –
Signed
up to
LES
First
Invites
made
Yes
Yes
975
121
Yes
181
Yes
716
Yes
147
Yes
144
Yes
116
Yes
234
Yes
337
No
Yes
0
363
Yes
0
Yes
108
Yes
539
Yes
304
Yes
1,002
Yes
122
Yes
136
Yes
373
Yes
78
Yes
114
Yes
420
Yes
152
Yes
379
Yes
Yes
294
1,063
Yes
159
8,577
% of
eligible
population
invited
(target20%)
28%
7%
24%
43%
18%
22%
12%
28%
9%
0%
24%
0%
15%
19%
34%
25%
18%
22%
40%
7%
11%
32%
15%
26%
22%
37%
30%
22%
Number
receiving
a NHS
health
check
358
13
89
295
57
144
22
96
337
0
130
0
108
318
34
677
122
37
58
73
95
265
41
202
146
517
125
4,359
37%
11%
Eligible
population
coverage
(target
10%)
10%
1%
49%
41%
12%
18%
39%
7%
100%
22%
19%
2%
41%
12%
100%
0%
36%
9%
0%
8%
0%
0%
100%
59%
15%
11%
11%
4%
68%
100%
17%
18%
27%
6%
16%
94%
6%
7%
83%
63%
9%
20%
27%
4%
53%
50%
49%
14%
11%
18%
79%
23%
51%
11%
Uptake of
invitations
(%)
20% of eligible population to be invited annually
10% (min) to 15% (aspirational) of eligible population to have an NHSHC annually
Page 3
Item No: 12 Enc: 10
Subject:
HR policies for ratification
Board Lead:
Andrew Donald
Officer Lead:
Sally Young
Recommendation:
For
Approval
For
Ratification

For
Discussion
For
Information
To ratify the Secondment Policy, the Secondment Agreement Template and the Ex-Offenders policies.
KEY POINTS:
The CCG already has a suite of HR policies on the web-site that were ratified in July 2013. The following
policies, which cover areas where we have a gaps, were approved at a meeting of the joint staff-side
partnership on the 8th September 2014;
Secondment Policy
Secondment Agreement Template
Ex-Offenders policies
CCGs are asked to ratify the policies and the secondment agreement template
To reduce health inequalities across The policies have been development to ensure equal
Cannock
Chase
through
targeted opportunities for staff and potential employees.
interventions.
To identify and support patients with N/A
To improve and increase overall life N/A
expectancy.
Page | 1
Item No: 12 Enc: 10
services
with N/A
Implications
Legal and/or Risk
The CCG needs to consider the health and safety implications of all
appointments.
CQC
N/A
Patient Safety
N/A
Patient Engagement
N/A
Financial
N/A
Sustainability
N/A
The secondment policy promotes development opportunities for staff.
The CCG is asked to ratify the Secondment and Ex-Offenders policies and the secondment agreement
template.
KEY REQUIREMENTS
Yes


Not
Applicable

No



Page | 2
Item: 12 Enc: 10
INSERT CCG LOGO
INSERT CCG NAME
(Employing Organisation)
-and-
INSERT ORGANISATION NAME
(Secondment Organisation)
-and-
INSERT EMPLOYEE NAME
(Name of Employee)
SECONDMENT AGREEMENT
THIS SECONDMENT AGREEMENT IS MADE ON INSERT DATE
Item: 12 Enc: 10
BETWEEN:
(1)
INSERT CCG NAME
(Employing Organisation)
(2)
INSERT ORGANISATION NAME
(Secondment Organisation)
(3)
INSERT EMPLOYEE NAME
(Employee)
1.
DEFINITION AND INTERPRETATION
1.1
In this Agreement the following expressions have the following meanings:
1.1.1 "The Agreement" means the Agreement concluded between the Secondment
Organisation, the Employing Organisation and the Employee as set out in this
document including all or any other documents that are incorporated or referred
to herein.
1.1.2 “The Contract of Employment” means the Contract between the Employing
Organisation and the Employee.
1.1.3 “The Secondment Period” means a fixed period from INSERT START DATE
to INSERT END DATE subject to earlier termination hereinafter provided.
1.1.4 “The Secondment Services” means the duties and services associated with
the secondment, which may vary from time to time in accordance with the needs
of the secondment organisation.
1.1.5 “The Statutory Payments” means PAYE, Employer National Insurance
contributions and such other payments as may be required by law to be made in
connection with the employment of the Employee.
Item: 12 Enc: 10
2.
PURPOSE
2.1
The purpose of this agreement is to describe the arrangements between The
Secondment Organisation and The Employing Organisation for the secondment
of INSERT SECONDEE NAME as INSERT JOB TITLE on a full time/part-time
basis from INSERT START DATE to INSERT END DATE. This secondment
period may be terminated subject to 1 month’s notice before this date by mutual
agreement.
The agreement sets out the expectations of all three parties and the
arrangements for ensuring that these expectations can be properly met.
3.
SECONDMENT
3.1
During the Secondment Period:
3.1.1 The salary during the period of secondment will be £XXXXX (AfC Band X or
VSM) per annum, pro rata. Where Agenda for Change terms and conditions
apply, this salary will be subject to increments and where Gateways exist
satisfactory progression against the knowledge and skills profile or agreed
objectives.
3.1.2 The Employee shall provide the Secondment Services to the Secondment
Organisation in accordance with the provisions of the Agreement whilst
continuing to be employed by the Employer under the Contract of Employment.
The Contract of Employment shall remain in force and the Employee shall not
be an Employee of the Secondment Organisation.
3.1.3 The Employee shall, subject always to the control of the Secondment
Organisation, perform the Secondment Services, whether or not they are within
the scope of their normal duties under their Contract of Employment.
Notwithstanding their job title contained within their Contract of Employment the
Employee shall perform those Secondment Services as if they were specifically
required under the Contract of Employment;
Item: 12 Enc: 10
3.1.4 The Employee shall faithfully and diligently perform the Secondment Services
and exercise such powers as may from time to time be reasonably assigned to
them or invested in them by or under the authority of the Secondment
Organisation for the performance of those Secondment Services. He/she shall
obey all reasonable and lawful directions given to him/her by or under such
authority in respect of the Secondment Services, and he will use his reasonable
endeavours to promote the interests of the Secondment Organisation.
3.1.5 If the secondment post falls within the criteria for a DBS check outlined by the
Department of Health circular HSC 2002/008 and subsequent guidance 2006
and 2013, then a DBS check will be undertaken.
3.1.6 The Employee shall notify both the Employing Organisation and the
Secondment Organisation of any absence due to sickness or holiday
entitlement.
3.1.7 The Employing Organisation will be responsible for recording any episodes of
absence that the Employee notifies them of on the Employing Organisation’s
Electronic Staff Record (ESR).
3.2
The Secondment Organisation will ensure that the Employee is provided with
an induction programme suitable to their needs and is properly and sufficiently
trained and instructed with regard to:
3.2.1 The provisions of the Agreement;
3.2.2 All relevant rules, policies, procedures and standards of the Secondment
Organisation as provided by the Secondment Organisation and all relevant
statutes and statutory instruments including those relating to fire risks, fire
precautions and health and safety.
3.2.3 Assessment and performance review processes
Item: 12 Enc: 10
3.3
It is agreed between the parties that:
3.3.1 The Employee will provide the Secondment Services from a base agreed by the
Secondment Organisation and such other reasonable locations as requested
by the Secondment Organisation;
3.3.2 The Secondment Organisation will draw up a Learning Agreement, KSF profile
or objectives, target dates and measures of performance, with the Employee, so
that it can conduct its own assessment of the Employee’s ability and
competence in providing the Secondment Services.
3.3.3 The Employer accordingly does not warrant in any way the Employee’s skill,
competence or diligence and any condition or warranty express or implied to
that effect is hereby excluded.
3.3.4 The resolution of any issues relating to the management of the Employee
including disciplinary and grievance procedures, issues relating to pay and
conditions, sick leave, pension and other employment issues remain the
responsibility of the Employer;
3.3.5 In relation to any of the issues referred to in Clause 3.3.2 the Secondment
Organisation agrees to provide any and all reasonable assistance which may be
required by the Employer in the resolution of any such issues, including but not
limited to any investigatory or documentary assistance, or witnesses and
witness evidence as appropriate, and shall afford the Employer access to the
Secondment
Organisation’s
premises
and
any
of
the
Secondment
Organisation’s own Employees as the Employer may reasonably require in the
resolution of those issues;
3.3.6 The Employee will assist the Secondment Organisation and the Employer in all
regards (including but not limited to providing documentation or access thereto,
witnesses and witness evidence) with any and all of the matters referred to in
Clause 3.3.4, whenever it is requested by the Secondment Organisation or the
Employer to do so.
Item: 12 Enc: 10
3.4
The responsibility for the appraisal of the Employee shall remain at all times
during the Secondment Period with the Secondment Organisation and will be
carried out in accordance with their policies and procedures. The Employer will
assist the Secondment Organisation in all regards with the appraisal process.
3.4.1 The Secondment Organisation will provide feedback to the Employer on the
outcome of the appraisal, the content of the personal development plan and of
any education, training and development activities undertaken by the Employee.
4.
PAYMENT FOR THE SECONDMENT SERVICES
4.1
The Employer will continue to pay the Employee through their own payroll
during the period of secondment.
The Employer will recharge the
Secondment Organisation for relevant salary costs and all business expenses
claimed by the Employee in respect to expenses necessarily incurred by the
Employee fulfilling the role of INSERT JOB TITLE.
5.
TERMINATION
5.1
Notwithstanding Clause 1.1.4 and Clause 6 of the Agreement, the Agreement
shall automatically terminate if the Contract of Employment is terminated for any
reason whatsoever before the expiry of the Secondment Period.
5.2
Upon termination of the Agreement for whatever reason the Employee shall
return to the Secondment Organisation all documents, correspondence,
information and property made or compiled by the Employee or delivered to the
Employee during the Secondment Period concerning the business, finances, or
affairs of the Secondment Organisation for the avoidance of doubt, it is hereby
declared that all property and rights in all such documents, goods or products
shall at all times be vested in the Secondment Organisation.
Item: 12 Enc: 10
5.3
Upon termination of the Agreement for any reason other than under Clause 5.1,
the terms and conditions of the Employee’s Contract of Employment shall
continue in full force and effect.
6.
DEFAULT
6.1
The Secondment Organisation may terminate the Agreement if either the
Employer or the Employee is in breach of any of the terms of the Agreement
which, if capable of remedy, has not been remedied by the party in breach
within 21 days of receipt by the Employer and/or the Employee of a written
notice from the Secondment Organisation specifying the breach and requiring its
remedy.
6.2.1 The Employer may terminate the Agreement if either the Secondment
Organisation or the Employee shall be in breach of any of the terms of the
Agreement which in the case of a breach capable of remedy has not been
remedied by the party in breach within 21 days of receipt by the Secondment
Organisation and/or the Employee of a written notice from the Employer
specifying the breach and requiring its remedy.
7.
VARIATION OF CONDITIONS
7.1
No changes or additions to the Secondment Services or the provisions of the
Agreement must be made without prior agreement in writing between the
Employer, the Secondment Organisation and the Employee.
8.
HOLIDAY ENTITLEMENT
8.1
The Secondee shall be entitled to XX Days/Hours paid holiday during the
Secondment Period (this includes X days Bank and other Public Holidays) to be
taken at times approved by the Secondment Organisation, such approval not to
be unreasonably withheld.
Item: 12 Enc: 10
8.2
Such holiday entitlement is part of the individual’s holiday entitlement paid by the
Employer to the Employee under the Contract of Employment and is not in
addition thereto.
9.
CONFIDENTIALITY
9.1
In addition to and without prejudice to the confidentiality obligations contained in
the Contract of Employment, the Employee shall not, (save in the proper
performance of the Secondment Services) either during or after the period of the
Agreement divulge or permit to divulge to any person (including the parties to
the Agreement) any information acquired by them in connection with the
Agreement or in connection with the Secondment Services which concerns:
9.1.1 Any matter of commercial interest contained or referred to in the Agreement;
9.1.2 The Secondment Organisation, its manner of operation, staff, patients or
procedures;
9.1.3 The Employer, its manner of operation, staff, patients or procedures;
9.1.4 The identity or address or medical condition or treatment received by any patient
of either the Secondment Organisation or Employer; unless previously
authorised by the party concerned in writing provided that these obligations will
not extend to any information which is or shall become public information
available in the United Kingdom otherwise than reason of a breach by the
Employee of the provisions of this clause.
10.
DATA PROTECTION
10.1
The Secondment Organisation and the Employer shall each comply with the
host’s Information Governance policies and the Data Protection Act 1998 and
shall protect the personal data, as defined in the Act, of their respective staff,
clients and patients.
Item: 12 Enc: 10
10.2
The Secondment Organisation and the Employer will indemnify the other
against all claims and proceedings and all liability, loss, costs and expenses
incurred in connection therewith made or brought by any person in respect of
any loss, damage or distress caused to that person by the disclosure of any
personal data by the Employee where the said claims and proceedings, liability,
loss, costs and expenses arise or are incurred as a result of the indemnifying
party’s breach of its obligations under Clause 10.1.
11.
INDEMNITY
11.1
It is agreed between the Employer and the Secondment Organisation that each
shall indemnify the other and its staff against all and any liability, loss, costs,
expenses, claims or proceedings whatsoever arising under any statute or at
common law in respect of any injury to any person, injury resulting in death and
any loss of or damage to personal property directly related to such injury where
such injury, loss or damage is caused as a direct result of the negligence of the
relevant party or any of the relevant party’s staff.
11.2
The Secondment Organisation will indemnify the Employer against any and all
liabilities, proceedings, costs, losses, claims and demands whatsoever arising
under any statute or at common law and made against the Employer by the
Employee where such claims are, in the reasonable opinion of the Employer,
brought about directly or indirectly by the actions of the Secondment
Organisation.
11.3
The Secondment Organisation will indemnify the Employer against any and all
liabilities, proceedings, costs, losses, claims and demands whatsoever arising
directly or indirectly out of the activities of the Employee in providing the
Secondment Services.
12.
DISCRIMINATION
12.1
Neither the Employer nor the Secondment Organisation will unlawfully
discriminate against the Employee within the meaning of the Equality Act 2010
Item: 12 Enc: 10
or any enactment relating to discrimination in employment and both the
Employer and the Secondment Organisation will take all reasonable steps to
secure the observance of this provision by all its staff or agents.
13.
SEVERABILITY
13.1
If any provision of the Agreement is or becomes illegal, void or invalid, that shall
not affect the legality and validity of the other provisions.
14.
WAIVER
14.1
The failure of any party to the Agreement to seek redress for breaches, or insist
on strict performance of any provision of the Agreement or the failure of any
party to the Agreement to exercise any right or remedy to which it is entitled
under the Agreement shall not constitute a waiver thereof and shall not cause a
diminution of the obligations under the Agreement.
14.2
No waiver of any provision of the Agreement shall be effective unless the party
concerned in writing agrees it.
14.3
No waiver of any default shall constitute a waiver of any subsequent default.
15.
INTELLECTUAL PROPERTY
15.1
The parties agree that any intellectual property rights including copyright
connected to the provision of the Secondment Services shall belong to the
Secondment Organisation.
15.2
It is agreed between the parties that the profits of any exploitation of any
intellectual property rights referred to in 15.1 by the Secondment Organisation,
will belong exclusively to the Secondment Organisation.
16.
FORCE MAJEURE
Item: 12 Enc: 10
16.1
No party to this Agreement shall be liable to the other for any failure to perform
its obligations under the Agreement where such performance is rendered
impossible by circumstances beyond its control, but nothing in this condition
shall limit the obligations of all parties to use their best endeavours to fulfil their
obligations under the Agreement.
17.
AUDIT
17.1
Both the Employer and the Secondment Organisation must allow the other
party’s internal and other nominated auditors access to any and all papers
relating to the Agreement for the purposes of each party’s audit.
18.
APPLICABLE LAW
18.1
The Agreement shall be governed by English Law and each of the parties
agrees to submit to the exclusive jurisdiction of the Courts of England.
Signed by [
] on behalf of the Employer:
Name:
Address:
Signed by [
Name:
Address:
Signed by the Employee:
Name:
Address:
] on behalf of the Secondment Organisation:
Item: 12 Enc: 10
Recruiting Ex-Offenders Policy
HR Policy:
Date Issued:
Date to be reviewed:
Periodically or if legislation changes
Page 1 of 11
Item: 12 Enc: 10
Policy Title:
Recruiting Ex-Offenders Policy
Supersedes:
All previous Recruiting Ex-Offenders Policies
Description of Amendment(s):
New Policy for CCG employees
This policy will impact on:
All staff.
Financial Implications:
No change.
Policy Area:
Version No:
Issued By:
Author:
Document Reference:
Effective Date:
Review Date:
Impact Assessment Date:
HR
1
CSU HR
CSU HR Policy Lead
8th September 2014
APPROVAL RECORD
Consultation:
Committees / Groups / Individual
CCG’s including local partnership forums
Date
N/A
Approved by Committees:
Management / Staff Side CCG Partnership Forum
September 14
Page 2 of 11
Item: 12 Enc: 10
Contents
1.0
POLICY STATEMENT
4
2.0
PRINCIPLES
4
3.0
EQUALITY STATEMENT
6
4.0
MONITORING AND REVIEW
6
1.0
Procedure
7
Appendix 1
Dealing With Disclosures in Recruitment
& Selection
8
Appendix 2
Deciding if a DBS check is required
10
Appendix 3
Equality Impact Assessment
11
Part 2
Page 3 of 11
Item: 12 Enc: 10
HR POLICIES
RECRUITING EX-OFFENDERS
1.
POLICY STATEMENT
1.1
The Organisation uses the Disclosure service provided by the Disclosure Barring Service
(DBS) to assess applicants’ suitability for positions of trust. The Organisation complies fully
with the DBS Code of Practice and undertakes to treat all applicants fairly.
1.2
The Organisation undertakes not to discriminate unfairly against any subject of a Disclosure
on the basis of conviction or other information received. Guidance on dealing with
disclosures is attached at Appendix 1.
1.3
This policy will be made available to all applicants who are required to provide a Disclosure,
at the beginning of the recruitment process.
2. PRINCIPLES
2.1
The Organisation actively promotes equality of opportunity for all and welcomes
applications from a wide range of candidates, including those with criminal records, as we
select all candidates for interview based on their skills, qualifications and experience.
2.2
Disclosures are only requested after a thorough risk assessment has indicated that it is
proportionate and relevant to the post concerned. For those posts that require a Disclosure,
all adverts, recruitment briefs and application forms will contain a statement indicating what
level of Disclosure will be required in the event of an individual being offered a position.
2.3
The Organisation will only ask for details of ‘unspent’ convictions as defined in the
Rehabilitation of Offenders Act 1974. However, the Organisation reserves the right, if
necessary, to ask details about an applicant’s entire criminal record.
2.4
The Organisation has a number of HR Representatives who are registered with the DBS as
the person authorised to handle Disclosures. HR Representatives have been trained to
identify and assess the circumstances and relevance of offences and have received
appropriate guidance and training in the relevant legislation relating to the employment of
ex-offenders.
2.5
HR Representatives will advise and guide recruiting managers where a Disclosure has
been made.
2.6
The Organisation undertakes to discuss any matter revealed in a Disclosure with the
person seeking employment, before withdrawing a conditional offer of employment.
2.7
The Organisation may conduct an interview to enable an open and measured discussion to
take place regarding any offences or other matters that might be relevant to the position.
Failure to reveal information that is directly relevant to the position sought, could lead to the
withdrawal of an offer of employment.
2.8
The Organisation complies fully with the DBS Code of Practice. Every person who is
subject to a Disclosure will be made aware of this Code of Practice and a copy will be
provided to all applicants.
Page 4 of 11
Item: 12 Enc: 10
2.9
Having a criminal record will not necessarily bar a potential employee from working with the
Organisation. This will depend on the nature of the position and the circumstance and
background of the offence(s).
Security, Storage, Handling, Use, Retention, and Disposal of Disclosures And
Disclosure Information
2.10
The Organisation complies fully with the DBS Code of Practice regarding the correct
handling, use, storage, retention and disposal of Disclosures and Disclosure information.
2.11
The Organisation complies fully with its obligations under the Data Protection Act and other
relevant legislation pertaining to the safe handling, use, storage, retention and disposal of
Disclosure information.
Storage, Access & Disposal
2.12
Disclosure information will be securely destroyed as soon as the relevant information has
been noted.
2.13
No Disclosure information will be kept on personal files and where a Disclosure needs to be
kept due to a dispute or because additional information has been supplied, it will be kept
separately and securely in a non-portable, lockable storage unit.
Where a Disclosure has been kept, it will be securely destroyed once the dispute is
resolved or a decision made regarding employment or at the latest after 6 months.
2.14
2.15
Access to Disclosure information is strictly controlled and limited to those who are entitled
to see it as part of their duties.
2.16
The Organisation will not keep any photocopy or other image of the Disclosure or any copy
or representation of the contents of a Disclosure. However, for record purposes only, the
Organisation will keep the following information:
• The name of the subject
• The level of Disclosure requested
• The position for which the Disclosure was requested
• The unique reference number of the Disclosure
• Details of the recruitment decision taken
Handling
2.17
In accordance with section 124 of the Police Act 1997, Disclosure information is only
passed to those who are authorised to receive it in the course of their duties.
2.18
The Organisation maintains a record of all people to whom Disclosures and Disclosure
information has been revealed and the Organisation recognises that is a criminal offence
to pass this information on to anyone who is not entitled to receive it.
Page 5 of 11
Item: 12 Enc: 10
Usage
2.19
Disclosure information is only used for the specific purpose for which it was requested and
for which the applicant’s full consent has been given.
2.20
The Organisation will comply with all recommendations from DBS on the proper use and
safekeeping of disclosure information.
Acting as an Umbrella Body (an external organisation)
2.21
As an Umbrella Body, the CSU has an independent organisation that will take all
reasonable steps to ensure that all CCGs for whom it receives Disclosure information
comply fully with the DBS Code of Practice and have a written policy regarding the
handling, use, storage, retention and disposure of Disclosure information.
2.22
Before undertaking a DBS check on behalf of a CCG, the Umbrella body will require the
CCG to confirm in writing t their intention to comply with the Code of Practice and that they
have such a policy or if not practicable, will comply with the code of practice.
3.
EQUALITY
In applying this policy, the Organisation will have due regard for the need to eliminate
unlawful discrimination, promote equality of opportunity, and provide for good relations
between people of diverse groups, in particular on the grounds of the following
characteristics protected by the Equality Act (2010); age, disability, gender, gender
reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or
belief, and sexual orientation, in addition to offending background, trade union membership,
or any other protected characteristic.
4.
MONITORING & REVIEW
4.1
This policy and procedure will be reviewed periodically by Human Resources in
conjunction with operational managers and Trade Union representatives. Where review is
necessary due to legislative change, this will happen immediately.
4.2
The implementation and operation of this policy will be audited on an annual basis,
including consideration of diversity data, by CSU Leadership Team and reported to the
senior management team on a 6 monthly basis
Page 6 of 11
Item: 12 Enc: 10
Part 2
1.
PROCEDURE
This Policy must be read in conjunction with local CCG Recruitment Procedures
1.1
When recruiting for a vacancy the Recruiting Manager needs to answer the questions on
the Authority to Recruitment Form. If the answers to those questions result in a DBS check
being necessary the Recruiting Manager needs to contact Employment Services team or
HR
1.2
The Recruiting Manager will ensure that the advert for the vacancy includes notification that
it is essential that the successful applicant obtains a satisfactory DBS check and at what
level that check must be, either standard or enhanced.
1.3
Once a provisional offer of employment has been made the applicant will be sent a
Disclosure Application Form and Guidance Booklet with the instruction that the completed
form must be returned with the supporting documentation.
1.4
The Disclosure Application Form will be verified and countersigned by one of the Human
Resources representatives who are registered with the DBS and sent for processing.
1.5
On receipt of the form from the DBS it will be processed by the Human Resources
representative who countersigned the form.
1.6
The Human Resources representative will inform the Recruiting Manager if the Disclosure
Application was satisfactory or if it contains any information that may affect the appointment
decision.
1.7
If the Disclosure Application contains information that may affect the appointment decision,
the Human Resources representative will discuss this with the Recruiting Manager (in all
instances), and the individual concerned, where appropriate.
1.8
Where the information contained on the Disclosure Application form significantly impacts on
a candidate’s ability to undertake the post for which they have been appointed, the offer of
employment must be withdrawn.
1.9
If the Disclosure Application contains no information, or information that is not relevant to
the post, the offer of employment can be confirmed (subject to all other pre-employment
checks having been completed).
1.10
Any decision to withdraw an offer of employment must be reached by the agreement of the
Human Resources representative and Recruiting Manager. Where both parties fail to agree
the decision will be referred to the Organisation’s Lead Counter signatory which can be
determined by the CCG for a final decision.
1.11
The decision to withdraw an offer of employment must be confirmed both verbally and in
writing to the candidate concerned.
1.12
All completed Disclosure Application Forms will be recorded and retained by Human
Resources. The forms will be recorded, stored and destroyed in line with the Data
Protection Act, this policy and DBS guidance.
Page 7 of 11
Item: 12 Enc: 10
Appendix 1
Dealing With Disclosures in Recruitment & Selection
Guidelines for Managers
The Organisation uses the Disclosure Service provided by the Disclosure Barring Service (DBS)
to assess applicants’ suitability for positions of trust.
When advertising/recruiting to a vacant post you must decide whether that position requires a DBS
check and if so, at what level. You can use the table outlined overleaf to assist you in making this
assessment.
If you decide that a DBS check needs to be undertaken you must inform Human Resources who
will ensure that the requirement for a check is made clear in the advertisement.
Departments dealing with their own recruitment will have responsibility for ensuring that the advert
contains the requirement for a DBS check.
Types of Check Available
There are three levels of check available:
BASIC LEVEL
Includes details of ‘unspent’ (current) convictions. This may be used for verifying information for
applicants for posts that do not fall under the Rehabilitation of Offenders Act (Exceptions) Order
but where the individual is being considered for a position of trust. Examples of such posts may
include chief executives; finance managers where the person is in charge of public funds or
internal budgets; board level directors or senior management. This level of check is permissible
where justifiable, whether or not to take this checks at the discretion of the employer. Basic Level
Disclosures can only currently be obtained through Disclosure Scotland. Details on how to obtain
basic disclosures are available at www.disclosurescotland.co.uk
STANDARD DISCLOSURE
Includes details of both spent (old) and unspent (current) convictions, cautions, reprimands and
final warnings held in England and Wales on the Police National Computer (PNC). Most of the
relevant convictions in Scotland and Northern Ireland may also be included.
Employers may carry out standard level criminal record checks to assess a person’s suitability for
work listed in the Exceptions Order i.e. where the type of work enables the person to have ‘access
to persons in receipt of such services in the course of [their] normal duties’. The term ‘access’ only
relates to where individuals have direct, physical contact with patients as part of their day to day
activities; it does not include positions where there is no contact with patients. Please note that
positions that purely involve having access to records are not covered under the terms of the
Exceptions Order and therefore employers cannot obtain a standard or enhanced criminal record
check for these positions. The changes to the barring arrangements on the 10 September 2012 do
no effect eligibility for standard checks. However, it is strongly recommended that employers refer
to the Exceptions Order to make an informed decision against positions which may be eligible for a
standard level check (paragraph 13, Part 2 of Schedule 1 of the Order specifically refers).
Page 8 of 11
Item: 12 Enc: 10
ENHANCED DISCLOSURE
An enhanced check contains the same information as a standard check but also includes any nonconviction information held by local police, where they consider it to be relevant to the post.
This information is referred to as ‘approved information’ on the enhanced check certificate.
From 10 September, there will be two levels of enhanced check – an enhanced disclosure with
barred list information (for those that fall under the new definition of regulated activity) and an
enhanced disclosure without barring information (for those previously falling within regulated
activity but not meeting the terms required under the new definition) – see further detail about
eligibility in the sections below.
Eligibility for enhanced with a barred list check
Individuals seeking work in a regulated activity position must be checked against the DBS barred
lists (this is known as a barred list check). This check is accessed through the process of applying
for an Enhanced Disclosure. Individuals in regulated activity are eligible for an enhanced disclosure
with barred list information. It will be possible to check against the children’s and/or adults’ barred
list(s), depending on the role under consideration.
Eligibility for enhanced without a barred list check
The number of individuals in regulated activity is being reduced by the changes to the disclosure
and barring services and, as a result there will be some positions which will no longer be eligible
for an enhanced disclosure with a barred list check from 10 September 2012.
Further information
NHS Employers have produced a helpful document regarding DBS checks which includes
scenarios and examples of when checks should be undertaken.
The link is
http://www.nhsemployers.org/case-studies-and-resources/2014/07/eligibility-for-dbs-checksscenarios
Page 9 of 11
Item: 12 Enc: 10
Deciding if a DBS check is required
Will the job holder be
required to work with
children? As per the
definition above.
required to work with
vulnerable adults? As
per the definition above.
Is
the
job
holder
required to be a member
of the Legal Profession
and
a
recognised
member of the Law
Society?
based at a location
where they may come in
to contact with children
or vulnerable adults,
such as a hospital or
prison? As per the
definition above.
regularly
caring
for
children or vulnerable
adults? As per the
definition above.
required to be a “named
person”
for
the
Authority in respect of
gaming,
lottery
or
entertainment licences?
Appendix 2
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Equality Analysis Initial Assessment
Page 10 of 11
Item: 12 Enc: 10
Title of the change proposal or policy:
Recruiting Ex-offenders Policy
Brief description of the proposal:
To ensure that the policy amends are fit for purpose, that the policy is legally compliant, complies
with NHS LA Standards, NHS Employment Check Standards, DSB Code of practice and takes
account of best practice.
Name(s) and role(s) of staff completing this assessment:
Date of assessment:
Please answer the following questions in relation to the proposed change:
Will it affect employees, customers, and/or the public? Please state which.
Yes it will affect all employees and members of the public applying for positions within the
organisation.
Is it a major change affecting how a service or policy is delivered or accessed?
No
Will it have an effect on how other organisations operate in terms of equality?
No
If you conclude that there will not be a detrimental impact on any equality group, caused by
the proposed change, please state how you have reached that conclusion:
No anticipated detrimental impact on any equality group. The policy adheres to the NHS LA
Standards, NHS Employment Check Standards, DBS Code of practice and takes account of best
practice. Makes all reasonable provision to ensure equity of access.
The policy will be applied consistently to all applicants regardless of any protected
characteristic they may be associated with.
Page 11 of 11
Item: 12 Enc: 10
SECONDMENT POLICY
HR Policy:
Date Issued:
Date to be reviewed:
Periodically or if statutory changes are required
Policy Title:
Secondment Policy
Supersedes:
All previous Secondment Policies
Description of Amendment(s):
New Policy for CCG employees
This policy will impact on:
All staff
Financial Implications:
No change
Policy Area:
HR
Version No:
1
Issued By:
HR CSU Midlands and Lancashire
Author:
CSU HR
Document Reference:
Effective Date:
8th September 2014
Review Date:
Impact Assessment Date:
APPROVAL RECORD
Committees / Groups / Individual
Consultation:
Approved by Committees:
CCGs’ including local Partnership Forums
Management / Staff Side Partnership Forum
Date
N/A
September 2014
Contents
2
1.0
POLICY STATEMENT
4
2.0
PRINCIPLES
4
3.0
EQUALITY STATEMENT
4
4.0
MONITORING AND REVIEW
4
1.0
PROCEDURE
5
Appendix 1
EQUALITY IMPACT ASSESSMENT
7
Part 2
3
1. POLICY STATEMENT
1.1
This policy facilitates the secondment of the CCGs staff both internally within the CCG and
externally within the wider NHS and exceptionally with other non NHS Bodies. It is also designed
to encourage staff from external organisations to take up a secondment where available within the
Organisation, for the mutual benefit of both organisations.
1.2
A secondment may be arranged to assist with individual development needs as a result of an
appraisal or be specifically requested for project work where specific skills or specialist knowledge
are required.
1.3
This Policy will apply to all employees within the Organisation.
2.
PRINCIPLES
2.1
Secondment requests will be considered in line with business needs and may be refused on that
basis.
2.2
Staff who enter into secondment agreements will be asked to sign a secondment agreement
outlining the terms and parameters of the secondment.
2.3
Any individual who agrees to undertake a secondment will be expected to keep any information,
which may be made available to them as a direct result of the secondment, (e.g. personnel, salary,
business sensitive information) confidential.
2.4
Employees on secondment with an external organisation will retain all of their continuity of service
rights with the CCG
2.5
Staff who undertake a secondment will be entitled to return to their substantive post on completion
of the secondment. Should the substantive post be subject to organisational change this will be
dealt with in line with the relevant CCG procedure.
2.6
The duration of a secondment will vary depending on the circumstances. However the minimum is
3 months and a maximum 24 months with exceptions to be arranged with the relevant line
manager and support from Human Resources.
2.7
Training and support will be provided to all Line Managers in the implementation and application of
this policy
3.
EQUALITY
3.1
In applying this policy, the CCG will have due regard for the need to eliminate unlawful
discrimination, promote equality of opportunity, and provide for good relations between people of
diverse groups, in particular on the grounds of the following characteristics protected by the
Equality Act (2010); age, disability, gender, gender reassignment, marriage and civil partnership,
pregnancy and maternity, race, religion or belief, and sexual orientation, in addition to offending
background, trade union membership, or any other protected characteristic.
4.
MONITORING & REVIEW
4 .1
The policy and procedure will be reviewed periodically by Human Resources in conjunction with
operational managers and Trade Union representatives. Where review is necessary due to
legislative change, this will happen immediately.
4.2
The implementation of this policy will be audited on an annual basis by CSU Leadership Team and
reported to the senior management team on a yearly or 3 yearly basis
4
PART 2
1. PROCEDURE
Requesting and organisation of Internal Secondments within CCG
1.1
Where a Department within the CCG identifies that a secondment opportunity exists, consideration
should be given to the length of the secondment, any training required and the skills set or
specialist knowledge required of staff undertaking the secondment.
1.2
Depending on the nature of secondment, the vacancy will either be advertised in line with the
CCGs Recruitment policy, or, a request will be made directly to the relevant
department/organisation if the secondment requires specialist skills or knowledge.
1.3
There is no explicit obligation on the manager to release an individual but proper consideration
should be given to such a request. Any refusal to allow an individual to uptake a secondment
opportunity should be carefully considered and the potential long term benefits to the CCG should
not be overlooked. An explanation should be given to the employee if a request is turned down.
1.4
Once agreed, Human Resources will liaise with the departments to assist with the terms of the
secondment and a confirmation letter and agree what parameters will be applied to it.
1.5
If the secondee is from an external organisation, Human Resources will liaise with the organisation
sending the secondment agreement template and agree what parameters will be applied to it,
detailing very clearly what funding arrangements have been agreed.
Organisation for secondments of CCG Staff to external organisations
1.6
Where an individual manager is approached by an external organisation regarding a secondment
opportunity for an employee, contact should be made with Human Resources. The opportunity
may be advertised depending on the nature of the request. If the secondment is feasible, Human
Resources will facilitate the agreement between all parties involved.
1.7
Where an employee wishes to pursue a secondment opportunity with an external organisation
they should approach their manager indicating that they are interested in applying for a position
and whether they can be released, if successful.
1.8
Agreement must be reached on how the secondee/placement individual's salary will be paid and
which body will be responsible for meeting any additional expenses such as travel and
subsistence allowances.
1.9
During the period of the secondment the individual’s Terms and Conditions will remain the same
and continue to be subject to CCG policies and procedures. Exceptions to this will be agreed in
advance between the host organisation and the secondee/CCG.
1.10
Secondees are responsible for reporting any reasons for absence to the host CCG/organisation in
accordance with their own absence management policies. It is advisable for the host organisation
to inform the appropriate manager in the other organisation if the employee is absent and in
particular if this is long term.
The CCG is responsible for ensuring that all episodes of absence are recorded on ESR
1.11
1.12
Whilst on any secondment employees will continue to accrue annual leave entitlements and be
permitted to take annual leave to their entitlement limit with the agreement of the host
organisation. Where an employee takes a period of Maternity Leave during the course of the
secondment accrual of her annual leave entitlements will continue to apply.
Funding Arrangements
1.13
Prior to the secondment taking place the appropriate manager(s) must liaise with Human
5
Resources and finance to agree who will be funding the secondment and how the payment
arrangements are to be facilitated. Depending on the individual agreements it may be appropriate
to submit an Organisation change form or arrange for a debtors invoice to be raised
1.14
Where the grade of the secondment post is higher than the grade of the employee’s substantive
post, the full salary cost will be paid by the Organisation and recovered from the host organisation.
On return to the Organisation the employee will revert to their substantive grade and salary.
1.1.5
The Employer will continue to pay the Employee through their own payroll during the period of
secondment. The Employer will recharge the Secondment Organisation for relevant salary costs
and all business expenses claimed by the Employee in respect to expenses necessarily incurred
by the Employee fulfilling the role of INSERT JOB TITLE.
Working Arrangements
1.14
For the duration of the secondment or work placement the individual will be required to comply
with the working/cover arrangements of the department or host employer. Any agreement to
exceed/reduce their contractual working hours will be subject to agreement at the initiation of the
secondment and the conditions of Working Time Regulations.
Communication
1.15
When the secondment is confirmed it must be agreed by all parties, that three way communication
between the secondee, host organisation and the CCG is maintained
1.16
Any secondee from an Organisation should be kept informed of and consulted about any
organisational change that takes place during their period of secondment, about their substantive
post.
Managers’ responsibilities
1.17
For managers who are accountable for managing the secondee it will be their responsibility to
outline at the start what their objectives are for the duration of the secondment. Managers must
also conduct performance reviews/appraisals in line with CCG policies
Termination or Extension of Secondment
1.18
A request for an extension of an existing secondment should be considered in accordance with the
needs of the service, and be mutually agreed by all parties and confirmed in writing. If an
extension is refused, an explanation should be given to the employee. The appropriate notice
periods as detailed in the secondment agreement should also be adhered to
1.19
The secondment may be terminated by either party in writing with the appropriate or previously
agreed notice period.
Secondment resulting in Permanent Appointment
1.20
Where a full recruitment process was carried out for the secondment, the individual may be offered
the post should it become permanent.
1.21
If a full recruitment process was not followed then a recruitment and selection process will need to
be carried out.
2.
APPEAL
An employee may use the Grievance Procedure if they feel that they have been treated unfairly in
relation to application of this policy.
6
Equality Analysis Initial Assessment
Title of the change proposal or policy:
Secondment
Brief description of the proposal:
To ensure that the policy amends are fit for purpose, that the policy is legally compliant, complies with
NHSLA standards and takes account of best practice.
Name(s) and role(s) of staff completing this assessment:
Date of assessment: DATE 2014
Please answer the following questions in relation to the proposed change:
Will it affect employees, customers, and/or the public? Please state which.
Yes, it will affect all employees
Is it a major change affecting how a service or policy is delivered or accessed?
No
Will it have an effect on how other organisations operate in terms of equality?
No
If you conclude that there will not be a detrimental impact on any equality group, caused by the
proposed change, please state how you have reached that conclusion:
No anticipated detrimental impact on any equality group. The policy adheres to the NHS LA Standards
and best practice. Makes all reasonable provision to ensure equity of access to all staff. There are no
statements, conditions or requirements that disadvantage any particular group of people with a protected
characteristic.
Please return a copy of the completed form to the Equality & Diversity Manager
7
Item No: 14 Enc: 11
TO BE HELD ON: 6th September 2014
Subject:
Quality Report
Board Lead:
Val Jones
Officer Lead:
Lynn Tolley
Recommendation:
For
Approval
For
Ratification
For
Discussion
For
Information

To update the Governing Body of the quality issues and matters relating to health care services
commissioned by the CCG.
KEY POINTS:
1. The level of concern for MSHFT remains at RED to reflect the Trust’s fragility although this has
stabilised to a certain extent with the Trust reporting that the workforce position has improved. The
preparations for the transition are progressing with plans for how there will be enhanced monitoring
during the immediate to short term transition period.
2. The level of concern for SSPOTPT is changed to AMBER to reflect the concerns which have yet to
be validated regarding workforce capacity in particular district nursing. Although there is no
evidence so far of safety issues the relationship between chronic capacity issues and quality and
safety are well known. Both North and South CCGs are jointly investigation this to establish any
issues and actions that may need to be taken.
3. The level of concern for SSSFHT is GREEN although the CCG has not yet received the most up to
date quality report from the Lead CCG. There has been an increase in suicides from last month
although their overall rates and trends have previously not been found to be outlier. However the
CCGs will continue to monitor these and ensure they are fully investigated and to maintain
vigilance of any emerging trends.
4. The level of concern for BHT remains AMBER/RED to reflect that the Trust remains in special
measures as a result of the second visit from the Keogh Review which has been reported
previously. The Trust still has issues with infection control, cancer waits and have recently had 4
falls resulting in serious harms.
5. The level of concern for UHNS is escalated to AMBER/RED due to a number of factors. The
chronic problems in A&E and Outpatients which do not seem to be resolving and A&E FFT scores
1
Item No: 14 Enc: 11
are showing a marked downward trend. There will need to be close monitoring following the
transfer of MSHFT services to ensure that this does not conflict any capacity issues. They have
also reported a second Never Event following the Never Event in July relating to a nasogastric
tube.
6. The level of concern for RWT remains at AMBER/RED whilst the Trust has had a reduction in
serious incidents and no C Diff cases issues they have had a Never Event and an HSE reportable
infection control issue. The CCG have not yet had full assurance around the capacity issues and
the ambitious recruitment and will be seeking this through the lead CCG and the RWT CQRM.
The level of concern for WHT remains at AMBER as a result of the ongoing cancer waits problem
and the actions being agreed to address this have demonstrated sufficient impact. They are
within trajectory for C Diff and inpatient FFT scores show an upward trend whilst there is a
reduction in A&E scores reflecting current pressures there.
interventions.
expectancy.
Commissioning for quality will enable the CCG to put in
place exemplary systems for commissioning intentions
and provider performance management that will deliver
its Key Goals
Implications
Legal and/or Risk
Enable the CCG to meet its statutory responsibilities for
commissioning quality; reduce and mitigate risks to the organisation and to
patients.
CQC
Enable the CCG to meet commissioner responsibilities for CQC Essential
Standards for Health including that providers have up to date registration
with the CQC.
Patient Safety
Integral element of the Quality Strategy which describes the systems that
will be deployed to “keep patients safe.”
Patient Engagement
Integral element of the Quality Strategy which describes how the CCG will
use patient engagement and experience to form the intelligence essential
for effective and safe commissioning
Financial
Following the baseline assessment of the CCG structure, systems
and processes there maybe implications for additional funding.
2
Item No: 14 Enc: 11
Sustainability
A three year plan which will be refreshed on an annual basis through
the annual Quality Improvement Plan
Organisational Development Plan for the CCG is in place to develop
members, staff and leadership.
The CCG Governing Body is asked to: Note the key quality and safety issues in the
report and actions taken to improve quality and reduce risk
KEY REQUIREMENTS
Yes
No
Not
Applicable






3
Item: 14 Enc: 11
Cannock Chase Governing Board Quality and Safety Report
November 2014
CSU Quality Lead: Mark Doran
CCG Director Lead: Val Jones
GP Clinical Lead:
Dr Tim Berriman
Main Issues/Top Themes For Providers
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Mid Staffordshire Hospital Foundation Trust (MSHFT)
a. CQC Inspection July 14 – Final report published
b. Transition of Services
c. Mortality Review - new back log
Staffordshire Stoke On Trent Partnership Trust (SSOTPT)
a. District Nursing
b. Pressure Ulcers
c. Infection control
South Staffordshire Shropshire Healthcare Foundation Trust (SSSHFT)
a. Quality report not available
Burton Hospital Foundation Trust (BHFT)
a. Cancer 62 day wait
b. Infection control
c. Falls
University Hospital North Staffordshire (UHNS)
a. Failure against the A & E 4hr wait
b. Outpatient backlog report
c. Never Event
Royal Wolverhampton Hospital Trust (RWHT)
a.
Cancer waiting times and recovery Plan
b.
WHO Safer Checklist Progress
c.
Infection control
d.
Never Event
Walsall Hospital Trust (WHT)
a. Cancer 62 day Referral to Treatment (RTT)
b. Infection Control
Level of Concern RAG Rating Index
Rowley Hall Hospital
RED = High level of concern relating to the main
a. CQRM not due until November
quality and safety issues reported to CQRM
Safe Guarding Reports
AMBER = Medium level of concern relating to the
a. Quarterly report to Quality Committee main quality and safety issues reported to CQRM
GREEN = Low level of concern relating to the main
Hospices
quality and safety issues reported to CQRM
=Insufficient information available at this time
British Pregnancy Association (BPAS)
Nursing Home Quality Assurance (NHQA) Update
a. Quarterly report to Quality Committee
BADGER (OOH)
b. CQRM not due until November
Mid Staffordshire Hospital Foundation Trust (MSHFT)
Regulators involvement and issues
CQC Quality report – The CQC report for the inspection visit made on the 1st & 2nd July has
now been published. The report confirms the preliminary finding reported to QSG: in a previous 3
Item: 14 Enc: 11
reports:•
•
•
•
That safe care is being delivered in each of the clinical areas except for medical care
which requires some improvement due to staffing levels. However the inspectors
acknowledged that whilst staffing fragility was being managed through a number of
strategies these were not sustainable post November; leaving the Trust vulnerable to
any additional pressures as might be experienced during the winter period.
That Ward 11 which was used to flex capacity and found to have had some patient
experience and safety incidents relating to capacity to be closed.
The role of the wider economy in stabilising the situation through the Sustaining
Services Board was recognised however
The Chief Inspector raised concern at the absence of a clear and timetabled
Transition Plan for these services.
An action plan to address the CQC recommendations will be presented to CQRM and a
comprehensive Transition Plan developed by the TSA has been shared with the CCG and at the
Local Transition Board.
Main Issues for Providers
Transition of Services
The CCG is working with the Trust Development Agency (TDA) and other stakeholders to
provide assurance on the safe transition of services from MHSHFT to the new providers. Thi sis
reported through the Local Transition Board (LTB) which provides economy wide oversight of
the processes. .
Mortality Review – new back log
Total number of over due (3 months) mortality reviews
2014
End
May
48
End
June
36
14 July
05 Aug
20 Aug
03 Sep
23 Sep
06 Oct
Medicine
End
April
82
33
12
4
21
19
33
Surgery
18
15
13
13
9
2
12
12
12
Total
100
63
49
46
21
6
33
31
45
It had been agreed by MSFT that this new backlog would be cleared by 30th September 2014.
The monthly update showed that the position had been deteriorating during the second half of
August. MSFT did not meet the number of target reviews by 31 August target and have advised
CQRM that the agreed target of zero overdue reviews by 30 September will not now be
achieved.
The CCG are now considering approaches to clear the following the transition of services and
will be discussed at the final MSHFT CQRM which will be attended by both RWT and UHNS
representatives.
4
Item: 14 Enc: 11
Infection Control
2014
MSHFT
Target
Trend
Apr
May
Jun
MRSA Bacteraemia
0
=
0
0
0
C Difficile
24

4
1
1
July
Aug
Sep
YTD
0
0
0
0
5
1
2
14
MRSA
There were no reports of MRSA Bacteraemia to commissioners during September 2014.
Clostridium difficile
MSFT reported 1 case of Clostridium difficile infection during August 2014. The Trust now has
12 cases against a year to date objective of 10 and an annual objective of 24. Of these, 10
cases were deemed unavoidable and 2 avoidable. The lapses in care related to audit scores for
environmental cleaning and hand hygiene. These issues have been addressed through the
Trust’s Clostridium difficile recovery group and plan.
One case in July diagnosed as pseudomonas colitis upon endoscopy. In line with national
reporting requirements, this has been reported as a case of Clostridium difficile. However, the
patient has not tested positive for the organism.
Outbreaks and Serious Incidents:
There were no reportable incidents or outbreaks of infection at the Trust during August 2014.
Patient Experience
Net Promoter
MSHFT
Apr
May
Jun
July
Aug
BHFT
UHNS
RWHT
WHT
F & F Inpatient Score
73
74
70
73
68
73
78
72
70
F & F Inpatient
Response Rate (%)
32.6
1
26.25
28.52
28.30
28.22
35.65
21.15
27.40
43.11
F & F Score - A &E
53
53
45
56
60
62
41
52
46
F & F - A & E Response
Rate (%)
F & F Score – maternity
(Birth)
30.7
31.5
18.9
30.8
23.7
24.1
17.6
14.0
7.4
92
91
100
93
92
86
80
97
88
F & F - Maternity
Response Rate (Birth)
(%)
15.8
17.3
27.2
26.6
47.3
9.5
16.9
7.1
August
18.3
5
Item: 14 Enc: 11
The above comparison table demonstrates that MSHFT Inpatient Net Promoter scores have
dropped in August to the lowest rate locally. However the gradual improvement in A&E scores
continues.
Complaints
The total number of complaints has decreased in the last month after reaching a peak in August
2014. For the last 6 quarters, complaints about poor communication have been the top theme
with complaints about medical care second.
The top themes for September are:• Communication (12)
• Medical Care (11)
• Attitude (7)
• Diagnosis (7)
• Discharge (6)
Stafford
Hospital
Cannock
Hospital
Sept
Oct
14
26
2
3
2013
Nov
Dec
Jan
Feb
Mar
Apr
27
17
21
25
15
21
0
0
3
3
0
2
2014
May
June
July
Aug
Sept
29
33
20
31
24
3
2
3
2
2
Complaints received for Stafford and Cannock Hospital:
Please note – once complaints are received, all complaints within a single communication are
extracted
Eliminating Mixed Sex Accommodation
There were no breaches in September 2014.
Patient Safety
Serious Incident (SIs)
The number of SIs reported to Commissioners in September was 3, a reduction from August
figure of 7. There were no reported Grade 3 or 4 pressure ulcers.
August 2014
Sept 2014
Pressure Ulcer – Grade 3 x 3
Delayed Diagnosis x 1
Sub-optimal care of the deteriorating patient x 1
Maternity Services - Intrauterine death x 1
Slips/Trips/Falls x 2
Maternity Services - Maternal unplanned admission
to ITU x 1
Adverse media coverage or public concern about
the organisation or the wider NHS x 1
*Captured by reported date so we can capture any serious incidents which are reported late
6
Item: 14 Enc: 11
Staffordshire Stoke On Trent Partnership Trust (SSOTP)
None reported
Main Issues for Providers
District Nurses
As a result of soft intelligence and queries relating to District Nursing capacity the CCG has
made a formal request through the contract for a workforce analysis and this is due at the end of
October 2014. In addition there is a Joint CQRM in October and a South Division CQRM in
November which will focus on capacity within district nursing.
Pressure Ulcers (PU)
In September the Trust reported a Grade 4 pressure ulcer on a patient in a residential home.
Commissioners have requested the Trust bring together all current pressure ulcer and
prevention relieving initiatives into a single plan which can be monitored more easily
Infection Control
2014
SSOTP
Target
Trend
Apr
May
Jun
July
Aug
Sept
YTD
MRSA Bacteraemia
0
=
0
0
0
0
0
0
C Difficile
8

0
1
0
3
1
5
Clostridium Difficile
There was 1 report of Clostridium difficile during August 2014; the RCA’s have all been
completed; 4 cases have been agreed as unavoidable and 1 as avoidable. The Trust’s objective
for 2014/15 remains at 8.
MRSA
There were no reports of MRSA Bacteraemia during August 2014.
Outbreaks
There was an outbreak of viral gastroenteritis on Cottage Ward during August 2014. A total of 5
patients were affected, with no staff or visitors reporting symptoms. Among these was 1
Clostridium difficile toxin positive result which may have been an incidental finding as the
symptom profile was not typical of Clostridium difficile. There were no other organisms
identified.
7
Item: 14 Enc: 11
Patient Experience
Trust Overall
Feb
Mar
Apr
May
June
July
Aug
Sept
72.12
70.61
70.32
69.79
73.57
68.31
68.66
71.31
2915
2419
2092
2189
2417
2977
1768
1969
Feb
Mar
Apr
May
June
July
Aug
Sept
Stafford (27 users)*
66.66
81.40
59.26
76.47
82.26
78.87
-
-
Cannock (28) *
88.99
100
75
87.50
70.00
92.86
-
-
F & F Score
Number of surveys received
Neighbourhood Area FFT
Score
*Data extracted from South Community Teams Dashboard
Complaints
The Trust received 37 complaints in September 2014 of which 13 ( 6 Health & 7 ASC) were
received for South Community Teams.
2014
Total Health & ASC
South
Apr
28
20
May
40
22
Jun
29
14
Q1
97
56
Jul
35
23
Aug
37
13
The five top themes are;
•
•
•
•
•
Quality of care (3)
Clinical treatment (2)
Staff attitude behavior (2)
Inaccurate financial information provided (2)
Case management (1)
No breaches reported in September 2014
Patient Safety
Serious Incident (SIs) North & South Divisions
The number of SIs reported to commissioners for September 2014 was 16 this is a significant
increase from 5 SIs reported in August 2014. They mainly related to an increase in the number
of reported Grade 3 Pressure Ulcers from 2 in August to 11 in September.
8
Item: 14 Enc: 11
August 2014
Pressure Ulcer Grade 3 x 2
September 2014
Ward Closure x 1
Ward Closure x 2
Unexpected Death of Community Patient (not in receipt) x
1
Unexpected Death of Community Patient (not in receipt)
x1
Unexpected Death of Inpatient (not in receipt) x 1
Safeguarding Vulnerable Adult x 1
South Staffordshire Shropshire Healthcare Foundation Trust (SSSHFT)
The CCG is awaiting the release of monthly quality report for SSSFHT from the lead CCG for
this provider at the end of the month. The information available here is that which can be
accessed from national database reports.
Infection Control
2014
SSSFT
Target
Trend
Apr
May
Jun
Jul
Aug
YTD
MRSA Bacteraemia
0
=
0
0
0
0
0
0
C Difficile
8

0
1
0
3
0
4
SSSFHT have an objective of zero for CDI and zero tolerance to avoidable MRSA Bacteraemia.
There were no reports of Clostridium difficile infection or MRSA Bacteraemia in August 2014.
Outbreaks and Serious Incidents
There were no outbreaks or serious incidents reported during August 2014.
The Trust reported no breaches in September 2014.
Patient Safety
Serious Incidents (SIs)
The number of SIs reported to commissioners for September 2014 has increased from 2 in
August to 6 as a result of the number of reported suicides. A request has been made by CC &
SAS CCGS to raise this at the next CQRM.
August 2014
September 2014
Suspected suicide x 2
Admission of under 18s to adult mental health ward x 1
Unexpected Death of Inpatient (in receipt) x 1
Unexpected Death of Community Patient (in receipt) x 3
Unexpected Death of Community Patient (in receipt) x 1
Unexpected Death of Inpatient (in receipt) x 1
Accident Whilst in Hospital x 1
Suspected suicide x 6
9
Item: 14 Enc: 11
Burton Hospital Foundation Trust (BHFT)
Nil to report
Main Issues
Cancer 62 day wait
Current performance for cancer 62 day wait consultant upgrade is 40% (target of 95%). The
CCG continues to monitor this in the CQRM
No breaches occurred in September 2014.
Infection Control
2014
BHFT
Target
Trend
Apr
May
Jun
MRSA Bacteraemia
0
=
1
0
0
C Difficile
15

2
1
6
July
Aug
Sept
YTD
1
0
0
2
4
0
0
13
There were no reports of Clostridium difficile from Burton Hospitals NHS Foundation Trust
during August 2014. Therefore, the Trust currently has 13 cases against an annual trajectory of
15. The RCA’s for all cases have been completed and of these, 12 were deemed unavoidable to
the Trust and 1 avoidable.
MRSA
There were no reports of Trust apportioned MRSA Bacteraemia during August 2014.
Patient experience
Net Promoter
BHFT
Apr
May
June
July
Aug
MSFT
UHNS
RWHT
WHT
72
75
78
77
73
68
78
72
70
F & F Inpatient
Response Rate (%)
F & F Score - A & E
32.8
35.20
44.18
38.94
35.65
28.22
21.15
27.40
43.11
69.78
67
63
55
62
60
41
52
46
14.8
13.2
23.3
23.1
24.1
23.7
17.6
14.0
7.4
August
F&F-A&E
Response Rate (%)
10
Item: 14 Enc: 11
F & F Score maternity
86
87
91
88
86
92
80
97
88
F & F - Maternity
Response Rate (%)
36
50.6
44
49.2
47.3
18.3
9.5
16.9
7.1
Family and Friends Test (FFT) scores and response rates for inpatients has dipped slightly in
August.
Complaints – No update available
There were 7 mixed sex accommodation breaches reported in August 2014. The breaches
were in the critical care unit as capacity impacted upon patients being transferred onto wards.
Patient Safety
Serious Incidents (SIs)
The number of SIs reported to commissioners for August 2014 was 13, this is a significant
increase from 5 SIs reported in July 2014. There have been 4 falls reported as serious
incidents and any trends or issues arising from these will be monitored and reported through the
BHT CQRM.
A falls care bundle will be developed within the Trust and focus on the holistic functional aspects
of a patient’s care. The functional falls assessment tool is now in use and has been rolled out
across the Trust in June and is part of the health informatics system (HIS). Posters referring to
high risk areas for falls have been displayed in bathrooms and toilets. The Host CCG are
closely monitoring falls and working with the Trust to identify areas of improvement.
August 2014
Unexpected Death of Inpatient (not in receipt) x 1
September 2014
Attempted Suicide by Inpatient (not in receipt) x 1
Maternity Services – unexpected neonatal death x 1
Communication issue – 16 urology cancer patients
have not received a recall appointment x 1
Other x 1
Unexpected Death (general) x 1
Pressure ulcer Grade 3 x 2
Sub-optimal care of the deteriorating patient x 1
University Hospital North Staffordshire (UHNS)
No issues reported
11
Item: 14 Enc: 11
Main Issues
A & E 4 Hour Wait
The performance at UHNS regarding the A&E 4 hour waits and the 12 hour trolley breaches
continues to deteriorate. NHS England have requested that CCGs are to have a programme of
monthly unannounced visits from October continuing right through the winter months, Area
Team to be involved in the visits. In a response to a query from the CCG around the rapid drop
in FFT scores the Lead CCG for this provider has reported that the Trust are introducing a new
system for collecting FFT responses and that this should improve the scores.
Within A&E the numbers of adverse incidents and complaints, in conjunction with operational
performance, are reviewed and monitored on a weekly basis to provide assurance that the
safety and quality of the services provided are being maintained and improved. There have not
been any serious incidents reported within A&E recently and incidents are reviewed promptly by
the directorate teams to ensure that any learning is extracted and shared.
UHNS have reported 18 12 hour trolley waits in August (2 breaches) and September (16
breaches). The RCAs for August were received by the SI Subgroup in October and the main
cause for the 12 hour breach was the wait for speciality beds (neuroscience). The remaining
final 16 RCA will be received at the November SI Subgroup.
Outpatient backlog report
The Trust has accumulated an outpatient backlog which is being scrutinised in the CQRM. The
CCG has specifically asked for additional information to be included in the October report;
• Monthly Clinical Validation Evidence
• Trajectory by Specialty for Outpatient Backlog
• National Monitoring of Outpatient Backlog
• Benchmarking
The outpatient backlog that has been a persistent problem for UHNS and in addition to the A&E
performance raises issues around capacity and will need to be monitored carefully following
transition of services from MSHFT.
Infection Control
2014
UHNS
MRSA
Bacteraemia
C Difficile
Target
Trend
Apr
May
Jun
Jul
Aug
YTD
0

0
1
1
0
0
2
50

5
4
2
3
9
23
MRSA
There were zero reports of MRSA bacteraemia during August 2014.
The Trust reported 9 cases of Clostridium difficile. This brings the Trust’s current number of
cases to 23 at the end of August, against an annual trajectory of 50. Of the RCA investigations
undertaken to date, 13 cases were classified as unavoidable, 1 avoidable and the remainder are
12
Item: 14 Enc: 11
under investigation.
.
Patient Experience
Family and Friends Test (FFT)
UHNS
Apr
May
June
July
Aug
MSFT
BHFT
RWHT
WHT
79
73
65
73
78
68
73
72
70
F & F Inpatient
Response Rate (%)
20.18
19.21
22.17
23.63
21.15
28.22
35.65
27.40
43.11
F & F Score - A & E
76
49
36
39
41
60
62
52
46
F&F-A&E
Response Rate (%)
3.7
1.1
2.5
19.1
17.6
23.7
24.1
14.0
7.4
F & F Score –
maternity
Birth
F & F - Maternity
Response Rate Birth
(%)
73
78
77
81
80
92
86
97
88
7.1
5.1
12.5
7.2
9.5
18.3
47.3
16.9
7.1
August
The F&F scores for the Trust are volatile particularly A&E where the Trust has some chronic
issues.
Complaints
There were 79 complaints received in July which is an increase from 56 in June 2014.
However, the complaints reduced to 58 in August 2014
No breaches in September 2014
Patient Safety
The number of SIs reported to commissioners for August 2014 was 10.
August 2014
Maternity Services - Unexpected admission to
NICU (neonatal intensive care unit) x 2
C’ Diff
September 2014
C.Diff & Health Care Acquired Infections
X1
Attempted Suicide by Inpatient (not in receipt) x 1
Communicable Disease and Infection Issue
X1
Maternity Service x 1
13
Item: 14 Enc: 11
A Never Event has been reported in September 2014 in relation to a retained vaginal pack. The
investigation is ongoing however as this is the second never event in this category in a short the
issues relating to maternity packs is to be escalated to CQRM.
Royal Wolverhampton Hospital Trust (RWT)
Nil to report
Main Issues for Provider
Cancer Waiting times and Recovery Plan
The recovery plan was discussed at the October 2014 CQRM. There has been a slight
improvements in the cancer waiting times, however this is not yet sufficient. The provider has
stated that one of the reasons is late referrals to them as a tertiary centre from other providers,
The CCG has requested evidence of this so that the commissioners can then address this with
the appropriate provider.
WHO Safer Checklist Progress – September
There are two audits in respect of the assurance for the WHO checklist. One audit measures
the rate of compliance with use of the WHO and the other measures of completion of the
checklist.
There continues to be monitoring of the WHO check list which is reported monthly at the CQRM.
The investigation of the latest Never Event has revealed that whilst the dentist fully complied
with the checklist behaviour of the child distracted the dentist at the point of extraction. There
have been recommendations that there needs to be improvement to the WHO checklist to cover
areas other than theatres where minor clinical procedures are carried out.
Infection Control
2014
RWT
Target
MRSA
Bacteraemia
0
C Difficile
39
Trend
Apr
May
Jun
July
Jul
YTD

1
0
0
1
2

2
1
2
3
8
There has been no cases since April 2014
Clostridium Difficile (C Diff) – Target 39
The Trust has reported 1 case in August and 7 cases in September 2014
Mucor Infection
Two patients identified with Mucorcytosis in September 2014. This can be linked to being in
contact with building work and it is not clear yet whether this could have occurred on or off the
14
Item: 14 Enc: 11
hospital site. This is being investigated and the HSE and PH have been informed and are
working with the Trust to identify the cause.
Patient Experience
Royal
Wolverhampton
Trust
Apr
May
June
July
Aug
MSFT
UHNS
BHFT
WHT
F & F Inpatient
Score
74
75
80
78
72
73
78
73
70
F & F Inpatient
Response Rate (%)
34.42
34.32
35.18
29.76
27.40
28.30
21.15
35.65
43.11
F & F Score - A & E
53
52
52
47
52
56
41
62
46
F&F-A&E
Response Rate (%)
19.5
18.5
16.3
14.8
14.0
30.8
17.6
24.1
7.4
72
91
98
100
97
93
80
86
88
F & F - Maternity
Response Rate (%)
25
12.6
13.8
10.9
16.9
26.6
9.5
47.3
7.1
August
The F&F scores for the Trust show a relatively stable A & E score. However, inpatient score has
decreased slightly in August.
Complaints
No update reported quarterly.
No breaches reported in September 2014
Patient Safety
Serious Incidents
The number of incidents between Aug and September has reduced considerably. During Aug
2014, 44 new Serious Incidents were reported. 24 were pressure ulcers of which 10 were
hospital acquired. In Sept 2014, 30 new Serious Incidents were reported. 13 were pressure
ulcers of which 9 were hospital acquired.
It should be noted that as an integrated acute /community Trust these include community
services. The incidents include corporate incidents where the detail was not provided.
August 2014
Pressure ulcer Grade 3 Hospital acquired x 10
September 2014
Pressure ulcer Grade 3 Hospital acquired x 9
Wrong site surgery x 1
Unexpected death x 2
Slip, Trip, Fall x 2
Confidentiality Incidents x 3
Confidentiality incident x 2
Intraprtum stillbirths x 2
15
Item: 14 Enc: 11
Delayed diagnosis x 3
Intra-uterine death x 1
Unexpected admission to ITU x 1
Slip, trip, fall x 3
Unexpected Admission to NNU x 1
Unexpected admission to NNU x1
Interuterine Deaths x 2
Pressure ulcers Grade 3 community acquired x 4
Unexpected deaths x 2
Health Acquired infection x 4 (2 MRSA, 1 C Diff and 1
Mucor Fungal Infection)
Sub Optimal Care x 2
Pressure ulcers Grade 3 community acquired x 13
MRSA x 1
Ward closure x 1
Failure to act on test results x 1
Mortality – 2013/2014
Due to the Provider using a different mortality analytical system to Dr Foster there is to be a
meeting with the performance leads of RWT to understand the methodology and how this
compare with the Dr Foster used extensively across the country.
Walsall Hospital Trust (WHT)
Nil to report
Main Issues for Provider
Cancer 62 day Referral to Treatment (RTT)
Validated figures for June is 77.61%, which shows a continued low performance over 3 months.
Several actions are being taken by the Provider to address this low performance, which is being
monitored by the CCG.
Infection Control
2014
Target
Trend
Apr
May
Jun
Jul
YTD
MRSA Bacteraemia
0

0
0
0
0
0
C Difficile
28

1
5
1
1
8
There was no reported MRSA in July 2014
16
Item: 14 Enc: 11
C. Difficile
There was 1 reported C Diff in July 2014. The Trust remains within trajectory.
Patient Experience
Walsall Hospital
Trust
Apr
May
June
July
Aug
BHFT
UHNS
RWHT
MSFT
F & F Inpatient
Score
F & F Inpatient
Response Rate (%)
F & F Score - A & E
68
68
72
71
70
73
78
72
73
47.67
53.04
45.23
77.01
43.11
35.65
21.15
27.40
28.30
52
58
54
45
46
62
41
52
56
F&F-A&E
Response Rate (%)
12.7
19.8
20.7
22.3
7.4
24.1
17.6
14.0
30.8
79
76
90
85
88
86
80
97
93
F & F - Maternity
Response Rate (%)
13.4
17
12.7
19.7
7.1
47.3
9.5
16.9
26.6
Aug
Family and Friends inpatient scores shows an upward trend. A & E scores are reducing and may reflect
current pressures within A & E.
Complaints – no update for August 2014
40 formal complaints were received in July 2014, this is an increase of 8 from the previous
month.
A breakdown of complaints were attributed to divisions:
•
•
•
Clinical Support Services – 2
Women’s Services – 1
Children’s and Family Services - 3
Nil reported in September 2014
Patient Safety
Serious incidents
During July 2014, there were 8 new Serious Incidents reported, of which 1 was a Community
acquired grade 3 pressure Ulcer and 1 grade 3 hospital acquired pressure ulcer.
June 2014
Grade 3 Pressure Ulcers - Community Acquired x 2
July 2014
Lost to follow up – outpatient cancer
appointment delay x 1
Grade 3 Pressure Hospital Acquired x 1
Intra-uterine death x 1
Patient Fall x 4
17
Item: 14 Enc: 11
Patient Fall x 1
Safeguarding Vulnerable Child x1
Security threat x 1
Maternal Admission to ITU x 1
Missed screening – DOH requested this to be
downgraded
Surgical Error x 1
Delayed diagnosis x 1
Pulmonary Embolism x 1
Explanation of acronyms used in this report:
Acronym
BADGER
BHFT
CCG
CHKS
CDIFF
CQRM
CSU
EMSA
EPR
FFT
HEFT
IPC
MRSA
NHQA
NICU
NSL
OFSTED
PALS
RCA
RTT
RWT
SSOTPT
SSSFT
Explanation
Birmingham And District General Emergency Rooms
Burton Hospitals Foundation Trust
Clinical Commissioning Group
Leading provider of healthcare intelligence and quality improvement services
Clostridium Difficile
Clinical Quality Review Meeting
Clinical Support Unit
Eliminating Mixed Single Sex Accommodation
Electronic Patient Record
Friends and Family Test
Heart of England Foundation Trust
Infection Prevention and Control
Methicillin Resistant Staphylococcus Aureus
Nursing Home Quality Assurance
Neonatal intensive care unit
Non Urgent Patient transport provider
Office for Standards in Education, Children’s Services and Skills
Patient Advisory Liaison Service
Root Cause Analysis
Referral to Treatment Times
Royal Wolverhampton Trust
Staffordshire and Stoke on Trent Partnership Trust
South Staffordshire and Shropshire NHS Mental Health Foundation Trust
18
Item No: 15 Enc: 12
REPORT TO THE CANNOCK CHASE
CLINICAL COMMISSIONING GROUP GOVERNING BODY
Subject:
Performance Report – August 2014
Board Lead:
Alex Bennett
Officer Lead:
Sarah Turner
Recommendation:
For Approval
For
Ratification
For
Discussion
For
Information

•
•
To provide a high level summary of the key performance issues for the CCG for August 2014.
Performance is shown for NHS Constitution measures.
To provide assurance and details of remedial action being taken to improve performance and
mitigate risk and, where applicable, contract queries that have been issued and financial
consequences applied.
KEY POINTS:
Performance measures not achieved in August 2014:
•
•
•
•
•
•
Referral To Treatment - 18 weeks admitted adjusted
Referral To Treatment – Patient on incomplete pathway waiting over 52 weeks.
Diagnostic test waiting times
A&E Waiting Time – Total time in the A&E Dept
Cancer Waits – 31 day standard for first definitive treatment; 31 day standard for first definitive
treatment – subsequent surgery; 62 days standard from urgent referral to treatment;
Ambulance - Category A calls resulting in an ambulance arriving at the scene within 8 minutes
(Red 2) –(September 2014)
1
Item No: 15 Enc: 12
To reduce health inequalities across Cannock
Chase through targeted interventions.
Performance metric to be developed to show
improvement.
To identify and support patients with Long Term
Conditions to ensure care delivery closer to
home.
improvement.
To improve and increase overall life expectancy.
improvement.
To develop integrated services with simple, easy Performance metric to be developed to show
access.
improvement.
IMPLICATIONS
Legal and/or Risk
CQC
Note the risks identified relating to delivery of Quality, Improvement, Productivity
and Prevention (QIPP), Acute Trust Activity and Continuing Care. Reputation risks
if any of the elements of the national operating framework are not delivered.
None
Patient Safety
Patients and their safety are at the centre of everything the CCG commission.
Poor performance in services where patients are waiting longer than required to
access services may be a patient safety risk.
Patient Engagement
The inclusion of patient feedback in performance reporting is essential for Board
assurance. Work is ongoing with colleagues in the Quality and Governance team
to establish lines of reporting.
Financial risks associated with delivering key performance targets and delivering
contracts in line with contract values.
None
Financial
Sustainability
Work to develop understanding of performance management
 Note those areas where the current performance rating is below target and the remedial actions
being taken to improve performance and mitigate risk.
KEY REQUIREMENTS
Yes
No
Not
Applicable





2
NHS Cannock Chase CCG - Constitution Report
Referral to Treatment pathways
RTT 18 weeks admitted adjusted
The percentage of admitted pathways
within 18 weeks for admitted patients
whose clocks stopped during the period
on an adjusted basis. (E.B.1)
Standard
Current
YTD
Month
90%
88.4%
88.6%
Aug-14
73%
94 91 91 93 92 92 88 87 87 88 91 89 88 n/a
A
S
O
N
D
J
F
M
A
M
J
J
A
P
90%
107%
18 months annualised trend
to Mar-14
The RTT Admitted Adjusted standard was not achieved for the CCG's patients. Breaches continue at Royal Wolverhampton and Walsall Hospitals in General Surgery and
Orthopaedics. The lead CCGs are applying contract penalties and Walsall is to provide a revised plan for achieving RTT To the Trust Development Authority (TDA). RWHT - Although
the overall standard was achieved, the Trust did not achieve compliance for 2 specialities (General Surgery and Trauma & Orthopaedics), therefore fines have been applied by the
host CCG.
RTT Non-admitted
The percentage of non-admitted
pathways within 18 weeks for nonadmitted patients whose clocks
stopped during the period. (E.B.2)
RTT Incomplete
The percentage of incomplete pathways
within 18 weeks for patients on
incomplete pathways at the end of the
period. (E.B.3)
Number of 52 week RTT Pathways
Standard
Current
YTD
Month
Standard
Current
YTD
Month
95%
97.4%
97.7%
Aug-14
99 98 97 98 97 98 97 98 98 98 98 97 97 n/a
A S O N D J
F M A M J
J A P
to Mar-14
95 94 95 94 95 94 93 95 95 94 95 97 92 n/a
A S O N D J
F M A M J
J A P
to Mar-14
to Mar-14
89%
95%
101%
76%
92%
108%
92%
92.1%
94.6%
Aug-14
Standard
0
The number of incomplete
Current
pathways greater than 52 weeks for
patients on incomplete pathways at Average YTD
the end of the period. (E.B.S.4)
Month
1
0
Aug-14
0
0
1
0
0
0
0
0
0
0
0
1
0
1 n/a
A
S
O
N
D
J
F
M
A
M
J
J
A
P
14
7
based on current month
per 100k populatoin
Long waiter reported by Walsall - The provider has a Remedial Action Plan in place and the patient was treated by the target date of 24/10/14 as well as to seek to prevent further 52
week breaches. The TDA are monitoring the providers performance against the Remedial Action Plan (RAP).
Printed: 29/10/2014
Page 1 of 5
Prepared by Midlands and Lancashire Commissioning Support Unit
Diagnostic test waiting times
Diagnostic Wait
The percentage of patients waiting 6
weeks or more for a diagnostic test.
(E.B.4)
Standard
Current
YTD
Month
99%
98.95%
98.7%
Aug-14
98 94 96 99 99 99 99 99 99 99 99 99 99 n/a
A S O N D J
F M A M J
J A P
to Mar-14
83%
99%
115%
12 CCG patients waiting over 6 weeks at the end of August, mostly at Mid Staffs FT (3 CT, 3 Non Obs Ultrasound, 1 Gastro), Walsall (3 cystoscopy),
Birmingham Childrens Hospital (1 MRI) and Derby (1 flex sig).
Whilst Walsall is taking a number of actions to address diagnostic waiting times, including additional activity throughout September and October for patients who are identified as
breaches and re-structuring clinics to provide additional capacity for cystoscopy the host CCG will issue a contract query for August’s breach to ensure a remedial action plan (RAP) is
agreed and implemented. Once agreed the RAP will be reviewed at monthly CRMs and the Trust will be requested to provide monthly progress reports. 2 of the CT patients now have
dates for 1/11/14 and 1 has chosen not to be treated and has since been removed from the waiting list.
Overall Mid Staffs achieved the 99% standard.
A&E waiting time - total time in the A&E department
Four hour wait
Standard
Current
Percentage of patients who spent 4
hours or less in A&E. (E.B.5)
YTD
Month
95%
90.3%
91.6%
Sep-14
80%
97 95 93 91 92 90 95 93 92 90 92 92 90
94
S
P
O
N
D
J
F
M
A
M
J
J
A
S
95%
110%
to Mar-14
Walsall - A recovery trajectory for A&E has recently been approved by both the TDA and NHS England Regional Office and this will be used by the host CCG to monitor the Trusts
performance over the coming months and any breach will be treated as a contractual breach. The service is currently exceeding the recovery trajectory agreed.
Royal Wolverhampton - July proved to be the busiest month the Trust had ever experienced. August and September attendances were also significantly up on last year. Fines have
been applied for non-achievement of this standard.
Mid Staffs FT are reporting lack of patient flow as a key contributing factor to poor performance and failure to achieve the target. There has been an increased number of delayed
transfers of care (DTOC) with capacity issues for Packages of Care (POC) which is being addressed via the CCG and Systems Resilience Group (SRG). The Trusts have established a
Recovery Board which had its inaugural meeting week beginning 22nd September and is now meeting weekly, attended by Commissioners. The ambulance divert put in place in
July 2014 to reduce the number of admissions at the Trust is achieving on average 12 diverts per day with subsequent reduction in admissions as required.
Printed: 29/10/2014
Page 2 of 5
Cancer Waiting Time Standards - the CCG will be undertaking a comprehensive analysis of cancer pathways to
ensure robust timescales for treatment.
Cancer waits - 2 week waits
Urgent GP Referrals
Standard
Percentage of patients seen within two
weeks of an urgent GP referral for
suspected cancer. (E.B.6)
Breast Symptoms Referrals
Current
YTD
Month
Standard
Percentage of patients seen within two
weeks of an urgent referral for breast
symptoms where cancer was not
initially suspected. (E.B.7)
Current
YTD
Month
93%
96.1%
95.6%
Aug-14
95 97 96 93 95 96 97 96 96 95 95 96 96 n/a
A S O N D J
F M A M J
J A P
to Mar-14
97 95 89 92 100 100 96 96 98 91 96 100 93 n/a
A S O N D J
F M A M J
J A P
to Mar-14
98 96 100 98 100 94 98 100 96 98 98 98 92 n/a
A S O N D J
F M A M J
J A P
to Mar-14
83%
93%
103%
71%
93%
115%
92%
96%
100%
86%
94%
102%
93%
93.1%
96.7%
Aug-14
Cancer waits - 31 days
First Definitive Treatment
Standard
Percentage of patients receiving first
definitive treatment within one month
of a cancer diagnosis. (E.B.8)
Current
YTD
Month
96%
92.3%
96.7%
Aug-14
4 breaches out of 52 patients in August: UHB (2 x UGI breached due to transplant priority / capacity issue)
2 x Urology (unable to schedule patients within standard) - UHNS and MSFT.
Subsequent surgery
Percentage of patients receiving
subsequent treatment for cancer within
31-days, where that treatment is
Surgery. (E.B.9)
Standard
Current
YTD
Month
94%
88.9%
95.5%
Aug-14
100 100 100 100 92 100 100 100 93 93 100 100 89 n/a
A S O N D J
F M A M J
J A P
to Mar-14
1 breach out of 9 patients. UHB - Surgery (breached due to lack of capacity)
Printed: 29/10/2014
Page 3 of 5
Drug Treatments
Standard
31-days, where that treatment is an
Anti-Cancer Drug Regimen. (E.B.10)
Current
YTD
Month
98%
100%
100%
Aug-14
100 100 100 100 100 100 100 100 100 100 100 100 100 n/a
A S O N D J
F M A M J
J A P
to Mar-14
95 100 100 92 100 97 100 100 93 100 100 100 96 n/a
to Mar-14
96%
98%
100%
75%
94%
113%
70%
85%
100%
Radiotherapy Treatments
Standard
31-days, where that treatment is a
Radiotherapy Treatment Course.
(E.B.11)
Current
YTD
Month
94%
96.3%
97.7%
Aug-14
A
S
O
N
D
J
F
M
A
M
J
J
A
P
Urgent GP referral
Standard
definitive treatment for cancer within
two months (62 days) of an urgent GP
referral for suspected cancer. (E.B.12)
Current
YTD
Month
85%
79.2%
81.2%
Aug-14
90 80 88 80 81 80 83 90 76 79 83 86 79 n/a
A
S
O
N
D
J
F
M
A
M
J
J
A
P
to Mar-14
5 breaches out of 24 patients in August - Mid Staffs FT (Lung - Treatment planning delayed due to clinical reason)
Walsall (Other tumour type - Complex pathway with many diagnostic tests)
MSFT/UHB (Upper GI - Capacity issue). UHNS (Urology - Many tests required before treatment)
MSFT (Lower GI - Patient DNA follow up appointment resulting in delay for anaesthetic review.
Walsall - whilst improvements were recorded in May and June, overall performance declined to 71.4% in July. Whilst the Trust is forecasting a significant improvement in August
the host CCG will require assurance this is sustainable by reviewing the new RAP and revised trajectory.
RWHT - A Recovery plan has been submitted to the Host CCG. The Trust has been experiencing problems in compliance against the national cancer waiting Times Targets. The
particular areas of concern are the 31 day subsequent surgery target (94%) and the 62 day referral to treatment compliance against the national target (85%). The main reasons for
this non-compliance have been identified and action plans have been developed.
Printed: 29/10/2014
Page 4 of 5
Screening service referral
Standard
Current
62- days of referral from an NHS Cancer
Screening Service. (E.B.13)
Consultant upgrade
YTD
90%
100%
100%
Month
Aug-14
Standard
N.O.S.
Current
62- days of a consultant decision to
upgrade their priority status. (E.B.14)
YTD
Month
40%
100 100 100 100 67 100 100 100 100 100 100 100 100 n/a
A
S
O
N
D
J
F
M
A
M
J
J
A
P
100%
97.6%
Aug-14
0%
100 94 100 100 95 100 100 100 100 93 100 95 100 n/a
A
S
O
N
D
J
F
M
A
M
J
J
A
P
90%
140%
50%
100%
to Mar-14
to Mar-14
Ambulance clinical quality
Ambulance Red 1
Category A calls resulting in an
emergency response arriving within 8
minutes - Red 1 incidents: immediately
life threatening and the most time
critical. (E.B.15.i)
Ambulance Red 2
emergency response arriving within 8
minutes - Red 2 incidents: life
threatening but less time critical than
Red 1. (E.B.15.ii)
Ambulance Red 19
ambulance arriving at the scene within
19 minutes. (E.B.16)
Standard
Current
YTD
Month
Standard
Current
YTD
Month
Standard
Current
YTD
Month
75%
75.0%
75.9%
Sep-14
73 81 62 90 70 64 79 67 100 75 76 63 75 n/a
S
O
N
D
J
F
M
A
M
J
J
A
S
P
to Mar-14
103%
47%
75%
benchmarking based on current
month
to Mar-14
86%
64%
75%
month
to Mar-14
103%
87%
95%
month
75%
73.1%
72.0%
Sep-14
66 72 69 69 69 63 70 74 74 73 67 71 73 n/a
S
O
N
D
J
F
M
A
M
J
J
A
S
P
95%
95.0%
93.9%
Sep-14
95 96 93 93 94 92 92 94 93 94 93 95 95 n/a
S
O
N
D
J
F
M
A
M
J
J
A
S
P
All 3 standards were not achieved in August, however two standards have been achieved in September 2014. An update has been requested from the Contract Lead in Sandwell
and West Birmingham CCG.
Printed: 29/10/2014
Page 5 of 5
Item: 16 Enc: 13
TO BE HELD ON: Thursday 6 November 2014
Subject:
Finance Report Month 6 (September 2014)
Board Lead:
Paul Simpson
Officer Lead:
Colin Groom
Recommendation:
For Approval

For Discussion

For Information

This paper provides the Governing Body with the financial position of Cannock Chase CCG for Month
6 of the financial year 2014/15, covering the period April 2014 to September 2014.
KEY POINTS:
1.
This report sets out the in-year financial position at Month 6. This shows a deficit of £1.844m
against plan.
2.
At this stage in the year, we are reporting that we will not spend more than the planned deficit
for 2014/15.
3.
The QIPP programme must continue to deliver in order to ensure that the planned deficit level
is not exceeded.
Cannock
Chase
through
targeted
interventions.
To identify and support patients with Long
Term Conditions to ensure care delivery
closer to home.
expectancy.
To develop integrated services with simple,
easy access.
Finance Plan supports delivery of key goals
Page | 1
Item: 16 Enc: 13
Implications
Legal and/or Risk
See risk section in body of report
CQC
None
Patient Safety
None
Patient Engagement
None
Financial
Deficit of £1.844m for the year to date
Sustainability
None
Workforce/Training
None
RECOMMENDATIONS/ACTION REQUIRED:
The Governing Body is asked to:
•
Note the position to date, the forecast for the year and the risks and mitigating actions.
KEY REQUIREMENTS
Yes
No
Not Applicable
N/A
N/A
Has a privacy impact assessment been completed?
N/A
Have partners/public been involved in design?
N/A
Are partners/public involved in implementation?
N/A
Are partners/public involved in evaluation?
N/A
Page | 2
Item: 16 Enc: 13
CANNOCK CHASE CLINICAL COMMISSIONING GROUP
MONTH 6 FINANCE REPORT
1. Introduction
This is the report to the end of September, based on Month 5 (August 2014) contracting information.
The aim is to present clearly the key financial issues for the year to date and highlight any risks to
achievement of our planned financial position.
2. Planned Deficit
The planned deficit for 2014/15 for Cannock Chase is £8.574m. At 30th September 2014 the year to
date planned deficit was £3.744m. The variance of £1.844m reported below is the variance from this
year to date plan.
3. Financial Position to Month 6
The summary Income and Expenditure position is shown in Table 1 below:
Table 1 - Cannock Chase CCG
Summary Financial Statement as at 30th September 201
Acute Contracts
Mental Health
Community Services
Total HCHS
Annual
Budget
£000's
Budget
£000's
Year to Date
Actual
£000's
Forecast
Outturn
Variance
£000's
Variance
£000's
87,001
14,913
15,191
117,104
44,350
7,551
7,920
59,822
46,392
7,886
7,963
62,241
2,042
335
43
2,419
2,718
(676)
206
2,248
Continuing Healthcare
15,155
7,832
8,107
275
73
Primary Care Services
24,856
12,244
12,182
(62)
(244)
Other Programme Services
1,179
589
546
(43)
84
Reserves
Contingency Reserve
Winter Monies Income Requirement
QIPP Reinvestments
QIPP to be allocated
QIPP Risk Reserve
CHC Legacy Provision Reserve
Commissioning Reserve
Total Reserves
756
(244)
1,807
(11)
1,404
0
224
3,937
186
0
325
0
298
0
0
809
0
0
0
0
0
0
0
0
(186)
0
(325)
0
(298)
0
0
(809)
(756)
0
0
0
(1,404)
0
0
(2,160)
Corporate Running Costs
Corporate Non Running Costs
3,282
197
1,698
99
1,762
99
65
0
0
0
165,710
83,093
84,937
1,844
0
(157,136)
(79,348)
(79,348)
0
0
In Year Position (Surplus)/Deficit
8,574
3,744
5,588
1,844
0
Repayment of previous year deficit
9,599
4,800
4,800
0
0
18,173
8,544
10,388
1,844
0
CCG Total Expenditure
Revenue Resource Limit prior to repaying previous
year deficit
Cumulative Position (Surplus)/Deficit
Page 1 of 7
Item: 16 Enc: 13
This shows a year to date deficit against plan of £1.84m, compared with £1.61m at
Month 5. Most of this is driven by an overspend across the contract portfolio of £2.4m.
There are also overspends in Continuing Healthcare (£0.275m) and Corporate Costs (£65k) supported
by a year to date release of reserves (£0.81m). More detail is given in Appendix 2.
4. Running Costs
CCG running costs are monitored separately within the Revenue Resource Limit. The position to date
is shown in Table 2 below:
Table 2 - Cannock Chase CCG
Summary of Running Costs as at 30th September 2014
Annual
Budget
£000's
Pay
Budget
£000's
Year to Date
Actual
£000's
Variance
£000's
Forecast
Outturn
Variance
£000's
1,554
776
760
(16)
0
875
495
578
82
0
Commissioning Support Service
1,154
577
609
32
0
Income
(301)
(150)
(184)
(33)
0
CCG Total
3,282
1,698
1,763
65
0
Non Pay
There is a £65k overspend to date, but a break-even position is expected by the end of the financial
year. The non-pay over spend relates mainly to consultancy support including work to support the
dissolution of MSFT.
5. Allocations
Additional allocation adjustments have been made in Month 6 for treatment of overseas visitors.
Changes to the initial allocation are shown in Table 3 below:
Table 3
Revenue Resource Limit as at 30th September 2014
£000
Confirmed Healthcare Allocation
Initial CCG Running Costs Allocation
Brought Forward Deficit
GPIT
Training Transfer from Shropshire & Staffs AT
Secondary Care Funding Returned to CCG's
GPIT
14/15 RTT Funding
3,282
(9,599)
336
24
232
67
668
CHC Risk Sharing Rebasing
1,510
Adjustments to 13/14 Baseline
(109)
NHSE Allocation adjustment - European Overseas Visitors
(124)
Total Resource Limit - Programme & Admin
6.
151,250
147,537
Contracting Position at Month 5
We now have contracting information to the end of August (Month 5). The month 5 variances against
plan have been extrapolated to give an estimated Month 6 position, which is included in the table
above.
Page 2 of 7
Item: 16 Enc: 13
The main contributors to the reported overspend of £2.4m against plan are Burton
Hospital (£642k), Royal Wolverhampton Trust (£499k), Rowley Hall (£340k), University
Hospitals of North Staffordshire (£135k) and Mid-Staffordshire Hospitals (£132k). The reasons for the
variances are as follows:
Burton
•
•
•
An increase in emergency admissions as a result of the anticipated ambulance diverts
A&E attendances, and
Critical Care.
Rowley Hall
•
This is an elective contract which continues to over-perform, but discussions are taking place
with the provider about curtailing this increase in activity.
Royal Wolverhampton
•
The over-performance is primarily due to emergency admissions as a result of the anticipated
ambulance diverts.
7. Reserves Position
Reserves are detailed within Table 1. As at Month 6, £809k of reserves have been used to support the
reported position including an element of the contingency. We have just received confirmation of our
System Resilience funding (formerly Winter Pressure funding) which is being reviewed and should
eliminate the negative reserve currently shown. However, there is a risk that commitments may
exceed the level of funding assumed in the plan.
8. QIPP Progress
Delivery of the CCG financial control total is still heavily dependent on achieving the planned QIPP
savings. Progress on QIPP implementation is considered in more detail within a separate QIPP
Performance Report. In the first six months, it is estimated that savings of just under £1.7m have been
delivered, which is £0.59m below plan. The CCG had created a reserve to mitigate against QIPP
slippage and within the reserves figure highlighted above, £0.3m has been released from this reserve
to support the programme.
The projected savings continue to be validated against contract performance information and will be
revised as necessary but due to slippage in some schemes, the projected full year savings are now
£5.51m against a plan of £6.99m, a shortfall of £1.48m. The risk reserve highlighted above is £1.4m in
total and therefore current projections are that the shortfall will be ostensibly covered by the reserve
available. The PMO responsible for the QIPP programme is assessing further schemes and mitigations
to address this shortfall.
The detailed programme is shown at Appendix 3.
Page 3 of 7
Item: 16 Enc: 13
9.
Balance Sheet, Better Payment Policy Compliance, Cash
The Summary balance sheet (Statement of Financial Position) confirming the position at the end of the
previous financial year and the most recent three months of the current financial year is included in
Table 4 below
31st
July
2014
£000s
31st
March
2014
£000s
Table 4
Summary Statement of Financial Position
31st
August
2014
£000s
30th
September
2014
£000s
Current assets:
Trade and other receivables
Cash and cash equivalents
1,931
31
2,380
39
1,307
2
1,880
519
Total current assets
1,962
2,419
1,309
2,399
Current liabilities
Trade and other payables
(9,499)
(10,683)
(10,010)
(7,065)
Total Assets Employed
(7,537)
(8,264)
(8,701)
(4,666)
Financed by Taxpayers’ Equity
General fund
(7,537)
(8,264)
(8,701)
(4,666)
Total Taxpayers Equity
(7,537)
(8,264)
(8,701)
(4,666)
Performance against the Better Payment Practice Code (BPPC) for the year to date is shown below:
BPPC Compliance 2014/15 Non NHS
100.0
95.0
90.0
85.0
80.0
75.0
70.0
65.0
60.0
55.0
50.0
Number
Value
APR
MAY
JUNE
JULY
AUG
SEPT
% Compliance
% Compliance
BPPC Compliance 2014/15 NHS
100.0
95.0
90.0
85.0
80.0
75.0
70.0
65.0
60.0
55.0
50.0
Number
Value
APR
MAY
JUNE
JULY
AUG
SEPT
The Better Payment Practice Code requires organisations to pay suppliers within 30 days, unless other
terms are specified.
Aged debtors and creditors analysis and cashflow information will be included in future months
reports.
10. Dissolution Costs
The CCG continues, along with Stafford CCG to be heavily involved in the contractual arrangements
linked to the dissolution of the MSFT. We have estimated that around £1m will be needed between
the CCGs to fund additional staff to manage the process over the next 3-6 months. In addition, the
CCG has had to incur costs associated with the dissolution and overall fragility of the acute system,
including the cost of diverting activity from MSFT to other providers such as UHNS and
Wolverhampton. The CCG is currently in an arbitration process with MSFT, the outcome of which will
determine whether these costs can be recovered.
Page 4 of 7
Item: 16 Enc: 13
11.
Risks and Mitigations
Several financial risks have been identified and are contained within the CCG risk register. The more
material risks are highlighted below.
There is a risk that elective activity will continue to over-perform in future months due to increased
referrals. There is a Commissioning reserve of £224k, which will be used to offset any projected overperformance.
Delivery of projected savings from the QIPP programme remains a risk. Performance is being
monitored through the PMO and Finance, Performance and Contracts Committee. As identified
above, the risk reserve of £1.4m is broadly sufficient to offset the projected under-delivery in year.
There is a risk that costs associated with fragility at MSFT cannot be recovered and will result in a cost
pressure for the CCG. MSFT have been notified that the CCG intends to recharge these costs in line
with the terms of the contract.
There are still some 2013/14 contractual issues unresolved and formal dispute resolution with
University Hospitals North Staffordshire Trust has commenced.
12. Forecast Outturn
The CCG continues to forecast achievement of its control total for 2014-15 and has commenced
regular reviews of the forecast position on a line by line basis through the Executive Management
Team. This work has highlighted a range of risks as identified above and a series of compensating
mitigations. Key to the delivery of the CCGs control total will be the satisfactory management of the
MSFT dissolution and associated risks. Table 1 above and Appendix 1 below show the current forecast
assumptions per area and these will continue to be reviewed in light of the risks highlighted above.
13. Recommendations
The Governing Body is asked to note the position to date, the forecast for the year and the risks and
mitigating actions.
Paul Simpson
Director of Finance
28th October 2014
Page 5 of 7
Appendix 1
Page 6 of 7
QIPP Programme
Appendix 2
Sep-14
Year to Date Position
Year-end Forecast
ID
Scheme Description
Start Date
Target
Predicted
Variance
Target
Predicted
Variance
Target
Predicted
Variance
BV01 &
BV02
Continuing Healthcare - improved management of clients with complex needs
& SSSFT management of identified patients
01-Apr-14
£98,403
£43,310
-£55,093
£409,581
£166,704
-£242,877
£1,000,000
£1,000,000
£0
BV03
MSFT locally agreed tariffs
01-Apr-14
£28,298
£28,298
£0
£169,785
£169,785
£0
£339,570
£339,570
£0
BV04
SSOTP efficiencies above national requirement
01-Apr-14
£24,361
£24,361
£0
£146,169
£146,169
£0
£292,337
£292,337
£0
PIP01
WMAS - A&E Overnight Contract
01-Sep-14
£31,831
£0
-£31,831
£31,831
£0
-£31,831
£222,818
£0
-£222,818
PIP06
SSSFT - Review of the effectiveness of the Out of Areas placement contract
01-Sep-14
£3,571
£3,571
£0
£3,571
£3,571
£0
£25,000
£25,000
£0
PIP07
SSSFT - Review of Children's Community Support Service (Reduction in
existing 25% management / overheads surcharges)
01-Sep-14
£2,232
£2,232
£0
£2,232
£2,232
£0
£15,625
£15,625
£0
PIP08
SSSFT - Further Contractual Efficiency
01-Sep-14
£14,286
£14,286
£0
£14,286
£14,286
£0
£100,000
£100,000
£0
DD01
Section 256 Staffs County council
01-Apr-14
£2,083
£2,092
£9
£12,500
£12,553
£53
£25,000
£25,106
£106
DD02
Section 256 HIV/AIDS
01-Apr-14
£1,104
£0
-£1,104
£6,625
£0
-£6,625
£13,250
£0
-£13,250
DD02
Voluntary Sector Grants
01-Apr-14
£1,983
£4,376
£2,393
£11,900
£26,255
£14,355
£23,800
£52,510
£28,710
DD03
Voluntary Block Contacts
01-Aug-14
£13,675
£5,091
-£8,584
£27,350
£30,546
£3,196
£109,400
£61,093
-£48,307
DD04
Acute Contracts (MSFT-PAU)
01-Oct-14
£0
£0
£0
£0
£0
£0
£250,000
£0
-£250,000
DD05
Acute Contracts (MSFT-Littleton)
01-Apr-14
£75,000
£75,000
£0
£450,000
£450,000
£0
£900,000
£1,100,000
£200,000
DD06
Community Provider (SSOTP-MIU)
01-Oct-14
£0
£0
£0
£0
£0
£0
£250,000
£250,000
£0
DD07
Community Provider (SSOTP-Diabetes)
01-Oct-14
£0
£0
£0
£0
£0
£0
£70,000
£0
-£70,000
DD08
Community Provider (SSOTP-Healthnet)
01-Jun-14
Subtotal
£10,000
£10,000
£0
£40,000
£40,000
£0
£100,000
£158,356
£58,356
£306,828
£212,617
-£94,211
£1,325,830
£1,062,101
-£263,729
£3,736,800
£3,419,597
-£317,203
£0
Transformational Service Redesign amd Pathway Changes
P01
Medicines Optimisation – Care Homes
01-Apr-14
£9,102
£9,102
£0
£54,612
£54,612
£0
£63,714
£63,714
P02
Pharmacy Schemes
01-Apr-14
£45,022
£45,755
£734
£339,334
£327,245
-£12,089
£527,980
£527,980
£0
P03
Medicines Optimisation – Medicines Utilisation review - Domiciliary Care
01-Apr-14
£1,000
£0
-£1,000
£6,000
£0
-£6,000
£12,000
£12,000
£0
P05
Back Pain triage - use of Start Back tool by GPs
01-Aug-14
£2,128
£0
-£2,128
£4,256
£0
-£4,256
£17,024
£12,768
-£4,256
P06
Demand Management
01-Jul-14
£22,002
£22,002
£0
£66,009
£66,009
£0
£198,015
£198,015
£0
CC01
Community Care Team with a focus on Reducing respiratory admissions
01-May-14
£43,182
-£12,483
-£55,665
£215,909
-£13,471
-£229,380
£475,000
£158,318
-£316,682
PC01
MSK one stop shop prime provider model
01-Oct-14
£0
£0
£0
£0
£0
£0
£231,046
£231,046
£0
PC02
Gastro / Calprotectin - direct access to testing to identify IBS
01-Aug-14
£5,972
£799
-£5,173
£11,000
£799
-£10,200
£46,835
£46,835
£0
PC04
BNP (Planned) direct access to testing to diagnosis heart failure
01-Apr-14
£6,954
£4,071
-£2,883
£41,723
£12,213
-£29,510
£83,445
£36,639
-£46,806
PC06
Ophthalmology - redesign of pathways
01-Oct-14
£0
£0
£0
£0
£0
£0
£14,476
£14,476
£0
UP01 &
UP02
Extend Acute Visiting Services (AVS) (including Care Homes)
01-Jul-14
£60,089
£53,256
-£6,833
£180,266
£155,330
-£24,936
£540,799
£555,649
£14,850
FE
Frail Elderly- To develop pathways and services
01-Oct-14
£0
£0
£0
£0
£0
£0
£386,529
£40,683
-£345,846
LTC
Long Term Conditions- Redesign of services
01-Oct-14
£0
£0
£0
£0
£0
£0
£478,326
£70,228
-£408,098
PIP02
Cardiology - reduction in 1st OPA and FU's - needs a work plan to understand
pathway
01-Sep-14
£3,571
£0
-£3,571
£3,571
£0
-£3,571
£25,000
£0
-£25,000
PIP03
E consultation (Reduction in FU's) - needs a work plan to understand pathway
01-Sep-14
£3,571
£0
-£3,571
£3,571
-£3,571
£25,000
£0
-£25,000
PIP04
PLCV list & audit for 14/15 while Oregon worked up
01-Sep-14
£2,857
£0
-£2,857
£2,857
-£2,857
£20,000
£10,000
-£10,000
PIP05
SSSFT - LD Intensive Support Service Transformation & Milford closure
01-Sep-14
£16,071
£16,071
£0
£16,071
£16,071
£0
£112,500
£112,500
£0
£221,521
£138,574
-£82,947
£945,178
£618,808
-£326,370
£3,257,688
£2,090,851
-£1,166,837
£528,349
£351,191
-£177,158
£2,271,008
£1,680,909
-£590,099
£6,994,488
£5,510,448
-£1,484,040
Subtotal
T otal Cannock
Item: 18 Enc: 14
Cannock Chase and Stafford & Surrounds Clinical Commissioning Groups
Audit Committee Meeting 13 August 2014
Boardroom, Greyfriars Therapy Centre, Stafford
Present
In
attendance
1.0
2.0
3.0
Names
Paul Gallagher (PG) (Chair)
David Pearsall (DP)
Paul Woodhead (PW)
Title
Lay Member PPI, CC CCG
Lay Member, SAS CCG
Lay Member, CC CCG
Sally Young (SY)
Tracey Revill (TR)
Mike Riley (MR)
Iain Daire (ID)
Paul Westwood (PWe)
Jackie Brown (JBr)
Grant Patterson (GPa)
Head of Governance
Office Manager, CC & SAS CCGs (Minute Taker)
Internal Audit, Baker Tilly
Internal Audit, Baker Tilly
CW Audit Services
Interim Finance Director, CC & SAS CCGs
Grant Thornton, External Audit
Apologies
Neil Chambers (NC) Chair, Cain Black (CB), CW Audit Services, Glenn Palethorpe (GP),
Ruth Goodison
Conflicts of Interest
A Declaration of Interest register was circulated with the papers. There were no conflicts
declared for any of the items on the Agenda.
a. Minutes from previous meeting held on 27 May 2014
Subject to the following amendments minutes were approved as a true and accurate record:
Page 1 - Initials for Paul Westwood to be amended to PWe
Initials for Jackie Brown to read JBr
Grant Pattison should be Patterson
Page 2 - 7th line of page 2 initials to be amended to JBr
Page 5 – 6.0 External Audit action for Grant Patterson, initials to be added to action column
Page 10 – Item 16.0 Any Other Business last paragraph to read “NC expressed concern at
the lack of Secondary Care Governing Body members”
Matters Arising from Minutes dated 27 May 2014
Page 2- Item 4 - PG asked if the review of CSU arrangements had been completed. SY
advised that this was ongoing as it was a large piece of work and every aspect of the
contracts held with CSU had to be reviewed. A report will be presented at the October Audit
Committee meeting.
Action
Action: Sally Young to present report to the Audit Committee on the outcome of the
CSU Audit on services provided.
SY
Page 4 – Annual Accounts - PG asked JBr if she had appointed to all the posts in the finance
team. JBr confirmed the following posts:
• Director of Finance – Paul Simpson recruited to post will commence on 15 September 14
– JBr will have a two week hand-over with Paul.
• Deputy Director of Finance – Internal interviews will be held middle of week commencing
18 August if not recruited to the post will go out to advert middle of September 14. JBr
has asked Martin Flowers, currently in post as Interim Deputy Finance Director, to
consider staying until Christmas to have a cross-over with the new post holder
• Band 7 post has been recruited to with a start date of 2 September 14.
1
Item: 18 Enc: 14
•
JBr also advised that she has formally written to the CSU advising that the CCG intend to
bring two senior contracting mangers in-house and requested they expedite a recruitment
process if there is no one suitable to TUPE across.
GPa advised that he had previously worked with Paul Simpson in local government and
considered Paul to be a good Finance Director and will be a good member of the CCG
Finance team.
Page 5 – Item 6 - PG noted that the action for GPa had been omitted from the minutes in
May, GPa confirmed that he had not yet produced a summary on lessons learned and will
meet with JBr and Paul Simpson.
Action: GPa to meet with JBr and Paul Simpson to produce a lessons learned
summary for the Annual Governance Statement and Annual Accounts.
GPa
Page 8 - Item 11.0 - PG asked if the additional information had been added to the Gifts and
Hospitality register regarding Andy Donald’s trip to Austria. SY apologised and will get the
register updated.
Action: SY/TR to update Gifts and Hospitality register with more detail on AD’s trip to
Austria.
SY/TR
Page 10 – Item 16 - SY confirmed that the adverts for the Secondary Care Consultant
Governing Body Members would be in the BMJ this week.
Repeat Prescribing – DP expressed concern about repeat prescribing. Discussion regarding
whether this issue was a was issue or something for Counter-Fraud to investigate took place.
The Audit Committee were not satisfied the update fully dealt with the question and asked
that Lynn Millar be asked to attend the next Audit Committee to provide an update.
Action: TR to invite Lynn Millar to the next Audit Committee Meeting on 22 October
2014.
b. Action points from previous meeting held on 27 May 2014
Action log updated as attached.
4.0
TR
CSU Assurance
JBr has written to the CSU requesting advance notice for a programme of reports as the CCG
require advance notice of what they will receive and when. What the CSU have sent back is
the same as that which was sent back at year end and does not provide a programme for
quarterly Type 1 and Type 2 reports.
JBr will send the letter from CSU to Baker Tilly for an opinion and JBr will write back to the
CSU also expressing the concerns from the Audit Committee. JBr will report back to the
Audit Committee at the next meeting.
Action: JBr to send letter from CSU to Baker Tilly for them to provide an opinion and JBr/MR
write back to CSU raising the Audit Committee’s concerns and asking for a quarterly
programme.
5.0
a.
Action: TR to include this item on the Agenda for the next meeting.
External Audit Letter
Cannock Chase
GPa noted the key findings:
The work carried out in the year comprised:
• Auditing the 2013/14 accounts
•
Assessing the CCG's arrangements for securing economy, efficiency and effectiveness in
its use of resources.
2
TR
Item: 18 Enc: 14
The Letter is intended to communicate key messages to the CCG and external stakeholders,
including members of the public.
The Letter summarises the outcomes from the first year audit. It also recognises that 2013/14
was the first year of operation of the CCG and it has made progress in a number of areas in
challenging circumstances. The key areas, looking forward, for the CCG's attention are:
•
Delivery to the agreed in-year deficit budget position of £8.57 million -
•
Delivery of the QIPP programme - for 2014/15
•
Development of a five year sustainable repayment plan of the first year deficit
•
The Staffordshire and Stoke-on-Trent health economy is one of the most challenged in
the country - the CCG will need to keep fully engaged with the programme and continue
working with its key partners to ensure that health services now and into the future are
provided effectively and efficiently to the local population.
GPa noted that the CCG have a five year sustainable plan in place to bring the deficit back
into balance in 16/17. GPa also noted that the CCG is one of 11 in the country in deficit as
noted in the KPMG Distressed Economy report.
b.
The Audit Committee NOTED the report.
Stafford & Surrounds
GPa confirmed Stafford and Surrounds is similar to Cannock above, with a caveat around
where MSFT sits and services moving out.
PW asked what the issues was around pensions disclosure, SY confirmed it was due to the
difficulty in obtaining pension information from the Pensions Agency in Blackpool for clinical
leaders who were in post later in the year and the due to the late release of national guidance.
This should not be an issue for this year.
6.0
a.
Internal Audit Update – Progress Reports
Cannock Chase
MR advised that two internal audit assignment have been completed:
• Strategic Commissioning – rated amber/red with 10 recommendations which have been
accepted by the CCG.
• Follow Up – 12 recommendations have been tracked, and are satisfied with what has
been reviewed. Phase 2 will correlate back to the Audit Tracker (Item 9.0 on the agenda).
Work in progress – three reviews with final report to Audit Committee in October:
• Collaborative Provider
• Provider Contract Management
• CIP Quality Impact Assessments
A schedule of further reviews are in the report presented. A review of GP First was to be
carried out but this has been put on hold pending the findings from the National Audit Office
review.
PG asked if there was an indication of when the work is to be completed by, it was confirmed
that this was the Implementation date. Once the work is completed it is moved on the Audit
tracker to “Work Implemented”, this document is updated monthly.
PW said that it would be useful to have the date on the audit report’s action plan when the
work has been finalised, MR confirmed this can be added to the report.
Action: MR to include the completion date in the action plan.
The Audit Committee NOTED the report and reviews carried out.
3
MR
Item: 18 Enc: 14
b.
7.0
As above for Cannock Chase.
The Audit Committee NOTED the report and reviews carried out.
Draft Board Assurance Framework
SY circulated a copy of the Board Assurance Framework (BAF) and advised that previously
the risk register had been presented to the committee. As part of the assurance for the
Governing Body the CCG are required to have a BAF, this was not in place last year, but SY
had assurance from Shauna Mallinson that the risk register encapsulated all the fields
required in the BAF. SY advised that following a considerable piece of work the BAF has now
been developed which details current scores of 15+ which also includes corporate risks.
SY noted two additional risks which need to be added to the risk register which are likely to
score 15+ and will be included in the BAF as:
•
•
The risk is the lack of effective collaboration with other CCGs particularly in relation to the
host/associate commissioner relationships.
The risk is the implementation of the KPMG Distressed Economy Report
recommendations, potential unforeseen consequences of large scale system change and
disruption to core business.
SY advised that the KPMG report has been circulated to the Stafford & Surrounds Governing
Body members for the confidential section of the meeting next week but the report cannot be
shared wider at the moment. PW asked when it is expected to be made public, SY advised
she is not sure at the moment.
PG asked if Stafford & Surrounds Governing Body members had received a copy could this
be shared with the Cannock Chase members. JBr confirmed that it could go to the Cannock
members in confidence.
Action: SY to send Cannock Chase Governing Body members a copy of the KPMG
Distressed Economy report in confidence.
SY
PW asked if there is someone responsible to do an overall check on the scoring, as there was
a difference on similar risks being scored differently.
SY confirmed that this will be a standing item on the EMT agenda where senior management
can review the scores.
PG thanked SY, TR and the team for the work done to bring the BAF together, this will be a
standing agenda item and the committee may request officers to attend audit if they feel they
need more detailed information on a particular risk. PW said they would need to see the BAF
more than a week prior to the meeting in order to be able to identify who they would wish to
call to the meeting. SY said that TR will get the most up-to-date BAF out when she calls for
papers/agenda items.
Action: TR to make sure the BAF is up-to-date and send out when she calls for papers
and agenda items.
TR
PW asked if over-prescribing was reflected elsewhere as it was not on the BAF. PG said that
more work needs to be undertaken before it is on the BAF. SY/T will check to see if overprescribing is on the risk register.
Action: SY/TR to check the register to see if over-prescribing is on.
SY/TR
8.0
a.
The Audit Committee APPROVED the BAF.
Anti-Fraud Report - Progress
Cannock Chase
PWe said it was surprising to note that there had not been any referrals from either CCG as
other CCGs have been. JBr asked what kind of issues were being referred. PWe said that
4
Item: 18 Enc: 14
concerns about GPs and prescribing but the main high risk problem is regarding personal
health budgets. JBr confirmed that neither Cannock Chase CCG or Stafford & Surrounds
CCG have yet implemented personal budget schemes. PW advised the CCG of the need to
ensure the policies and procedures in contract are fraud-proof, JBr said that Chris Brown from
Continuing Health Care was dealing with personal health budgets and would ask her to speak
to PWe to go through the paperwork.
JBr
Action: JBr to ask Chris Brown to meet with PWe to go through the paperwork for
DP queried if the issues were with patients themselves, PWe confirmed it was about patients
receiving money and not using that money for the purpose it is intended, or patients not
having the condition they are claiming for.
It was agreed the CCG need to look at lessons learned from other CCGs and make sure the
opportunity for fraud is reduced when personal health budgets are implemented.
b.
c.
As above.
Counter Fraud Survey Report
PWe confirmed that the survey had been sent to all staff and Governing Body members at
Cannock Chase and Stafford & Surrounds CCGs as well as Practice Managers.
There had been 14 responses from Cannock Chase which was disappointing but noted the
following:
•
•
•
•
•
100% of responders stated that they would report fraud if they suspected it.
84.9% of responders were aware of the CCGs anti-fraud, corruption and bribery
policy.
76.9% of responders were aware of the CCGs whistleblowing policy.
61.5% of responders reported that they had received counter fraud materials.
There was an excellent understanding of the examples given regarding what
constitutes fraudulent activity.
PWe noted that it was disappointing that only 38.5% were aware that the CCG had a LCFS
provision.
There had been 64 responses from Stafford & Surrounds and noted the following:
•
•
•
•
98.1% of responders stated that they would report fraud if they suspected it
69.0% of responders were aware of the CCGs anti-fraud, corruption and bribery policy
75.9% of responders were aware of the CCGs whistleblowing policy
There was an excellent understanding of the examples given regarding what constitutes
fraudulent activity
There were disappointing responses concerning the CCG LCFS / NHS Protect:
• 32.8% of responders were aware that the CCG had a LCFS provision
• 41.4% of responders had seen or received counter fraud awareness materials
It was suggested that the disappointing response for Cannock could be that the majority of
staff completed the Stafford survey as staff are working across both CCGs.
PW asked if it was an intention to repeat the exercise. PWe said there is a plan to do more
work to increase awareness and can do the survey again. SY asked PWe to avoid March,
PWe will send the survey again in February 2015.
5
Item: 18 Enc: 14
Action: PWe to carry out survey in February 2015.
PWe
The Audit Committee NOTED the survey results.
d.
Bribery & Corruption Policy
PWe advised the previous policy was an old PCT version, this policy is now a CCG policy
which will go onto the website and SY will send an email to all staff and Governing Body
members to make them aware there is a new policy and asking them to confirm they have
read it.
Action: SY to email all staff advising of the new policy when it is put on the website.
9.0
SY
The Audit Committee APPROVED the policy.
Audit Tracker
Cannock Chase
All recommendations/actions that have been received from all Baker Tilly’s audit reports have
been put into one place on an Audit Tracker. They have been rated red/amber/green
depending on priority and due date.
JBr noted that some actions were quite old and should not be on, JBr also noted that there
are two officers who do not appear to have done any updates and JBr will speak to them.
Action: JBr to speak to the two Officers concerned to update the audit tracker.
JBr
SY will also ask Officers to date when the action has been completed. JBr agreed that there
is still further work to be done on the tracker and have it red rated in priority so members can
focus on those that are a priority without having to look down to find them.
PW asked for the tracker to be checked with an update at the next meeting to give assurance
to the Audit Committee that the actions are being progressed.
PW queried if there are any differences under Stafford & Surrounds, MR said that in the main
the recommendations were the same for both CCGs. PW said rather than having two sets
could there be one document with an extra column added in to identify which CCG the
recommendation referred to. PW also asked for thefront cover to be more informative, where
there are overdue actions giving more detail. SY will action this.
SY confirmed that there needs to be separate audit trackers for each CCG but that a joint one
with the additional column could be done for Audit Committee.
Action: SY to make the front report cover for the audit tracker more informative.
SY
Action: TR to provide one document and include an additional column to identify the
relevant CCG.
TR
JBr said that this document could also be used to ask Officers to attend Audit Committee to
give more detail around the action where it is overdue and a high risk. PW said that again
members would need the document more than a week prior to the meeting to give time to ask
Officers to attend the meeting. NC and Director of Finance, previously the Chief Finance
Officer and the Head of Governance meet to agree the agenda for the Audit Committee.
Action: PG to speak to NC about making sure this happens once new Director of
Finance starts.
As above.
The Audit Committee NOTED the process for implementing and managing audit
recommendations the Audit Tracker.
6
PG
Item: 18 Enc: 14
10.0
11.0
Gifts and Hospitality Register
No updates received.
IG Handbook and Policy
SY advised that the IG Handbook and Policy circulated with the papers had been presented
and signed off at the IG Meeting on the 8th July 2014 and SY was now asking the Audit
Committee to sign them off.
SY advised that the handbook replaces the 16 policies that had been approved and brings
them all together with an overarching policy. The handbook will replace the 16 policies on the
website.
CF attended to respond to any queries the committee members have. CF said that this
document will make things easier and give staff one place to search for IG issues, although it
is a large document it is smaller than the 16 individual polices.
PW said that it was a good document and was supplemented by the interactive training
Cannock Chase Governing Body members had received.
PG thanked CF for the hard work in pulling the document together and asked her to pass on
the committees thanks to her colleagues.
12.0
13.0
The Audit Committee APPROVED the IG Handbook and Policy.
National Audit Office Visit re GP First
JBr is still awaiting sight of the report from the National Audit Office, which is due around
September. This item was deferred to the October meeting.
Action: TR to include on the October Agenda.
Draft Policies for CCG Financial Procedures:
MR presented the following policies for approval:
a. Expenses Policy
b. Petty Cash Policy
c. Budgetary Control Policy
d. Cash Treasury Management Policy
TR
MR explained they had been asked by other CCGs to put together some financial policies for
them to adopt and has shared them with the CCGs should Cannock and Stafford wish to use
them.
SY circulated updated copies of the Petty Cash Policy and Procedures which had been
changed to reflect the CCG rather than a Trust. PG queried if the documents had version
numbers, SY confirmed they would have once approved to adopt.
PWe asked if the policies had been reviewed by Counter-Fraud, as from looking through the
expenses policy it states that anyone authorising fraudulent claims would be subject to
disciplinary, PWe said this would also need to include any employee submitting a fraudulent
claim.
PWe will go through all the policies and send any amendments to JBr, SY and TR. The
policies will then be circulated by email to Committee members for approval. The documents
will then be put onto the website.
SY also asked PWe to review the HR policies on the websites and make any comments.
Action: PWe to review the CCG Financial Procedures and HR policies and send any
amendments to JBr/SY/TR for action.
Action: SY to send policies round to Committee members via email for approval and to
then put on the website.
7
PWe
SY/TR
Item: 18 Enc: 14
14.0
Constitutional Arrangements for Audit Committees
SY said that she is waiting to see if there is any more guidance and will take an action to see
what the position is.
Action: SY to check if there is any further guidance for constitutional arrangements for
Audit Committees.
SY
GPa advised that the July consultation document is now published for appointing external
auditor arrangements. SY will pick this up for consideration. GPa will send an electronic to
SY who will share with the Audit Committee for feedback.
15.0
16.0
16.0
17.0
Action: GPa will send an electronic copy of the July consultation document for
appointing external auditor arrangements to SY.
Items for Information
Information Governance Minutes
• 13 May 2014
The Audit Committee NOTED the Information Governance Minutes.
Items to report to Governing Body
• Inform them IG handbook and Policy has been signed off
• BAF will go as an Agenda item
• Policies approved at today’s committee meeting
Any Other Business
There was no further business to discuss.
Date and Time of Next Meeting
22 October 2014,
1pm – 4pm
Boardroom, Greyfriars Therapy Centre, Stafford
8
GPa
Item: 18 Enc: 15
FINANCE, PERFORMANCE AND CONTRACTS (FPC) COMMITTEE MEETING
Tuesday 9 September 2014
2.00 pm – 5.00 pm
Boardroom, Greyfriars Therapy Centre, Unit 12 Greyfriars Business Park,
Frank Foley Way, Stafford ST16 2ST
Minutes
Present:
In attendance:
Names
Paul Woodhead (PW)
Alex Bennett (AB)
Michael Brookes (MB)
Martin Flowers (MF)
Dr Gary Free (GF)
Dr Paddy Hannigan (PH)
Lynn Millar (LM)
Tim Rideout (TR)
Role
Chair – Lay Member
Director of Design and Performance
Commissioning Manager, CSU
Associate Director of Finance
Clinical Lead
Clinical Lead
Director of Primary Care
Director of Transition
Alex Birch (ABi)
Mark Jones (MJ)
Claire McHugh (CLM)
Laura Mitchell (LCM)
Sharuna Reddy (SR)
Mel Savage
Bev Thomas
Primary Care Development Manager
Strategic Locality Director – CSU
Minute Taker – Executive Assistant
Financial Planning Manager
Medicines Management – CC
Senior Commissioning Manager
Head of Procurement, Midlands &
Lancashire CSU
Action
1.
Welcome by the Chairman
Chair thanked those present for attending and welcomed Laura Mitchell,
Financial Planning Manager attending as part of her induction. PW confirmed
that the meeting is quorate unless stated otherwise within the minutes.
2.
Apologies
Dr Mohammed Huda
David Pearsall
3.
Minutes of Previous Meeting – 21 August 2014
The minutes were approved as an accurate record.
The item ‘QIPP PMO Report’ should be a standing item, this had been omitted
Approved 16.10.14
Page 1 of 7
Item: 18 Enc: 15
Action
from the Agenda because of the short timescale from the last meeting. It would
be placed as item 5.
Action:
3.1
Ensure QIPP PMO Report is a standing agenda item
Actions
Actions were reviewed and updated on the Action List. Discussion recorded as
below:
3.1.1
Item 46: Winter Monies/Referral to Treatment Time (RTT)
AB updated the meeting and confirmed that the full amount of monies has been
awarded to the CCGs. NHS England have informed that any monies not
appropriately used for RTT has the potential to be clawed back and there may
be a requirement to demonstrate how the money has been spent. Providers
have been asked to report on spend.
LM added that Primary Care Resilience Monies could be used for AVS and
confirmation is awaited that this is an option. AB is communicating with the
appropriate colleagues to progress this.
There is an additional £1.6m that may be awarded for non-elective system
resilience monies.
3.1.2
Item 45: Walsall Healthcare Trust
The position is still not confirmed because data is not currently available. MF
expressed concern that there is currently no data to confirm the over
performance however, this is currently the assumption. MJ informed the
meeting that requests for further information have not been well received.
3.1.3
Item 44: Risk Register
MB has obtained access to the Risk Register and this will now be updated for
the meeting in October 2014.
3.1.4
Items 41, 42, 43: Reporting Outcomes
This will be provided within the October Report.
3.1.5
Item 40: CCG Performance Report
This action will be addressed for October 2014.
3.1.6
Item 36: Quarterly Report
This will need to be addressed for December 2014.
3.1.7
Item 35: October Meeting Date
It is thought that the next Membership Board/PLT was on 16/10/2014 and the
FPC could not attend on the same date, but this may have moved to 14/10/2014.
Action:
3.1.8
CLM to check whether MB is moving to 14/10/2014 and plan
16/10/2014 as appropriate.
Item 33: Repeat Prescriptions
LM confirmed that this matter is ongoing and can be completed.
Approved 16.10.14
Page 2 of 7
CLM
Item: 18 Enc: 15
Action
3.1.9
Item 32: ‘Stemming the Flow’ Business Case
TR confirmed that this item has been completed.
3.1.10
Item 30: Provider Meetings
AB confirmed that meetings are taking place with RWHT and although UHNS
have not met, she has had opportunity to discuss issues with them at other key
meetings. This is now complete.
3.1.11
Item 27: UHNS KPI
AB confirmed that as there is no contract lever for this, the action is now
complete.
4.
Conflicts of Interest
Michael Brookes’ declared a conflict of interest as his spouse works at South
Staffordshire and Shropshire Healthcare NHS Foundation Trust (SSSFT).
All GPs declare a conflict of interest for any issues relating to GP First.
5.
QIPP PMO Report
AB presented her report and provided copies for all attendees.
Action:
AB provide electronic copy of the QIPP PMO Report to CLM
AB
LM expressed concern because QIPP monies has already been taken from her
budgets. AB/LCM are considering how future communications will take place
regarding QIPP with budget holders.
MF informed the meeting that there is allowance for slippage, however, there is
a high dependence on schemes achieving their QIPP targets and consideration
should also be given for additional savings.
TR recommended that careful consideration be given to both Continuing Care
and Community Respiratory and asked that a more detailed report be submitted
at October FPC.
Action:
6.
MB/MJ to produce detailed report regarding Continuing Care
and Community Respiratory
Finance Reports Month 4 (July 2014)
MF presented the report to the meeting. Month 5 has not yet been reported,
both Stafford & Surrounds and Cannock Chase have not performed well but MF
did not have final figures to share with the meeting.
NHS England have revised guidance on how to report forecast outturn, it is no
longer possible to operate outside control total without prior approval.
GF suggested that it would be useful to be aware of where the over performance
is for Cannock. MB reported that the main over performance is in a number of
Approved 16.10.14
Page 3 of 7
MB/MJ
Item: 18 Enc: 15
Action
areas with the largest being elective and day case.
LM reported that there is a reduction in referrals for practices as part of an
exercise to improve performance. TR asked what should be done to address
these issues.
LM explained that there are other issues that need to be considered, although
GP referrals are reducing, they are still higher than other areas of the country.
There may be issues regarding activity and GF suggested that some referrals
are inter-department eg, fracture clinic to physiotherapy.
The meeting agreed that it is important for performance and primary care to
meet to discuss demand management.
Action:
LM arrange meeting with appropriate colleagues to address
demand management and report back to October FPC
LM
Discussion took place around the soft intelligence available to CCG and
mechanisms to report back.
LCM explained that at other CCG there are also Consultant to Consultant
benchmarks but AB explained that this is not a particular issue for these CCGs.
MF informed the meeting that he will share a report by the end of the week.
7.
CCG Performance Report – June 2014
AB presented both reports.
i)
Cannock Chase
TR raised the 62 day cancer waits at Cannock. AB will meet with the tertiary
centre to discuss but informed the meeting that the centre is experiencing
difficulties with getting prompt referrals from providers. MB reiterated that the
transfer of patients between providers does not appear to work to the patients
advantage.
PW asked AB to consider what resources would be needed to address these
issues.
Action:
AB/TR consider what resources are needed to address the
referral issues.
ii)
Discussion took place regarding Red2 breaches which AB had brought to the
previous meeting. PH explained that any concerns had been raised and
discussed at the Q1 Assurance meeting with NHS England.
8.
Report on Month 5 Position and Ability to Deliver Control Total
MF presented the report and explained that progress on improvement is good
and he will provide an up to date report in November 2014 when further steps
will have been agreed.
Approved 16.10.14
Page 4 of 7
AB/TR
Item: 18 Enc: 15
Action
Action:
9.
MF to provide report at the November meeting.
Finance and Contracting Improvement Plan
MF led discussion around finance and contract improvement plans and it was
agreed that he would update at the meeting in November.
Committee moved to Item 13 EMIS Web Conversion
13.
EMIS Web Proposed Conversion
LM presented the report and provided more information. PH had attended an
IM&T meeting earlier and explained that North Staffs are also trying to align
systems between practices.
LM explained that the original plan had been to identify capital funding from
‘Stemming the Flow’ Business Case, however, there is a timing issue eg, a
system change in the winter period could create a risk so it should be done now,
or wait until Spring 2015.
Stemming the Flow has currently been put on hold and LM is asking if the £110k
funding can be approved.
15:29 Sharuna Reddy joined the meeting
Melanie Savage and Bev Thomas joined the meeting
LM explained that a system would only normally be replaced when they were no
longer functioning, however, changing the system will reduce the need to fund
changing systems at differing times.
TR expressed concern that if the funding, without confirmation of the ‘Stemming
the Flow’, is approved then this is an additional risk that the CCG does not have
the source of funds for. MF confirmed that this is not factored into any costings.
TR confirmed that if the ‘Stemming the Flow’ funding is accessed then this is
potentially a priority for funding.
GF reminded the meeting that there are potential savings eg, for out of hours
and SR confirmed that medicines management would benefit from shared
systems. It was proposed that if savings can be identified that this could be
represented.
The request for £110k funding was denied.
Committee moved to Item 11 QIPP – Medicines Utilisation Review
Exception Report
11.
QIPP – Medicines Utilisation Review Exception Report
SR presented the report and assured Chair that there is a commitment to the
Approved 16.10.14
Page 5 of 7
MF
Item: 18 Enc: 15
Action
activity, however, the savings cannot be confirmed.
LM explained that there are other benefits and SR confirmed that this about
adverse events. This is a defining pilot in Rugeley and when it is established, it
will be rolled out to other areas.
Following confirmation from Clair Fleet that IG is complete, then the programme
can start.
Committee noted the elements identified within the report and agreed that
the project should be reviewed in November 2014.
Committee moved to Item 12 Non-NHS Contracts Procurement
12.
Non-NHS Contracts Procurement
15:43 Sharuna Reddy left the meeting
Lynn Millar left the meeting
Alex Birch joined the meeting
MS presented the report.
15:46 Lynn Millar returned to the meeting
MS confirmed to TR that if any of the services, except Out of Hours, were
removed, then patients would still be able to access treatment. TR asked MS to
consider which services can be decommissioned and which need to continue.
TR explained to GF that if MS’s report finds that it will cost more money for
patients to be referred elsewhere then this will support any decision making
process.
Action:
MS to present findings around
September Performance meeting
decommissioning
to
MB reminded the meeting that the plan from April 2015 is for mental health to be
payment by results.
15:51 Mel Savage/Bev Thomas left the meeting
Committee moved to Item 10 QIPP Scheme Update – P05 Back Pain Triage
Update
9.
QIPP Scheme Update – P05 Back Pain Triage Update
ABi presented the report. This has also been discussed at Stafford & Surrounds
Membership Board and there is discussion about whether to enforce decisions
made at Membership Board, ie, make processes mandatory. It will be discussed
with Cannock Members on 10/09/2014.
ABi informed the meeting that Physiotherapy Service will also use the tool.
Some GPs have reported that patients appear to appreciate the screening tool
Approved 16.10.14
Page 6 of 7
MS
Item: 18 Enc: 15
Action
and are less inclined to book further appointments.
Discussion followed regarding the practicalities of the tool and GF expressed
concern regarding the resource issues in the Cannock Chase area. PH has
been using the tool for some time and finds that it gives greater structure to
appointments and it has found it to be valuable.
ABi explained that consideration has been given to what GPs are telling the
CCG but this is an evidence based tool, used internationally. LM explained that
it is hoped that Cannock GPs agree to make use of the tool.
ABi explained that Keele University are doing further work in attempts to make it
even easier/more practical to use. It was agreed that it may be valuable to
introduce the tool in Cannock, following Membership Board approval, and
establish good practice.
Committee noted the areas where the current performance rating is below
target and the remedial actions being taken to improve performance and
mitigate risk.
16:06 Alex Birch left the meeting
Committee moved to Item 13 Risk Register Review
13.
Risk Register Review
AB asked to identify an additional risk regarding performance.
Action:
16.
AB to update Risk Register
Any Other Business
There were no matters for any other business.
17.
Next Meeting
Date:
Time:
Venue:
Thursday 16 October 2014
2.00 pm – 5.00 pm
Boardroom, Greyfriars Therapy Centre, Unit 12 Greyfriars
Business Park, Frank Foley Way, Stafford
Approved 16.10.14
Page 7 of 7
AB
Item No: 02 Enc:01
Communications & Engagement Committee
Wednesday 16th July 2014
Springfields Health & Well Being Centre
Present
Paul Gallagher (Chair)( PG)
Ruth Goodison (Vice Chair)
(RG)
Adele Edmondson (AE)
Clive Cropper (CC)
Katie Woods (KW)
Hester Parsons (HP)
Carole Howard (CH)
Lay Member, Patient and Public Involvement CC CCG
Lay Member, Patient and Public Involvement SAS CCG
Communications & Engagement CSU Lead Cannock/Stafford
Practice Manager, Moss Street Surgery, Cannock
Communications & Engagement Officer
Healthwatch
Patient Champion
In
attendance Paul Woodhead
Lay Member, CC CCG
Sally Young
Head of Governance
1.
Apologies
Dr Johnny McMahon, Tamsin Carr, Lynn Millar
2.
Declaration of Interest
Nil declared
3.
Minutes of the last meeting
The minutes of the meeting were agreed as a true and accurate record subject to
the following amendments:
 Item 6. Engagement Activity CSU/CCG to read antenatal
 Item 9. Report on Lay Member Committees to read
Action List
The action list was updated and distributed to members.
4.
Chairman/Terms of Reference
Chairman
PG advised members that following a discussion and with the agreement of the
committee that RG to take over as Chair at the next meeting.
The committee agreed the change of Chair.
5.
Action: PG to email AMH and JM to confirm their support for the change of Chair.
PG
Action: TOR to be changed to reflect this.
SY
Communications & Engagement Strategy – Work shop feedback
AE reported that there was mixed feedback regarding the outcome of the
workshop. Members were disappointed that the session did not implement the
strategy and the lack of clinical representation and focus on engagement.
Action: Meeting between PG/RG/TC to take forward.
PG/RG/TC
Further to the Management of Change process taking place at the CCG HQ, the
committee agreed that job descriptions and person specifications include
communications and engagement within the responsibilities.
Action: All JDs and PS to include communications and engagement
SY
Members agreed to create a standing agenda item for inclusion in the annual
report.
Action: standing agenda item for inclusion in the annual report (engagement and
annual report articles)
SY
The committee received and noted the feedback.
6.
Engagement Activity CSU/CCG
CCG

MIU survey - purpose to find out why people are going to the unit and shape
any options that will go forward for the consultation
PG thanked all officers for conducting the survey.
CSU

Events at school?
TC
Action: CSU report to be circulated to members.
The committee received and noted the update.
7.
Healthwatch Update

AGM recently held, 70 people attended votes were taken next 3 priorities

Finalising information gathering for young carers.

SS and Shropshire dignity and respect work

Healthwatch England looking at inappropriate discharges for Staffordshire
footprint

Enter and View GP practices and appointments, mystery shoppers
PG/RG
Action: SB RG PG and HP to meet
8.
360° Stakeholder Survey 2014
Strong relationships with a range of health and care partners in order to be
successful commissioners within the local system. The stakeholder survey is a key
part of ensuring strong relationships are on place. The survey, conducted by NHS
2
England allows stakeholders to provide feedback on working relationships with
CCGs.
Members discussed the survey, reservations were had specifically regarding
engagement work and ‘survey response rates’ AE commented that engagement
needs to be measured over the last 12 months.
The committee received and noted the report.
9.
Patients in Control
AE discussed the programme which takes a community development approach,
working in partnership with patients, carers and the voluntary sector to understand
what high quality outcomes and experience look like from a patients’ perspective.
The programme will focus on the role that commissioners can play to put patients in
control and aim to:





Identify and work with organisations which are already leading the way.
Review the commissioning cycle to ensure that opportunities to put patients
in control are taken at each stage.
Work with the leadership of commissioning organisations to help them
understand how they can put the patients in control
Develop practical tools and interventions through which commissioners can
encourage patients to exercise control through the system.
Support commissioning organisations to create their own development
programme to take the work forward.
10.
Engagement – What do we mean?
The committee discussed what patient’s and public expectation of engagement is.
Action: AE & RG to take discussion forward and feedback to the committee.
Action: AE to distribute ‘ladder of engagement to members’
11.
Website Action Plan
AE updated members on outstanding actions.
12.
Equality & Inclusion Report
AE reported that the CCG has a statutory duty to publish the report which details
the progress made over the last year on equality and inclusion issues in regard to
its staff, patients and service users and other stakeholders.
AE asked the committee to review the report and submit any comments.
Action: review the report and forward comments to AE.
AE
3
The committee discussed EDS grading process which provides the Governing
Body with an assurance mechanism for compliance with the Equality Act 2010 and
enables local people to co design the CCG equality objectives to ensure
improvements.
Action: review EDS2 grading process and report comments back by August 16th
ALL
13.
PPG Training
The committee discussed feedback from the recent training event, and felt that the
members at the last PPG District Group meeting have a more proactive
understanding as to their role. Priorities were summarised as GP access and
access to patients.
14.
Any Other Business
SY advised the committee that interviews will be taking place on 15th August for
SAS Lay Members.
The next meeting date is confirmed as:
17th September 14:00 – 16:00 Meeting Room 1, Springfields Health & Well Being
Centre
4

jbr staffing

Transcription

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